Abby C. King

All Publications

• Urban Care for Unpaid Caregivers: Community Voices in the Care Block Program, in Bogotá, Colombia. Journal of urban health : bulletin of the New York Academy of Medicine Guevara-Aladino, P., Sarmiento, O. L., Rubio, M. A., Gómez-García, L. M., Doueiri, Z. N., Martínez, D., King, A. C., Hurtado-Tarazona, A., Banchoff, A., Guzman, L. A., Álvarez-Rivadulla, M. J., Palencia, L. 2024

  Abstract

  The Care Block of Bogotá, Colombia, is an urban program that offers services for low-income unpaid caregivers. This study aimed to (i) characterize unpaid caregivers' subjective well-being, mental health symptoms, physical activity levels, and use of public spaces linked to the Care Block; (ii) identify caregivers' perceived built and social environment facilitators and barriers to accessing the Care Block facility; and (iii) document the community-led advocacy process to improve the Care Block program. The quantitative component included a subjective well-being and mental health symptoms survey, and the System for Observing Play and Recreation in Communities (SOPARC) instrument. The qualitative component included the Our Voice citizen science method augmented with portable virtual reality equipment to engage participants in advocacy for changes. Participants (median age of 53 years) dedicated a median of 13.8 h a day to unpaid caregiving, had an average subjective well-being score of 7.0, and 19.1% and 23.8% reported having depression and generalized anxiety symptoms respectively. Caregivers reported that the program fosters their perception of purpose, enjoyment, resilience, and cognitive and emotional awareness. SOPARC evaluation showed that most women engaged in moderate to vigorous physical activity. The caregivers highlighted education, physical activity services, and integration of facilities as facilitators to accessing the Care Block program. Poor quality and lack of sidewalks and roads, limited personal safety, and the risk of pedestrian-vehicle collisions were identified as barriers. Virtual Reality sparked compelling dialogue between participants and stakeholders, allowing stakeholders to reflect on an urban program facilitating unpaid care work.

  View details for DOI 10.1007/s11524-024-00899-z

  View details for PubMedID 39316308

  View details for PubMedCentralID 6286281

• Toowoomba Healthy Towns: A Citizen Science Initiative on Active Transport in Regional South East Queensland, Australia. Journal of physical activity & health Kolbe-Alexander, T., Gardiner, P. A., Banchoff, A., Schmidt, A., Covey-Hansen, M., King, A. C. 2024: 1-10

  Abstract

  Engaging in active transport will enable individuals across the life course to increase their habitual levels of physical activity. The aim of this study was to engage citizen scientists (CS) to identify factors that influence active transport in their community.The Our Voice citizen science methodology developed at Stanford University was employed. CS completed a "discovery walk," taking photos of things that help or hinder active transport. Three groups were recruited: children aged 10-12 years (n = 11), adults (n = 12), and older adults >65 years (n = 10). CS rated each photo and provided a narrative explaining their reason for taking the photo. Once all CS in a specific age group had completed the walk, they met for a group discussion. The CS worked together to analyze the data, arranging them into themes and identifying priority actions. Two CS representatives from each age group presented their findings to the local council decision makers.Children highlighted the need for safer crossings, especially from their school to the local park, and suggested zebra crossings as a solution. The adults highlighted that road signs prioritized vehicles, not pedestrians, and requested that this be reversed. Older adults noted that the poor condition of the pavements made it harder for people in wheelchairs to navigate. The CS recommendations have informed the council's walking and cycling network program.Engaging with citizen science provided the community with an opportunity to advocate for meaningful yet realistic improvements in the built environment that could promote neighborhood active transport and physical activity across the lifespan.

  View details for DOI 10.1123/jpah.2024-0119

  View details for PubMedID 39304175

• Bringing Micro to the Macro: How Citizen Science Data Enrich Geospatial Visualizations to Advance Health Equity. Journal of maps Soltani, S., Hinman, J. A., Blanco-Velazquez, I., Banchoff, A. W., Campero, M. I., Nelson, L. M., King, A. C. 2023; 19 (1)

  Abstract

  Social and spatial contexts affect health, and understanding nuances of context is key to informing successful interventions for health equity. Layering mixed methods and mixed scale data sources to visualize patterns of health outcomes facilitates analysis of both broad trends and person-level experiences across time and space. We used micro-scale citizen scientist-collected data from four Bay Area communities along with aggregate epidemiologic and population-level data sets to illustrate barriers to, and facilitators of, physical activity in low-income aging adults. These data integrations highlight the synergistic value added by combining data sources, and what might be missed by relying on either a micro- or macro-level data source alone. Mixed methods and granularity data integration can generate a deeper understanding of environmental context, which in turn can inform more relevant and attainable community, advocacy, and policy improvements.

  View details for DOI 10.1080/17445647.2023.2216217

  View details for PubMedID 37448978

  View details for PubMedCentralID PMC10338004

• Integrating Photovoice and Citizen Science: The Our Voice Initiative in Practice. Health promotion practice Zha, C. C., Jansen, B., Banchoff, A., Fernes, P., Chong, J., Castro, V., Vallez-Kelly, T., Fenton, M., Rogers, J., King, A. C. 2022; 23 (2): 241-249

  Abstract

  Community engagement methods like photovoice have allowed researchers to gather and incorporate the experiences and perspectives of community members in their work but have at times faced challenges regarding systematization, accessibility, and scalability. This practice note describes the Our Voice initiative, one example of a community-based participatory research framework that aims to build on photovoice theories and best practices and address these challenges by incorporating the use of a mobile app as well as elements of participatory action-based citizen science to support community-driven data collection, analysis, and advocacy. We explore the application of the Our Voice method and evaluation of multilevel participant and community outcomes across three different Bay Area, California, communities. In doing so, we hope to provide a potential example for practitioners of other community-based participatory research and photovoice-based models to draw from when working with diverse communities to integrate local perspectives and insights in the generation and implementation of sustainable community health improvements.

  View details for DOI 10.1177/15248399211054784

  View details for PubMedID 35285322

• An in-depth comparison of well-being among Latinx and non-Latinx White adults: A cautionary tale. Preventive medicine reports Rodriguez Espinosa, P., Patel, M. L., King, A. C., Campero, I., Freeman, M. 2., Garcia, D. M., Winter, S. J., Heaney, C. A. 2021; 24: 101513

  Abstract

  Understanding how to optimize the health and well-being of Latinxs is crucial and will aid in informing actions to address inequities. Latinxs' unique cultural backgrounds and lived experiences could have implications for their well-being, which may differ from other racial/ethnic groups. We compared overall and domain-specific well-being and their socio-demographic correlates among two samples of Latinxs and a sample of non-Latinx Whites. Cross-sectional samples were independently drawn from the Stanford WELL Initiative (n=217 Latinxs, n=943 non-Latinx Whites) and the On the Move Trial (n=238 Latinxs), both recruiting in Northern California. Well-being was assessed using the Stanford WELL scale, a novel multifaceted measure. Propensity score matching and mixed effect regressions were employed to compare well-being between samples. Overall well-being levels did not differ between groups. However, when examining constituent domains of well-being, several differences were found. Both Latinx samples reported experiencing more stress, having worse physical health, and being more religious than did the matched non-Latinx White sample. However, on four other well-being domains, only one of the Latinx samples differed from the non-Latinx White sample. Moreover, the two Latinx samples differed from each other in four out of nine domains examined. When evaluating well-being across racial/ethnic groups, we recommend employing multidimensional measures and multiple samples to promote greater confidence in the conclusions. This approach can better inform future research and the tailoring of public health efforts by furthering our understanding of the nature of group well-being differences. Our methods offer a blueprint for similar studies examining well-being in multi-ethnic groups.

  View details for DOI 10.1016/j.pmedr.2021.101513

  View details for PubMedID 34401222

• Urban blue spaces and human health: A systematic review and meta-analysis of quantitative studies CITIES Smith, N., Georgiou, M., King, A. C., Tieges, Z., Webb, S., Chastin, S. 2021; 119

  View details for DOI 10.1016/j.cities.2021.103413

  View details for Web of Science ID 000704767300006

• The Role of Citizen Science in Promoting Health Equity. Annual review of public health Rosas, L. G., Espinosa, P. R., Jimenez, F. M., King, A. C. 2021

  Abstract

  While there are many definitions of citizen science, the term usually refers to the participation of the general public in the scientific process in collaboration with professional scientists. Citizen scientists have been engaged to promote health equity, especially in the areas of environmental contaminant exposures, physical activity, and healthy eating. Citizen scientists commonly come from communities experiencing health inequities and have collected data using a range of strategies and technologies, such as air sensors, water quality kits, and mobile applications. On the basis of our review, and to advance the field of citizen science to address health equity, we recommend (a) expanding the focus on topics important for health equity, (b) increasing the diversity of people serving as citizen scientists, (c) increasing the integration of citizen scientists in additional research phases, (d) continuing to leverage emerging technologies that enable citizen scientists to collect data relevant for health equity, and (e) strengthening the rigor of methods to evaluate impacts on health equity. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

  View details for DOI 10.1146/annurev-publhealth-090419-102856

  View details for PubMedID 34724389

• Testing the effectiveness of community-engaged citizen science to promote physical activity, foster healthier neighborhood environments, and advance health equity in vulnerable communities: The steps for change randomized controlled trial design and methods. Contemporary clinical trials King, A. C., Campero, M. I., Garcia, D., Blanco-Velazquez, I., Banchoff, A., Fierros, F., Escobar, M., Cortes, A. L., Sheats, J. L., Hua, J., Chazaro, A., Done, M., Espinosa, P. R., Vuong, D., Ahn, D. K. 2021: 106526

  Abstract

  While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. TRIAL REGISTRATION: clinicaltrial.gov Identifier = NCT03041415.

  View details for DOI 10.1016/j.cct.2021.106526

  View details for PubMedID 34371162

• A Novel Model for Generating Creative, Community-Responsive Interventions to Reduce Gender-Based Violence on College Campuses. International journal of environmental research and public health Graham, S., Zha, C. C., King, A. C., Banchoff, A. W., Sarnquist, C., Dauber, M., Baiocchi, M. 2021; 18 (15)

  Abstract

  Currently, the most successful prevention interventions against sexual violence (SV) on United States college campuses target modifications at the individual and interpersonal levels. Community-level interventions have been under-developed for college campuses. To address this gap, we employ a citizen science model for understanding campus community factors affecting SV risk. The model, called Our Voice, starts by engaging groups of college students to collect data in their own communities, identifying factors they view as increasing the risk of SV. In facilitated meetings, participants then review and analyze their collective data and use it to generate actionable community-level solutions and advocate for them with local decision-makers. We share findings from a first-generation study of the Our Voice model applied to SV prevention on one college campus, and include recommendations for further research.

  View details for DOI 10.3390/ijerph18157933

  View details for PubMedID 34360224

• An ecosystem service perspective on urban nature, physical activity, and health. Proceedings of the National Academy of Sciences of the United States of America Remme, R. P., Frumkin, H., Guerry, A. D., King, A. C., Mandle, L., Sarabu, C., Bratman, G. N., Giles-Corti, B., Hamel, P., Han, B., Hicks, J. L., James, P., Lawler, J. J., Lindahl, T., Liu, H., Lu, Y., Oosterbroek, B., Paudel, B., Sallis, J. F., Schipperijn, J., Sosic, R., de Vries, S., Wheeler, B. W., Wood, S. A., Wu, T., Daily, G. C. 2021; 118 (22)

  Abstract

  Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.

  View details for DOI 10.1073/pnas.2018472118

  View details for PubMedID 33990458

• Childhood obesity prevention across borders: The promise of U.S.-Latin American research collaboration. Obesity reviews : an official journal of the International Association for the Study of Obesity King, A. C., Perez-Escamilla, R., Vorkoper, S., Anand, N., Rivera, J. 2021: e13238

  View details for DOI 10.1111/obr.13238

  View details for PubMedID 33949095

• Community-driven citizen science approach to explore cardiovascular disease risk perception, and develop prevention advocacy strategies in sub-Saharan Africa: a programme protocol. Research involvement and engagement Okop, K. J., Murphy, K., Lambert, E. V., Kedir, K., Getachew, H., Howe, R., Niyibizi, J. B., Ntawuyirushintege, S., Bavuma, C., Rulisa, S., Kasenda, S., Chipeta, E., Bunn, C., Crampin, A. C., Chapotera, G., King, A. C., Banchoff, A., Winter, S. J., Levitt, N. S. 2021; 7 (1): 11

  Abstract

  BACKGROUND: In sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk.METHODS: This protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy.DISCUSSION: Contextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.

  View details for DOI 10.1186/s40900-020-00246-x

  View details for PubMedID 33637131

• Community-Based Approaches to Reducing Health Inequities and Fostering Environmental Justice through Global Youth-Engaged Citizen Science. International journal of environmental research and public health King, A. C., Odunitan-Wayas, F. A., Chaudhury, M., Rubio, M. A., Baiocchi, M., Kolbe-Alexander, T., Montes, F., Banchoff, A., Sarmiento, O. L., Balter, K., Hinckson, E., Chastin, S., Lambert, E. V., Gonzalez, S. A., Guerra, A. M., Gelius, P., Zha, C., Sarabu, C., Kakar, P. A., Fernes, P., Rosas, L. G., Winter, S. J., McClain, E., Gardiner, P. A., On Behalf Of The Our Voice Global Citizen Science Research Network 2021; 18 (3)

  Abstract

  Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world's youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

  View details for DOI 10.3390/ijerph18030892

  View details for PubMedID 33494135

• Building healthy schools through technology-enabled citizen science: The case of the our voice participatory action model in schools from Bogota, Colombia. Global public health Gonzalez, S. A., Rubio, M. A., Triana, C. A., King, A. C., Banchoff, A. W., Sarmiento, O. L. 2021: 1–17

  Abstract

  The physical and social environment of school settings are important for health promotion among children and adolescents. Efforts to create supportive environments at the school level can benefit from including community engagement and empowerment processes to advocate for health promotion. The Our Voice model presents a unique opportunity for Latin American students to improve their school environments. The objective of this study was to engage and empower students (9-18 years) from five schools in Bogota, Colombia to use the Our Voice model to assess and seek to improve their local school environments. This study employed Our Voice's 'citizen science by the people' method using a mobile application for data collection. The Our Voice initiative included the following four phases: (1) Design, planning and recruitment; (2) Data collection; (3) Community meetings for thematic analysis, priority setting and initial design of feasible solutions; and (4) Community meetings with decision-makers to advocate for changes. The citizen scientists identified and advocated for safer physical activity-supportive environments and healthier food and drinks availability. This study allowed children and adolescent citizen scientists to make their voices heard by policymakers and empowered them as agents of change in the process of building healthier schools.

  View details for DOI 10.1080/17441692.2020.1869285

  View details for PubMedID 33427068

• Food insecurity and social injustice: The plight of urban poor African immigrants in South Africa during the COVID-19 crisis GLOBAL PUBLIC HEALTH Odunitan-Wayas, F. A., Alaba, O. A., Lambert, E. 2020

  View details for DOI 10.1080/17441692.2020.1854325

  View details for Web of Science ID 000596162300001

• A Mixed Method Study to Inform the Implementation and Expansion of Pop-Up Parks for Economic, Behavioral, and Social Benefits. Journal of urban health : bulletin of the New York Academy of Medicine Winter, S. J., Sheats, J. L., Salvo, D., Banda, J. A., Quinn, J., Rivera, B. R., King, A. C. 2020

  Abstract

  The availability of parks and urban green spaces has been associated with a number of benefits, including increased physical activity, improvements in mental health, increases in social interactions, improvements to the environment, and increases in property values. The installation of temporary pop-up parks in urban areas is one way for urban communities to obtain these benefits. In this mixed-methods study, quantitative and qualitative data were gathered by researchers, the city council, a local investment company, and community residents that informed the initiation, iteration, and incremental expansion of a series of temporary, summer pop-up parks in the downtown business district of the City of Los Altos in Northern California over a 4-year period (2013-2016). Results showed that the parks were visited by a large, multigenerational group of users who engaged in leisure-time physical activity, shopped at local stores, attended programed events, and socialized with others. Direct observation and survey data gathered in year 2014 also indicated that foot traffic into businesses directly fronting on a pop-up park (n=8) was higher during a 4-day period when the park was in place, as compared to a similar 4-day period before the park was installed. The majority of downtown business owners/managers reported no decrease in sales compared to the month before the pop-up park was installed. City sales tax data indicated increases in year-on-year sales tax revenue in the summer quarter of 2014 and 2016 compared with the year (2015) when there was no downtown pop-up park. Perspectives of community residents collected before, during, and after the installation of the pop-up parks indicated that the pop-up park created a vibrant space in an otherwise underutilized area that was enjoyed by a variety of people in a host of ways (e.g., children playing, families relaxing, people shopping and eating at downtown stores and restaurants, people of all ages attending scheduled park events). These results informed a number of discussions and meetings between key stakeholders about the pop-up parks, culminating in a temporary park that was held in a new location in 2017 that was substantially larger in size, installed for a longer time period, cost more, and had more scheduled park events. Results from this prospective investigation of the initial impacts of pop-up parks in this urban location provide insights regarding the potential benefits and viability of such temporary parks for residents and businesses alike.

  View details for DOI 10.1007/s11524-020-00434-w

  View details for PubMedID 32613496

• Employing Participatory Citizen Science Methods to Promote Age-Friendly Environments Worldwide. International journal of environmental research and public health King, A. C., King, D. K., Banchoff, A., Solomonov, S., Ben Natan, O., Hua, J., Gardiner, P., Rosas, L. G., Espinosa, P. R., Winter, S. J., Sheats, J., Salvo, D., Aguilar-Farias, N., Stathi, A., Akira Hino, A., Porter, M. M., Our Voice Global Citizen Science Research Network, O. B. 2020; 17 (5)

  Abstract

  The trajectory of aging is profoundly impacted by the physical and social environmental contexts in which we live. While "top-down" policy activities can have potentially wide impacts on such contexts, they often take time, resources, and political will, and therefore can be less accessible to underserved communities. This article describes a "bottom-up", resident-engaged method to advance local environmental and policy change, called Our Voice, that can complement policy-level strategies for improving the health, function, and well-being of older adults. Using the World Health Organization's age-friendly cities global strategy, we describe the Our Voice citizen science program of research that has specifically targeted older adults as environmental change agents to improve their own health and well-being as well as that of their communities. Results from 14 Our Voice studies that have occurred across five continents demonstrate that older adults can learn to use mobile technology to systematically capture and collectively analyze their own data. They can then successfully build consensus around high-priority issues that can be realistically changed and work effectively with local stakeholders to enact meaningful environmental and policy changes that can help to promote healthy aging. The article ends with recommended next steps for growing the resident-engaged citizen science field to advance the health and welfare of all older adults.

  View details for DOI 10.3390/ijerph17051541

  View details for PubMedID 32121001

• Solution-based science to prevent and control diabetes in underserved communities around the world (commentary, for Diabetes special section). Translational behavioral medicine King, A. C. 2020; 10 (1): 55–57

  Abstract

  Despite the numerous successful behavioral interventions that have been published in the behavioral medicine field over a number of decades, surprisingly few have been translated and adapted for real-world settings using participatory research methods. The purpose of this commentary is to highlight the advances in participatory behavioral medicine reflected in the articles contained in the Diabetes special section. The articles contained in the Diabetes special section were reviewed, with a focus on the advances made with this type of research and the challenges that came to light. Numerous strengths of the large-scale translational studies were identified. The studies also highlighted important areas meriting further attention, including exploration of additional dissemination pathways, and further piloting and refinement of program components for different population segments. The articles in this special section represent major advances in implementing successful, impactful programs for diabetes prevention and control in low- and middle-income countries.

  View details for DOI 10.1093/tbm/ibz196

  View details for PubMedID 32011718

• A citizen science approach to determine perceived barriers and promoters of physical activity in a low-income South African community. Global public health Odunitan-Wayas, F. A., Hamann, N., Sinyanya, N. A., King, A. C., Banchoff, A., Winter, S. J., Hendricks, S., Okop, K. J., Lambert, E. V. 2020: 1–14

  Abstract

  The study's objective was to assess the feasibility of using citizen science to identify and address physical activity (PA) barriers in a low-income South African community. We purposively selected as citizen scientists, eleven participants (21-45 years) from a cohort study who expressed interest in becoming physically active or were already active. They used the Stanford Neighborhood Discovery Tool mobile application to take photos and provide audio narratives of factors in their community that were barriers to or facilitated PA. Thereafter, in a facilitated workshop, citizen scientists thematically reviewed their findings, prioritised issues and proffered potential solutions. Researchers also thematically coded these data. PA levels were measured using standard questionnaires. None of the citizen scientists owned a car, and their PA was either work- or transport-related. Themes identified as priorities that hindered citizen scientists' PA were dirt, sidewalks appropriated by vendors or homeowners, parks and gym vandalisation, and personal safety fears. Access to stadiums and parks enabled PA. Citizen scientists identified their local councillors and street committee chairpersons as fundamental for advocacy for a PA-friendly environment. Low-income community members can be empowered to gather meaningful data using mobile technology and work together to identify potential solutions for promoting PA-friendly environments.

  View details for DOI 10.1080/17441692.2020.1712449

  View details for PubMedID 31992139

• Urban Transformations and Health: Methods for TrUST-a Natural Experiment Evaluating the Impacts of a Mass Transit Cable Car in Bogota, Colombia. Frontiers in public health Sarmiento, O. L., Higuera-Mendieta, D., Wilches-Mogollon, M. A., Guzman, L. A., Rodriguez, D. A., Morales, R., Mendez, D., Bedoya, C., Linares-Vasquez, M., Arevalo, M. I., Martinez-Herrera, E., Montes, F., Meisel, J. D., Useche, A. F., Garcia, E., Triana, C. A., Medaglia, A. L., Hessel, P., Arellana, J., Moncada, C., King, A. C., Diez Roux, A. V. 2020; 8: 64

  Abstract

  Background: Cable cars provide urban mobility benefits for vulnerable populations. However, no evaluation has assessed cable cars' impact from a health perspective. TransMiCable in Bogota, Colombia, provides a unique opportunity to (1) assess the effects of its implementation on the environmental and social determinants of health (microenvironment pollution, transport accessibility, physical environment, employment, social capital, and leisure time), physical activity, and health outcomes (health-related quality of life, respiratory diseases, and homicides); and (2) use citizen science methods to identify, prioritize, and communicate the most salient negative and positive features impacting health and quality of life in TransMiCable's area, as well as facilitate a consensus and advocacy-building change process among community members, policymakers, and academic researchers. Methods: TrUST (In Spanish: Transformaciones Urbanas y Salud: el caso de TransMiCable en Bogota) is a quasi-experimental study using a mixed-methods approach. The intervention group includes adults from Ciudad Bolivar, the area of influence of TransMiCable. The control group includes adults from San Cristobal, an area of future expansion for TransMiCable. A conceptual framework was developed through group-model building. Outcomes related to environmental and social determinants of health as well as health outcomes are assessed using questionnaires (health outcomes, physical activity, and perceptions), secondary data (crime and respiratory outcomes) use of portable devices (air pollution exposure and accelerometry), mobility tracking apps (for transport trajectories), and direct observation (parks). The Stanford Healthy Neighborhood Discovery Tool is being used to capture residents' perceptions of their physical and social environments as part of the citizen science component of the investigation. Discussion: TrUST is innovative in its use of a mixed-methods, and interdisciplinary research approach, and in its systematic engagement of citizens and policymakers throughout the design and evaluation process. This study will help to understand better how to maximize health benefits and minimize unintended negative consequences of TransMiCable.

  View details for DOI 10.3389/fpubh.2020.00064

  View details for PubMedID 32211367

• Effects of Counseling by Peer Human Advisors vs Computers to Increase Walking in Underserved Populations: The COMPASS Randomized Clinical Trial. JAMA internal medicine King, A. C., Campero, M. I., Sheats, J. L., Castro Sweet, C. M., Hauser, M. E., Garcia, D. n., Chazaro, A. n., Blanco, G. n., Banda, J. n., Ahn, D. K., Fernandez, J. n., Bickmore, T. n. 2020

  Abstract

  Effective and practical treatments are needed to increase physical activity among those at heightened risk from inactivity. Walking represents a popular physical activity that can produce a range of desirable health effects, particularly as people age.To test the hypothesis that counseling by a computer-based virtual advisor is no worse than (ie, noninferior to) counseling by trained human advisors for increasing 12-month walking levels among inactive adults.A cluster-randomized, noninferiority parallel trial enrolled 245 adults between July 21, 2014, and July 29, 2016, with follow-up through September 15, 2017. Data analysis was performed from March 15 to December 20, 2018. The evidence-derived noninferiority margin was 30 minutes of walking per week. Participants included inactive adults aged 50 years and older, primarily of Latin American descent and capable of walking without significant limitations, from 10 community centers in Santa Clara and San Mateo counties, California.All participants received similar evidence-based, 12-month physical activity counseling at their local community center, with the 10 centers randomized to a computerized virtual advisor program (virtual) or a previously validated peer advisor program (human).The primary outcome was change in walking minutes per week over 12 months using validated interview assessment corroborated with accelerometry. Both per-protocol and intention-to-treat analysis was performed.Among the 245 participants randomized, 193 were women (78.8%) and 241 participants (98.4%) were Latino. Mean (SD) age was 62.3 (8.4) years (range, 50-87 years), 107 individuals (43.7%) had high school or less educational level, mean BMI was 32.8 (6.8), and mean years residence in the US was 47.4 (17.0) years. A total of 231 participants (94.3%) completed the study. Mean 12-month change in walking was 153.9 min/wk (95% CI, 126.3 min/wk to infinity) for the virtual cohort (n = 123) and 131.9 min/wk (95% CI, 101.4 min/wk to infinity) for the human cohort (n = 122) (difference, 22.0, with lower limit of 1-sided 95% CI, -20.6 to infinity; P = .02); this finding supports noninferiority. Improvements emerged in both arms for relevant clinical risk factors, sedentary behavior, and well-being measures.The findings of this study indicate that a virtual advisor using evidence-based strategies produces significant 12-month walking increases for older, lower-income Latino adults that are no worse than the significant improvements achieved by human advisors. Changes produced by both programs are commensurate with those reported in previous investigations of these behavioral interventions and provide support for broadening the range of light-touch physical activity programs that can be offered to a diverse population.ClinicalTrials.gov Identifier: NCT02111213.

  View details for DOI 10.1001/jamainternmed.2020.4143

  View details for PubMedID 32986075

• Engaging citizen scientists to build healthy park environments in Colombia. Health promotion international Rubio, M. A., Triana, C. n., King, A. C., Rosas, L. G., Banchoff, A. W., Rubiano, O. n., Chrisinger, B. W., Sarmiento, O. L. 2020

  Abstract

  Colombia's Recreovía program offers community-based free physical activity (PA) classes in parks. We evaluated built and social environmental factors influencing Recreovía local park environments, and facilitated a consensus-building and advocacy process among community members, policymakers and academic researchers aimed at improving uptake and impact of the Recreovía program. We used a mixed-methods approach, with individual and contextual PA measurements and a resident-enabled participatory approach (the Our Voice citizen science engagement model). Recreovía participants were likely to be women meeting PA recommendations, and highly satisfied with the Recreovía classes. Reported facilitators of the Recreovía included its role in enhancing social and individual well-being through PA classes. Reported barriers to usage were related to park maintenance, cleanliness and safety. The Our Voice process elicited community reflection, empowerment, advocacy and action. Our Voice facilitated the interplay among stakeholders and community members to optimize the Recreovía program as a facilitator of active living, and to make park environments more welcoming.

  View details for DOI 10.1093/heapro/daaa031

  View details for PubMedID 32361761

• The effect of digital physical activity interventions on daily step count: a randomised controlled crossover substudy of the MyHeart Counts Cardiovascular Health Study LANCET DIGITAL HEALTH Shcherbina, A., Hershman, S. G., Lazzeroni, L., King, A. C., O'Sullivan, J. W., Hekler, E., Moayedi, Y., Pavlovic, A., Waggott, D., Sharma, A., Yeung, A., Christle, J. W., Wheeler, M. T., McConnell, M. V., Harrington, R. A., Ashley, E. A. 2019; 1 (7): E344–E352

  View details for DOI 10.1016/S2589-7500(19)30129-3

  View details for Web of Science ID 000525872200012

• The effect of digital physical activity interventions on daily step count: a randomised controlled crossover substudy of the MyHeart Counts Cardiovascular Health Study. The Lancet. Digital health Shcherbina, A., Hershman, S. G., Lazzeroni, L., King, A. C., O'Sullivan, J. W., Hekler, E., Moayedi, Y., Pavlovic, A., Waggott, D., Sharma, A., Yeung, A., Christle, J. W., Wheeler, M. T., McConnell, M. V., Harrington, R. A., Ashley, E. A. 2019; 1 (7): e344-e352

  Abstract

  Smartphone apps might enable interventions to increase physical activity, but few randomised trials testing this hypothesis have been done. The MyHeart Counts Cardiovascular Health Study is a longitudinal smartphone-based study with the aim of elucidating the determinants of cardiovascular health. We aimed to investigate the effect of four different physical activity coaching interventions on daily step count in a substudy of the MyHeart Counts Study.In this randomised, controlled crossover trial, we recruited adults (aged ≥18 years) in the USA with access to an iPhone smartphone (Apple, Cupertino, CA, USA; version 5S or newer) who had downloaded the MyHeart Counts app (version 2.0). After completion of a 1 week baseline period of interaction with the MyHeart Counts app, participants were randomly assigned to receive one of 24 permutations (four combinations of four 7 day interventions) in a crossover design using a random number generator built into the app. Interventions consisted of either daily prompts to complete 10 000 steps, hourly prompts to stand following 1 h of sitting, instructions to read the guidelines from the American Heart Association website, or e-coaching based upon the individual's personal activity patterns from the baseline week of data collection. Participants completed the trial in a free-living setting. Due to the nature of the interventions, participants could not be masked from the intervention. Investigators were not masked to intervention allocation. The primary outcome was change in mean daily step count from baseline for each of the four interventions, assessed in the modified intention-to-treat analysis set, which included all participants who had completed 7 days of baseline monitoring and at least 1 day of one of the four interventions. This trial is registered with ClinicalTrials.gov, NCT03090321.Between Dec 12, 2016, and June 6, 2018, 2783 participants consented to enrol in the coaching study, of whom 1075 completed 7 days of baseline monitoring and at least 1 day of one of the four interventions and thus were included in the modified intention-to-treat analysis set. 493 individuals completed the full set of assigned interventions. All four interventions significantly increased mean daily step count from baseline (mean daily step count 2914 [SE 74]): mean step count increased by 319 steps (75) for participants in the American Heart Association website prompt group (p<0·0001), 267 steps (74) for participants in the hourly stand prompt group (p=0·0003), 254 steps (74) for participants in the cluster-specific prompts group (p=0·0006), and by 226 steps (75) for participants in the 10 000 daily step prompt group (p=0·0026 vs baseline).Four smartphone-based physical activity coaching interventions significantly increased daily physical activity. These findings suggests that digital interventions delivered via a mobile app have the ability to increase short-term physical activity levels in a free-living cohort.Stanford Data Science Initiative.

  View details for DOI 10.1016/S2589-7500(19)30129-3

  View details for PubMedID 33323209

• The selection of comparators for randomized controlled trials of health-related behavioral interventions: recommendations of an NIH expert panel JOURNAL OF CLINICAL EPIDEMIOLOGY Freedland, K. E., King, A. C., Ambrosius, W. T., Mayo-Wilson, E., Mohr, D. C., Czajkowski, S. M., Thabane, L., Collins, M., Rebok, G. W., Treweek, S. P., Cook, T. D., Edinger, J. D., Stoney, C. M., Campo, R. A., Young-Hyman, D., Riley, W. T., Natl Inst Hlth, Off Behav & Social Sci Res Expert 2019; 110: 74–81

  View details for DOI 10.1016/j.jclinepi.2019.02.011

  View details for Web of Science ID 000487194400009

• Enhancing safe routes to school programs through community-engaged citizen science: two pilot investigations in lower density areas of Santa Clara County, California, USA BMC PUBLIC HEALTH Rodriguez, N. M., Arce, A., Kawaguchi, A., Hua, J., Broderick, B., Winter, S. J., King, A. C. 2019; 19

  View details for DOI 10.1186/s12889-019-6563-1

  View details for Web of Science ID 000460041500003

• Enhancing safe routes to school programs through community-engaged citizen science: two pilot investigations in lower density areas of Santa Clara County, California, USA. BMC public health Rodriguez, N. M., Arce, A., Kawaguchi, A., Hua, J., Broderick, B., Winter, S. J., King, A. C. 2019; 19 (1): 256

  Abstract

  BACKGROUND: While promoting active commuting to school can positively affect children's daily physical activity levels, effectively engaging community members to maximize program impact remains challenging. We evaluated the initial utility of adding a technology-enabled citizen science engagement model, called Our Voice, to a standard Safe Routes to School (SRTS) program to enhance program engagement activities and student travel mode behavior.METHODS: In Investigation 1, a prospective controlled comparison design was used to compare the initial year of the Santa Clara County Public Health Department's SRTS program, with and without the Our Voice engagement model added, in two elementary schools in Gilroy, California, USA. School parents served as Our Voice citizen scientists in the SRTS + Our Voice school. In Investigation 2, the feasibility of the combined SRTS + Our Voice methods was evaluated in a middle school in the same district using students, rather than adults, as citizen scientists. Standard SRTS program engagement measures and student travel mode tallies were collected at the beginning and end of the school year for each school.RESULTS: In the elementary school investigation (Investigation 1), the SRTS + Our Voice elementary school held twice as many first-year SRTS planning/encouragement events compared to the SRTS-Alone elementary school, and between-school changes in walking/biking to school rates favored the SRTS + Our Voice school (increases of 24.5% vs. 2.6%, P<.001). The Investigation 2 results supported the feasibility of using students to conduct SRTS + Our Voice in a middle school-age population.CONCLUSIONS: The findings from this first-generation study indicated that adding a technology-enabled citizen science process to a standard elementary school SRTS program was associated with higher levels of community engagement and walking/biking to school compared to SRTS alone. The approach was also found to be acceptable and feasible in a middle school setting.

  View details for PubMedID 30823917

• The Selection of Comparators for Randomized Controlled Trials of Health-Related Behavioral Interventions: Recommendations of an NIH Expert Panel. Journal of clinical epidemiology Freedland, K. E., King, A. C., Ambrosius, W. T., Mayo-Wilson, E., Mohr, D. C., Czajkowski, S. M., Thabane, L., Collins, L. M., Rebok, G. W., Treweek, S. P., Cook, T. D., Edinger, J. D., Stoney, C. M., Campo, R. A., Young-Hyman, D., Riley, W. T., National Institutes of Health Office of Behavioral and Social Sciences Research Expert Panel on Comparator Selection in Behavioral and Social Science Clinical Trials 2019

  Abstract

  OBJECTIVES: To provide recommendations for the selection of comparators for randomized controlled trials of health-related behavioral interventions.STUDY DESIGN AND SETTING: The National Institutes of Health Office of Behavioral and Social Science Research (OBSSR) convened an expert panel to critically review the literature on control or comparison groups for behavioral trials and to develop strategies for improving comparator choices and for resolving controversies and disagreements about comparators.RESULTS: The panel developed a Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials. The model indicates that the optimal comparator is the one that best serves the primary purpose of the trial, but that the optimal comparator's limitations and barriers to its use must also be taken into account.CONCLUSION: We developed best practice recommendations for the selection of comparators for health-related behavioral trials. Use of the Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials can improve the comparator selection process and help to resolve disagreements about comparator choices.

  View details for PubMedID 30826377

• Maximizing the promise of citizen science to advance health and prevent disease PREVENTIVE MEDICINE King, A. C., Winter, S. J., Chrisinger, B. W., Hua, J., Banchoff, A. W. 2019; 119: 44-47

  View details for DOI 10.1016/j.ypmed.2018.12.016

  View details for Web of Science ID 000455729700008

• The Scientific Foundation for the Physical Activity Guidelines for Americans, 2nd Edition JOURNAL OF PHYSICAL ACTIVITY & HEALTH Powell, K. E., King, A. C., Buchner, D. M., Campbell, W. W., DiPietro, L., Erickson, K. I., Hillman, C. H., Jakicic, J. M., Janz, K. F., Katzmarzyk, P. T., Kraus, W. E., Macko, R. F., Marquez, D. X., McTiernan, A., Pate, R. R., Pescatello, L. S., Whitt-Glover, M. C. 2019; 16 (1): 1–11

  Abstract

  The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides the evidence base for the Physical Activity Guidelines for Americans, 2nd Edition.The 2018 Physical Activity Guidelines Advisory Committee addressed 38 questions and 104 subquestions selected for their public health relevance, potential to inform public policies and programs, maturity of the relevant science, and applicability to the general US population. Rigorous systematic literature searches and literature reviews were performed using standardized methods.Newly described benefits of physical activity include reduced risk of excessive weight gain in children and adults, incidence of 6 types of cancer, and fall-related injuries in older people. Physical activity is associated with enhanced cognitive function and mental health across the life span, plus improved mental health and physical function. There is no threshold that must be exceeded before benefits begin to accrue; the accrual is most rapid for the least active individuals. Sedentary time is directly associated with elevated risk of all-cause and cardiovascular mortality, incident cardiovascular disease and type 2 diabetes, and selected cancer sites. A wide range of intervention strategies have demonstrated success in increasing physical activity.The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides compelling new evidence to inform physical activity recommendations, practice, and policy.

  View details for DOI 10.1123/jpah.2018-0618

  View details for Web of Science ID 000456666300001

  View details for PubMedID 30558473

• The US Physical Activity Guidelines Advisory Committee Report-Introduction. Medicine and science in sports and exercise King, A. C., Powell, K. E., Kraus, W. E. 2019; 51 (6): 1203–5

  View details for DOI 10.1249/MSS.0000000000001946

  View details for PubMedID 31095076

• Physical Activity Promotion: Highlights from the 2018 Physical Activity Guidelines Advisory Committee Systematic Review. Medicine and science in sports and exercise King, A. C., Whitt-Glover, M. C., Marquez, D. X., Buman, M. P., Napolitano, M. A., Jakicic, J. n., Fulton, J. E., Tennant, B. L. 2019; 51 (6): 1340–53

  Abstract

  This article describes effective interventions to promote regular physical activity and reduce sedentary behavior that were identified as part of the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.A comprehensive literature search was conducted of eligible systematic reviews, meta-analyses, and relevant governmental reports published between 2011 and 2016. For the physical activity promotion question, articles were first sorted by four social ecological levels of impact (i.e., individual, community, communication environment, and physical environment and policy levels) and then further sorted into more specific categories that emerged during the review process. For the sedentary behavior reduction question, the literature was sorted directly into emergent categories (i.e., youth, adult, and worksite interventions).Effective physical activity promotion strategies were identified at each level of impact, including those based on behavior change theories and those occurring at different settings throughout the community. Effective interventions also included those delivered in person by trained staff or peer volunteers and through different information and communication technologies, such as by phone, Web or Internet, and computer-tailored print. A range of built environment features were associated with more transit-based and recreational physical activity in children and adults. Effective sedentary reduction interventions were found for youth and in the workplace.A promising number of interventions with demonstrated effectiveness were identified. Future recommendations for research include investigating the most useful methods for disseminating them to real-world settings; incorporating more diverse population subgroups, including vulnerable and underrepresented subgroups; collecting cost data to inform cost-effectiveness comparisons; and testing strategies across different levels of impact to determine which combinations achieve the greatest effects on different modes of physical activity across the week.

  View details for DOI 10.1249/MSS.0000000000001945

  View details for PubMedID 31095090

• Maximizing the promise of citizen science to advance health and prevent disease. Preventive medicine King, A. C., Winter, S. J., Chrisinger, B. W., Hua, J., Banchoff, A. W. 2018

  View details for PubMedID 30593793

• The Myheart Counts Cardiovascular Health Study: A Randomized Controlled Trial of Digital Health Coaching for Physical Activity Promotion Shcherbina, A., Hershman, S., King, A. C., Hekler, E., Pavlovic, A., Waggott, D., McConnell, M. V., Ashley, E. A., Harrington, R. A. LIPPINCOTT WILLIAMS & WILKINS. 2018: E767

  View details for Web of Science ID 000453713500032

• LEVERAGING CITIZEN SCIENCE TO CREATE HEALTH-PROMOTING ENVIRONMENTS WORLDWIDE: FINDINGS FROM THE OUR VOICE GLOBAL CITIZEN SCIENCE RESEARCH NETWORK King, A., Banchoff, A., Winter, S., Hua, J., Sarmiento, O., Aguilar-Farias, N. I., Chastin, S., Lambert, E. V. SPRINGER. 2018: S180

  View details for Web of Science ID 000446532700551

• Mobile Health Advances in Physical Activity, Fitness, and Atrial Fibrillation Moving Hearts JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY McConnell, M. V., Turakhia, M. P., Harrington, R. A., King, A. C., Ashley, E. A. 2018; 71 (23): 2691–2701

  Abstract

  The growing recognition that "health" takes place outside of the hospital and clinic, plus recent advances in mobile and wearable devices, have propelled the field of mobile health (mHealth). Cardiovascular disease and prevention are major opportunities for mHealth, as mobile devices can monitor key physiological signals (e.g., physical activity, heart rate and rhythm) for promoting healthy behaviors, detecting disease, and aid in ongoing care. In this review, the authors provide an update on cardiovascular mHealth by highlighting recent progress and challenges with mobile and wearable devices for assessing and promoting physical activity and fitness, and for monitoring heart rate and rhythm for the detection and management of atrial fibrillation.

  View details for PubMedID 29880130

• HARNESSING TECHNOLOGY AND CITIZEN SCIENCE TO SUPPORT AGE-FRIENDLY NEIGHBORHOODS IN TAIWAN Chou, Y., Hua, J., Banchoff, A., Winter, S. J., Liou, D., King, A. C. OXFORD UNIV PRESS INC. 2018: S818

  View details for Web of Science ID 000431185202360

• SHAPING THE FUTURE OF PHYSICAL ACTIVITY PROMOTION: HIGHLIGHTS FROM THE 2018 PA GUIDELINES SCIENTIFIC ADVISORY COMMITTEE REVIEW King, A. C., Marquez, D. X., Napolitano, M. A., Buman, M. P., Whitt-Glover, M. OXFORD UNIV PRESS INC. 2018: S173

  View details for Web of Science ID 000431185200409

• PHYSICAL ACTIVITY RESEARCH IN THE 21ST CENTURY: HARNESSING KEY PATHWAYS FOR ACHIEVING GLOBAL IMPACT King, A. C., Sallis, J. F., Winter, S. J., King, A. C., Orleans, T. OXFORD UNIV PRESS INC. 2018: S384

  View details for Web of Science ID 000431185201140

• ACTING LOCALLY TO IMPROVE HEALTH GLOBALLY: ENGAGING CITIZEN SCIENTISTS TO CHANGE ENVIRONMENTS AND POLICIES FOR ACTIVE LIVING Winter, S. J., Banchoff, A., King, A. OXFORD UNIV PRESS INC. 2018: S385

  View details for Web of Science ID 000431185201142

• Stress experiences in neighborhood and social environments (SENSE): a pilot study to integrate the quantified self with citizen science to improve the built environment and health. International journal of health geographics Chrisinger, B. W., King, A. C. 2018; 17 (1): 17

  Abstract

  Identifying elements of one's environment-observable and unobservable-that contribute to chronic stress including the perception of comfort and discomfort associated with different settings, presents many methodological and analytical challenges. However, it also presents an opportunity to engage the public in collecting and analyzing their own geospatial and biometric data to increase community member understanding of their local environments and activate potential environmental improvements. In this first-generation project, we developed a methodology to integrate geospatial technology with biometric sensing within a previously developed, evidence-based "citizen science" protocol, called "Our Voice." Participants used a smartphone/tablet-based application, called the Discovery Tool (DT), to collect photos and audio narratives about elements of the built environment that contributed to or detracted from their well-being. A wrist-worn sensor (Empatica E4) was used to collect time-stamped data, including 3-axis accelerometry, skin temperature, blood volume pressure, heart rate, heartbeat inter-beat interval, and electrodermal activity (EDA). Open-source R packages were employed to automatically organize, clean, geocode, and visualize the biometric data.In total, 14 adults (8 women, 6 men) were successfully recruited to participate in the investigation. Participants recorded 174 images and 124 audio files with the DT. Among captured images with a participant-determined positive or negative rating (n = 131), over half were positive (58.8%, n = 77). Within-participant positive/negative rating ratios were similar, with most participants rating 53.0% of their images as positive (SD 21.4%). Significant spatial clusters of positive and negative photos were identified using the Getis-Ord Gi* local statistic, and significant associations between participant EDA and distance to DT photos, and street and land use characteristics were also observed with linear mixed models. Interactive data maps allowed participants to (1) reflect on data collected during the neighborhood walk, (2) see how EDA levels changed over the course of the walk in relation to objective neighborhood features (using basemap and DT app photos), and (3) compare their data to other participants along the same route.Participants identified a variety of social and environmental features that contributed to or detracted from their well-being. This initial investigation sets the stage for further research combining qualitative and quantitative data capture and interpretation to identify objective and perceived elements of the built environment influence our embodied experience in different settings. It provides a systematic process for simultaneously collecting multiple kinds of data, and lays a foundation for future statistical and spatial analyses in addition to more in-depth interpretation of how these responses vary within and between individuals.

  View details for PubMedID 29871687

• Citizen science applied to building healthier community environments: advancing the field through shared construct and measurement development INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Hinckson, E., Schneider, M., Winter, S. J., Stone, E., Puhan, M., Stathi, A., Porter, M. M., Gardiner, P. A., dos Santos, D., Wolff, A., King, A. C. 2017; 14: 133

  Abstract

  Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting.We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact.Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol.We provided the rationale for and a list of contextual factors along with specific examples of measures to encourage consistency among studies that plan to use a citizen science participatory approach. The potential of this approach to promote health and wellbeing in communities is high and we hope that we have provided the tools needed to optimally promote synergistic gains in knowledge across a range of Citizen Science participatory projects.

  View details for PubMedID 28962580

• Impacts of a Temporary Urban Pop-Up Park on Physical Activity and Other Individual- and Community-Level Outcomes JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE Salvo, D., Banda, J. A., Sheats, J. L., Winter, S. J., dos Santos, D., King, A. C. 2017; 94 (4): 470–81

  Abstract

  Physical inactivity is a known risk factor for obesity and a number of chronic diseases. Modifying the physical features of neighborhoods to provide residents with equitable and convenient access to spaces for physical activity (PA) is a promising strategy for promoting PA. Public urban recreation spaces (e.g., parks) play an important role in promoting PA and are potentially an important neighborhood element for optimizing social capital and liveability in cities. Most studies examining the effects of park availability and use on PA have focused on traditional, permanent parks. The aims of this study were to (1) document patterns of park use and park-based PA at a temporary urban pop-up park implemented in the downtown business district of Los Altos, California during July-August 2013 and May-June 2014, (2) identify factors associated with park-based PA in 2014, and (3) examine the effects of the 2014 pop-up park on additional outcomes of potential benefit for park users and the Los Altos community at large. Park use remained high during most hours of the day in 2013 and 2014. Although the park attracted a multigenerational group of users, children and adolescents were most likely to engage in walking or more vigorous PA at the park. Park presence was significantly associated with potentially beneficial changes in time-allocation patterns among users, including a reduction in screen-time and an increase in overall park-time and time spent outdoors. Park implementation resulted in notable use among people who would otherwise not be spending time at a park (85% of surveyed users would not be spending time at any other park if the pop-up park was not there-2014 data analysis). Our results (significantly higher odds of spending time in downtown Los Altos due to park presence) suggest that urban pop-up parks may also have broader community benefits, such as attracting people to visit downtown business districts. Pending larger, confirmatory studies, our results suggest that temporary urban pop-up parks may contribute to solving the limited access to public physical activity recreation spaces many urban residents face.

  View details for PubMedID 28646369

  View details for PubMedCentralID PMC5533666

• Large-scale physical activity data reveal worldwide activity inequality NATURE Althoff, T., Sosic, R., Hicks, J. L., King, A. C., Delp, S. L., Leskovec, J. 2017; 547 (7663): 336-+

  Abstract

  To be able to curb the global pandemic of physical inactivity and the associated 5.3 million deaths per year, we need to understand the basic principles that govern physical activity. However, there is a lack of large-scale measurements of physical activity patterns across free-living populations worldwide. Here we leverage the wide usage of smartphones with built-in accelerometry to measure physical activity at the global scale. We study a dataset consisting of 68 million days of physical activity for 717,527 people, giving us a window into activity in 111 countries across the globe. We find inequality in how activity is distributed within countries and that this inequality is a better predictor of obesity prevalence in the population than average activity volume. Reduced activity in females contributes to a large portion of the observed activity inequality. Aspects of the built environment, such as the walkability of a city, are associated with a smaller gender gap in activity and lower activity inequality. In more walkable cities, activity is greater throughout the day and throughout the week, across age, gender, and body mass index (BMI) groups, with the greatest increases in activity found for females. Our findings have implications for global public health policy and urban planning and highlight the role of activity inequality and the built environment in improving physical activity and health.

  View details for PubMedID 28693034

  View details for PubMedCentralID PMC5774986

• Preserving older adults' routine outdoor activities in contrasting neighborhood environments through a physical activity intervention. Preventive medicine King, A. C., Salvo, D., Banda, J. A., Ahn, D. K., Chapman, J. E., Gill, T. M., Fielding, R. A., Demons, J., Tudor-Locke, C., Rosso, A., Pahor, M., Frank, L. D. 2017; 96: 87-93

  Abstract

  While neighborhood design can potentially influence routine outdoor physical activities (PA), little is known concerning its effects on such activities among older adults attempting to increase their PA levels. We evaluated the effects of living in neighborhoods differing in compactness on changes in routine outdoor activities (e.g., walking, gardening, yard work) among older adults at increased mobility disability risk participating in the LIFE-Pilot PA trial (2003-07; ages 70-89years; from Dallas, TX, San Francisco Bay area, Pittsburgh, PA, and Winston-Salem, NC). Analyses were conducted on the 400 LIFE-Pilot participants randomized to a one-year endurance-plus-strengthening PA intervention or health education control that completed one-year PA assessment (CHAMPS questionnaire). Outcomes of interest were exercise and leisure walking, walking for errands, and moderate-intensity gardening. Neighborhood compactness was assessed objectively using geographic information systems via a subsequent grant (2008-12). PA increased weekly exercise and leisure walking relative to control, irrespective of neighborhood compactness. However, walking for errands decreased significantly more in PA relative to control (net mean [SD] difference=16.2min/week [7.7], p=0.037), particularly among those living in less compact neighborhoods (net mean [SD] difference=29.8 [10.8] minutes/week, p=0.006). PA participants living in less compact neighborhoods maintained or increased participation in gardening and yard work to a greater extent than controls (net mean [SD] difference=29.3 [10.8] minutes/week, p=0.007). The results indicate that formal targeting of active transport as an adjunct to structured PA programs may be important to diminish potential compensatory responses in functionally impaired older adults. Structured endurance-plus-strengthening PA may help older adults maintain or increase such routine activities over time.clinicaltrials.gov Identifier=NCT01072500.

  View details for DOI 10.1016/j.ypmed.2016.12.049

  View details for PubMedID 28039068

• HARNESSING COMMUNITY-ENGAGED CITIZEN SCIENCE TO PROMOTE SAFE ROUTES TO SCHOOL IN RURAL PARTS OF SANTA CLARA COUNTY, CA Rodriguez, N. M., Winter, S., Broderick, B., Arce, A., King, A. C., Banchoff, A. SPRINGER. 2017: S810–S811

  View details for Web of Science ID 000398947201075

• FEAST: Empowering Community Residents to Use Technology to Assess and Advocate for Healthy Food Environments. Journal of urban health : bulletin of the New York Academy of Medicine Sheats, J. L., Winter, S. J., Romero, P. P., King, A. C. 2017

  Abstract

  Creating environments that support healthy eating is important for successful aging, particularly in light of the growing population of older adults in the United States. There is an urgent need to identify innovative upstream solutions to barriers experienced by older adults in accessing and buying healthy food. FEAST (Food Environment Assessment STudy) is an effort that is part of the global Our Voice initiative, which utilizes a combination of technology and community-engaged methods to empower citizen scientists (i.e., community residents) to: (1) use the Healthy Neighborhood Discovery Tool (Discovery Tool) mobile application to collect data (geocoded photos, audio narratives) about aspects of their environment that facilitate or hinder healthy living; and (2) use findings to advocate for change in partnership with local decision and policy makers. In FEAST, 23 racially/ethnically diverse, low-income, and food-insecure older adults residing in urban, North San Mateo County, CA, were recruited to use the Discovery Tool to examine factors that facilitated or hindered their access to food as well as their food-related behaviors. Participants collectively reviewed data retrieved from the Discovery Tool and identified and prioritized important, yet feasible, issues to address. Access to affordable healthy food and transportation were identified as the major barriers to eating healthfully and navigating their neighborhood food environments. Subsequently, participants were trained in advocacy skills and shared their findings with relevant decision and policymakers, who in turn dispelled myths and discussed and shared resources to address relevant community needs. Proximal and distal effects of the community-engaged process at 3, 6, 12, and 24 months were documented and revealed individual-, community-, and policy-level impacts. Finally, FEAST contributes to the evidence on multi-level challenges that low-income, racially/ethnically diverse older adults experience when accessing, choosing and buying healthy foods.

  View details for DOI 10.1007/s11524-017-0141-6

  View details for PubMedID 28247054

  View details for PubMedCentralID PMC5391337

• IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior JOURNAL OF MEDICAL INTERNET RESEARCH Mummah, S. A., Robinson, T. N., King, A. C., Gardner, C. D., Sutton, S. 2016; 18 (12): 205-218

  Abstract

  Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions.

  View details for DOI 10.2196/jmir.5927

  View details for Web of Science ID 000391065600019

  View details for PubMedID 27986647

• Harnessing Technology and Citizen Science to Support Neighborhoods that Promote Active Living in Mexico. Journal of urban health : bulletin of the New York Academy of Medicine Rosas, L. G., Salvo, D., Winter, S. J., Cortes, D., Rivera, J., Rodriguez, N. M., King, A. C. 2016: -?

  Abstract

  Middle- and low-income countries bear 80 % of the global chronic disease burden. Population-level, multi-sectoral approaches to promoting healthful lifestyles that take into local physical, socioeconomic, and sociocultural characteristics of both the environment and the population are needed. The "Nuestra Voz (Our Voice)" is one such approach that involves neighborhood residents acting as "citizen scientists" to systematically gather information on the barriers and facilitators of physical activity in their neighborhoods and then use their data to collectively advocate for local environmental- and policy-level changes to support active living. We pilot tested this approach in Cuernavaca, Mexico with adults and adolescents. This community-engaged and participatory approach is driven by residents, who utilize a GPS-enabled electronic tablet-based application with simple audio-based instructions to take photographs and record audio narratives of facets of their neighborhood that promote or hinder active living. After collecting these data, the citizen scientists come together in a community meeting and use their data to prioritize realistic, multi-level changes for promoting active living in their neighborhoods. A survey assessed participants' acceptability of the approach. Participating citizen scientists included 32 adults and 9 adolescents. The citizen scientists rated the acceptability of five of the nine acceptability survey items with an average of 4.0 or higher out of 5.0, indicating they thought it was "fun," were comfortable carrying the tablet, were likely to use it again, and would recommend it to friends and family. Items with average scores of less than 4 were all related to safety concerns. The most common barriers reported by citizen scientists using the tablet were poor sidewalk quality, presence of trash, negative characteristics of the streets, unpleasant aesthetics (e.g., graffiti), and presence of parks and recreational facilities. The Our Voice citizen scientist approach using the Discovery Tool has high potential for assisting communities in diverse settings to begin to identify both local barriers to active living as well as potentially useful strategies for promoting physical activity in culturally congruent ways that are appropriate and feasible in the local context.

  View details for PubMedID 27752825

• Using Citizen Scientists to Gather, Analyze, and Disseminate Information About Neighborhood Features That Affect Active Living. Journal of immigrant and minority health Winter, S. J., Goldman Rosas, L., Padilla Romero, P., Sheats, J. L., Buman, M. P., Baker, C., King, A. C. 2016; 18 (5): 1126-1138

  Abstract

  Many Latinos are insufficiently active, partly due to neighborhoods with little environmental support for physical activity. Multi-level approaches are needed to create health-promoting neighborhoods in disadvantaged communities. Participant "citizen scientists" were adolescent (n = 10, mean age = 12.8 ± 0.6 years) and older adult (n = 10, mean age = 71.3 ± 6.5 years), low income Latinos in North Fair Oaks, California. Citizen scientists conducted environmental assessments to document perceived barriers to active living using the Stanford Healthy Neighborhood Discovery Tool, which records GPS-tracked walking routes, photographs, audio narratives, and survey responses. Using a community-engaged approach, citizen scientists subsequently attended a community meeting to engage in advocacy training, review assessment data, prioritize issues to address and brainstorm potential solutions and partners. Citizen scientists each conducted a neighborhood environmental assessment and recorded 366 photographs and audio narratives. Adolescents (n = 4), older adults (n = 7) and community members (n = 4) collectively identified reducing trash and improving personal safety and sidewalk quality as the priority issues to address. Three adolescent and four older adult citizen scientists volunteered to present study findings to key stakeholders. This study demonstrated that with minimal training, low-income, Latino adolescent and older adult citizen scientists can: (1) use innovative technology to gather information about features of their neighborhood environment that influence active living, (2) analyze their information and identify potential solutions, and (3) engage with stakeholders to advocate for the development of healthier neighborhoods.

  View details for DOI 10.1007/s10903-015-0241-x

  View details for PubMedID 26184398

• Using Citizen Scientists to Gather, Analyze, and Disseminate Information About Neighborhood Features That Affect Active Living JOURNAL OF IMMIGRANT AND MINORITY HEALTH Winter, S. J., Rosas, L. G., Romero, P. P., Sheats, J. L., Buman, M. P., Baker, C., King, A. C. 2016; 18 (5): 1126-1138

  Abstract

  Many Latinos are insufficiently active, partly due to neighborhoods with little environmental support for physical activity. Multi-level approaches are needed to create health-promoting neighborhoods in disadvantaged communities. Participant "citizen scientists" were adolescent (n = 10, mean age = 12.8 ± 0.6 years) and older adult (n = 10, mean age = 71.3 ± 6.5 years), low income Latinos in North Fair Oaks, California. Citizen scientists conducted environmental assessments to document perceived barriers to active living using the Stanford Healthy Neighborhood Discovery Tool, which records GPS-tracked walking routes, photographs, audio narratives, and survey responses. Using a community-engaged approach, citizen scientists subsequently attended a community meeting to engage in advocacy training, review assessment data, prioritize issues to address and brainstorm potential solutions and partners. Citizen scientists each conducted a neighborhood environmental assessment and recorded 366 photographs and audio narratives. Adolescents (n = 4), older adults (n = 7) and community members (n = 4) collectively identified reducing trash and improving personal safety and sidewalk quality as the priority issues to address. Three adolescent and four older adult citizen scientists volunteered to present study findings to key stakeholders. This study demonstrated that with minimal training, low-income, Latino adolescent and older adult citizen scientists can: (1) use innovative technology to gather information about features of their neighborhood environment that influence active living, (2) analyze their information and identify potential solutions, and (3) engage with stakeholders to advocate for the development of healthier neighborhoods.

  View details for DOI 10.1007/s10903-015-0241-x

  View details for Web of Science ID 000386501700026

• Effects of Three Motivationally Targeted Mobile Device Applications on Initial Physical Activity and Sedentary Behavior Change in Midlife and Older Adults: A Randomized Trial PLOS ONE King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 2016; 11 (6)

  Abstract

  While there has been an explosion of mobile device applications (apps) promoting healthful behaviors, including physical activity and sedentary patterns, surprisingly few have been based explicitly on strategies drawn from behavioral theory and evidence.This study provided an initial 8-week evaluation of three different customized physical activity-sedentary behavior apps drawn from conceptually distinct motivational frames in comparison with a commercially available control app.Ninety-five underactive adults ages 45 years and older with no prior smartphone experience were randomized to use an analytically framed app, a socially framed app, an affectively framed app, or a diet-tracker control app. Daily physical activity and sedentary behavior were measured using the smartphone's built-in accelerometer and daily self-report measures.Mixed-effects models indicated that, over the 8-week period, the social app users showed significantly greater overall increases in weekly accelerometry-derived moderate to vigorous physical activity relative to the other three arms (P values for between-arm differences = .04-.005; Social vs. Control app: d = 1.05, CI = 0.44,1.67; Social vs. Affect app: d = 0.89, CI = 0.27,1.51; Social vs. Analytic app: d = 0.89, CI = 0.27,1.51), while more variable responses were observed among users of the other two motivationally framed apps. Social app users also had significantly lower overall amounts of accelerometry-derived sedentary behavior relative to the other three arms (P values for between-arm differences = .02-.001; Social vs. Control app: d = 1.10,CI = 0.48,1.72; Social vs. Affect app: d = 0.94, CI = 0.32,1.56; Social vs. Analytic app: d = 1.24, CI = 0.59,1.89). Additionally, Social and Affect app users reported lower overall sitting time compared to the other two arms (P values for between-arm differences < .001; Social vs. Control app: d = 1.59,CI = 0.92, 2.25; Social vs. Analytic app: d = 1.89,CI = 1.17, 2.61; Affect vs. Control app: d = 1.19,CI = 0.56, 1.81; Affect vs. Analytic app: d = 1.41,CI = 0.74, 2.07).The results provide initial support for the use of a smartphone-delivered social frame in the early induction of both physical activity and sedentary behavior changes. The information obtained also sets the stage for further investigation of subgroups that might particularly benefit from different motivationally framed apps in these two key health promotion areas.ClinicalTrials.gov NCT01516411.

  View details for DOI 10.1371/journal.pone.0156370

  View details for Web of Science ID 000378858900002

  View details for PubMedID 27352250

  View details for PubMedCentralID PMC4924838

• Leveraging Citizen Science and Information Technology for Population Physical Activity Promotion. Translational journal of the American College of Sports Medicine King, A. C., Winter, S. J., Sheats, J. L., Rosas, L. G., Buman, M. P., Salvo, D., Rodriguez, N. M., Seguin, R. A., Moran, M., Garber, R., Broderick, B., Zieff, S. G., Sarmiento, O. L., Gonzalez, S. A., Banchoff, A., Dommarco, J. R. 2016; 1 (4): 30-44

  Abstract

  While technology is a major driver of many of society's comforts, conveniences, and advances, it has been responsible, in a significant way, for engineering regular physical activity and a number of other positive health behaviors out of people's daily lives. A key question concerns how to harness information and communication technologies (ICT) to bring about positive changes in the health promotion field. One such approach involves community-engaged "citizen science," in which local residents leverage the potential of ICT to foster data-driven consensus-building and mobilization efforts that advance physical activity at the individual, social, built environment, and policy levels.The history of citizen science in the research arena is briefly described and an evidence-based method that embeds citizen science in a multi-level, multi-sectoral community-based participatory research framework for physical activity promotion is presented.Several examples of this citizen science-driven community engagement framework for promoting active lifestyles, called "Our Voice", are discussed, including pilot projects from diverse communities in the U.S. as well as internationally.The opportunities and challenges involved in leveraging citizen science activities as part of a broader population approach to promoting regular physical activity are explored. The strategic engagement of citizen scientists from socio-demographically diverse communities across the globe as both assessment as well as change agents provides a promising, potentially low-cost and scalable strategy for creating more active, healthful, and equitable neighborhoods and communities worldwide.

  View details for PubMedID 27525309

• The Use of Behavior Change Techniques and Theory in Technologies for Cardiovascular Disease Prevention and Treatment in Adults: A Comprehensive Review PROGRESS IN CARDIOVASCULAR DISEASES Winter, S. J., Sheats, J. L., King, A. C. 2016; 58 (6): 605-612

  Abstract

  This review examined the use of health behavior change techniques and theory in technology-enabled interventions targeting risk factors and indicators for cardiovascular disease (CVD) prevention and treatment. Articles targeting physical activity, weight loss, smoking cessation and management of hypertension, lipids and blood glucose were sourced from PubMed (November 2010-2015) and coded for use of 1) technology, 2) health behavior change techniques (using the CALO-RE taxonomy), and 3) health behavior theories. Of the 984 articles reviewed, 304 were relevant (240=intervention, 64=review). Twenty-two different technologies were used (M=1.45, SD=+/-0.719). The most frequently used behavior change techniques were self-monitoring and feedback on performance (M=5.4, SD=+/-2.9). Half (52%) of the intervention studies named a theory/model - most frequently Social Cognitive Theory, the Trans-theoretical Model, and the Theory of Planned Behavior/Reasoned Action. To optimize technology-enabled interventions targeting CVD risk factors, integrated behavior change theories that incorporate a variety of evidence-based health behavior change techniques are needed.

  View details for DOI 10.1016/j.pcad.2016.02.005

  View details for Web of Science ID 000376552200005

  View details for PubMedID 26902519

  View details for PubMedCentralID PMC4868665

• Theory's role in shaping behavioral health research for population health INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY King, A. C. 2015; 12

  Abstract

  The careful application of theory often is used in the behavioral health field to enhance our understanding of how the world currently works. But theory also can help us visualize what the world can become, particularly through its potential impacts on population-wide health. Applying a multi-level ecological perspective can help in expanding the field's focus upward toward the population at large. While ecological frameworks have become increasingly popular, arguably such perspectives have fallen short of their potential to actively bridge conceptual constructs and, by extension, intervention approaches, across different levels of population impact. Theoretical and conceptual perspectives that explicitly span levels of impact offer arguably the greatest potential for achieving scientific insights that may in turn produce the largest population health effects. Examples of such "bridging" approaches include theories and models that span behavioral + micro-environment, behavioral + social/cultural, and social + physical environment constructs. Several recommendations are presented related to opportunities for leveraging theories to attain the greatest impact in the population health science field. These include applying the evidence obtained from person-level theories to inform methods for positively impacting the behaviors of community gatekeepers and decision-makers for greater population change and reach; leveraging the potential of residents as "citizen scientists"--a resource for enacting behavioral health changes at the individual, environmental, and policy levels; using empirical observations and theory in equal parts to build more robust, relevant, and solution-oriented behavior change programs; exploring moderators and mediators of change at levels of impact that go beyond the individual; and considering the circumstances in which applying conceptual methods that embrace a "complexity" as opposed to "causality" perspective may lead to more flexible and agile scientific approaches that could accelerate both population-relevant discoveries and applications in the field. The commentary closes with suggestions concerning additional areas to be considered to facilitate continued advances in the health behavior field more generally to attain the greatest impacts on population health.

  View details for DOI 10.1186/s12966-015-0307-0

  View details for Web of Science ID 000365584100002

  View details for PubMedID 26612691

  View details for PubMedCentralID PMC4660825

• Technologies to Measure and Modify Physical Activity and Eating Environments AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Glanz, K., Patrick, K. 2015; 48 (5): 630-638

  Abstract

  The explosion of technologic advances in information capture and delivery offers unparalleled opportunities to assess and modify built and social environments in ways that can positively impact health behaviors. This paper highlights some potentially transformative current and emerging trends in the technology arena applicable to environmental context-based assessment and intervention relevant to physical activity and dietary behaviors.A team of experts convened in 2013 to discuss the main issues related to technology use in assessing and changing built environments for health behaviors particularly relevant to obesity prevention. Each expert was assigned a specific domain to describe, commensurate with their research and expertise in the field, along with examples of specific applications. This activity was accompanied by selective examination of published literature to cover the main issues and elucidate relevant applications of technologic tools and innovations in this field.Decisions concerning which technology examples to highlight were reached through discussion and consensus-building among the team of experts. Two levels of impact are highlighted: the "me" domain, which primarily targets measurement and intervention activities aimed at individual-level behaviors and their surrounding environments; and the "we" domain, which generally focuses on aggregated data aimed at groups and larger population segments and locales.The paper ends with a set of challenges and opportunities for significantly advancing the field. Key areas for progress include data collection and expansion, managing technologic considerations, and working across sectors to maximize the population potential of behavioral health technologies.

  View details for DOI 10.1016/j.amepre.2014.10.005

  View details for PubMedID 25891063

• A qualitative study of shopper experiences at an urban farmers' market using the Stanford Healthy Neighborhood Discovery Tool. Public health nutrition Buman, M. P., Bertmann, F., Hekler, E. B., Winter, S. J., Sheats, J. L., King, A. C., Wharton, C. M. 2015; 18 (6): 994-1000

  Abstract

  To understand factors which enhance or detract from farmers' market shopper experiences to inform targeted interventions to increase farmers' market utilization, community-building and social marketing strategies.A consumer-intercept study using the Stanford Healthy Neighborhood Discovery Tool to capture real-time perceptions via photographs and audio narratives.An urban farmers' market in a large metropolitan US city. Participants Thirty-eight farmers' market shoppers, who recorded 748 unique coded elements through community-based participatory research methods.Shoppers were primarily women (65 %), 18-35 years of age (54 %), non-Hispanic (81 %) and white (73 %). Shoppers captured 291 photographs (7·9 (sd 6·3) per shopper), 171 audio narratives (5·3 (sd 4·7) per shopper), and ninety-one linked photograph + audio narrative pairs (3·8 (sd 2·8) per shopper). A systematic content analysis of the photographs and audio narratives was conducted by eight independent coders. In total, nine common elements emerged from the data that enhanced the farmers' market experience (61·8 %), detracted from the experience (5·7 %) or were neutral (32·4 %). The most frequently noted elements were freshness/abundance of produce (23·3 %), product presentation (12·8 %), social interactions (12·4 %) and farmers' market attractions (e.g. live entertainment, dining offerings; 10·3 %).While produce quality (i.e. freshness/abundance) was of primary importance, other contextual factors also appeared important to the shoppers' experiences. These results may inform social marketing strategies to increase farmers' market utilization and community-building efforts that target market venues.

  View details for DOI 10.1017/S136898001400127X

  View details for PubMedID 24956064

• FEAST: UTILIZATION OF A TECHNOLOGY-DRIVEN APPROACH TO EMPOWER CITIZEN SCIENTISTS TO ADVOCATE FOR HEALTHY FOOD ENVIRONMENTS Sheats, J., Winter, S. J., Padilla-romero, P., Vu, M., Mamaril, L., King, A. SPRINGER. 2015: S190

  View details for Web of Science ID 000367825002235

• "It's Got to Be on This Page": Age and Cognitive Style in a Study of Online Health Information Seeking JOURNAL OF MEDICAL INTERNET RESEARCH Agree, E. M., King, A. C., Castro, C. M., Wiley, A., Borzekowski, D. L. 2015; 17 (3)

  Abstract

  The extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy.This study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy.The Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing.Cognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved.The increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Greater support for those who are in the oldest cohorts and for design of interfaces that support users with different cognitive styles may be required in an age of shared medical decision making.

  View details for DOI 10.2196/jmir.3352

  View details for Web of Science ID 000356780900019

  View details for PubMedID 25831483

  View details for PubMedCentralID PMC4389106

• Fostering Multiple Healthy Lifestyle Behaviors for Primary Prevention of Cancer AMERICAN PSYCHOLOGIST Spring, B., King, A. C., Pagoto, S. L., Van Horn, L., Fisher, J. D. 2015; 70 (2): 75-90

  Abstract

  The odds of developing cancer are increased by specific lifestyle behaviors (tobacco use, excess energy and alcohol intakes, low fruit and vegetable intake, physical inactivity, risky sexual behaviors, and inadequate sun protection) that are established risk factors for developing cancer. These behaviors are largely absent in childhood, emerge and tend to cluster over the life span, and show an increased prevalence among those disadvantaged by low education, low income, or minority status. Even though these risk behaviors are modifiable, few are diminishing in the population over time. We review the prevalence and population distribution of these behaviors and apply an ecological model to describe effective or promising healthy lifestyle interventions targeted to the individual, the sociocultural context, or environmental and policy influences. We suggest that implementing multiple health behavior change interventions across these levels could substantially reduce the prevalence of cancer and the burden it places on the public and the health care system. We note important still-unresolved questions about which behaviors can be intervened upon simultaneously in order to maximize positive behavioral synergies, minimize negative ones, and effectively engage underserved populations. We conclude that interprofessional collaboration is needed to appropriately determine and convey the value of primary prevention of cancer and other chronic diseases.

  View details for DOI 10.1037/a0038806

  View details for Web of Science ID 000350556800002

  View details for PubMedID 25730716

• Validation of Physical Activity Tracking via Android Smartphones Compared to ActiGraph Accelerometer: Laboratory-Based and Free-Living Validation Studies. JMIR mHealth and uHealth Hekler, E. B., Buman, M. P., Grieco, L., Rosenberger, M., Winter, S. J., Haskell, W., King, A. C. 2015; 3 (2)

  Abstract

  There is increasing interest in using smartphones as stand-alone physical activity monitors via their built-in accelerometers, but there is presently limited data on the validity of this approach.The purpose of this work was to determine the validity and reliability of 3 Android smartphones for measuring physical activity among midlife and older adults.A laboratory (study 1) and a free-living (study 2) protocol were conducted. In study 1, individuals engaged in prescribed activities including sedentary (eg, sitting), light (sweeping), moderate (eg, walking 3 mph on a treadmill), and vigorous (eg, jogging 5 mph on a treadmill) activity over a 2-hour period wearing both an ActiGraph and 3 Android smartphones (ie, HTC MyTouch, Google Nexus One, and Motorola Cliq). In the free-living study, individuals engaged in usual daily activities over 7 days while wearing an Android smartphone (Google Nexus One) and an ActiGraph.Study 1 included 15 participants (age: mean 55.5, SD 6.6 years; women: 56%, 8/15). Correlations between the ActiGraph and the 3 phones were strong to very strong (ρ=.77-.82). Further, after excluding bicycling and standing, cut-point derived classifications of activities yielded a high percentage of activities classified correctly according to intensity level (eg, 78%-91% by phone) that were similar to the ActiGraph's percent correctly classified (ie, 91%). Study 2 included 23 participants (age: mean 57.0, SD 6.4 years; women: 74%, 17/23). Within the free-living context, results suggested a moderate correlation (ie, ρ=.59, P<.001) between the raw ActiGraph counts/minute and the phone's raw counts/minute and a strong correlation on minutes of moderate-to-vigorous physical activity (MVPA; ie, ρ=.67, P<.001). Results from Bland-Altman plots suggested close mean absolute estimates of sedentary (mean difference=-26 min/day of sedentary behavior) and MVPA (mean difference=-1.3 min/day of MVPA) although there was large variation.Overall, results suggest that an Android smartphone can provide comparable estimates of physical activity to an ActiGraph in both a laboratory-based and free-living context for estimating sedentary and MVPA and that different Android smartphones may reliably confer similar estimates.

  View details for DOI 10.2196/mhealth.3505

  View details for PubMedID 25881662

  View details for PubMedCentralID PMC4414958

• Is Your Neighborhood Designed to Support Physical Activity? A Brief Streetscape Audit Tool. Preventing chronic disease Sallis, J. F., Cain, K. L., Conway, T. L., Gavand, K. A., Millstein, R. A., Geremia, C. M., Frank, L. D., Saelens, B. E., Glanz, K., King, A. C. 2015; 12: E141-?

  Abstract

  Macro level built environment factors (eg, street connectivity, walkability) are correlated with physical activity. Less studied but more modifiable microscale elements of the environment (eg, crosswalks) may also affect physical activity, but short audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of a 15-item neighborhood environment audit tool with a full version of the tool to assess neighborhood design on physical activity in 4 age groups.From the 120-item Microscale Audit of Pedestrian Streetscapes (MAPS) measure of street design, sidewalks, and street crossings, we developed the 15-item version (MAPS-Mini) on the basis of associations with physical activity and attribute modifiability. As a sample of a likely walking route, MAPS-Mini was conducted on a 0.25-mile route from participant residences toward the nearest nonresidential destination for children (n = 758), adolescents (n = 897), younger adults (n = 1,655), and older adults (n = 367). Active transportation and leisure physical activity were measured with age-appropriate surveys, and accelerometers provided objective physical activity measures. Mixed-model regressions were conducted for each MAPS item and a total environment score, adjusted for demographics, participant clustering, and macrolevel walkability.Total scores of MAPS-Mini and the 120-item MAPS correlated at r = .85. Total microscale environment scores were significantly related to active transportation in all age groups. Items related to active transport in 3 age groups were presence of sidewalks, curb cuts, street lights, benches, and buffer between street and sidewalk. The total score was related to leisure physical activity and accelerometer measures only in children.The MAPS-Mini environment measure is short enough to be practical for use by community groups and planning agencies and is a valid substitute for the full version that is 8 times longer.

  View details for DOI 10.5888/pcd12.150098

  View details for PubMedID 26334713

  View details for PubMedCentralID PMC4561538

• Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults The LIFE Study Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Pahor, M., Guralnik, J. M., Ambrosius, W. T., Blair, S., Bonds, D. E., Church, T. S., Espeland, M. A., Fielding, R. A., Gill, T. M., Groessl, E. J., King, A. C., Kritchevsky, S. B., Manini, T. M., McDermott, M. M., Miller, M. E., Newman, A. B., Rejeski, W. J., Sink, K. M., Williamson, J. D. 2014; 311 (23): 2387-2396

  Abstract

  In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability.To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability.The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m.Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises.The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m.Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]).A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults.clinicaltrials.gov Identifier: NCT01072500.

  View details for DOI 10.1001/jama.2014.5616

  View details for Web of Science ID 000337301500019

• Harnessing the potential of older adults to measure and modify their environments: long-term successes of the Neighborhood Eating and Activity Advocacy Team (NEAAT) Study. Translational behavioral medicine Winter, S. J., Buman, M. P., Sheats, J. L., Hekler, E. B., Otten, J. J., Baker, C., Cohen, D., Butler, B. A., King, A. C. 2014; 4 (2): 226-227

  View details for DOI 10.1007/s13142-014-0264-1

  View details for PubMedID 24904707

  View details for PubMedCentralID PMC4041927

• Exercise advice by humans versus computers: Maintenance effects at 18 months. Health psychology King, A. C., Hekler, E. B., Castro, C. M., Buman, M. P., Marcus, B. H., Friedman, R. H., Napolitano, M. A. 2014; 33 (2): 192-196

  Abstract

  Objective: An automated telehealth counseling system, aimed at inactive midlife and older adults, was shown previously to achieve 12-month physical activity levels similar to those attained by human advisors. This investigation evaluated the sustained 18-month impacts of the automated advisor compared with human advisors. Methods: Following the end of the 12-month randomized, controlled trial, participants who had been randomized to either the human advisor (n = 73) or automated advisor (n = 75) arms were followed for an additional 6 months. During that period, human or automated advisor-initiated telephone contacts ceased and participants were encouraged to initiate contact with their advisor as deemed relevant. The primary outcome was moderate-to-vigorous physical activity (MVPA), measured using the Stanford Physical Activity Recall and validated during the major trial via accelerometry. Results: The two arms did not differ significantly in 18-month MVPA or the percentage of participants meeting national physical activity guidelines (ps >.50). No significant within-arm MVPA differences emerged between 12 and 18 months. Evaluation of the trajectory of physical activity change across the 18-month study period indicated that, for both arms, the greatest physical activity increases occurred during the first 6 months of intervention, followed by a relatively steady amount of physical activity across the remaining months. Conclusions: The results provide evidence that an automated telehealth advice system can maintain physical activity increases at a level similar to that achieved by human advisors through 18 months. Given the accelerated use of mobile phones in developing countries, as well as industrialized nations, automated telehealth systems merit further evaluation. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  View details for DOI 10.1037/a0030646

  View details for PubMedID 23421896

• Behavioral Medicine in the 21st Century: Transforming "the Road Less Traveled" into the "American Way of Life" ANNALS OF BEHAVIORAL MEDICINE King, A. C. 2014; 47 (1): 71-78

  Abstract

  A key objective of this paper is to describe some major challenges and opportunities facing the behavioral medicine field in the current decade. Amidst current US statistics that present a sobering image of the nation's health, there have been a number of notable achievements in the behavioral medicine field that span the scientific/health continuum. However, many of these achievements have received little notice by the public and decision makers.A case is presented for the potential of scientific narrative for presenting behavioral medicine evidence in ways that engage attention and compel action. Additional areas for behavioral medicine engagement include expanding interdisciplinary connections into new arenas, continuing the growth of activities involving emerging technologies, building international connections, and engaging with policy.Finally, the fundamental importance of an integrated behavioral medicine field that plays an active role in supporting and advancing its members and the field as a whole is discussed.

  View details for DOI 10.1007/s12160-013-9530-6

  View details for Web of Science ID 000331646100008

  View details for PubMedID 24096957

  View details for PubMedCentralID PMC3945721

• Impact of San Francisco's toy ordinance on restaurants and children's food purchases, 2011-2012. Preventing chronic disease Otten, J. J., Saelens, B. E., Kapphahn, K. I., Hekler, E. B., Buman, M. P., Goldstein, B. A., Krukowski, R. A., O'Donohue, L. S., Gardner, C. D., King, A. C. 2014; 11: E122-?

  Abstract

  In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children's meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children's menus), and the energy and nutrient content of all orders and children's-meal-only orders purchased for children aged 0 through 12 years.Restaurant responses were examined from January 2010 through March 2012. Parent-caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.Both restaurant chains responded to the ordinance by selling toys separately from children's meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children's meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children's side dishes and beverages at Chain A.Although the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes.

  View details for DOI 10.5888/pcd11.140026

  View details for PubMedID 25032837

  View details for PubMedCentralID PMC4110247

• Employing Virtual Advisors in Preventive Care for Underserved Communities: Results From the COMPASS Study JOURNAL OF HEALTH COMMUNICATION King, A. C., Bickmore, T. W., Campero, M. I., Pruitt, L. A., Yin, J. L. 2013; 18 (12): 1449-1464

  Abstract

  Electronically delivered health promotion programs that are aimed primarily at educated, health-literate individuals have proliferated, raising concerns that such trends could exacerbate health disparities in the United States and elsewhere. The efficacy of a culturally and linguistically adapted virtual advisor that provides tailored physical activity advice and support was tested in low-income older adults. Forty inactive adults (92.5% Latino) 55 years of age and older were randomized to a 4-month virtual advisor walking intervention or a waitlist control. Four-month increases in reported minutes of walking/week were greater in the virtual advisor arm (mean increase = 253.5 ± 248.7 minutes/week) relative to the control (mean increase = 26.8 ± 67.0 minutes/week; p = .0008). Walking increases in the virtual advisor arm were substantiated via objectively measured daily steps (slope analysis p = .002). All but one intervention participant continued some interaction with the virtual advisor in the 20-week poststudy period (mean number of poststudy sessions = 14.0 ± 20.5). The results indicate that a virtual advisor delivering culturally and linguistically adapted physical activity advice led to meaningful 4-month increases in walking relative to control among underserved older adults. This interactive technology, which requires minimal language and computer literacy, may help reduce health disparities by ensuring that all groups benefit from e-health opportunities.

  View details for DOI 10.1080/10810730.2013.798374

  View details for Web of Science ID 000328192800005

  View details for PubMedID 23941610

• Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial. Annals of behavioral medicine King, A. C., Castro, C. M., Buman, M. P., Hekler, E. B., Urizar, G. G., Ahn, D. K. 2013; 46 (2): 157-168

  Abstract

  BACKGROUND: Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence. PURPOSE: We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes. METHODS: Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms. RESULTS: Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms. CONCLUSIONS: We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.

  View details for DOI 10.1007/s12160-013-9501-y

  View details for PubMedID 23609341

• The stanford healthy neighborhood discovery tool: a computerized tool to assess active living environments. American journal of preventive medicine Buman, M. P., Winter, S. J., Sheats, J. L., Hekler, E. B., Otten, J. J., Grieco, L. A., King, A. C. 2013; 44 (4): e41-7

  Abstract

  The built environment can influence physical activity, particularly among older populations with impaired mobility. Existing tools to assess environmental features associated with walkability are often cumbersome, require extensive training, and are not readily available for use by community residents.This project aimed to develop and evaluate the utility of a computerized, tablet-based participatory tool designed to engage older residents in identifying neighborhood elements that affect active living opportunities.Following formative testing, the tool was used by older adults (aged ≥65 years, in 2011) to record common walking routes (tracked using built-in GPS) and geocoded audio narratives and photographs of the local neighborhood environment. Residents (N=27; 73% women; 77% with some college education; 42% used assistive devices) from three low-income communal senior housing sites used the tool while navigating their usual walking route in their neighborhood. Data were analyzed in 2012.Elements (from 464 audio narratives and photographs) identified as affecting active living were commensurate with the existing literature (e.g., sidewalk features, aesthetics, parks/playgrounds, crosswalks). However, within each housing site, the profile of environmental elements identified was distinct, reflecting the importance of granular-level information collected by the tool. Additionally, consensus among residents was reached regarding which elements affected active living opportunities.This tool serves to complement other assessments and assist decision makers in consensus-building processes for environmental change.

  View details for DOI 10.1016/j.amepre.2012.11.028

  View details for PubMedID 23498112

  View details for PubMedCentralID PMC3601583

• ETHNOGRAPHIC STUDY OF SHOPPERS' EXPERIENCES AT AN URBAN FARMER'S MARKET Buman, M. P., Bertmann, F., Winter, S. J., Wharton, C. M., Hekler, E. B., Sheats, J. L., King, A. C. SPRINGER. 2013: S214

  View details for Web of Science ID 000209928001411

• Harnessing different motivational frames via mobile phones to promote daily physical activity and reduce sedentary behavior in aging adults. PloS one King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 2013; 8 (4)

  Abstract

  Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors. Despite an explosion of mobile phone applications aimed at physical activity and other health behaviors, few have been based on theoretically derived constructs and empirical evidence. Eighty adults ages 45 years and older who were insufficiently physically active, engaged in prolonged daily sitting, and were new to smartphone technology, participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence. An "analytically" framed custom application focused on personalized goal setting, self-monitoring, and active problem solving around barriers to behavior change. A "socially" framed custom application focused on social comparisons, norms, and support. An "affectively" framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar, whose movements and behaviors reflected the physical activity and sedentary levels of the user. To explore the applications' initial efficacy in changing regular physical activity and leisure-time sitting, behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity questionnaire and the Australian sedentary behavior questionnaire. User acceptability of and satisfaction with the applications was explored via a post-intervention user survey. The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period. Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology. Preliminary data exploring sustained use of the applications across a longer time period yielded promising results. The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors.

  View details for DOI 10.1371/journal.pone.0062613

  View details for PubMedID 23638127

  View details for PubMedCentralID PMC3636222

• Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial. international journal of behavioral nutrition and physical activity Hekler, E. B., Buman, M. P., Otten, J., Castro, C. M., Grieco, L., Marcus, B., Friedman, R. H., Napolitano, M. A., King, A. C. 2013; 10: 109-?

  Abstract

  Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions.Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12).Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

  View details for DOI 10.1186/1479-5868-10-109

  View details for PubMedID 24053756

• Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults. PloS one King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 2013; 8 (4)

  View details for DOI 10.1371/journal.pone.0062613

  View details for PubMedID 23638127

• Neighborhood Eating and Activity Advocacy Teams (NEAAT): engaging older adults in policy activities to improve food and physical environments. Translational behavioral medicine Buman, M. P., Winter, S. J., Baker, C., Hekler, E. B., Otten, J. J., King, A. C. 2012; 2 (2): 249-253

  Abstract

  Local food and physical activity environments are known to impact health, and older adults are generally more vulnerable to health-related environmental impacts due to poorer physical function and mobility impairments. There is a need to develop cost-conscious, community-focused strategies that impact local food and physical activity environment policies. Engaging older adult community residents in assessment and advocacy activities is one avenue to address this need. We describe the Neighborhood Eating and Activity Advocacy Team project, a community-based participatory project in low-income communal housing settings in San Mateo County, CA, as one method for engaging older adults in food and physical activity environment and policy change. Methods and strategies used by the "community action teams" to generate relevant neighborhood environmental data, build coalitions, prioritize complex issues, and advocate for change are presented. Advocacy groups are feasible among older adults to improve food and physical activity environments.

  View details for DOI 10.1007/s13142-011-0100-9

  View details for PubMedID 24073118

  View details for PubMedCentralID PMC3717885

• Neighborhood Eating and Activity Advocacy Teams (NEAAT): engaging older adults in policy activities to improve food and physical environments TRANSLATIONAL BEHAVIORAL MEDICINE Buman, M. P., Winter, S. J., Baker, C., Hekler, E. B., Otten, J. J., King, A. C. 2012; 2 (2): 249-253

  Abstract

  Local food and physical activity environments are known to impact health, and older adults are generally more vulnerable to health-related environmental impacts due to poorer physical function and mobility impairments. There is a need to develop cost-conscious, community-focused strategies that impact local food and physical activity environment policies. Engaging older adult community residents in assessment and advocacy activities is one avenue to address this need. We describe the Neighborhood Eating and Activity Advocacy Team project, a community-based participatory project in low-income communal housing settings in San Mateo County, CA, as one method for engaging older adults in food and physical activity environment and policy change. Methods and strategies used by the "community action teams" to generate relevant neighborhood environmental data, build coalitions, prioritize complex issues, and advocate for change are presented. Advocacy groups are feasible among older adults to improve food and physical activity environments.

  View details for DOI 10.1007/s13142-011-0100-9

  View details for Web of Science ID 000209412400019

  View details for PubMedCentralID PMC3717885

• Food Marketing to Children Through Toys Response of Restaurants to the First U.S. Toy Ordinance AMERICAN JOURNAL OF PREVENTIVE MEDICINE Otten, J. J., Hekler, E. B., Krukowski, R. A., Buman, M. P., Saelens, B. E., Gardner, C. D., King, A. C. 2012; 42 (1): 56-60

  Abstract

  On August 9, 2010, Santa Clara County CA became the first U.S. jurisdiction to implement an ordinance that prohibits the distribution of toys and other incentives to children in conjunction with meals, foods, or beverages that do not meet minimal nutritional criteria. Restaurants had many different options for complying with this ordinance, such as introducing more healthful menu options, reformulating current menu items, or changing marketing or toy distribution practices.To assess how ordinance-affected restaurants changed their child menus, marketing, and toy distribution practices relative to non-affected restaurants.Children's menu items and child-directed marketing and toy distribution practices were examined before and at two time points after ordinance implementation (from July through November 2010) at ordinance-affected fast-food restaurants compared with demographically matched unaffected same-chain restaurants using the Children's Menu Assessment tool.Affected restaurants showed a 2.8- to 3.4-fold improvement in Children's Menu Assessment scores from pre- to post-ordinance with minimal changes at unaffected restaurants. Response to the ordinance varied by restaurant. Improvements were seen in on-site nutritional guidance; promotion of healthy meals, beverages, and side items; and toy marketing and distribution activities.The ordinance appears to have positively influenced marketing of healthful menu items and toys as well as toy distribution practices at ordinance-affected restaurants, but did not affect the number of healthful food items offered.

  View details for DOI 10.1016/j.amepre.2011.08.020

  View details for Web of Science ID 000298294000011

  View details for PubMedID 22176847

• Aging in neighborhoods differing in walkability and income: Associations with physical activity and obesity in older adults SOCIAL SCIENCE & MEDICINE King, A. C., Sallis, J. F., Frank, L. D., Saelens, B. E., Cain, K., Conway, T. L., Chapman, J. E., Ahn, D. K., Kerr, J. 2011; 73 (10): 1525-1533

  Abstract

  While there is a growing literature on the relations between neighborhood design and health factors such as physical activity and obesity, less focus has been placed on older adults, who may be particularly vulnerable to environmental influences. This study evaluates the relations among objectively measured neighborhood design, mobility impairment, and physical activity and body weight in two U.S. regional samples of community dwelling older adults living in neighborhoods differing in walkability and income levels. An observational design involving two time points six months apart was employed between 2005 and 2008. U.S. Census block groups in Seattle-King County, Washington and Baltimore, Maryland-Washington DC regions were selected via geographic information systems to maximize variability in walkability and income. Participants were 719 adults ages 66 years and older who were able to complete surveys in English and walk at least 10 feet continuously. Measurements included reported walking or bicycling for errands (i.e., transport activity) and other outdoor aerobic activities measured via the CHAMPS questionnaire: accelerometry-based moderate-to-vigorous physical activity; reported body mass index; and reported lower extremity mobility impairment measured via the Late-Life Function and Disability Instrument. Across regions, time, and neighborhood income, older adults living in more walkable neighborhoods had more transport activity and moderate-to- vigorous physical activity and lower body mass index relative to those living in less walkable neighborhoods. The most mobility-impaired adults living in more walkable neighborhoods reported transport activity levels that were similar to less mobility-impaired adults living in less walkable neighborhoods. The results add to the small literature aimed at understanding how neighborhood design may influence physical activity and related aspects of health linked with day-to-day function and independence as people age.

  View details for DOI 10.1016/j.socscimed.2011.08.032

  View details for Web of Science ID 000297906100011

  View details for PubMedID 21975025

  View details for PubMedCentralID PMC3637547

• Physical Activity Program Delivery by Professionals Versus Volunteers: The TEAM Randomized Trial HEALTH PSYCHOLOGY Castro, C. M., Pruitt, L. A., Buman, M. P., King, A. C. 2011; 30 (3): 285-294

  Abstract

  Older adults have low rates of physical activity participation, but respond positively to telephone-mediated support programs. Programs are often limited by reliance on professional staff. This study tested telephone-based physical activity advice delivered by professional staff versus trained volunteer peer mentors.A 12-month, randomized, controlled clinical trial was executed from 2003-2008. Twelve volunteer peer mentors and 181 initially inactive adults ages 50 years and older were recruited from the San Francisco Bay Area. Participants were randomized to: (1) telephone-based physical activity advice delivered by professional staff, (2) telephone-based physical activity advice delivered by trained volunteer peers, or (3) an attention-control arm of staff-delivered telephone support for nutrition.Moderate-intensity or more vigorous physical activity (MVPA) was assessed at baseline, 6, and 12 months with the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire, with accelerometry validation (Actigraph) in a randomly selected subsample. Treatment fidelity was examined through analysis of quantity and quality of intervention delivery.At 6 and 12 months, both physical activity arms significantly increased MVPA relative to the control arm. Both physical activity arms were comparable in quantity of intervention delivery, but peers demonstrated more versatility and comprehensiveness in quality of intervention content.This study demonstrates that trained peer volunteers can effectively promote physical activity increases through telephone-based advice. The results support a program delivery model with good dissemination potential for a variety of community settings.

  View details for DOI 10.1037/a0021980

  View details for Web of Science ID 000290695300006

  View details for PubMedID 21553972

  View details for PubMedCentralID PMC3092123

• WHO RESPONDS BETTER TO A COMPUTER-DELIVERED VS. HUMAN-DELIVERED PHYSICAL ACTIVITY INTERVENTION? Hekler, E. B., Buman, M., Otten, J., Castro, C., Ahn, D., Marcus, B., Friedman, R., King, A. SPRINGER. 2011: S57–S57

  View details for Web of Science ID 000289297700223

• Maximizing the Potential of an Aging Population JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION King, A. C., Guralnik, J. M. 2010; 304 (17): 1944-1945

  View details for Web of Science ID 000283725900025

  View details for PubMedID 21045101

• Identifying Subgroups of US Adults at Risk for Prolonged Television Viewing to Inform Program Development AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Goldberg, J. H., Salmon, J., Owen, N., Dunstan, D., Weber, D., Doyle, C., Robinson, T. N. 2010; 38 (1): 17-26

  Abstract

  Although adverse health effects of prolonged TV viewing have been increasingly recognized, little population-wide information is available concerning subgroups at greatest risk for this behavior.This study sought to identify, in a U.S. population-derived sample, combinations of variables that defined subgroups with higher versus lower levels of usual TV-viewing time.A total of 5556 adults from a national consumer panel participated in the mail survey in 2001 (55% women, 71% white, 13% black, and 11% Hispanic). Nonparametric risk classification analyses were conducted in 2008.Subgroups with the highest proportions of people watching >14 hours/week of TV were identified and described using a combination of demographic (i.e., lower household incomes, divorced/separated); health and mental health (i.e., poorer rated overall health, higher BMI, more depression); and behavioral (i.e., eating dinner in front of the TV, smoking, less physical activity) variables. The subgroup with the highest rates of TV viewing routinely ate dinner while watching TV and had lower income and poorer health. Prolonged TV viewing also was associated with perceived aspects of the neighborhood environment (i.e., heavy traffic and crime, lack of neighborhood lighting, and poor scenery).The results can help inform intervention development in this increasingly important behavioral health area.

  View details for DOI 10.1016/j.amepre.2009.08.032

  View details for Web of Science ID 000273413800003

  View details for PubMedID 20117553

• Why and how to improve physical activity promotion: Lessons from behavioral science and related fields PREVENTIVE MEDICINE King, A. C., Sallis, J. F. 2009; 49 (4): 286-288

  Abstract

  This commentary highlights the importance of regular physical activity to the nation's health and discusses some of the major challenges and opportunities currently facing the field.

  View details for DOI 10.1016/j.ypmed.2009.07.007

  View details for Web of Science ID 000271451700004

  View details for PubMedID 19631233

  View details for PubMedCentralID PMC2998537

• Effects of Moderate-Intensity Exercise on Polysomnographic and Subjective Sleep Quality in Older Adults With Mild to Moderate Sleep Complaints JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Pruitt, L. A., Woo, S., Castro, C. M., Ahn, D. K., Vitiello, M. V., Woodward, S. H., Bliwise, D. L. 2008; 63 (9): 997-1004

  Abstract

  This study sought to determine the 12-month effects of exercise increases on objective and subjective sleep quality in initially inactive older persons with mild to moderate sleep complaints.A nonclinical sample of underactive adults 55 years old or older (n=66) with mild to moderate chronic sleep complaints were randomly assigned to a 12-month program of primarily moderate-intensity endurance exercise (n=36) or a health education control program (n=30). The main outcome measure was polysomnographic sleep recordings, with additional measures of subjective sleep quality, physical activity, and physical fitness. Directional hypotheses were tested.Using intent-to-treat methods, at 12 months exercisers, relative to controls, spent significantly less time in polysomnographically measured Stage 1 sleep (between-arm difference=2.3, 95% confidence interval [CI], 0.7-4.0; p=003), spent more time in Stage 2 sleep (between-arm difference=3.2, 95% CI, 0.6-5.7; p=.04), and had fewer awakenings during the first third of the sleep period (between-arm difference=1.0, 95% CI, 0.39-1.55; p=.03). Exercisers also reported greater 12-month improvements relative to controls in Pittsburgh Sleep Quality Index (PSQI) sleep disturbance subscale score (p=.009), sleep diary-based minutes to fall asleep (p=.01), and feeling more rested in the morning (p=.02).Compared with general health education, a 12-month moderate-intensity exercise program that met current physical activity recommendations for older adults improved some objective and subjective dimensions of sleep to a modest degree. The results suggest additional areas for investigation in this understudied area.

  View details for Web of Science ID 000260074800015

  View details for PubMedID 18840807

• Exploring refinements in targeted behavioral medicine intervention to advance public health ANNALS OF BEHAVIORAL MEDICINE King, A. C., Ahn, D. F., Atienza, A. A., Kraemer, H. C. 2008; 35 (3): 251-260

  Abstract

  Similar to other fields, a targeted behavioral medicine perspective can aid decision-making related to participant-intervention matching.To present one potentially useful definition of intervention targeting activity; describe potential targeting domains of particular relevance to behavioral medicine; discuss different statistical approaches to aid the targeted intervention development process; and discuss the challenges and opportunities accompanying the incorporation of targeted intervention development methods into behavioral randomized clinical trial (RCT) research.Drawing from recent conceptual work by the MacArthur group and other scientists in the field, methods and approaches to undertaking moderator analysis are discussed.Examples of moderator analyses are provided which reflect the different statistical methods and variable domains that may serve as moderators of intervention success.The recommended exploratory work can help to make the most efficient use of RCTs to identify the best paths for subsequent RCT development in a resource-constrained era.

  View details for DOI 10.1007/s12160-008-9032-0

  View details for Web of Science ID 000258554500001

  View details for PubMedID 18568380

• Promoting physical activity through hand-held computer technology AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Ahn, D. K., Oliveira, B. M., Atienza, A. A., Castro, C. M., Gardner, C. D. 2008; 34 (2): 138-142

  Abstract

  Efforts to achieve population-wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies. Yet few systematic efforts to evaluate the efficacy of hand-held computers and similar devices for enhancing physical activity levels have occurred. The purpose of this first-generation study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing moderate intensity or more vigorous (MOD+) physical activity levels over 8 weeks in mid-life and older adults relative to a standard information control arm.Randomized, controlled 8-week experiment. Data were collected in 2005 and analyzed in 2006-2007.Community-based study of 37 healthy, initially underactive adults aged 50 years and older who were randomized and completed the 8-week study (intervention=19, control=18).Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback, goal setting, and support. Controls received standard, age-appropriate written physical activity educational materials.Physical activity was assessed via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and 8 weeks.Relative to controls, intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity (p<0.04). Satisfaction with the PDA was reasonably high in this largely PDA-naive sample.Results from this first-generation study indicate that hand-held computers may be effective tools for increasing initial physical activity levels among underactive adults.

  View details for DOI 10.1016/j.amepre.2007.09.025

  View details for Web of Science ID 000252758300008

  View details for PubMedID 18201644

  View details for PubMedCentralID PMC2715220

• Ongoing physical activity advice by humans versus computers: The community health advice by telephone (CHAT) trial HEALTH PSYCHOLOGY King, A. C., Friedman, R., Marcus, B., Castro, C., Napolitano, M., Alm, D., Baker, L. 2007; 26 (6): 718-727

  Abstract

  Given the prevalence of physical inactivity among American adults, convenient, low-cost interventions are strongly indicated. This study determined the 6- and 12-month effectiveness of telephone interventions delivered by health educators or by an automated computer system in promoting physical activity.Initially inactive men and women age 55 years and older (N = 218) in stable health participated. Participants were randomly assigned to human advice, automated advice, or health education control.The validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. Physical activity differences by experimental arm were verified on a random subsample via accelerometry.Using intention-to-treat analysis, at 6 months, participants in both interventions, although not differing from one another, showed significant improvements in weekly physical activity compared with controls. These differences were generally maintained at 12 months, with both intervention arms remaining above the target of 150 min per week of moderate to vigorous physical activity on average.Automated telephone-linked delivery systems represent an effective alternative for delivering physical activity advice to inactive older adults.

  View details for DOI 10.1037/0278-6133.26.6.718

  View details for Web of Science ID 000250861700011

  View details for PubMedID 18020844

• Physical activity and public health in older adults - Recommendation from the American college of sports medicine and the American heart association CIRCULATION Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., Macera, C. A., Castaneda-Sceppa, C. 2007; 116 (9): 1094-1105

  Abstract

  To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature.After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

  View details for DOI 10.1161/CIRCULATIONAHA.107.185650

  View details for Web of Science ID 000249031100014

  View details for PubMedID 17671236

• Effects of a physical activity intervention on measures of physical performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Pahor, M., Blair, S. N., Espeland, M., Fielding, R., Gill, T. M., Guralnik, J. M., Hadley, E. C., King, A. C., Kritchevsky, S. B., Maraldi, C., Miller, M. E., Newman, A. B., Rejeski, W. J., Romashkan, S., Studenski, S., Blair, S. N., Church, T., Ashmore, J. A., Dubreuil, J., Frierson, G., Jordan, A. N., Morss, G., Rodarte, R. Q., Wallace, J. M., Guralnik, J. M., Hadley, E. C., Romashkan, S., King, A. C., Haskell, W. L., Pruitt, L. A., Abbott-Pilolla, K., Fortmann, S., Prosak, C., Wallace, K., Bolen, K., Fielding, R., Nelson, M., Kaplan, R. M., Groessl, E. J., Pahor, M., Perri, M., Caudle, C., Crump, L., Hayden, S., Holmes, L., Maraldi, C., Quirin, C., Newman, A. B., Studenski, S., Goodpaster, B. H., Aiken, E. K., Anthony, S., Glynn, N. W., Kadosh, J., Kost, P., Newman, M., Taylor, C. A., Vincent, P., Kritchevsky, S. B., Brubaker, P., Demons, J., Furberg, C., Katula, J. A., Marsh, A., Nicklas, B. J., Williamson, J. D., Fries, R., Kennedy, K., Murphy, K., Nagaria, S., Wickley-Krupel, K., Miller, M. E., Espeland, M., Hsu, F., Rejeski, W. J., Babcock, D. P., Costanza, L., Harvin, L. N., Kaltenbach, L., Roberson, W. A., Rushing, J., Rushing, S., Walkup, M. P., Lang, W., Gill, T. M. 2006; 61 (11): 1157-1165

  Abstract

  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.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.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).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.

  View details for Web of Science ID 000243118800007

  View details for PubMedID 17167156

• Identifying subgroups that succeed or fail with three levels of physical activity intervention: The activity counseling trial HEALTH PSYCHOLOGY King, A. C., Marcus, B., Ahn, D., Dunn, A. L., Rejeski, W. J., Sallis, J. F., Coday, M. 2006; 25 (3): 336-347

  Abstract

  The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.

  View details for DOI 10.1037/0278-6133.25.3.336

  View details for Web of Science ID 000237761300010

  View details for PubMedID 16719605

• Theoretical approaches to the promotion of physical activity - Forging a transdisciplinary paradigm AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Stokols, D., Talen, E., Brassington, G. S., Killingsworth, R. 2002; 23 (2): 15-25

  Abstract

  Research in the physical activity promotion arena has focused on the application of theoretical perspectives aimed primarily at personal levels of understanding and analysis. The investigation of such theories has provided some insights related to potentially useful mediators of physical activity behavior. However, to continue to expand this field, new perspectives on personal-level theories, in addition to the exploration of more macro-level conceptual perspectives, are required.The purpose of this article is to: (1) briefly review the current strengths and limitations of the personal-level, physical activity-theory literature; and (2) introduce concepts and perspectives from other fields, including the social-ecology and urban-planning fields, of potential relevance to the physical activity arena.We provide an overview of potentially relevant theoretical perspectives aimed at different levels of understanding and analysis, from the personal level through the broader-scale meso- and macro-environmental perspectives. In addition, we suggest initial steps to take in developing a transdisciplinary paradigm encompassing all such levels of analysis and investigation.Given the scope of the physical inactivity epidemic facing the U.S. population currently and in the future, methods and approaches that integrate theory and concepts across a broader group of disciplines will be increasingly necessary.

  View details for Web of Science ID 000177181500005

  View details for PubMedID 12133734

• Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: A randomized controlled trial JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Baumann, K., O'Sullivan, P., Wilcox, S., Castro, C. 2002; 57 (1): M26-M36

  Abstract

  The study objective was to determine the health and quality-of-life effects of moderate-intensity exercise among older women family caregivers.This 12-month randomized controlled trial involved a volunteer sample of 100 women aged 49 to 82 years who were sedentary, free of cardiovascular disease, and caring for a relative with dementia. Participants were randomized to 12 months of home-based, telephone-supervised, moderate-intensity exercise training or to an attention-control (nutrition education) program. Exercise consisted of four 30- to 40-minute endurance exercise sessions (brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate. Main outcomes were stress-induced cardiovascular reactivity levels, rated sleep quality, and reported psychological distress.Compared with nutrition participants (NU), exercise participants (EX) showed significant improvements in the following: total energy expenditure (baseline and post-test means [SD] for EX = 1.4 [1.9] and 2.2 [2.2] kcal/kg/day; for NU = 1.2 [1.7] and 1.2 [1.6] kcal/kg/day; p <.02); stress-induced blood pressure reactivity (baseline and post-test systolic blood pressure reactivity values for EX = 21.6 [12.3] and 12.4 [11.2] mm Hg; for NU = 17.9 [10.2] and 17.7 [13.8] mm Hg; p <.024); and sleep quality (p <.05). NU showed significant improvements in percentages of total calories from fats and saturated fats relative to EX (p values <.01). Both groups reported improvements in psychological distress. Conclusions. Family caregivers can benefit from initiating a regular moderate-intensity exercise program in terms of reductions in stress-induced cardiovascular reactivity and improvements in rated sleep quality.

  View details for Web of Science ID 000173163800010

  View details for PubMedID 11773209

• Interventions to promote physical activity by older adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C. 2001; 56: 36-46

  Abstract

  Physical inactivity has been established to be an independent risk factor for a range of chronic diseases and conditions that threaten the health of the nation. However, only a minority of the population is currently meeting the recommended levels of regular physical activity, which have been linked with important health and quality-of-life benefits. Older adults are at particular risk for leading sedentary lifestyles. This article provides an overview of factors associated with physical activity for older adults and also describes potentially promising interventions for promoting regular physical activity in this growing population segment. Examples of interventions undertaken at personal and interpersonal as well as broader levels of analysis (e.g., environmental) are provided. Major issues currently facing the field are discussed, including the ongoing challenge of developing assessment tools that are sensitive to the more moderate-intensity physical activities favored by older adults and the formidable task of combining clinical approaches with environmental and policy strategies aimed at combating this public health problem.

  View details for Web of Science ID 000171992700005

  View details for PubMedID 11730236

• Effects of physical activity counseling in primary care - The activity counseling trial: A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Simons-Morton, D. G., Blair, S. N., King, A. C., Morgan, T. M., Applegate, W. B., O'Toole, M., Haskell, W. L., Albright, C. L., Cohen, S. J., Ribisl, P. M., Shih, J. H. 2001; 286 (6): 677-687

  Abstract

  Physical activity is important for health, yet few studies have examined the effectiveness of physical activity patient counseling in primary care.To compare the effects of 2 physical activity counseling interventions with current recommended care and with each other in a primary care setting.The Activity Counseling Trial, a randomized controlled trial with recruitment in 1995-1997, with 24 months of follow-up.Eleven primary care facilities affiliated with 3 US clinical research centers.Volunteer sample of 395 female and 479 male inactive primary care patients aged 35 to 75 years without clinical cardiovascular disease.Participants were randomly assigned to 1 of 3 groups: advice (n = 292), which included physician advice and written educational materials (recommended care); assistance (n = 293), which included all the components received by the advice group plus interactive mail and behavioral counseling at physician visits; or counseling (n = 289), which included the assistance and advice group components plus regular telephone counseling and behavioral classes.Cardiorespiratory fitness, measured by maximal oxygen uptake (VO(2)max), and self-reported total physical activity, measured by a 7-day Physical Activity Recall, compared among the 3 groups and analyzed separately for men and women at 24 months.At 24 months, 91.4% of the sample had completed physical activity and 77.6% had completed cardiorespiratory fitness measurements. For women at 24 months, VO(2)max was significantly higher in the assistance group than in the advice group (mean difference, 80.7 mL/min; 99.2% confidence interval [CI], 8.1-153.2 mL/min) and in the counseling group than in the advice group (mean difference, 73.9 mL/min; 99.2% CI, 0.9-147.0 mL/min), with no difference between the counseling and assistance groups and no significant differences in reported total physical activity. For men, there were no significant between-group differences in cardiorespiratory fitness or total physical activity.Two patient counseling interventions differing in type and number of contacts were equally effective in women in improving cardiorespiratory fitness over 2 years compared with recommended care. In men, neither of the 2 counseling interventions was more effective than recommended care.

  View details for Web of Science ID 000170271500023

  View details for PubMedID 11495617

• Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of US middle-aged and older-aged women HEALTH PSYCHOLOGY King, A. C., Castro, C., Wilcox, S., Eyler, A. A., Sallis, J. F., Brownson, R. C. 2000; 19 (4): 354-364

  Abstract

  Personal, program-based, and environmental barriers to physical activity were explored among a U.S. population-derived sample of 2,912 women 40 years of age and older. Factors significantly associated with inactivity included American Indian ethnicity, older age, less education, lack of energy, lack of hills in one's neighborhood, absence of enjoyable scenery, and infrequent observation of others exercising in one's neighborhood. For all ethnic subgroups, caregiving duties and lacking energy to exercise ranked among the top 4 most frequently reported barriers. Approximately 62% of respondents rated exercise on one's own with instruction as more appealing than undertaking exercise in an instructor-led group, regardless of ethnicity or current physical activity levels. The results underscore the importance of a multifaceted approach to understanding physical activity determinants in this understudied, high-risk population segment.

  View details for DOI 10.1037//0278-6133.19.4.354

  View details for Web of Science ID 000088061600006

  View details for PubMedID 10907654

• Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Pruitt, L. A., Phillips, W., Oka, R., Rodenburg, A., Haskell, W. L. 2000; 55 (2): M74-M83

  Abstract

  Although inactivity is an important contributor to impaired functioning and disability with age, little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken.One hundred three adults age 65 years and older, recruited via population-based methods, were randomized to 12 months of community-based, moderate-intensity endurance and strengthening exercises (Fit & Firm) or stretching and flexibility exercises (Stretch & Flex). A combination of class- and home-based exercise formats was used. Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention.Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects. Stretch & Flex subjects reported greater improvements in bodily pain, and Stretch & Flex men evidenced greater improvements in flexibility relative to Fit & Firm subjects. Although overall exercise adherence was high in both exercise conditions (approximately 80%), subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions.Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes. This represents one of the first studies to report significant improvements in an important quality of life outcome-bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults.

  View details for Web of Science ID 000088044200014

  View details for PubMedID 10737689

• Physical activity interventions targeting older adults - A critical review and recommendations AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Rejeski, W. J., Buchner, D. M. 1998; 15 (4): 316-333

  Abstract

  Although many of the chronic conditions plaguing older populations are preventable through appropriate lifestyle interventions such as regular physical activity, persons in this age group represent the most sedentary segment of the adult population. The purpose of the current paper was to provide a critical selected review of the scientific literature focusing on interventions to promote physical activity among older adults.Comprehensive computerized searches of the recent English language literature aimed at physical activity intervention in adults aged 50 years and older, supplemented with visual scans of several journal on aging, were undertaken. Articles were considered to be relevant for the current review if they were community-based, employed a randomized design or a quasi-experimental design with an appropriate comparison group, and included information on intervention participation rates, pre- and post-intervention physical activity levels, and/or pre/post changes in relevant physical performance measures.Twenty-nine studies were identified that fit the stated criteria. Among the strengths of the studies reviewed were reasonable physical activity participation rates and relatively long study durations. Among the weaknesses of the literature reviewed were the relative lack of specific behavioral or program-based strategies aimed at promoting physical activity participation, as well as the dearth of studies aimed at replication, generalizability of interventions to important subgroups, implementation, and cost-effectiveness evaluation.Recommendations for future scientific endeavors targeting older adults are discussed.

  View details for Web of Science ID 000076982900005

  View details for PubMedID 9838975

• Overview of the Activity Counseling Trial (ACT) intervention for promoting physical activity in primary health care settings MEDICINE AND SCIENCE IN SPORTS AND EXERCISE King, A. C., Sallis, J. F., Dunn, A. L., Simons-Morton, D. G., Albright, C. A., Cohen, S., Rejeski, W. J., Marcus, B. H., Coday, M. C. 1998; 30 (7): 1086-1096

  Abstract

  Counseling by health care providers has the potential to increase physical activity in sedentary patients, yet few studies have tested interventions for physical activity counseling delivered in health care settings. The Activity Counseling Trial (ACT) is a 5-yr randomized clinical trial to evaluate the efficacy of two primary care, practice-based physical activity behavioral interventions relative to a standard care control condition. A total of 874 sedentary men and women, 35-75 yr of age, have been recruited from primary care physician offices at three clinical centers for 2 yr of participation. They were randomly assigned to one of three experimental conditions that vary, in a hierarchical fashion, by level of counseling intensity and resource requirements. The interventions, which are based on social cognitive theory and the transtheoretical model, are designed to alter empirically based psychosocial mediators that are known to be associated with physical activity. The present paper describes the theoretical background of the intervention, the intervention methods, and intervention training and quality control procedures.

  View details for Web of Science ID 000074599300011

  View details for PubMedID 9662678

• Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making HEALTH PSYCHOLOGY King, A. C., Kiernan, M., Oman, R. F., Kraemer, H. C., Hull, M., Ahn, D. 1997; 16 (4): 380-389

  Abstract

  Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.

  View details for Web of Science ID A1997XJ90600011

  View details for PubMedID 9237091

• Moderate-intensity exercise and self-rated quality of sleep in older adults - A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION King, A. C., Oman, R. F., Brassington, G. S., Bliwise, D. L., Haskell, W. L. 1997; 277 (1): 32-37

  Abstract

  To determine the effects of moderate-intensity exercise training on self-rated (subjective) sleep quality among healthy, sedentary older adults reporting moderate sleep complaints.Randomized controlled trial of 16 weeks' duration.General community.Volunteer sample of 29 women and 14 men (of 67 eligible subjects) aged 50 to 76 years who were sedentary, free of cardiovascular disease, and reported moderate sleep complaints. No participant was withdrawn for adverse effects.Randomized to 16 weeks of community-based, moderate-intensity exercise training or to a wait-listed control condition. Exercise consisted primarily of four 30- to 40-minute endurance training sessions (low-impact aerobics; brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate.Pittsburgh Sleep Quality Index (PSQI).Compared with controls (C), subjects in the exercise training condition (E) showed significant improvement in the PSQI global sleep score at 16 weeks (baseline and posttest values in mean [SD] for C=8.93 [3.1] and 8.8 [2.6]; baseline and posttest values for E=8.7 [3.0] and 5.4 [2.8]; mean posttest difference between conditions=3.4; P<.001; 95% confidence interval, 1.9-5.4), as well as in the sleep parameters of rated sleep quality, sleep-onset latency (baseline and posttest values for C=26.1 [20.0] and 23.8 [15.3]; for E=28.4 [20.2] and 14.6 [13.0]; net improvement=11.5 minutes), and sleep duration baseline and posttest scores for C=5.8 [1.1] and 6.0 [1.0]; for E=6.0 [1.1] and 6.8 [1.2]; net improvement=42 minutes) assessed via PSQI and sleep diaries (P=.05).Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program.

  View details for Web of Science ID A1997VZ76700026

  View details for PubMedID 8980207

• LONG-TERM EFFECTS OF VARYING INTENSITIES AND FORMATS OF PHYSICAL-ACTIVITY ON PARTICIPATION RATES, FITNESS, AND LIPOPROTEINS IN MEN AND WOMEN AGED 50 TO 65 YEARS CIRCULATION King, A. C., Haskell, W. L., Young, D. R., Oka, R. K., Stefanick, M. L. 1995; 91 (10): 2596-2604

  Abstract

  Although exercise parameters such as intensity and format have been shown to influence exercise participation rates and physiological outcomes in the short term, few data are available evaluating their longer-term effects. The study objective was to determine the 2-year effects of differing intensities and formats of endurance exercise on exercise participation rates, fitness, and plasma HDL cholesterol levels among healthy older adults.Higher-intensity, group-based exercise training; higher-intensity, home-based exercise; and lower-intensity, home-based exercise were compared in a 2-year randomized trial. Participants were 149 men and 120 postmenopausal women 50 to 65 years of age who were sedentary and free of cardiovascular disease. Recruitment was achieved through a random digit-dial community telephone survey and media promotion. All exercise occurred in community settings. For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate. Treadmill exercise performance, lipoprotein levels and other heart disease risk factors, and exercise adherence were evaluated at baseline and across the 2-year period. Treadmill exercise test performance improved for all three training conditions during year 1 and was successfully maintained during year 2, particularly for subjects in the higher-intensity, home-based condition. Subjects in that condition also showed the greatest year 2 exercise adherence rates (P < .003). Although no significant increases in HDL cholesterol were observed during year 1, by the end of year 2 subjects in the two home-based training conditions showed small but significant HDL cholesterol increases over baseline (P < .01). The increases were particularly pronounced for subjects in the lower-intensity condition, whose exercise prescription required more frequent exercise sessions per week. For all exercise conditions, increases in HDL cholesterol were associated with decreases in waist-to-hip ratio in both men and women (P < .04).While older adults can benefit from initiating a regular regimen of moderate-intensity exercise in terms of improved fitness levels and small improvements in HDL cholesterol levels, the time frame needed to achieve HDL cholesterol change (2 years) may be longer than that reported previously for younger populations. Frequency of participation may be particularly important for achieving such changes. Supervised home-based exercise regimens represent a safe, attractive alternative for achieving sustained participation.

  View details for Web of Science ID A1995QX58700017

  View details for PubMedID 7743622

• EFFECTS OF DIFFERING INTENSITIES AND FORMATS OF 12 MONTHS OF EXERCISE TRAINING ON PSYCHOLOGICAL OUTCOMES IN OLDER ADULTS HEALTH PSYCHOLOGY King, A. C., Taylor, C. B., Haskell, W. L. 1993; 12 (4): 292-300

  Abstract

  The 12-month effects of exercise training on psychological outcomes in adults ages 50-65 years were evaluated. Ss (N = 357) were randomly assigned to assessment-only control or to higher intensity group, higher intensity home, or lower intensity home exercise training. Exercisers showed reductions in perceived stress and anxiety in relation to controls (p < .04). Reductions in stress were particularly notable in smokers. Regardless of program assignment, greater exercise participation was significantly related to less anxiety and fewer depressive symptoms, independent of changes in fitness or body weight (p < .05). It was concluded that neither a group format nor vigorous activity was essential in attaining psychological benefits from exercise training in healthy adults.

  View details for Web of Science ID A1993NL74100006

  View details for PubMedID 8404803

• GROUP-BASED VS HOME-BASED EXERCISE TRAINING IN HEALTHY OLDER MEN AND WOMEN - A COMMUNITY-BASED CLINICAL-TRIAL JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION King, A. C., Haskell, W. L., Taylor, C. B., Kraemer, H. C., DeBusk, R. F. 1991; 266 (11): 1535-1542

  Abstract

  --To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults.--Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control.--General community located in northern California.--One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized.--For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate.--Treadmill exercise test performance, exercise participation rates, and heart disease risk factors.--Compared with controls, subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months (P less than .03). Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training. Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition (P less than .0005). There were no significant training-induced changes in lipid levels, weight, or blood pressure.--We conclude that (1) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary, healthy older adults; (2) home-based exercise was as effective as group exercise in producing these changes; (3) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting; and (4) the exercise programs were relatively safe.

  View details for Web of Science ID A1991GE45800034

  View details for PubMedID 1880885

• Sustainable Lifestyle Among Office Workers (the SOFIA Study): Protocol for a Cluster Randomized Controlled Trial. JMIR research protocols Bälter, K., King, A. C., Fritz, J., Tillander, A., Halling Ullberg, O. 2024; 13: e57777

  Abstract

  Society is facing multiple challenges, including lifestyle- and age-related diseases of major public health relevance, and this is of particular importance when the general population, as well as the workforce, is getting older. In addition, we are facing global climate change due to extensive emissions of greenhouse gases and negative environmental effects. A lifestyle that promotes healthy life choices as well as climate and environmentally friendly decisions is considered a sustainable lifestyle.This study aims to evaluate if providing information about a sustainable lifestyle encourages individuals to adopt more nutritious dietary habits and increase physical activity, as compared to receiving information solely centered around health-related recommendations for dietary intake and physical activity by the Nordic Nutrition Recommendations and the World Health Organization. Novel features of this study include the use of the workplace as an arena for health promotion, particularly among office workers-a group known to be often sedentary at work and making up 60% of all employees in Sweden.The Sustainable Office Intervention (SOFIA) study is a 2-arm, participant-blinded, cluster randomized controlled trial that includes a multilevel sustainable lifestyle arm (intervention arm, n=19) and a healthy lifestyle arm (control arm, n=14). The eligibility criteria were being aged 18-65 years and doing office work ≥20 hours per week. Both intervention arms are embedded in the theoretically based behavioral change wheel method. The intervention study runs for approximately 8 weeks and contains 6 workshops. The study focuses on individual behavior change as well as environmental and policy features at an organizational level to facilitate or hinder a sustainable lifestyle at work. Through implementing a citizen science methodology within the trial, the participants (citizen scientists) collect data using the Stanford Our Voice Discovery Tool app and are involved in analyzing the data, formulating a list of potential actions to bring about feasible changes in the workplace.Participant recruitment and data collection began in August 2022. As of June 2024, a total of 37 participants have been recruited. The results of the pilot phase are expected to be published in 2024 or 2025.Given the ongoing climate change, negative environmental effects, and the global epidemic of metabolic diseases, a sustainable lifestyle among office workers holds important potential to help in counteracting this trend. Thus, there is an urgent unmet need to test the impact of a sustainable lifestyle on food intake, physical activity, and environmental and climate impacts in a worksite-based randomized controlled trial. This study protocol responds to a societal need by addressing multilevel aspects, including individual behavior changes as well as environmental and organizational changes of importance for the successful implementation of sustainable lifestyle habits in an office setting.DERR1-10.2196/57777.

  View details for DOI 10.2196/57777

  View details for PubMedID 39083333

• Examining Relationships between Perceptions of Air Quality-Objectively Assessed Particulate Matter-And Health-Related Attributions among Midlife and Older Adults from the San Francisco Bay Area, California, USA. International journal of environmental research and public health Zamora, A. N., Campero, M. I., Garcia, D. M., King, A. C. 2024; 21 (8)

  Abstract

  This investigation explored (1) correlations between midlife and older adults' air quality perceptions with objective particulate matter 2.5 (PM2.5) and diesel PM, and (2) correlations between air quality perceptions with health-related attributions among a sample of midlife and older adults (n = 66) living in or around senior affordable public housing sites in California's San Francisco Bay Area. The adapted air quality perception scale was used to measure perceptions of air quality, while health-related attributions were obtained from the vitality plus scale (VPS), with higher values indicating worse perceptions of air quality and poorer responses to health-related attributions, respectively. Self-reported data were linked to zip code level PM2.5 and diesel PM obtained from the CalEnviroScreen 4.0. All correlations were evaluated using Spearman's rank correlations. The mean (SD) age was 70.6 (9.1) years, and 75.7% were female. We observed moderate, positive correlations between both PM2.5 and diesel PM with three domains: perceptions related to protection measures against air quality, emotional/mental perceptions, and sensorial perceptions. We also found evidence of moderate, positive correlations between the domains of physical symptoms, perceptions related to protection measures against air quality, and emotional/mental perceptions with health-related attributions, such as sleep-related items and feelings of restlessness or agitation. Results from this exploratory study suggest that midlife and older adults' perceptions of air quality may be moderately related to both objective air quality data and certain health behaviors and symptoms. Findings underscore the importance of considering individual perceptions as an additional area in public health strategies aimed at protecting midlife and older adults from the impacts of air pollution.

  View details for DOI 10.3390/ijerph21081010

  View details for PubMedID 39200620

• Crime-related perceptions and walking for recreation inside and outside one's home neighborhood. Health & place Roman, C. G., Chen, R., Natarajan, L., Conway, T. L., Patch, C., Taylor, R. B., Cain, K. L., Roesch, S., Adams, M. A., Saelens, B. E., King, A. C., Frank, L. D., Glanz, K., Sallis, J. F. 2024; 89: 103316

  Abstract

  It is widely assumed crime and related concerns, including neighborhood incivilities and fear of crime, are barriers to physical activity (PA). Past studies reveal mixed evidence. Studies of impacts for crime-protective factors are less common but have similarly mixed results. This paper evaluates a comprehensive transdisciplinary conceptual framework of cross-sectional associations between crime-related perceptions and reported minutes/week of recreational walking inside and outside one's home neighborhood. Safe and Fit Environments Study (SAFE) recruited and surveyed 2302 participants from adolescents to older adults from four U.S. metropolitan areas. A zero-inflated model estimated two components of each outcome: whether the respondent walked, and minutes/week walked. Correlates of recreational walking were location-specific, differing based on walking location. Fear of crime, risk evaluation, victimization, and incivilities were not consistently associated with walking for recreation inside one's neighborhood. People with crime concerns about their own neighborhoods, however, more commonly walked for recreation outside their neighborhoods. Protective crime-related perceptions that seldom have been studied in relation to PA, such as street efficacy (i.e., the perceived ability to avoid and manage danger), were strongly associated with recreational walking in both locations, indicating the additional heuristic value of the SAFE conceptual framework. Crime-related perceptions and walking for recreation: Evaluating a conceptual model.

  View details for DOI 10.1016/j.healthplace.2024.103316

  View details for PubMedID 39089217

• Serving up FLAN. a food literacy and nutrition intervention to fend off food insecurity. BMC nutrition Royer, M. F., Hauser, M. E., Zamora, A. N., Campero, M. I., Garcia, D., Gabaray, M., Sheats, J. L., King, A. C. 2024; 10 (1): 102

  Abstract

  Food insecurity, an ongoing and accelerating problem in the U.S., is an economic and social condition involving limited or uncertain access to adequate food. Some of the highest rates of food insecurity in 2022 were found among individuals who were Hispanic/Latinx (20.8%), a population that already faces disproportionate health and socioeconomic disadvantages. There remains an urgent health-related need to identify sustainable strategies to prevent food insecurity in the Latinx population.A first-generation pilot investigation was conducted using data derived from a sub-study connected to the Computerized Physical Activity Support for Seniors (COMPASS) Trial, a 12-month cluster-randomized controlled trial among older Latinx adults. The sub-study focused on two nutrition interventions that included (1) the Food Literacy and Nutrition (FLAN) curriculum, and (2) a nutrition information-only control. Research hypotheses aimed to determine whether the FLAN intervention reduced food insecurity and increased daily fruit and vegetable servings.On average, participants (n = 39) were 61.5 years of age (SD = 6.7), mostly female (69%), and reported Spanish as their primary language (69%). The FLAN intervention was associated with decreased odds of food insecurity at 12 months (AOR = 0.71, 95% CI = 0.54, 0.95; p = 0.03) when compared to the nutrition-information only control intervention. Although no between-group differences in daily fruit and vegetable servings were found, there was a significant correlation between changes in daily fruit and vegetable servings from baseline to six months and changes in food insecurity from baseline to 12 months (r = -0.51, p = 0.01).The FLAN intervention, a bilingual and culturally tailored educational curriculum, yielded 12-month improvements in food security among a small sample of older Latinx adults. Evidence from this investigation highlights the potential utility of implementing the FLAN curriculum among individuals who are at an increased risk of food insecurity. Further investigation in a larger sample is merited to determine whether the 12-month decreases in food insecurity that were produced by the FLAN intervention can be replicated.ClinicalTrials gov Identifier: NCT02111213. Registered on 04/02/2014.

  View details for DOI 10.1186/s40795-024-00909-y

  View details for PubMedID 39044224

  View details for PubMedCentralID PMC11264464

• Who Benefits? A Mixed Methods Study Assessing Community Use of a Major Metropolitan Park During the COVID-19 Pandemic. Journal of urban health : bulletin of the New York Academy of Medicine O'Connor, A., Resendiz, E., Nason, L., Eyler, A. A., Brownson, R. C., Reis, R. S., Banchoff, A., King, A. C., Salvo, D. 2024

  Abstract

  By providing spaces for recreation, physical activity, social gatherings, and time in nature, urban parks offer physical, mental, and social benefits to users. However, many urban residents face barriers to park use. The COVID-19 pandemic introduced new potential barriers to urban park access and use, including changes to daily life and employment, closure of park amenities and restrictions to public movement, and risk from the coronavirus itself. The mixed-methods PARCS study measured use and perceptions of a large urban park in St. Louis, Missouri before, during, and after local COVID-19 contingency measures and restrictions. We examine data from 1,157 direct observation assessments of park usership, an online survey of park users (n=561), interviews with key stakeholders (n=27), four focus groups (n=30), and a community-based participatory research sub-study (n=66) to comprehensively characterize the effects of the COVID-19 pandemic on park use. Park users who felt unsafe from the coronavirus experienced 2.65 higher odds of reducing park use. However, estimated park visits during COVID-19 contingency measures (n=5,023,759) were twice as high as post-contingency (n=2,277,496). Participants reported using the park for physical activity, recreation, time in nature, and socializing during the contingency period. Black, Hispanic/Latino, and young people were less likely to visit the park than others, suggesting an additional, disproportionate impact of the pandemic on minoritized and socioeconomically disadvantaged communities. This study highlights the role of public spaces like parks as resources for health and sites where urban health inequities can be alleviated in times of public crisis.

  View details for DOI 10.1007/s11524-024-00886-4

  View details for PubMedID 39023683

• Engaging Nigerian Older Persons in Neighborhood Environment Assessment for Physical Activity Participation: A Citizen Science Project. Innovation in aging Odeyemi, E., Chesser, S., King, A. C., Porter, M. M. 2024; 8 (4): igad066

  Abstract

  Global organizations are advocating that older persons' voices should guide communities in age-friendly design. An important aspect of age friendliness to enable daily function and health is ensuring that physical activity can occur, regardless of age, within local neighborhoods.This study used a specific citizen science approach, Our Voice, to engage a sample (N = 13) of older adults (60 or older) in Festac Town, Nigeria. The citizen scientists' roles were to assess and identify how different aspects of the neighborhood environment act as supports or barriers to their physical activity participation. They were individually enabled using a tablet-based mobile application called the Stanford Healthy Neighborhood Discovery Tool to record a total of 156 geocoded photos and 151 commentaries of neighborhood environmental features that facilitate or hinder physical activity in and around their neighborhoods. In a guided process, the following occurred: collaborative discussions of findings with other citizen scientists to determine common targets, setting of priority targets for change, and brainstorming strategies and solutions.Facilitators of physical activity included: pedestrian and traffic facilities (e.g., traffic lights, walkways); green areas and parks; multigenerational community features (e.g., programs/facilities); opportunities for social connection (e.g., neighborhood associations, churches); safety of destinations and services; and public toilets. Barriers to physical activity included: hazardous walkways/traffic; noise pollution; refuse, selling of public parks; crime (e.g., kidnapping, criminal hideouts); no safe drinking water; and ageism. The priorities for changes were social connectivity; improved pedestrian and traffic facilities; and green and beautiful environments.In this study, both physical and social aspects of the environment were deemed important for older Nigerians to enable physical activity in their local community. This approach has a promise for age-friendly initiatives seeking local changes by meaningfully engaging older adults.

  View details for DOI 10.1093/geroni/igad066

  View details for PubMedID 38577518

  View details for PubMedCentralID PMC10993715

• Exploring the Relationship between Built Environment Attributes and Physical Activity in Lower-Income Aging Adults: Preliminary Insights from a Multi-Level Trial. International journal of environmental research and public health Walia, A. S., King, A. C., Campero, M. I., Garcia, D. M., Lee, R. E., Zamora, A. N. 2024; 21 (5)

  Abstract

  The built environment has been linked to physical activity (PA) behaviors, yet there is limited knowledge of this association among lower-income midlife and older adults who are insufficiently active. The present cross-sectional study utilized baseline data collected between October 2017 and November 2019 from a clustered randomized controlled trial to determine how built environment attributes were associated with PA behaviors among midlife and older adults (n = 255) residing in or near affordable housing sites (n = 10). At each site, perceptions of the built environment were collected and scored at the participant level via the abbreviated Neighborhood Environment Walkability Survey (NEWS-A), while objective built environment attributes were measured and scored by trained research staff using the Physical Activity Resource Assessment (PARA). Multiple PA behaviors-walking, total PA, and moderate-to-vigorous PA (MVPA) (min/wk)-were measured using the validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Adjusted linear regression models examined associations between NEWS-A measures and PA behaviors, and site-level correlations between PARA measures and PA behaviors were examined using Spearman's rank correlations. At the participant level, adjusted models revealed that a one point increase in the NEWS-A aesthetics score was associated with a 57.37 min/wk increase in walking (β = 57.37 [95% CI: 20.84, 93.91], p = 0.002), with a similar association observed for street connectivity and MVPA (β = 24.31 min/wk [95% CI: 3.22, 45.41], p = 0.02). At the site level, MVPA was positively correlated with the quality of the features of local, PA-supportive environmental resources (ρ = 0.82, p = 0.004). Findings indicate that participant- and site-level measures of the built environment may play a role in promoting PA behavior among this demographic and similar populations. Results also suggest that improvements in aesthetic attributes and street connectivity, along with enhancing the quality of local, PA-supportive environmental resources, may be effective strategies for promoting physical activity among lower-income midlife and older adults.

  View details for DOI 10.3390/ijerph21050607

  View details for PubMedID 38791821

• Serving Up FLAN. A Food Literacy and Nutrition Intervention to Fend Off Food Insecurity. Research square Royer, M. F., Hauser, M. E., Zamora, A. N., Campero, M. I., Garcia, D., Gabaray, M., Sheats, J. L., King, A. C. 2024

  Abstract

  Food insecurity, an ongoing and accelerating problem in the U.S., is an economic and social condition involving limited or uncertain access to adequate food. Some of the highest rates of food insecurity in 2022 were found among individuals who were Hispanic-Latinx (20.8%), a population that already faces disproportionate health and socioeconomic disadvantages. There remains an urgent health-related need to identify sustainable strategies to prevent food insecurity in the Latinx population.A first-generation pilot investigation was conducted using data derived from a sub-study connected to the Computerized Physical Activity Support for Seniors (COMPASS) Trial, a 12-month cluster-randomized controlled trial among older Latinx adults. The sub-study focused on two nutrition interventions that included 1) the Food Literacy and Nutrition (FLAN) curriculum, and 2) a nutrition information-only control. Research hypotheses aimed to determine whether the FLAN intervention reduced food insecurity and increased daily fruit and vegetable servings.On average, participants (n = 39) were 61.5 years of age (SD = 6.7), mostly female (69%), and reported Spanish as their primary language (69%). The FLAN intervention was associated with decreased odds of food insecurity at 12 months (AOR = 0.71, 95% CI = 0.54, 0.95; p = 0.03) when compared to the nutrition-information only control intervention. Although no between-group differences in daily fruit and vegetable servings were found, there was a significant correlation between changes in daily fruit and vegetable servings from baseline to six months and changes in food insecurity from baseline to 12 months (r = -0.51, p = 0.01).The FLAN intervention, a bilingual and culturally tailored educational curriculum, yielded 12-month improvements in food security among a small sample of older Latinx adults. Evidence from this investigation suggests the potential utility of implementing the FLAN curriculum among individuals who are at an increased risk of food insecurity. Further investigation in a larger sample is merited to determine whether the 12-month decreases in food insecurity that were produced by the FLAN intervention can be replicated.ClinicalTrials.gov Identifier: NCT02111213.

  View details for DOI 10.21203/rs.3.rs-4331290/v1

  View details for PubMedID 38766254

  View details for PubMedCentralID PMC11100874

• Engagement With Remote Delivery Channels in a Physical Activity Intervention for Senior Women in the US. American journal of health promotion : AJHP Mendoza-Vasconez, A. S., King, A. C., Chandler, G., Mackey, S., Follis, S., Stefanick, M. L. 2024: 8901171241229537

  Abstract

  Identify the effects of engagement with different intervention delivery channels on physical activity (PA), and the participant subgroups engaging with the different channels, among Women's Health Initiative Strong and Healthy (WHISH) PA trial participants.Secondary analysis of data from WHISH, a pragmatic trial that used passive randomized consent.United States (remote intervention in all 50 states).18,080 U.S. women, aged 68-99 years, assigned to the WHISH PA intervention arm.6 dichotomous variables operationalized engagement: Engagement with Targeted Inserts, Email (opened), Email (clicked links), Website (logging in), Website (tracking), Interactive Voice Response (IVR). PA was measured using the CHAMPS PA questionnaire.Linear regressions evaluated effects of engagement on PA. Conditional Inference Trees identified subgroups of participants engaging with different channels based on demographic and psychosocial variables.Engagement with each channel, except IVR, was associated with significantly more hours/week of PA (square root coefficients .29 - .13, P values <.001). Consistently across channels, features that identified subgroups of participants with higher engagement included younger age, and higher levels of PA and physical function. Subgroups with the highest engagement differed from those with the lowest in most participant characteristics.For equitable population-level impact via large-scale remotely-delivered PA programs, it may be necessary to identify strategies to engage and target harder to reach subgroups more precisely.The WHISH trial is registered at ClinicalTrials.gov (No. NCT02425345).

  View details for DOI 10.1177/08901171241229537

  View details for PubMedID 38344760

• Bringing micro to the macro: how citizen science data enrich geospatial visualizations to advance health equity JOURNAL OF MAPS Soltani, S., Hinman, J. A., Blanco-Velazquez, I., Banchoff, A. W., Campero, M. I., Nelson, L. M., King, A. C. 2023; 19 (1)

  View details for DOI 10.1080/17445647.2023.2216217

  View details for Web of Science ID 001013240600001

• Multi-country collaborative citizen science projects to co-design cardiovascular disease prevention strategies and advocacy: findings from Ethiopia, Malawi, Rwanda, and South Africa. BMC public health Okop, K. J., Kedir, K., Kasenda, S., Niyibizi, J. B., Chipeta, E., Getachew, H., Sell, K., Lambert, E. V., Puoane, T., Rulisa, S., Bunn, C., King, A. C., Bavuma, C., Howe, R., Crampin, A. C., Levitt, N. S. 2023; 23 (1): 2484

  Abstract

  Cardiovascular diseases (CVD) were responsible for 20.5 million annual deaths globally in 2021, with a disproportionally high burden in sub-Saharan Africa (SSA). There is growing evidence of the use of citizen science and co-design approaches in developing interventions in different fields, but less so in the context of CVD prevention interventions in SSA. This paper reports on the collaborative multi-country project that employed citizen science and a co-design approach to (i) explore CVD risk perceptions, (ii) develop tailored prevention strategies, and (iii) support advocacy in different low-income settings in SSA.This is a participatory citizen science study with a co-design component. Data was collected from 205 participants aged 18 to 75 years in rural and urban communities in Malawi, Ethiopia and Rwanda, and urban South Africa. Fifty-one trained citizen scientists used a mobile app-based (EpiCollect) semi-structured survey questionnaire to collect data on CVD risk perceptions from participants purposively selected from two communities per country. Data collected per community included 100-150 photographs and 150-240 voice recordings on CVD risk perceptions, communication and health-seeking intentions. Thematic and comparative analysis were undertaken with the citizen scientists and the results were used to support citizen scientists-led stakeholder advocacy workshops. Findings are presented using bubble graphs based on weighted proportions of key risk factors indicated.Nearly three in every five of the participants interviewed reported having a relative with CVD. The main perceived causes of CVD in all communities were substance use, food-related factors, and litter, followed by physical inactivity, emotional factors, poverty, crime, and violence. The perceived positive factors for cardiovascular health were nutrition, physical activity, green space, and clean/peaceful communities. Multi-level stakeholders (45-84 persons/country) including key decision makers participated in advocacy workshops and supported the identification and prioritization of community-specific CVD prevention strategies and implementation actions. Citizen science-informed CVD risk screening and referral to care interventions were piloted in six communities in three countries with about 4795 adults screened and those at risk referred for care. Health sector stakeholders indicated their support for utilising a citizen-engaged approach in national NCDs prevention programmes. The citizen scientists were excited by the opportunity to lead research and advocacy.The collaborative engagement, participatory learning, and co-designing activities enhanced active engagement between citizen scientists, researchers, and stakeholders. This, in turn, provided context-specific insights on CVD prevention in the different SSA settings.

  View details for DOI 10.1186/s12889-023-17393-x

  View details for PubMedID 38087240

  View details for PubMedCentralID 4850665

• Personalized digital behaviour interventions increase short-term physical activity: a randomized control crossover trial substudy of the MyHeart Counts Cardiovascular Health Study. European heart journal. Digital health Javed, A., Kim, D. S., Hershman, S. G., Shcherbina, A., Johnson, A., Tolas, A., O'Sullivan, J. W., McConnell, M. V., Lazzeroni, L., King, A. C., Christle, J. W., Oppezzo, M., Mattsson, C. M., Harrington, R. A., Wheeler, M. T., Ashley, E. A. 2023; 4 (5): 411-419

  Abstract

  Physical activity is associated with decreased incidence of the chronic diseases associated with aging. We previously demonstrated that digital interventions delivered through a smartphone app can increase short-term physical activity.We offered enrolment to community-living iPhone-using adults aged ≥18 years in the USA, UK, and Hong Kong who downloaded the MyHeart Counts app. After completion of a 1-week baseline period, e-consented participants were randomized to four 7-day interventions. Interventions consisted of: (i) daily personalized e-coaching based on the individual's baseline activity patterns, (ii) daily prompts to complete 10 000 steps, (iii) hourly prompts to stand following inactivity, and (iv) daily instructions to read guidelines from the American Heart Association (AHA) website. After completion of one 7-day intervention, participants subsequently randomized to the next intervention of the crossover trial. The trial was completed in a free-living setting, where neither the participants nor investigators were blinded to the intervention. The primary outcome was change in mean daily step count from baseline for each of the four interventions, assessed in a modified intention-to-treat analysis (modified in that participants had to complete 7 days of baseline monitoring and at least 1 day of an intervention to be included in analyses). This trial is registered with ClinicalTrials.gov, NCT03090321.Between 1 January 2017 and 1 April 2022, 4500 participants consented to enrol in the trial (a subset of the approximately 50 000 participants in the larger MyHeart Counts study), of whom 2458 completed 7 days of baseline monitoring (mean daily steps 4232 ± 73) and at least 1 day of one of the four interventions. Personalized e-coaching prompts, tailored to an individual based on their baseline activity, increased step count significantly (+402 ± 71 steps from baseline, P = 7.1⨯10-8). Hourly stand prompts (+292 steps from baseline, P = 0.00029) and a daily prompt to read AHA guidelines (+215 steps from baseline, P = 0.021) were significantly associated with increased mean daily step count, while a daily reminder to complete 10 000 steps was not (+170 steps from baseline, P = 0.11). Digital studies have a significant advantage over traditional clinical trials in that they can continuously recruit participants in a cost-effective manner, allowing for new insights provided by increased statistical power and refinement of prior signals. Here, we present a novel finding that digital interventions tailored to an individual are effective in increasing short-term physical activity in a free-living cohort. These data suggest that participants are more likely to react positively and increase their physical activity when prompts are personalized. Further studies are needed to determine the effects of digital interventions on long-term outcomes.

  View details for DOI 10.1093/ehjdh/ztad047

  View details for PubMedID 37794870

  View details for PubMedCentralID PMC10545510

• Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring. JAMA network open Addala, A., Ding, V., Zaharieva, D. P., Bishop, F. K., Adams, A. S., King, A. C., Johari, R., Scheinker, D., Hood, K. K., Desai, M., Maahs, D. M., Prahalad, P. 2023; 6 (4): e238881

  Abstract

  Continuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes.To determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM.This cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children's Hospital, a single-site, freestanding children's hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022.All eligible participants were offered CGM within 1 month of diabetes diagnosis.To assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016.The Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants' race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, -0.26% [95% CI, -1.05% to 0.43%], -0.60% [-1.46% to 0.21%], and -0.15% [-1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, -0.27% [95% CI, -0.62% to 0.10%], -0.50% [-0.81% to -0.11%], and -0.47% [-0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, -0.52% [95% CI, -1.22% to 0.15%], -0.38% [-1.26% to 0.33%], and -0.57% [-2.08% to 0.74%]) and privately insured individuals (estimated difference, -0.34% [95% CI, -0.67% to 0.03%], -0.57% [-0.85% to -0.26%], and -0.43% [-0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, -0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, -0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [-0.09% to 2.13%]).The findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.ClinicalTrials.gov Identifier: NCT04336969.

  View details for DOI 10.1001/jamanetworkopen.2023.8881

  View details for PubMedID 37074715

  View details for PubMedCentralID PMC10116368

• Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping. Translational behavioral medicine Rodriguez Espinosa, P., King, A. C., Blanco-Velazquez, I., Banchoff, A. W., Campero, M. I., Chen, W., Rosas, L. G. 2023

  Abstract

  Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.

  View details for DOI 10.1093/tbm/ibad018

  View details for PubMedID 37011041

• How Can Sport-Based Interventions Improve Health among Women and Girls? A Scoping Review. International journal of environmental research and public health Pedersen, M., King, A. C. 2023; 20 (6)

  Abstract

  Sport has been identified by the World Health Organization as an underutilized yet important contributor to global physical activity, by UNESCO as a fundamental right, and by the United Nations as a promising driver for gender equity through improved long-term health of women and girls. Although sport-based interventions have been popularized to advance educational, social, and political development globally, little attention has been given to its impacts on health outcomes among women and girls. We undertook a scoping review of research on sport-based interventions for health among women and girls to summarize current research approaches and findings. PRISMA scoping review guidelines were observed. Online databases (PubMed, PsycINFO, Web of Science) were used to identify peer-reviewed records published through August 2022. The interventions identified (n = 4) targeted health outcomes such as gender-based violence, HIV prevention, reproductive health, and child marriage. Based on our review, we recommend four key opportunities to advance the field of sport-based interventions in addressing health equity among women and girls. In addition, we highlight promising future research directions to broaden sport engagement of women and girls, improve long-term health, and build capacity toward health equity.

  View details for DOI 10.3390/ijerph20064818

  View details for PubMedID 36981727

• "My Body, My Rhythm, My Voice": a community dance pilot intervention engaging breast cancer survivors in physical activity in a middle-income country. Pilot and feasibility studies Rubio, M. A., Mejía-Arbeláez, C. M., Wilches-Mogollon, M. A., Moreno, S., Finck, C., Rosas, L. G., Romero, S. A., Guevara, P., Cabas, S., Rubiano, O., Flórez-Pregonero, A., León, J. G., Alarcón, L. F., Haile, R., Sarmiento, O. L., King, A. C. 2023; 9 (1): 30

  Abstract

  Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia.We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability.Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews.The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia.ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.

  View details for DOI 10.1186/s40814-023-01253-x

  View details for PubMedID 36855214

  View details for PubMedCentralID 5879496

• Emergence of social support networks among breast cancer survivors through a community-based physical activity program in Colombia SOCIAL NETWORKS Blanco, M., Guerra, A. M., Rubio, M. A., Finck, C., King, A. C., Rosas, L. G., Sarmiento, O. L., Montes, F. 2023; 73: 62-71

  View details for DOI 10.1016/j.socnet.2022.12.007

  View details for Web of Science ID 000918760600001

• Moderators of a diet and physical activity intervention: who responds best to sequential vs. simultaneous approaches International Journal of Behavioral Medicine Patel, M. L., Rodriguez Espinosa, P., King, A. C. 2023

  View details for DOI 10.1007/s12529-023-10223-9

• Implementing and Evaluating Community Health Worker-Led Cardiovascular Disease Risk Screening Intervention in Sub-Saharan Africa Communities: A Participatory Implementation Research Protocol. International journal of environmental research and public health Okop, K., Delobelle, P., Lambert, E. V., Getachew, H., Howe, R., Kedir, K., Niyibizi, J. B., Bavuma, C., Kasenda, S., Crampin, A. C., King, A. C., Puoane, T., Levitt, N. S. 2022; 20 (1)

  Abstract

  The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach. The study builds upon a prior community-driven multicentre study conducted by the Collaboration for Evidence-based Health Care and Public Health in Africa (CEBHA+). This is a participatory implementation research. The study will leverage on the CVD risk citizen science pilot studies conducted in the four selected CEBHA+ project countries (viz. Ethiopia, Rwanda, Malawi, and South Africa). Through planned engagements with communities and health system stakeholders, CHWs and lay health worker volunteers will be recruited and trained to screen and identify persons that are at high risk of CVD, provide referral services, and follow-up at designated community health clinics. In each country, we will use a multi-stage random sampling to select and then screen 1000 study participants aged 35-70 years from two communities (one rural and one urban). Screening will be done using a simple validated non-laboratory-based CVD risk assessment mobile application. The RE-AIM model will be used in evaluating the project implementation outcomes, including reach, fidelity, adoption and perceived effectiveness. Developing the capacities of CHWs and lay health worker volunteers in SSA to support population-based, non-invasive population-based CVD risk prevention has the potential to impact on early identification, treatment and secondary prevention of CVDs in often under-resourced communities. Using a participatory research approach to implementing mobile phone-based CHW-led CVD risk screening, referral and follow-up in SSA will provide the evidence needed to determine the effectiveness of CVD risk screening and the potential for scaling up in the wider region.

  View details for DOI 10.3390/ijerph20010298

  View details for PubMedID 36612620

• Our Voice in a rural community: empowering Colombian adolescents to advocate for school community well-being through citizen science. BMC public health Montes, F., Guerra, A. M., Higuera-Mendieta, D., De La Vega-Taboada, E., King, A. C., Banchoff, A., Maturana, A. C., Sarmiento, O. L. 2022; 22 (1): 2411

  Abstract

  BACKGROUND: Santa Ana is home to an Afro-descendant rural population of the island of Baru in Cartagena, Colombia. While a popular area for tourism, Santa Ana's population is affected by multidimensional poverty, precarious work conditions, homelessness, broken streets and sewer systems, limited quality education, and a lack of recreation and sport spaces. While Santa Ana's Community Action Board aims to unify efforts and resources to solve these problems, the state's capacity to meet the requirements of the Board is limited.METHODS: We evaluated the relationship between healthy lifestyles and characteristics of Santa Ana's school using the Our Voice Citizen Science Research Method. This systemic approach combines information and communication technologies with group facilitation to empower adolescents to: 1) collect and discuss data about factors in their local environments that facilitate or hinder well-being within their school community; 2) identify relevant local stakeholders who could help to address the issues identified; and 3) advocate collectively for local improvements to support increased well-being at a community level.RESULTS: Eleven citizen scientists ages 13 to 17years from the science club of Institucion Educativa Santa Ana were recruited and together conducted 11 walks within the school to collect data about the facilitators and barriers to student well-being. They identified barriers to well-being related to school infrastructure, furniture, bathrooms, and sense of belonging. They then advocated with school stakeholders and reached agreements on concrete actions to address identified barriers, including fostering a culture among students of caring for school property and presenting their findings to the community action board. This methodology allowed the community to realize how students can become agents of change and take collective action when motivated by solution-oriented methodologies such as Our Voice. Project ripple effects, including greater empowerment and participation in collective actions by students, also were observed.CONCLUSIONS: This study underscores the importance of the school's built environment in the well-being of students in rural areas. The Our Voice method provided the opportunity to inform school-based interventions, and promoted ripple effects that expanded productive dialogue to the community level and generated systemic actions involving actors outside of the school community.

  View details for DOI 10.1186/s12889-022-14559-x

  View details for PubMedID 36550541

• Leveraging Mobile Technology for Public Health Promotion: A Multidisciplinary Perspective. Annual review of public health Hicks, J. L., Boswell, M. A., Althoff, T., Crum, A. J., Ku, J. P., Landay, J. A., Moya, P. M., Murnane, E. L., Snyder, M. P., King, A. C., Delp, S. L. 2022

  Abstract

  Health behaviors are inextricably linked to health and well-being, yet issues such as physical inactivity and insufficient sleep remain significant global public health problems. Mobile technology-and the unprecedented scope and quantity of data it generates-has a promising but largely untapped potential to promote health behaviors at the individual and population levels. This perspective article provides multidisciplinary recommendations on the design and use of mobile technology, and the concomitant wealth of data, to promote behaviors that support overall health. Using physical activity as an exemplar health behavior, we review emerging strategies for health behavior change interventions. We describe progress on personalizing interventions to an individual and their social, cultural, and built environments, as well as on evaluating relationships between mobile technology data and health to establish evidence-based guidelines. In reviewing these strategies and highlighting directions for future research, we advance the use of theory-based, personalized, and human-centered approaches in promoting health behaviors. Expected final online publication date for the Annual Review of Public Health, Volume 44 is April 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

  View details for DOI 10.1146/annurev-publhealth-060220-041643

  View details for PubMedID 36542772

• Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study. JMIR formative research Patel, M. L., Cleare, A. E., Smith, C. M., Rosas, L. G., King, A. C. 2022; 6 (12): e42191

  Abstract

  Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment.In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring.We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively.The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was -3.4 (95% CI -4.6 to -2.2) kg for detailed and -3.3 (95% CI -4.4 to -2.2) kg for simplified.A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults.ASPREDICTED #66674; https://aspredicted.org/ka478.pdf.

  View details for DOI 10.2196/42191

  View details for PubMedID 36512404

• Our Voice NOLA: Leveraging a Community Engaged Citizen Science Method to Contextualize the New Orleans Food Environment. International journal of environmental research and public health Afaneh, H., Fernes, P. K., Lewis, E. C., King, A. C., Banchoff, A., Sheats, J. L. 2022; 19 (22)

  Abstract

  OBJECTIVE: We employed the Our Voice citizen scientist method using a mobile application (app) to identify and contextualize neighborhood-level features influencing food access and wellbeing in New Orleans, Louisiana.DESIGN: A three-phase, multi-method study comprised of: (1) a researcher-assisted tag-a-long neighborhood walk (referred to as a 'journey') with the Discovery Tool (DT) app to document neighborhood-level features via geo-coded photos and audio-recorded narratives; (2) a post-journey interview to enable citizen scientists to share their lived experiences; and (3) a community meeting with citizen scientists and local stakeholders.SETTING: Various neighborhoods in New Orleans, Louisiana, USA.PARTICIPANTS: Citizen Scientists (i.e., residents) aged 18 years and older.MAIN OUTCOME MEASURE(S): Features that influence food access and health behaviors.ANALYSIS: Descriptive statistics and a thematic content analysis were conducted to assess survey and app data.RESULTS: Citizen scientists (N = 14) captured 178 photos and 184 audio narratives. Eight major themes were identified: safety; walkability; aesthetics; amenities; food; health services; neighborhood changes; and infrastructure/city planning. The post-journey interview provided insights around the abovementioned themes. The community meeting demonstrated the willingness of citizen scientists and stakeholders to convene and discuss issues and relevant solutions.CONCLUSIONS AND IMPLICATIONS: Findings demonstrate the ability of technology and citizen science to help better understand the complexities of New Orleans' past, present and distinct culture-and implications for food access and wellbeing in the context of trauma in an urban ecosystem.

  View details for DOI 10.3390/ijerph192214790

  View details for PubMedID 36429511

• The "Our Voice" Method: Participatory Action Citizen Science Research to Advance Behavioral Health and Health Equity Outcomes. International journal of environmental research and public health Pedersen, M., Wood, G. E., Fernes, P. K., Goldman Rosas, L., Banchoff, A., King, A. C. 2022; 19 (22)

  Abstract

  Citizen science research that more fully engages the community can systematically involve people from under-resourced groups to create practical health-enhancing improvements across physical, social and food environments. Exemplary health equity-focused outcomes include key health behaviors (e.g., healthy eating or physical activity) and community-level changes (e.g., public transit to food shops) that are central to health promotion while being demonstrably impacted by local environmental contexts. Yet, few examples of this approach are readily available for application within complex, community-based settings. In this paper, we present the Our Voice (OV) four-step method to demonstrate an integrated participatory citizen science approach and its usability for action-focused researchers and community health practitioners. In addition, we present a summary of the major research, processes, and community outcomes, with examples drawn from nutrition and healthy food access areas, among others. Finally, we explore the hallmark features of the OV method that effectively engage citizen scientists, empowering action and fostering solution-building across social and environmental structures impacting community health. Expanding research that marries participatory research philosophies with innovative citizen science methods, supported by systematic data collection, visualization, and delivery technologies, in turn provides a powerful toolkit for tackling local to global health equity challenges.

  View details for DOI 10.3390/ijerph192214773

  View details for PubMedID 36429494

• Shared Autonomy to Reduce Sedentary Behavior Among Sit-Stand Desk Users in the United States and India: Web-Based Study. JMIR formative research Kim, L. H., Saha, G., Leon, A. A., King, A. C., Mauriello, M. L., Paredes, P. E. 2022; 6 (11): e35447

  Abstract

  BACKGROUND: Fitness technologies such as wearables and sit-stand desks are increasingly being used to fight sedentary lifestyles by encouraging physical activity. However, adherence to such technologies decreases over time because of apathy and increased dismissal of behavioral nudges.OBJECTIVE: To address this problem, we introduced shared autonomy in the context of sit-stand desks, where user input is integrated with robot autonomy to control the desk and reduce sedentary behavior and investigated user reactions and preferences for levels of automation with a sit-stand desk. As demographics affect user acceptance of robotic technology, we also studied how perceptions of nonvolitional behavior change differ across cultures (United States and India), sex, familiarity, dispositional factors, and health priming messages.METHODS: We conducted a web-based vignette study in the United States and India where a total of 279 participants watched video vignettes of a person interacting with sit-stand desks of various levels of automation and answered questions about their perceptions of the desks such as ranking of the different levels of automation.RESULTS: Participants generally preferred either manual or semiautonomous desks over the fully autonomous option (P<.001). However, participants in India were generally more amenable to the idea of nonvolitional interventions from the desk than participants in the United States (P<.001). Male participants had a stronger desire for having control over the desk than female participants (P=.01). Participants who were more familiar with sit-stand desks were more likely to adopt autonomous sit-stand desks (P=.001). No effects of health priming messages were observed. We estimated the projected health outcome by combining ranking data and hazard ratios from previous work and found that the semiautonomous desk led to the highest projected health outcome.CONCLUSIONS: These results suggest that the shared autonomy desk is the optimal level of automation in terms of both user preferences and estimated projected health outcomes. Demographics such as culture and sex had significant effects on how receptive users were to autonomous intervention. As familiarity improves the likelihood of adoption, we propose a gradual behavior change intervention to increase acceptance and adherence, especially for populations with a high desire for control.

  View details for DOI 10.2196/35447

  View details for PubMedID 36350687

• Patterns Of Engagement With Remote Delivery Channels In A Physical Activity Intervention For Older Women Mendoza-Vasconez, A. S., King, A. C., Chandler, G., Mackey, S., Stefanick, M. L. LIPPINCOTT WILLIAMS & WILKINS. 2022: 359

  View details for Web of Science ID 000888056601425

• P04-06 Employing citizen science to promote active and healthy ageing across diverse local urban communities in Birmingham, UK Wood, G., Pykett, J., King, A., Banchoff, A., Stathi, A. OXFORD UNIV PRESS. 2022

  View details for DOI 10.1093/eurpub/ckac095.060

  View details for Web of Science ID 000848627100189

• Cross-sector co-creation of a community-based physical activity program for breast cancer survivors in Colombia. Health promotion international Rubio, M. A., Mosquera, D., Blanco, M., Montes, F., Finck, C., Duval, M., Trillos, C., Jaramillo, A. M., Rosas, L. G., King, A. C., Sarmiento, O. L. 2022; 37 (3)

  Abstract

  Benefits of physical activity (PA) in breast cancer survivors (BCS) are well established. However, programs to promote PA among BCS tailored to real-world contexts within low- to middle-income countries are limited. Cross-sector co-creation can be key to effective and scalable programs for BCS in these countries. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS called My Body. We employed a mixed-methods design including semistructured interviews, workshops and a social network analysis of centrality measures to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The descriptive analysis and the centrality measures of the network revealed that 19 cross-sector stakeholders engaged in the My Body collaborative network. Through ongoing communication and cooperation, My Body built relationships between the academic lead institutions (local and international), and local and national public, private and academic institutions working in public health, sports and recreation, social sciences and engineering fields. The outcomes included the co-creation of the community-based PA program for BCS, its implementation through cross-sector synergies, increased relationships and communications among stakeholders, and successful dissemination of evidence and project results to the collaboration partners and other relevant stakeholders and community members. The mixed-methods assessment enabled understanding of ways to advance cross-sector co-creation of health promotion programs. The findings can help to enable continued development of sustainable cross-sector co-creation processes aimed at advancing PA promotion.

  View details for DOI 10.1093/heapro/daac073

  View details for PubMedID 35853152

• Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial. JAMA internal medicine Shlipak, M. G., Sheshadri, A., Hsu, F., Chen, S., Jotwani, V., Tranah, G., Fielding, R. A., Liu, C. K., Ix, J., Coca, S. G., LIFE Investigators, Pahor, M., Guralnik, J. M., Leeuwenburgh, C., Caudle, C., Crump, L., Holmes, L., Leeuwenburgh, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Lovato, L., Roberson, W., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Rejeski, W. J., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Hadley, E. C., Romashkan, S., Patel, K. V., Bonds, D., McDermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M., McGucken, A., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Berra, K., Yank, V., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kirn, D. R., Pasha, E. P., Kim, W. S., Beard, V. E., Tsiroyannis, E. X., Hau, C., Manini, T. M., Anton, S. D., Nayfield, S., Buford, T. W., Marsiske, M., Sandesara, B. D., Knaggs, J. D., Lorow, M. S., Marena, W. C., Korytov, I., Morris, H. L., Fitch, M., Singletary, F. F., Causer, J., Radcliff, K. A., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Glynn, N. W., Lopez, O., Nadkarni, N. K., Williams, K., Newman, M. A., Grove, G., Bonk, J. T., Rushing, J., Kost, P., Ives, D. G., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Wu, K. C., Shepard, D. M., Fennelly, B., Iannone, L. P., Mautner, R., Sweeney Barnett, T., Halpin, S. N., Brennan, M. J., Bugaj, J. A., Zenoni, M. A., Mignosa, B. M., Williamson, J., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Hankinson, J. L., Vaz Fragoso, C. A., Groessl, E. J., Kaplan, R. M. 2022

  Abstract

  Importance: Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults.Objective: To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults.Design, Setting, and Participants: This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022.Interventions: Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers.Main Outcomes and Measures: The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y.Results: Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97).Conclusions and Relevance: Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.Trial Registration: ClinicalTrials.gov Identifier: NCT01072500.

  View details for DOI 10.1001/jamainternmed.2022.1449

  View details for PubMedID 35499834

• ADDRESSING SOCIAL DETERMINANTS OF HEALTH IN BEHAVIORAL INTERVENTIONS TO IMPROVE HEALTH EQUITY Espinosa, P., Campero, M. I., Blanco-Velazquez, I., Escobar, M., Banchoff, A., Pedersen, M., King, A. C. OXFORD UNIV PRESS INC. 2022: S78

  View details for Web of Science ID 000788118600169

• USING RIPPLE EFFECTS MAPPING TO ASSESS COVID-RELATED IMPACTS IN A PHYSICAL ACTIVITY INTERVENTION FOR LOWER-INCOME AGING ADULTS Condor, J. L., Espinosa, P., Blanco-Velazquez, I., Escobar, M., Campero, M. I., Rosas, L., Banchoff, A., King, A. C. OXFORD UNIV PRESS INC. 2022: S669

  View details for Web of Science ID 000788118602148

• BEHAVIORAL OBESITY TREATMENT USING DIGITAL TOOLS FOR RACIAL/ETHNIC MINORITY ADULTS: FEASIBILITY OF THE SPARK PILOT STUDY Patel, M. L., Cleare, A. E., Smith, C. M., Rosas, L., King, A. C. OXFORD UNIV PRESS INC. 2022: S189

  View details for Web of Science ID 000788118600401

• UNDER- OR OVER-ESTIMATION OF NEIGHBORHOOD WALKABILITY AND OLDER ADULTS' PHYSICAL ACTIVITY LEVELS Mendoza-Vasconez, A., Sallis, J., Conway, T. L., King, A. C. OXFORD UNIV PRESS INC. 2022: S659

  View details for Web of Science ID 000788118602129

• Innovative participatory evaluation methodologies to assess and sustain multilevel impacts of two community-based physical activity programs for women in Colombia. BMC public health Rubio, M. A., Guevara-Aladino, P., Urbano, M., Cabas, S., Mejia-Arbelaez, C., Rodriguez Espinosa, P., Rosas, L. G., King, A. C., Chazdon, S., Sarmiento, O. L. 2022; 22 (1): 771

  Abstract

  BACKGROUND: Community-based physical activity (PA) programs are appealing to women in Latin America and show potential for improving women's health. This study aimed to engage healthy middle-aged women, breast cancer survivors and local stakeholders participating in two publicly funded community-based PA programs in Bogota, Colombia (Recreovia and My Body) to assess and visually map the perceived barriers, facilitators, and outcomes to promote programs' improvement, scaling and sustainability.METHODS: We used two participatory action research methods, the 1) Our Voice citizen science method to capture data and drive local change in built and social environmental facilitators and barriers that influence women's engagement in community-based PA; and 2) Ripple Effects Mapping to visually map the intended and unintended outcomes of PA programs. We used thematic analysis to classify the results at the individual, social, and community levels.RESULTS: The stakeholders engaged in the participatory evaluation included cross-sector actors from the programs (N=6) and program users (total N=34) from the two programs (Recreovia N=16; My Body N=18). Program users were women with a mean age of 55.7years (SD=8.03), 65% lived in low-income neighborhoods. They identified infrastructure as the main feature affecting PA, having both positive (e.g., appropriate facilities) and negative (e.g., poorly built areas for PA) effects. Regarding program improvements, stakeholders advocated for parks' cleaning, safety, and appropriate use. The most highlighted outcomes were the expansion and strengthening of social bonds and the engagement in collective wellbeing, which leveraged some participants' leadership skills for PA promotion strategies in their community. The facilitated dialogue among program users and stakeholders fostered the sustainability and expansion of the community-based PA programs, even during the COVID-19 pandemic.CONCLUSIONS: The implementation of both participatory methodologies provided a multidimensional understanding of the programs' impacts and multisectoral dialogues that fostered efforts to sustain the community-based PA programs.

  View details for DOI 10.1186/s12889-022-13180-2

  View details for PubMedID 35428285

• Factors influencing usage of urban blue spaces: A systems-based approach to identify leverage points. Health & place Smith, N., Georgiou, M., King, A. C., Tieges, Z., Chastin, S. 1800; 73: 102735

  Abstract

  Urban blue spaces may have salutogenic health benefits. It is crucial to understand the factors that influence the use of urban blue spaces so that urban populations can benefit equitably. A system map of factors influencing usage was developed by qualitatively analysing 203 intercept interviews conducted with people actively using the towpath along the canal in North Glasgow, Scotland. Network analysis was used to analyse the system map's structure identifying Exercise & Health and Urban Nature as key leverage points and Cleanliness & Maintenance as the key area for improvement. Findings could be used to inform the management, governance and revitalisation of urban blue spaces with the ultimate aim of maximising their potential to be equitable, sustainable and salutogenic.

  View details for DOI 10.1016/j.healthplace.2021.102735

  View details for PubMedID 34933144

• Cooperative planning and its utilization in German physical activity promotion: a brief introduction. Health promotion international Gelius, P. C., Jansen, M., King, A. C. 1800; 36 (Supplement_2): ii1-ii7

  View details for DOI 10.1093/heapro/daab170

  View details for PubMedID 34905606

• Harnessing Citizen Science to Assess and Improve Utilization of Metropolitan Parks: the Park Activity, Recreation, and Community Study (PARCS) in St. Louis, MO. Journal of healthy eating and active living O'Connor, Á., King, A. C., Banchoff, A., Eyler, A., Reis, R., Brownson, R. C., Resendiz, E., Holland, D., Salvo, D. 2021; 1 (4): 198-215

  Abstract

  Access to and use of parks is associated with physical activity participation. Our Voice is a systematic method blending community-based participatory research (CBPR) and citizen science. As part of a comprehensive, mixed-methods study in St. Louis, Missouri (PARCS), we tested the feasibility of the Our Voice method for gathering community input on the barriers to and facilitators of accessibility and use of large metropolitan parks, by describing the implementation of the Our Voice method among recreational and commuter users of a large metropolitan park in St. Louis, MO. Due to challenges posed by COVID-19, the Our Voice methodology was adapted for remote participation. Twenty-three citizen scientists (14 recreational park users and 9 commuters) collected and analyzed geolocated route, photo, and audio or text data on facilitators and barriers to park use and access. They identified 6 priority themes and 12 solution ideas, and presented them to stakeholders. In contrast to previous Our Voice studies, separate user groups (recreation and commuter users) independently prioritized many of the same themes. Adaptation of the Our Voice protocol to virtual practices during COVID-19 revealed positive implications for cost, reach, and scale of studies grounded in CBPR and citizen science. We provide a set of recommended practices for using Our Voice as a method to evaluate and promote equity of access and use of metropolitan parks.

  View details for DOI 10.1016/j.amepre.2004.10.024

  View details for PubMedID 37771562

  View details for PubMedCentralID PMC10522010

• Physical activity, well-being, and priorities of older women during the COVID-19 pandemic: a survey of Women's Health Initiative Strong and Healthy (WHISH) intervention participants TRANSLATIONAL BEHAVIORAL MEDICINE Wegner, L., Mendoza-Vasconez, A. S., Mackey, S., McGuire, V., To, C., White, B., King, A. C., Stefanick, M. L. 2021; 11 (12): 2155-2163

  View details for DOI 10.1093/tbm/lbab122

  View details for Web of Science ID 000745653400011

• Physical activity, well-being, and priorities of older women during the COVID-19 pandemic: a survey of Women's Health Initiative Strong and Healthy (WHISH) intervention participants. Translational behavioral medicine Wegner, L., Mendoza-Vasconez, A. S., Mackey, S., McGuire, V., To, C., White, B., King, A. C., Stefanick, M. L. 2021

  Abstract

  Sheltering-in-place, social distancing, and other strategies to minimize COVID-19 transmission may impact physical activity (PA) and well-being in older adults. To assess self-reported PA changes, well-being, and priorities of older women across the USA early in the COVID-19 pandemic. In May 2020, a 10-question survey was emailed to 5,822 women, aged over 70 years, who had been assigned to the Women's Health Initiative (WHI) Strong and Healthy (WHISH) trial PA intervention and had provided email addresses. The survey assessed general and physical well-being, current priorities, and PA levels before and during the COVID-19 pandemic. Demographic and physical function data were collected previously. Descriptive analyses characterized participants' priorities and PA changes from before the pandemic to the time of data collection during the pandemic. Differences in PA change by age, physical function, and geographic region were assessed by Kruskal-Wallis and post hoc Dunn tests. Among 2,876 survey respondents, 89% perceived their general well-being as good, very good, or excellent, despite 90% reporting at least moderate (to extreme) concern about the pandemic, with 18.2% reporting increased PA levels, 27.1% reporting no changes, and 54.7% reporting decreased PA levels. Top priorities "in the midst of the COVID-19 outbreak" were staying in touch with family/friends (21%) and taking care of one's body (20%). Among priorities related to physical well-being, staying active was selected most frequently (33%). Support for maintaining PA in older populations should be a priority during a pandemic and similarly disruptive events.

  View details for DOI 10.1093/tbm/ibab122

  View details for PubMedID 34633465

• El entorno construido en los programas disenados para promover la actividad fisica entre las ninas, ninos y jovenes latinos que viven en Estados Unidos y America Latina. Obesity reviews : an official journal of the International Association for the Study of Obesity Sarmiento, O. L., Rubio, M. A., King, A. C., Serrano, N., Hino, A. A., Hunter, R. F., Aguilar-Farias, N., Parra, D. C., Salvo, D., Jauregui, A., Lee, R. E., Kohl, B. 2021; 22 Suppl 5: e13345

  Abstract

  Prevenir la obesidad entre los jovenes latinos que viven en Estados Unidos y en paises latinoamericanos requiere reconocer la especificidad de los contextos y las interacciones entre actividad fisica (AF) y entorno construido (EC). El objetivo de este articulo es avanzar en la agenda de investigacion sobre el EC y la AF con el fin de prevenir la obesidad en Latinoamerica y entre los jovenes latinos de Estados Unidos mediante (1) la identificacion de indicadores del entorno que contribuyan en el diseno de intervenciones y politicas; (2) la identificacion de enfoques metodologicos interdisciplinarios para el estudio de la relacion compleja que se establece entre el EC y la AF y (3) la presentacion de estudios de casos sobre programas de EC que promueven la AF. Un grupo de cientificos estadounidenses y latinoamericanos trabajo en colaboracion para proponer nuevos indicadores sobre el EC, establecer enfoques metodologicos que permitan estudiar la relacion compleja entre EC y AF, y revisar estudios de caso sobre programas de EC que promueven la AF en ambas regiones. Como resultado, se identificaron lagunas de conocimiento, se propusieron indicadores del entorno (como el paisaje, el diseno de las calles, los patrones de movilidad, la delincuencia y la seguridad), se revisaron enfoques metodologicos (analisis de redes sociales, metodos de ciencia ciudadana) y se analizaron estudios de caso de programas del EC que promueven la AF (calles para el juego, desplazamiento activo a la escuela e intervenciones en el entorno escolar). La prevencion de la obesidad entre los jovenes latinos y latinoamericanos exige una investigacion avanzada del EC y de la AF que aborde las prioridades especificas de cada contexto y permita intercambiar las lecciones aprendidas.

  View details for DOI 10.1111/obr.13345

  View details for PubMedID 34708530

• Entorno social y obesidad infantil: implicaciones para la investigacion y la practica en Estados Unidos y en los paises latinoamericanos. Obesity reviews : an official journal of the International Association for the Study of Obesity Ayala, G. X., Monge-Rojas, R., King, A. C., Hunter, R., Berge, J. M. 2021; 22 Suppl 5: e13350

  Abstract

  El entorno en el que viven los ninos influye en su riesgo de sufrir obesidad debido, entre otros factores, a los comportamientos relacionados con el peso (es decir, a la dieta y la actividad fisica). En este articulo presentaremos evidencia sobre los factores socioambientales asociados a la dieta y la actividad fisica de los ninos y, de forma mas general, a la prevencion y el control de la obesidad infantil entre los ninos hispanos y latinos de Estados Unidos y los paises latinoamericanos. Utilizando un enfoque socioecologico, presentaremos evidencia procedente de varios estudios transversales y longitudinales realizados en Estados Unidos con ninos hispanos y latinos, asi como de otros estudios realizados en Latinoamerica en los que tambien participaron ninos. Nos hemos centrado especialmente en los estudios que analizan los factores relacionados con la crianza en el entorno domestico (p. ej., estrategias de crianza) y, aunque en menor medida, tambien en los factores socioambientales relacionados con otros contextos de la vida (p. ej., la escuela). La influencia de la aculturacion sobre las relaciones sociales transciende los limites del marco conceptual socioecologico. La investigacion sobre intervenciones permitio identificar estrategias y brechas de investigacion para intervenir los factores sociales que promueven comportamientos saludables y reducen el riesgo de obesidad infantil. Los trabajadores de salud comunitaria y otras formas de apoyo de los pares fueron identificados como elementos relevantes en multiples niveles del marco socioecologico. Este articulo concluye brindando algunas lineas de trabajo para que futuras investigaciones comprendan mejor el entorno social usando las nuevas tecnologias de informacion y comunicacion.

  View details for DOI 10.1111/obr.13350

  View details for PubMedID 34708540

• Prevencion transfronteriza de la obesidad infantil: la promesa de colaboracion entre EE. UU. y Latinoamerica en investigacion. Obesity reviews : an official journal of the International Association for the Study of Obesity King, A. C., Perez-Escamilla, R., Vorkoper, S., Anand, N., Rivera, J. 2021; 22 Suppl 5: e13343

  View details for DOI 10.1111/obr.13343

  View details for PubMedID 34708533

• Un marco conceptual orientado a la accion para soluciones sistemicas de prevencion de la obesidad infantil en Latinoamerica y en las poblaciones latinas de Estados Unidos. Obesity reviews : an official journal of the International Association for the Study of Obesity Garcia, L. M., Hunter, R. F., de la Haye, K., Economos, C. D., King, A. C. 2021; 22 Suppl 5: e13354

  Abstract

  La obesidad infantil en Latinoamerica y en las poblaciones latinas de Estados Unidos es un problema de salud publica complejo y persistente y, como tal, requiere soluciones basadas en la teoria y los metodos de la ciencia de sistemas. En este articulo presentamos un marco conceptual orientado a la accion para disenar, implementar, evaluar y mantener cambios sistemicos comunitarios con el fin de prevenir la obesidad infantil en Latinoamerica y en las poblaciones latinas de Estados Unidos. Las acciones de nuestro marco conceptual comprenden seis etapas: (1) promover la formacion de un equipo multisectorial; (2) mapear el sistema, el contexto y los impulsores; (3) concebir cambios sistemicos; (4) realizar cambios sistemicos; (5) monitorear, aprender y adaptar; (6) escalar y mantener. Tambien proponemos diez principios que colocan los derechos humanos y ambientales y el pensamiento sistemico en el centro de estas soluciones que afectan al conjunto del sistema. A cada etapa de accion le corresponde una lista de actividades, metodos, enfoques y ejemplos concretos que pueden utilizarse como guia y base del trabajo que hay que realizar para alcanzar los resultados esperados. Por ultimo, presentamos como ampliar y mantener el uso de la ciencia de sistemas para prevenir la obesidad infantil en Latinoamerica y en las poblaciones latinas de Estados Unidos.

  View details for DOI 10.1111/obr.13354

  View details for PubMedID 34708532

• Citizen Science in Sweden's Stigmatized Neighborhoods SUSTAINABILITY Fell, T., Rydenstam, T., Buli, B., King, A. C., Balter, K. 2021; 13 (18)

  View details for DOI 10.3390/su131810205

  View details for Web of Science ID 000701831700001

• Adolescent Levers for a Diet and Physical Activity Intervention Across Socioecological Levels in Kenya, South Africa, Cameroon, and Jamaica: Mixed Methods Study Protocol. JMIR research protocols Odunitan-Wayas, F. A., Wadende, P., Mogo, E. R., Brugulat-Panes, A., Micklesfield, L. K., Govia, I., Mapa-Tassou, C., Mukoma, G., Smith, J. A., Motlhalhedi, M., Wasnyo, Y., Were, V., Assah, F., Okop, K. J., Norris, S. A., Obonyo, C., Mbanya, J. C., Tulloch-Reid, M. K., King, A. C., Lambert, E. V., Oni, T. 2021; 10 (7): e26739

  Abstract

  BACKGROUND: The increasing burden of noncommunicable diseases that are prevalent in low- and middle-income countries (LMICs) is largely attributed to modifiable behavioral risk factors such as unhealthy diets and insufficient physical activity (PA). The adolescent stage, defined as 10 to 24 years of age, is an important formative phase of life and offers an opportunity to reduce the risk of noncommunicable diseases across the life course and for future generations.OBJECTIVE: The aim of this paper is to describe a protocol for a study using a convergent mixed methods design to explore exposures in the household, neighborhood, school, and the journey from home to school that may influence diet and PA behaviors in adolescents from LMICs.METHODS: Male and female adolescents (n≥150) aged between 13 and 24 years will be recruited from selected high schools or households in project site countries to ensure the socioeconomic diversity of perspectives and experiences at the individual, home, and neighborhood levels. The project will be conducted at 5 sites in 4 countries: Kenya, Cameroon, Jamaica, and South Africa (Cape Town and Johannesburg). Data on anthropometric measures, food intake, and PA knowledge and behavior will be collected using self-report questionnaires. In addition, a small number of learners (n=30-45) from each site will be selected as citizen scientists to capture data (photographs, audio notes, text, and geolocations) on their lived experiences in relation to food and PA in their homes, the journey to and from school, and the school and neighborhood environments using a mobile app, and for objective PA measurements. In-depth interviews will be conducted with the citizen scientists and their caregivers to explore household experiences and determinants of food intake and foodways, as well as the PA of household members.RESULTS: The study described in this protocol paper was primarily funded through a UK National Institute for Health Research grant in 2017 and approved by the relevant institutional ethics review boards in the country sites (South Africa, Cameroun, and Jamaica in 2019, and Kenya in 2020). As of December 23, 2020, we had completed data collection from adolescents (n≥150) in all the country sites, except Kenya, and data collection for the subgroup (n=30-45) is ongoing. Data analysis is ongoing and the output of findings from the study described in this protocol is expected to be published by 2022.CONCLUSIONS: This project protocol contributes to research that focuses on adolescents and the socioecological determinants of food intake and PA in LMIC settings. It includes innovative methodologies to interrogate and map the contexts of these determinants and will generate much-needed data to understand the multilevel system of factors that can be leveraged through upstream and downstream strategies and interventions to improve health outcomes.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26739.

  View details for DOI 10.2196/26739

  View details for PubMedID 34255729

• Using citizen science to empower older adults to improve a food security initiative in Australia. Health promotion international Tuckett, A. G., Rowbotham, S., Hetherington, S., Goddard, J., King, A. C. 2021

  Abstract

  Food security is an increasing problem for older adults who are living longer and having to stretch their resources further. Initiatives such as subsidized community market days are increasingly important in bolstering food security amongst these groups but there have been few attempts to understand these initiatives from the perspective of community members. This exploratory study examined the utility of a novel citizen science approach to engage older adults in evaluating and improving a local food security initiative. Using the Our Voice methodology, citizen scientists recorded their perceptions of their local Market Day via photographs and audio narratives. Thirteen citizen scientists captured 127 photographs and 125 commentaries. Citizen scientists participated in workshops to discuss, code and synthesize their data, and used their findings to advocate for change. A number of improvements to the Market Day were made by key stakeholders on the basis of citizen scientist recommendations, including improving the processes for sourcing and storing food and changing the layout to improve access. This study demonstrates that citizen science is a useful and feasible approach to engaging community members in capturing data and advocating for change to ensure that local initiatives meet the needs of communities.

  View details for DOI 10.1093/heapro/daab060

  View details for PubMedID 34165525

• What moves you? Physical activity strategies in older women. Journal of health psychology Oppezzo, M., Wegner, L., Gross, J. J., Schwartz, D. L., Eckley, T., King, A. C., Mackey, S., Stefanick, M. L. 2021: 13591053211014593

  Abstract

  Physical activity improves quality of life and extends independence in older adults. Yet, how to motivate older adults to engage in physical activity is unclear. In the present study, 4108 older women, aged 70-99, reported how they motivated themselves to move when they did not feel like it, and their hours of physical activity and walking each week. Findings indicated that participants who endorsed more strategies had more hours of physical activity and walking. Strategic categories that correlated with more physical activity include focusing on the benefits and utilizing the surrounding environment to help motivate movement.

  View details for DOI 10.1177/13591053211014593

  View details for PubMedID 34006131

• The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America. Obesity reviews : an official journal of the International Association for the Study of Obesity Ayala, G. X., Monge-Rojas, R., King, A. C., Hunter, R., Berge, J. M. 2021: e13246

  Abstract

  The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

  View details for DOI 10.1111/obr.13246

  View details for PubMedID 33951272

• Metabolic syndrome and the benefit of a physical activity intervention on lower-extremity function: Results from a randomized clinical trial. Experimental gerontology Botoseneanu, A., Chen, H., Ambrosius, W. T., Allore, H. G., Anton, S., Folta, S. C., King, A. C., Nicklas, B. J., Spring, B., Strotmeyer, E. S., Gill, T. M. 2021: 111343

  Abstract

  BACKGROUND: In older adults, increases in physical activity may prevent decline in lower-extremity function, but whether the benefit differs according to metabolic syndrome (MetS) status is uncertain. We aim to investigate whether structured physical activity is associated with less decline in lower-extremity function among older adults with versus without MetS.METHODS: We used data from the multicenter Lifestyle Interventions and Independence for Elders (LIFE) study to analyze 1535 sedentary functionally-vulnerable women and men, aged 70 to 89 years old, assessed every 6 months (February 2010-December 2013) for an average of 2.7 years. Participants were randomized to a structured, moderate-intensity physical activity intervention (PA; n = 766) or health education program (HE; n = 769). MetS was defined according to the 2009 multi-agency harmonized criteria. Lower-extremity function was assessed by 400-m walking speed and the Short Physical Performance Battery (SPPB) score.RESULTS: 763 (49.7%) participants met criteria for MetS at baseline. Relative to HE, PA was associated with faster 400-m walking speed among participants with MetS (P < 0.001) but not among those without MetS (P = 0.91), although the test for statistical interaction was marginally non-significant (P = 0.07). In contrast, no benefit of PA versus HE was observed on the SPPB score in either MetS subgroup.CONCLUSIONS: Among older adults at high risk for mobility disability, moderate-intensity physical activity conveys significant benefits in 400-m walking speed but not SPPB in those with, but not without, MetS. The LIFE physical activity program may be an effective strategy for maintaining or improving walking speed among vulnerable older adults with MetS.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01072500.

  View details for DOI 10.1016/j.exger.2021.111343

  View details for PubMedID 33848565

• An action-oriented framework for systems-based solutions aimed at childhood obesity prevention in US Latinx and Latin American populations. Obesity reviews : an official journal of the International Association for the Study of Obesity Garcia, L. M., Hunter, R. F., de la Haye, K., Economos, C. D., King, A. C. 2021: e13241

  Abstract

  Childhood obesity in US Latinx and Latin American populations is a persistent, complex public health issue and, as such, requires solutions grounded on systems science theory and methods. In this paper, we introduce an action-oriented framework to design, implement, evaluate, and sustain whole-of-community systems changes for childhood obesity prevention in US Latinx and Latin American populations. Our framework covers six action steps: (1) foster multisectoral team; (2) map the system, its context, and drivers; (3) envision system-wide changes; (4) effect system-wide changes; (5) monitor, learn, and adapt; and (6) scale and sustain. We also propose 10 principles that put human and environmental rights and systems thinking at the center of these systems-based solutions. For each action step, we provide a list of concrete activities, methods, approaches, and examples that can be used to guide and inform the work needed to achieve the expected outputs. Finally, we discuss how a wider adoption of systems science for childhood obesity prevention among US Latinx and Latin American populations can be encouraged and sustained.

  View details for DOI 10.1111/obr.13241

  View details for PubMedID 33825301

• Built environment in programs to promote physical activity among Latino children and youth living in the United States and in Latin America. Obesity reviews : an official journal of the International Association for the Study of Obesity Sarmiento, O. L., Rubio, M. A., King, A. C., Serrano, N., Hino, A. A., Hunter, R. F., Aguilar-Farias, N., Parra, D. C., Salvo, D., Jauregui, A., Lee, R. E., Kohl, B. 2021: e13236

  Abstract

  To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA-promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA-promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA-promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context-specific priorities and exchanging lessons learned.

  View details for DOI 10.1111/obr.13236

  View details for PubMedID 33825294

• Elevated IL-6 and CRP levels are associated with incident self-reported major mobility disability: A pooled analysis of older adults with slow gait speed. The journals of gerontology. Series A, Biological sciences and medical sciences Beavers, D. P., Kritchevsky, S. B., Gill, T. M., Ambrosius, W. T., Anton, S. D., Fielding, R. A., King, A. C., Rejeski, W. J., Lovato, L., McDermott, M. M., Newman, A. B., Pahor, M., Walkup, M. P., Tracy, R. P., Manini, T. M. 2021

  Abstract

  BACKGROUND: Elevated Interleukine-6 (IL-6) and C-reactive protein (CRP) are associated with aging-related reductions in physical function, but little is known about their independent and combined relationships with major mobility disability (MMD), defined as the self-reported inability to walk a quarter-mile.METHODS: We estimated the absolute and relative effect of elevated baseline IL-6, CRP, and their combination on self-reported MMD risk among older adults (≥68 years; 59% female) with slow gait speed (<1.0m/s). Participants were MMD-free at baseline. IL-6 and CRP were assessed using a central laboratory. The study combined a cohort of community dwelling high-functioning older adults (Health ABC) with two trials of low-functioning adults at risk of MMD (LIFE-P, LIFE). Analyses utilized Poisson regression for absolute MMD incidence and proportional hazards models for relative risk.RESULTS: We found higher MMD risk per unit increase in log IL-6 [HR=1.26 (95% CI 1.13 to 1.41)]. IL-6 meeting pre-determined threshold considered to be high (>2.5 pg/mL) was similarly associated with higher risk of MMD [HR=1.31 (95% CI: 1.12 to 1.54)]. Elevated CRP (CRP >3.0mg/L) was also associated with increased MMD risk [HR=1.38 (95% CI: 1.10 to 1.74)]. The CRP effect was more pronounced among participants with elevated IL-6 [HR=1.62 (95% CI: 1.12 to 2.33)] compared to lower IL-6 levels [HR=1.19 (95% CI: 0.85 to 1.66)].CONCLUSIONS: High baseline IL-6 and CRP were associated with increased risk of MMD among older adults with slow gait speed. A combined biomarker model suggests CRP was associated with MMD when IL-6 was elevated.

  View details for DOI 10.1093/gerona/glab093

  View details for PubMedID 33822946

• RIPPLE EFFECTS MAPPING IN BEHAVIORAL INTERVENTIONS: A PARTICIPATORY METHOD TO ACCELERATE TRANSLATION AND IMPLEMENTATION Espinosa, P., Rosas, L., Campero, M. I., Rubio Rojas, M., Sarmiento, O. L., Chazdon, S., King, A. C. OXFORD UNIV PRESS INC. 2021: S568

  View details for Web of Science ID 000648922701350

• ADAPTING GROUP-BASED BEHAVIORAL INTERVENTIONS AND QUALITATIVE ASSESSMENTS WITH UNDERSERVED LOW-INCOME MID-LIFE AND OLDER ADULTS DURING THE COVID-19 ERA Campero, M. I., Espinosa, P., Blanco-Velazquez, I., Escobar, M., Fierros, F., King, A. C. OXFORD UNIV PRESS INC. 2021: S569

  View details for Web of Science ID 000648922701352

• WHO RESPONDS BEST TO SEQUENTIAL VS. SIMULTANEOUS INTERVENTIONS FOR DIET AND PHYSICAL ACTIVITY? EXAMINING BASELINE MODERATORS Patel, M. L., Espinosa, P., King, A. C. OXFORD UNIV PRESS INC. 2021: S513

  View details for Web of Science ID 000648922701231

• ENGAGING ETHNICALLY DIVERSE MID-LIFE AND OLDER ADULTS IN A MULTILEVEL PARTICIPATORY PHYSICAL ACTIVITY INTERVENTION: EVALUATING IMPACTS USING RIPPLE EFFECTS MAPPING Rosas, L., Espinosa, P., Campero, M. I., Blanco-Velazquez, I., Chen, W., King, A. C. OXFORD UNIV PRESS INC. 2021: S569

  View details for Web of Science ID 000648922701351

• PROFILING ENVIRONMENTALISM: WHO ENGAGES IN DIFFERENT CLIMATE CHANGE-MITIGATING BEHAVIORS? Mendoza-Vasconez, A. S., Chandler, G., Felberbaum, Y., King, A. C. OXFORD UNIV PRESS INC. 2021: S375

  View details for Web of Science ID 000648922700759

• Social cohesion emerging from a community-based physical activity program: A temporal network analysis NETWORK SCIENCE Jaramillo, A., Montes, F., Sarmiento, O. L., Rios, A., Rosas, L. G., Hunter, R. F., Rodriguez, A., King, A. C. 2021; 9 (1): 35-48

  View details for DOI 10.1017/nws.2020.31

  View details for Web of Science ID 000672040100003

• Social cohesion emerging from a community-based physical activity program: A temporal network analysis. Network science (Cambridge University Press) Jaramillo, A. M., Montes, F., Sarmiento, O. L., Ríos, A. P., Rosas, L. G., Hunter, R., Rodríguez, A. L., King, A. C. 2021; 9 (1): 35-48

  Abstract

  Community-based physical activity programs, such as the Recreovía, are effective in promoting healthy behaviors in Latin America. To understand Recreovías' challenges and scalability, we characterized its social network longitudinally while studying its participants' social cohesion and interactions. First, we constructed the Main network of the program's Facebook profile in 2013 to determine the main stakeholders and communities of participants. Second, we studied the Temporal network growth of the Facebook profiles of three Recreovía locations from 2008 to 2016. We implemented a Time Windows in Networks algorithm to determine observation periods and a scaling model of cities' growth to measure social cohesion over time. Our results show physical activity instructors as the main stakeholders (20.84% nodes of the network). As emerging cohesion, we found: (1) incremental growth of Facebook users (43-272 nodes), friendships (55-2565 edges), clustering coefficient (0.19-0.21), and density (0.04-0.07); (2) no preferential attachment behavior; and (3) a social cohesion super-linear growth with 1.73 new friendships per joined user. Our results underscore the physical activity instructors' influence and the emergent cohesion in innovation periods as a co-benefit of the program. This analysis associates the social and healthy behavior dimensions of a program occurring in natural environments under a systemic approach.

  View details for DOI 10.1017/nws.2020.31

  View details for PubMedID 34322275

  View details for PubMedCentralID PMC8315584

• We're all in this together: recommendations from the Society of Behavioral Medicine's Open Science Working Group. Translational behavioral medicine Hesse, B. W., Conroy, D. E., Kwasnicka, D., Waring, M. E., Hekler, E., Andrus, S., Tercyak, K. P., King, A. C., Diefenbach, M. A. 2021

  View details for DOI 10.1093/tbm/ibaa126

  View details for PubMedID 33595059

• Ratings of Perceived Exertion during Walking: Predicting Major Mobility Disability and Effect of Structured Physical Activity in Mobility-Limited Older Adults. The journals of gerontology. Series A, Biological sciences and medical sciences Cenko, E., Chen, H., Gill, T. M., Glynn, N. W., Henderson, R. M., King, A. C., Pahor, M., Qiu, P., Rego, A., Reid, K. F., Tudor-Locke, C., Valiani, V., You, L., Manini, T. M. 2021

  Abstract

  BACKGROUND: This study evaluated the association between ratings of perceived exertion (RPE) of walking and major mobility disability (MMD), as well as their transitions in response to a physical activity (PA) compared to a health education (HE) program.METHODS: Older adults (n=1633) at risk for mobility impairment were randomized to structured PA or HE programs. During a 400m walk, participants rated exertion as "light" or "hard". An MMD event was defined as the inability to walk 400m. MMD events and RPE values were assessed every 6-months for an average of 2.6 years.RESULTS: Participants rating their exertion as "hard" had a nearly 3-fold higher risk of MMD compared with those rating their exertion as "light" (HR: 2.61, 95%CI: 2.19-3.11). The association held after adjusting for disease conditions, depression, cognitive function and walking speed (HR: 2.24, 95%CI: 1.87-2.69). The PA group was 25% more likely to transition from "light" to "hard" RPE than the HE group (1.25, 1.05-1.49). Additionally, the PA group was 27% (0.73, 0.55 - 0.97) less likely to transition from a "hard" RPE to inability to walk 400m and was more likely to recover their ability to walk 400m by transitioning to a "hard" RPE (2.10, 1.39-3.17) than the HE group.CONCLUSIONS: Older adults rating "hard" effort during a standardized walk test were at increased risk of subsequent MMD. A structured PA program enabled walking recovery, but was more likely to increase transition from "light" to "hard" effort, which may reflect greater capacity to perform the test.

  View details for DOI 10.1093/gerona/glab036

  View details for PubMedID 33585918

• Effects of Health Behavior Interventions on Psychosocial Outcomes and Cortisol Regulation Among Chronically Stressed Midlife and Older Adults. International journal of behavioral medicine Urizar, G. G., Miller, K., Saldana, K. S., Garovoy, N., Sweet, C. M., King, A. C. 2021

  Abstract

  BACKGROUND: Altered cortisol dynamics have been associated with increased risk for chronic health problems among midlife and older adults (≥45 years of age). Yet, studies investigating the impact of health behavior interventions on cortisol activity in this age group are limited.OBJECTIVE AND METHODS: The current study examined whether 48 midlife and older adults (50% family caregivers, 69% women) randomized to one of four telephone-based health behavior interventions (stress management (SM), exercise (EX), nutrition (NUT), or exercise plus nutrition (EX+NUT)) showed improvements in their perceived stress, mood, and cortisol dynamics at 4 months post-intervention. Participants collected four salivary cortisol samples (waking, 30 min after waking, 4 p.m., and bedtime) across two collection days at baseline and at 4 months post-intervention to assess for total cortisol, cortisol awakening response (CAR), and diurnal cortisol slope.RESULTS: Participants in SM showed lower levels of total cortisol and a smaller CAR compared with those in EX, NUT, or EX+NUT from baseline to 4 months post-intervention. Participants in EX showed lower levels of perceived stress, depression, and anxiety compared with those in NUT or SM. Finally, participants in NUT showed a greater diurnal decline in cortisol and lower levels of anxiety compared with those in SM.CONCLUSIONS: These findings provide support for the efficacy of telephone-based, health behavior interventions in improving different stress outcomes among chronically stressed midlife and older adults and suggest the need to test the longer-term effects of these interventions for improving health outcomes in this population.

  View details for DOI 10.1007/s12529-021-09957-1

  View details for PubMedID 33495978

• Women's Health Initiative Strong and Healthy (WHISH) Pragmatic Physical Activity Intervention Trial for Cardiovascular Disease Prevention: Design and Baseline Characteristics. The journals of gerontology. Series A, Biological sciences and medical sciences Stefanick, M. L., King, A. C., Mackey, S. n., Tinker, L. F., Hlatky, M. A., LaMonte, M. J., Bellettiere, J. n., Larson, J. C., Anderson, G. n., Kooperberg, C. L., LaCroix, A. Z. 2021

  Abstract

  National guidelines promote physical activity to prevent cardiovascular disease (CVD), yet no randomized controlled trial has tested whether physical activity reduces prevent CVD.The Women's Health Initiative (WHI) Strong and Healthy (WHISH) pragmatic trial used a randomized consent design to assign women for whom cardiovascular outcomes were available through WHI data collection (N=18,985) or linkage to the Centers for Medicare and Medicaid Services (N30,346), to a physical activity intervention or "usual activity" comparison, stratified by ages 68-99 years (in tertiles), U.S. geographic region, and outcomes data source. Women assigned to the intervention could "opt out" after receiving initial physical activity materials. Intervention materials applied evidence-based behavioral science principles to promote current national recommendations for older Americans The intervention was adapted to participant input regarding preferences, resources, barriers and motivational drivers and was targetted for three categories of women at lower, middle or higher levels of self-reported physical functioning and physical activity. Physical activity was assessed in both arms through annual questionnaires. The primary outcome is major cardiovascular events, specifically myocardial infarction, stroke, or CVD death; primary safety outcomes are hip fracture and non-CVD death. The trial is monitored annually by an independent Data Safety and Monitoring Board. Final analyses will be based on intention-to-treat in all randomized participants, regardless of intervention engagement.The 49,331 randomized participants had a mean baseline age of 79.7 years; 84.3% were white, 9.2% black, 3.3% Hispanic, 1.9% Asian/Pacific Islander, 0.3% Native American, and 1% were of unknown race/ethnicity. The mean baseline RAND-36 physical function score was 71.6 (± 25.2 SD). There were no differences between Intervention (N=24,657) and Control (N=24,674) at baseline for age, race/ethnicity, current smoking (2.5%), use of blood pressure or lipid-lowering medications, body mass index, physical function, physical activity, or prior CVD (10.1%).The WHISH trial is rigorously testing whether a physical activity intervention reduces major CV events in a large, diverse cohort of older women.

  View details for DOI 10.1093/gerona/glaa325

  View details for PubMedID 33433559

• Data from an Our Voice citizen science initiative in neighborhoods with low socioeconomic status in Sweden: A proof of concept for collecting complex data. Data in brief Balter, K., Rydenstam, T., Fell, T., King, A. C., Buli, B. G. 2020; 33: 106394

  Abstract

  This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad "smiley face"), and an 8-item survey. In addition, we used official statistics from the City of Vasteras describing the two neighborhoods as well as the whole city. This data article is associated with the article titled "Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study" [1].

  View details for DOI 10.1016/j.dib.2020.106394

  View details for PubMedID 33117863

• Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - The NESLA study. Health & place Rydenstam, T., Fell, T., Buli, B. G., King, A. C., Balter, K. 2020; 65: 102387

  Abstract

  Socioeconomic status (SES) as well as adolescents' perceptions of the neighborhood's built and social environments have been shown to influence adolescents' physical activity. Twenty-four adolescents from two low SES neighborhoods in Sweden participated as citizen scientists, using the Stanford Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived facilitate or hinder their physical activity. The most frequently reported facilitators were 'parks, playgrounds and outdoor gym' as well as 'amenities' and 'sport facilities', whereas lack of or shortcomings regarding 'bikeability and walkability', 'personal safety' and 'lighting' were the most frequently reported barriers. The results will be used to inform local politicians and policy makers about new ways to improve physical activity among residents in Sweden's low SES neighborhoods. Also, this study shows that a Swedish version of the Discovery Tool app is acceptable and can generate useful information in the context of adolescents from disadvantaged neighborhoods.

  View details for DOI 10.1016/j.healthplace.2020.102387

  View details for PubMedID 32889390

• Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods. Contemporary clinical trials King, A. C., Campero, I., Sheats, J. L., Castro Sweet, C. M., Espinosa, P. R., Garcia, D., Hauser, M., Done, M., Patel, M. L., Parikh, N. M., Corral, C., Ahn, D. K. 2020: 106084

  Abstract

  Physical inactivity is a key risk factor for a range of chronic diseases and conditions, yet, approximately 50% of U.S. adults fall below recommended levels of regular aerobic physical activity (PA). This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. Text messaging (SMS) represents a convenient and accessible communication channel for delivering targeted PA information and support, but has not been rigorously evaluated against standard telehealth advising programs. The objective of the On The Move randomized controlled trial is to test the effectiveness of a linguistically and culturally targeted SMS PA intervention (SMS PA Advisor) versus two comparison conditions: a) a standard, staff-delivered phone PA intervention (Telephone PA Advisor) and b) an attention-control arm consisting of a culturally targeted SMS intervention to promote a healthy diet (SMS Nutrition Advisor). The study sample (N = 350) consists of generally healthy, insufficiently active Latino adults ages 35 years and older living in five northern California counties. Study assessments occur at baseline, 6, and 12 months, with a subset of participants completing 18-month assessments. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of PA, assessed via validated self-report measures and supported by accelerometry, and physical function and well-being variables. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. Trial Registration: clinicaltrial.gov Identifier = NCT02385591.

  View details for DOI 10.1016/j.cct.2020.106084

  View details for PubMedID 32659437

• USING TARGETED MAILINGS TO RECRUIT LATINO AND OTHER UNDERSERVED ADULT POPULATIONS FOR BEHAVIORAL HEALTH INTERVENTION TRIALS Espinosa, P., Campero, I., Escobar, M., King, A. C. OXFORD UNIV PRESS INC. 2020: S202

  View details for Web of Science ID 000546262400423

• PHYSICAL ACTIVITY ADVISING BY HUMANS VS. COMPUTERS IN UNDERSERVED POPULATIONS: THE COMPASS2 TRIAL MAJOR RESULTS King, A. C., Campero, I., Sheats, J. L., Sweet, C., Hauser, M. E., Banda, J. A., Ahn, D. K., Bickmore, T. OXFORD UNIV PRESS INC. 2020: S526

  View details for Web of Science ID 000546262401274

• PHYSICAL ACTIVITY IMPROVEMENTS AMONG PEER MENTORS ENGAGED IN A BEHAVIORAL INTERVENTION TRIAL OF LATINO ADULTSY Campero, I., Blanco, G., Espinosa, P., Sheats, J. L., King, A. C. OXFORD UNIV PRESS INC. 2020: S103

  View details for Web of Science ID 000546262400212

• CHALLENGES AND SOLUTIONS OF OPEN SCIENCE RELATED TO OPEN ACCESS PUBLISHING, RESOURCE SHARING, AND CITIZEN SCIENCE Kwasnicka, D., Hesse, B. W., Waring, M. E., Hekler, E. B., Conroy, D. E., Andrus, S., Tercyak, K. P., King, A. C. OXFORD UNIV PRESS INC. 2020: S180

  View details for Web of Science ID 000546262400375

• THE ASSOCIATIONS BETWEEN PERCEIVED AND OBJECTIVELY MEASURED AIR QUALITY AMONG VULNERABLE AGING ADULTS IN SAN FRANCISCO BAY AREA Hua, J., Seto, E., Campero, I., Garcia, D., Austin, E., Huang, C., Done, M., Blanco-Velazquez, I., Fierros, F., Carmona, N., King, A. C. OXFORD UNIV PRESS INC. 2020: S650

  View details for Web of Science ID 000546262401524

• PROMOTING WELL-BEING AMONG LATINOS: CAN A PHYSICAL ACTIVITY INTERVENTION MOVE THE NEEDLE? Espinosa, P., Campero, I., Patel, M. L., Garcia, D., Winter, S. J., Heaney, C. A., King, A. C. OXFORD UNIV PRESS INC. 2020: S370

  View details for Web of Science ID 000546262400767

• Impact and Lessons From the Lifestyle Interventions and Independence for Elders (LIFE) Clinical Trials of Physical Activity to Prevent Mobility Disability. Journal of the American Geriatrics Society Pahor, M., Guralnik, J. M., Anton, S. D., Ambrosius, W. T., Blair, S. N., Church, T. S., Espeland, M. A., Fielding, R. A., Gill, T. M., Glynn, N. W., Groessl, E. J., King, A. C., Kritchevsky, S. B., Manini, T. M., McDermott, M. M., Miller, M. E., Newman, A. B., Williamson, J. D. 2020

  Abstract

  BACKGROUND: Walking independently is basic to human functioning. The Lifestyle Interventions and Independence for Elders (LIFE) studies were developed to assess whether initiating physical activity could prevent major mobility disability (MMD) in sedentary older adults.METHODS: We review the development and selected findings of the LIFE studies from 2000 through 2019, including the planning phase, the LIFE-Pilot Study, and the LIFE Study.RESULTS: The planning phase and the LIFE-Pilot provided key information for the successful implementation of the LIFE Study. The LIFE Study, involving 1635 participants randomized at eight sites throughout the United States, showed that compared with health education, the physical activity program reduced the risk of the primary outcome of MMD (inability to walk 400m: hazard ratio = 0.82; 95% confidence interval = 0.69-0.98; P = .03), and that the intervention was cost-effective. There were no significant effects on cognitive outcomes, cardiovascular events, or serious fall injuries. In addition, the LIFE studies provided relevant findings on a broad range of other outcomes, including health, frailty, behavioral outcomes, biomarkers, and imaging. To date, the LIFE studies have generated a legacy of 109 peer-reviewed publications, 19 ancillary studies, and 38 independently funded grants and clinical trials, and advanced the development of 59 early career scientists. Data and biological samples of the LIFE Study are now publicly available from a repository sponsored by the National Institute on Aging (https://agingresearchbiobank.nia.nih.gov).CONCLUSIONS: The LIFE studies generated a wealth of important scientific findings and accelerated research in geriatrics and gerontology, benefiting the research community, trainees, clinicians, policy makers, and the general public.

  View details for DOI 10.1111/jgs.16365

  View details for PubMedID 32105353

• Toward an open mechanistic science of behavior change. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Hekler, E. n., King, A. C. 2020; 39 (9): 841–45

  Abstract

  The Science of Behavior Change Network (SOBC) offers a pragmatic "experimental medicine" approach for advancing mechanisms of change regarding behavior. The key promise of the SOBC is to facilitate more effective knowledge accumulation about not only whether behavior change occurs in response to an intervention, but also how and why behavior change occurs. This work is being advanced during a time of rapid evolution on scientific best practices, particularly "open science" practices, which at their core, seek to increase the trustworthiness of science. The purpose of this commentary is to facilitate a broader discussion on opportunities and challenges involved with conducting mechanistic science related to behavior change (i.e., SOBC) via open science practices. The 10 studies published in this special issue highlight the considerable complexity involved in a mechanistic science of behavior change. Conducting this type of science will require a rich, multifaceted "team science" approach that can match that level of complexity, while constantly striving toward being as straightforward or as simple as possible, no simpler. Effective open science practices, which involve the sharing of resources whenever possible, can facilitate this type of team science. Moving to this new future would benefit from careful shifts in our scientific culture and financial models toward better supporting team and open science. In addition, there is also need for continued advancements in methods and infrastructure that can support the inherent complexities involved in advancing a mechanistic science of behavior change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

  View details for DOI 10.1037/hea0000924

  View details for PubMedID 32833485

• A systematic review of physical activity and quality of life and well-being. Translational behavioral medicine Marquez, D. X., Aguiñaga, S. n., Vásquez, P. M., Conroy, D. E., Erickson, K. I., Hillman, C. n., Stillman, C. M., Ballard, R. M., Sheppard, B. B., Petruzzello, S. J., King, A. C., Powell, K. E. 2020; 10 (5): 1098–1109

  Abstract

  Maintaining or improving quality of life (QoL) and well-being is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials [RCTs]) demonstrated that, for adults aged 18-65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson's disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.

  View details for DOI 10.1093/tbm/ibz198

  View details for PubMedID 33044541

• Corrigendum to: Exploring University Age-Friendliness Using Collaborative Citizen Science. The Gerontologist Chesser, S. A., Porter, M. M., Barclay, R. n., King, A. C., Menec, V. H., Ripat, J. n., Sibley, K. M., Sylvestre, G. M., Webber, S. C. 2020

  View details for DOI 10.1093/geront/gnaa124

  View details for PubMedID 32945336

• Exploring University Age-Friendliness Using Collaborative Citizen Science. The Gerontologist Chesser, S. A., Porter, M. M., Barclay, R. n., King, A. C., Menec, V. H., Ripat, J. n., Sibley, K. M., Sylvestre, G. M., Webber, S. C. 2020; 60 (8): 1527–37

  Abstract

  Since the launch of Dublin City University's Age-Friendly University (AFU) Initiative in 2012, relatively little empirical research has been published on its feasibility or implementation by institutions of higher learning. This article describes how collaborative citizen science-a research method where professional researchers and community members work together across multiple stages of the research process (e.g., data collection, analysis, and/or knowledge mobilization) to investigate an issue-was used to identify barriers and supports to university age-friendliness at the University of Manitoba (UofM) in Canada.Ten citizen scientists each completed 1 data collection walk around the UofM campus and used a tablet application to document AFU barriers and supports via photographs and accompanying audio commentaries. The citizen scientists and university researchers then worked together in 2 analysis sessions to identify AFU priority areas and brainstorm recommendations for institutional change. These were then presented to a group of interested university stakeholders.The citizen scientists collected 157 photos documenting AFU barriers and supports on campus. Accessibility, signage, and transportation were identified as being the most pressing issues for the university to address to improve overall age-friendliness.We suggest that academic institutions looking to complete assessments of their age-friendliness, particularly those exploring physical barriers and supports, could benefit from incorporating older citizen scientists into the process of collecting, analyzing, and mobilizing findings.

  View details for DOI 10.1093/geront/gnaa026

  View details for PubMedID 32277697

• Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability. Journal of the American Geriatrics Society Glynn, N. W., Gmelin, T., Santanasto, A. J., Lovato, L. C., Lange-Maia, B. S., Nicklas, B. J., Fielding, R. A., Manini, T. M., Myers, V. H., de Rekeneire, N., Spring, B. J., Pahor, M., King, A. C., Rejeski, W. J., Newman, A. B., Lifestyle Interventions and Independence for Elders Study Group, Pahor, M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Manini, T. M., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Rejeski, W. J., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Chen, S., Pierce, J. J., Chen, H., Hadley, E. C., Romashkan, S., Patel, K. V., Bethesda, Bonds, D., McDermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M. N., McGucken, A. P., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kirn, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Manini, T. M., Pahor, M., Anton, S. D., Buford, T. W., Marsiske, M., Nayfield, S. G., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M. P., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Glynn, N. W., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Sink, K. M., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Gill, T. M., Hankinson, J. L., Vaz Fragoso, C. A., Groessl, E. J., Kaplan, R. M. 2019

  Abstract

  OBJECTIVES: Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study.DESIGN: Prospective cohort of individuals aged 65years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6years.SETTING: LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD.PARTICIPANTS: Study participants (N=1591) at baseline were 78.9±5.2years of age, with low PA and at risk for mobility impairment.MEASUREMENTS: Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher=more fatigue (N=856) and lower than 2=less fatigue (N=735). Participants performed a usual-paced 400-m walk every 6months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates.RESULTS: Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD=.71; 95% confidence interval [CI] =.57-.90; P=.004) and PMMD (HR=.60; 95% CI=.44-.82; P=.001). For those with lower baseline fatigue, no group differences in MMD (P=.36) or PMMD (P=.82) were found. Results of baseline fatigue by intervention interaction was MMD (P=.18) and PMMD (P=.05).CONCLUSION: A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue.

  View details for DOI 10.1111/jgs.16274

  View details for PubMedID 31867713

• Association of Fish Oil and Physical Activity on Mobility Disability in Older Adults. Medicine and science in sports and exercise Balachandran, A., Gundermann, D. M., Walkup, M. P., King, A. C., Ambrosius, W. T., Kritchevsky, S. B., Pahor, M., Newman, A. B., Manini, T. M. 2019

  Abstract

  PURPOSE: To examine whether long-term fish oil (FO) supplementation is associated with a lower risk of mobility disability and enhances benefits of physical activity.METHODS: 1635 sedentary adults aged 70 to 89 years from the Lifestyle Interventions and Independence for Elders (LIFE) single-blinded randomized, multi-center clinical trial, which compared a structured physical activity (PA) program to a health education (HE) program. Primary outcome was incident major mobility disability (MMD), defined by loss of ability to walk 400m, measured every 6 months for an average of 2.6 years. Secondary outcomes included persistent mobility disability (PMD), Short Physical Performance Battery (SPPB), 400m walk speed, and grip strength.RESULTS: A third of participants reported using FO at baseline (456, 28%; mean age, 78.5 years; 70.5% women). MMD was experienced by 131 participants (28.7%) in the FO group and 405 (34.4%) participants in the nonuser group. After adjusting for confounders, FO supplementation was associated with a lower risk (hazard ratio [HR], 0.78; 95% CI, 0.64-0.96) of incident MMD. However, there was no interaction (P= .19) between FO supplementation and PA intervention for MMD. For the secondary outcome of PMD, the intervention association differed by supplementation (P= .002) with PA intervention associations of (HR, 1.36; 95% CI, 0.83-2.23) for users and (HR, 0.61; 95% CI, 0.46-0.81) for nonusers. Changes in physical performance outcomes were not modified by baseline FO supplementation or combination with PA.CONCLUSIONS: FO supplementation was associated with a lower risk of major mobility disability in low to moderate functioning older adults. However, supplementation did not enhance the benefit of physical activity on risk of mobility disability. These results are hypothesis generating and need to be confirmed in randomized trials.

  View details for DOI 10.1249/MSS.0000000000002195

  View details for PubMedID 31688650

• Characteristics of mental health trials registered in ClinicalTrials.gov. Psychiatry research Arnow, K. D., King, A. C., Wagner, T. H. 2019; 281: 112552

  Abstract

  The ClinicalTrials.gov registry was established in 2000 to address concerns about publication bias and public access to information about clinical trials. We aimed to evaluate differences between for-profit and non-profit sponsors of efficacy mental health trials registered in ClinicalTrials.gov on key trial characteristics that relate to data integrity. We also sought to evaluate whether the registry is fulfilling its purpose as a means of promoting transparency between researchers and the public by providing complete and quality information about the trials it contains. We found that trials tend to be small, use a placebo instead of an active comparator, and employ randomization and blinding. We discuss the implications of these design characteristics and the limitations of the registry.

  View details for DOI 10.1016/j.psychres.2019.112552

  View details for PubMedID 31627072

• Best practices for analyzing large-scale health data from wearables and smartphone apps NPJ DIGITAL MEDICINE Hicks, J. L., Althoff, T., Sosic, R., Kuhar, P., Bostjancic, B., King, A. C., Leskovec, J., Delp, S. L. 2019; 2

  View details for DOI 10.1038/s41746-019-0121-1

  View details for Web of Science ID 000470039200002

• Best practices for analyzing large-scale health data from wearables and smartphone apps. NPJ digital medicine Hicks, J. L., Althoff, T., Sosic, R., Kuhar, P., Bostjancic, B., King, A. C., Leskovec, J., Delp, S. L. 2019; 2: 45

  Abstract

  Smartphone apps and wearable devices for tracking physical activity and other health behaviors have become popular in recent years and provide a largely untapped source of data about health behaviors in the free-living environment. The data are large in scale, collected at low cost in the "wild", and often recorded in an automatic fashion, providing a powerful complement to traditional surveillance studies and controlled trials. These data are helping to reveal, for example, new insights about environmental and social influences on physical activity. The observational nature of the datasets and collection via commercial devices and apps pose challenges, however, including the potential for measurement, population, and/or selection bias, as well as missing data. In this article, we review insights gleaned from these datasets and propose best practices for addressing the limitations of large-scale data from apps and wearables. Our goal is to enable researchers to effectively harness the data from smartphone apps and wearable devices to better understand what drives physical activity and other health behaviors.

  View details for DOI 10.1038/s41746-019-0121-1

  View details for PubMedID 31304391

  View details for PubMedCentralID PMC6550237

• Understanding Where We Are Well: Neighborhood-Level Social and Environmental Correlates of Well-Being in the Stanford Well for Life Study. International journal of environmental research and public health Chrisinger, B. W., Gustafson, J. A., King, A. C., Winter, S. J. 2019; 16 (10)

  Abstract

  Individual well-being is a complex concept that varies among and between individuals and is impacted by individual, interpersonal, community, organizational, policy and environmental factors. This research explored associations between select environmental characteristics measured at the ZIP code level and individual well-being. Participants (n = 3288, mean age = 41.4 years, 71.0% female, 57.9% white) were drawn from a registry of individuals who completed the Stanford WELL for Life Scale (SWLS), a 76-question online survey that asks about 10 domains of well-being: social connectedness, lifestyle and daily practices, physical health, stress and resilience, emotional and mental health, purpose and meaning, sense of self, financial security and satisfaction, spirituality and religiosity, and exploration and creativity. Based on a nationally-representative 2018 study of associations between an independent well-being measure and county-level characteristics, we selected twelve identical or analogous neighborhood (ZIP-code level) indicators to test against the SWLS measure and its ten constituent domains. Data were collected from secondary sources to describe socio-economic (median household income, percent unemployment, percent child poverty), demographic (race/ethnicity), and physical environment (commute by bicycle and public transit), and healthcare (number of healthcare facilities, percent mammogram screenings, percent preventable hospital stays). All continuous neighborhood factors were re-classified into quantile groups. Linear mixed models were fit to assess relationships between each neighborhood measure and each of the ten domains of well-being, as well as the overall SWLS well-being measure, and were adjusted for spatial autocorrelation and individual-level covariates. In models exploring associations between the overall SWLS score and neighborhood characteristics, six of the twelve neighborhood factors exhibited significant differences between quantile groups (p < 0.05). All of the ten SWLS domains had at least one instance of significant (p < 0.05) variation across quantile groups for a neighborhood factor; stress and resilience, emotional and mental health, and financial security had the greatest number of significant associations (6/12 factors), followed by physical health (5/12 factors) and social connectedness (4/12 factors). All but one of the neighborhood factors (number of Federally Qualified Health Centers) showed at least one significant association with a well-being domain. Among the neighborhood factors with the most associations with well-being domains were rate of preventable hospital stays (7/10 domains), percent holding bachelor's degrees (6/10 domains), and median income and percent with less than high school completion (5/10 domains). These observational insights suggest that neighborhood factors are associated with individuals' overall self-rated well-being, though variation exists among its constituent domains. Further research that employs such multi-dimensional measures of well-being is needed to determine targets for intervention at the neighborhood level that may improve well-being at both the individual and, ultimately, neighborhood levels.

  View details for DOI 10.3390/ijerph16101786

  View details for PubMedID 31137589

• Cognitive Function as a Predictor of Major Mobility Disability in Older Adults: Results From the LIFE Study INNOVATION IN AGING Handing, E. P., Chen, H., Rejeski, W., Rosso, A. L., Balachandran, A. T., King, A. C., Kritchevsky, S. B. 2019; 3 (2)

  View details for DOI 10.1093/geroni/igz010

  View details for Web of Science ID 000486953700002

• How Well Do Seniors Estimate Distance to Food? The Accuracy of Older Adults' Reported Proximity to Local Grocery Stores GERIATRICS Chrisinger, B. W., King, A. C., Hua, J., Saelens, B. E., Frank, L. D., Conway, T. L., Cain, K. L., Sallis, J. F. 2019; 4 (1)

  View details for DOI 10.3390/geriatrics4010011

  View details for Web of Science ID 000463998700010

• RECRUITING LATINOS INTO MOBILE-PHONE BASED TECHNOLOGY CLINICAL TRIALS Done, M., Campero, M. I., Sheats, J. L., Patel, M. L., Espinosa, P., Vuong, D. K., Blanco, I., King, A. OXFORD UNIV PRESS INC. 2019: S306

  View details for Web of Science ID 000473349400652

• WELL-BEING AND ITS CORRELATES AMONG LATINO ADULTS: WHAT REALLY MATTERS AND TO WHOM? Espinosa, P., Peng, K., Garcia, D., Campero, M. I., Winter, S. J., Heaney, C., King, A. OXFORD UNIV PRESS INC. 2019: S123

  View details for Web of Science ID 000473349400250

• PREVENTION AND MANAGEMENT OF DIABETES IN LOW-INCOME, URBAN, AND RURAL SETTINGS: GLOBAL LESSONS LEARNED Oldenburg, B., Fisher, E. B., Catley, D., Thankappan, K., King, A. OXFORD UNIV PRESS INC. 2019: S202

  View details for Web of Science ID 000473349400437

• GOING GLOBAL: WHAT YOU ALWAYS WANTED TO KNOW ABOUT DEVELOPING A CAREER IN GLOBAL BEHAVIORAL MEDICINE BUT WERE AFRAID TO ASK? Oldenburg, B., Sallis, J., King, A., Gbenga, O. OXFORD UNIV PRESS INC. 2019: S4

  View details for Web of Science ID 000473349400009

• A Case for Promoting Movement Medicine: Preventing Disability in the LIFE Randomized Controlled Trial. The journals of gerontology. Series A, Biological sciences and medical sciences Fanning, J., Rejeski, W. J., Chen, S., Nicklas, B. J., Walkup, M. P., Axtell, R. S., Fielding, R. A., Glynn, N. W., King, A. C., Manini, T. M., McDermott, M. M., Newman, A. B., Pahor, M., Tudor-Locke, C., Miller, M. E., LIFE Study Investigators 2019

  Abstract

  BACKGROUND: The movement profile of older adults with compromised function is unknown, as is the relationship between these profiles and the development of major mobility disability (MMD)-a critical clinical outcome. We first describe the dimensions of movement in older adults with compromised function and then examine whether these dimensions predict the onset of MMD.METHODS: Older adults at risk for MMD (N=1,022, mean age=78.7) were randomized to receive a structured physical activity (PA) intervention or health education control (HE). We assessed MMD in 6-month intervals (average follow-up of 2.2 years until incident MMD), with activity assessed at baseline, 6-, 12- and 24-month follow-up via accelerometry.RESULTS: A principal components analysis of 11 accelerometer-derived metrics yielded three components representing lifestyle movement (LM), extended bouts of moderate to vigorous physical activity (MVPA), and stationary body posture. LM accounted for the greatest proportion of variance in movement (53%). Within HE, both baseline LM (HR=0.74; 95% CI 0.62-0.88) and MVPA (HR=0.69; 95% CI 0.54-0.87) were associated with MMD, while only LM was associated with MMD within PA (HR=0.74; 95% CI 0.61-0.89). There were similar non-linear relationships present for LM in both PA and HE (p < .04), whereby risk for MMD was lower among individuals with higher levels of LM.CONCLUSIONS: Both LM and MVPA should be central in treatment regimens for older adults at risk for MMD.

  View details for DOI 10.1093/gerona/glz050

  View details for PubMedID 30778518

• Co-producing active lifestyles as whole-system-approach: theory, intervention and knowledge-to-action implications. Health promotion international Rutten, A., Frahsa, A., Abel, T., Bergmann, M., de Leeuw, E., Hunter, D., Jansen, M., King, A., Potvin, L. 2019; 34 (1): 47–59

  Abstract

  Population health interventions tend to lack links to the emerging discourse on interactive knowledge production and exchange. This situation may limit both a better understanding of mechanisms that impact health lifestyles and the development of strategies for population level change. This paper introduces an integrated approach based on structure-agency theory in the context of 'social practice'. It investigates the mechanisms of co-production of active lifestyles by population groups, professionals, policymakers and researchers. It combines a whole system approach with an interactive knowledge-to-action strategy for developing and implementing active lifestyle interventions. A system model is outlined to describe and explain how social practices of selected groups co-produce active lifestyles. Four intervention models for promoting the co-production of active lifestyles through an interactive-knowledge-to-action approach are discussed. Examples from case studies of the German research network Capital4Health are used to illustrate, how intervention models might be operationalized in a real-world intervention. Five subprojects develop, implement and evaluate interventions across the life-course. Although subprojects differ with regard to settings and population groups involved, they all focus on the four key components of the system model. The paper contributes new strategies to address the intervention research challenge of sustainable change of inactive lifestyles. The interactive approach presented allows consideration of the specificities of settings and scientific contexts for manifold purposes. Further research remains needed on what a co-produced knowledge-to-action agenda would look like and what impact it might have for whole system change.

  View details for PubMedID 28973298

• Effect of Hospitalizations on Physical Activity Patterns in Mobility-Limited Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Wanigatunga, A. A., Gill, T. M., Marsh, A. P., Hsu, F., Yaghjyan, L., Woods, A. J., Glynn, N. W., King, A. C., Newton, R. L., Fielding, R. A., Pahor, M., Manini, T. M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Rejeski, W., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Hadley, E. C., Romashkan, S., Patel, K., Bonds, D., McDermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M., McGucken, A., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kirn, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Marsiske, M., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Hankinson, J. L., Fragoso, C., Groessl, E. J., Kaplan, R. M., Lifestyles Intervention Independen 2019; 67 (2): 261–68

  View details for DOI 10.1111/jgs.15631

  View details for Web of Science ID 000459714900011

• Co-producing active lifestyles as whole-system-approach: theory, intervention and knowledge-to-action implications HEALTH PROMOTION INTERNATIONAL Ruetten, A., Frahsa, A., Abel, T., Bergmann, M., de Leeuw, E., Hunter, D., Jansen, M., King, A., Potvin, L. 2019; 34 (1): 47–59

  View details for DOI 10.1093/heapro/dax053

  View details for Web of Science ID 000462578100006

• A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial BMC PUBLIC HEALTH Beck, A. M., Eyler, A. A., Hipp, J., King, A. C., Tabak, R. G., Yan, Y., Reis, R. S., Duncan, D. D., Gilbert, A. S., Serrano, N. H., Brownson, R. C. 2019; 19

  View details for DOI 10.1186/s12889-019-6443-8

  View details for Web of Science ID 000457268000002

• A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial. BMC public health Beck, A. M., Eyler, A. A., Aaron Hipp, J., King, A. C., Tabak, R. G., Yan, Y., Reis, R. S., Duncan, D. D., Gilbert, A. S., Serrano, N. H., Brownson, R. C. 2019; 19 (1): 126

  Abstract

  BACKGROUND: Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents.METHODS/DESIGN: Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n=600) along with 6 control communities (n=600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments.DISCUSSION: This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations.TRIAL REGISTRATION: Clinical Trials NCT03683173 , September 25, 2018.

  View details for PubMedID 30700262

• Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability. American journal of preventive medicine Groessl, E. J., Kaplan, R. M., Rejeski, W. J., Katula, J. A., Glynn, N. W., King, A. C., Anton, S. D., Walkup, M., Lu, C., Reid, K., Spring, B., Pahor, M. 2019; 56 (1): 141–46

  Abstract

  INTRODUCTION: Older adults are a rapidly growing segment of the U.S.POPULATION: Mobility problems that lead to further disability can be addressed through physical activity interventions. Quality of life outcome results are reported from a large trial of physical activity for sedentary older adults at risk for mobility disability.METHODS: Data were from the Lifestyle Interventions and Independence for Elders study. This multisite RCT compared physical activity to health education among 1,635 randomly assigned sedentary older adults at risk for mobility disability in 2010-2011. Measures included demographics; comorbidity; a timed 400-meter walk; the Short Physical Performance Battery; and the Quality of Well-Being Scale (0-1.0 scale). Baseline and long-term follow-up (2.6 years) health-related quality of life data were collected as a secondary outcome. Multivariate linear regression modeling was used to examine covariates of health-related quality of life over time in 2017.RESULTS: The sample had an overall mean Quality of Well-Being score of 0.613. Both groups declined in quality of life over time, but assignment to the physical activity intervention resulted in a slower decline in health-related quality of life scores (p=0.03). Intervention attendance was associated with higher health-related quality of life for both groups. Baseline characteristics including younger age, fewer comorbid conditions, non-white ethnicity, and faster 400-meter walk times were also associated with higher health-related quality of life over time.CONCLUSIONS: Declining mobility measured by physical performance is associated with lower quality of life in sedentary older adults. Physical activity interventions can slow the decline in quality of life, and targeting specific subgroups may enhance the effects of such interventions.

  View details for PubMedID 30573142

• Original research Socio-demographic patterning of self-reported physical activity and sitting time in Latin American countries: findings from ELANS. BMC public health Luis de Moraes Ferrari, G. n., Kovalskys, I. n., Fisberg, M. n., Gómez, G. n., Rigotti, A. n., Sanabria, L. Y., García, M. C., Torres, R. G., Herrera-Cuenca, M. n., Zimberg, I. Z., Guajardo, V. n., Pratt, M. n., King, A. C., Solé, D. n. 2019; 19 (1): 1723

  Abstract

  Low levels of physical activity (PA) and prolonged sitting time (ST) increase the risk of non-communicable diseases and mortality, and can be influenced by socio-demographic characteristics. The aim of this study was to use self-report data to characterise socio-demographic patterns of PA and ST in eight Latin American countries.Data were obtained from the Latin American Study of Nutrition and Health (ELANS), a household population-based, multi-national, cross-sectional survey (n = 9218, aged 15-65 years), collected from September 2014 to February 2015. Transport and leisure PA and ST were assessed using the International Physical Activity Questionnaire-long version. Overall and country-specific mean and median levels of time spent in transport and leisure PA and ST were compared by sex, age, socioeconomic and education level.Mean levels of transport and leisure PA were 220.3 min/week (ranging from 177.6 min/week in Venezuela to 275.3 min/week in Costa Rica) and 316.4 min/week (ranging from 272.1 min/week in Peru to 401.4 min/week in Ecuador). Transport and leisure PA were higher (p < 0.005) in men than women with mean differences of 58.0 and 34.0 min/week. The mean and median for transport PA were similar across age groups (15-29 years: mean 215.5 and median 120 min/week; 30-59 years: mean 225.0 and median 120 min/week; ≥60 years: mean 212.0 and median 120 min/week). The median time spent in transport and leisure PA between three strata of socioeconomic and education levels were similar. The prevalence of not meeting PA recommendations were 69.9% (95% CI: 68.9-70.8) for transport and 72.8% (95% CI: 72.0-73.7) for leisure. Men, younger people (15-29 years), individuals with higher socioeconomic and education levels spent significantly (p < 0.001) more time sitting than women, older people (30-59 years and ≥ 60 years) and those in the middle and low socioeconomic and education groups, respectively.Transport and leisure PA and ST range widely by country, sex, and age group in Latin America. Programs for promoting leisure and transport PA and reducing ST in Latin America should consider these differences by age and gender and between countries.ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

  View details for DOI 10.1186/s12889-019-8048-7

  View details for PubMedID 31870408

• Baseline Psychosocial and Demographic Factors Associated with Study Attrition and 12‐Month Weight Gain in the DIETFITS Trial Obesity Fielding-Singh, P., Patel, M., King, A., Gardner, C. 2019

  View details for DOI 10.1002/oby.22650

• Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability AMERICAN JOURNAL OF PREVENTIVE MEDICINE Groessl, E. J., Kaplan, R. M., Rejeski, W., Katula, J. A., Glynn, N. W., King, A. C., Anton, S. D., Walkup, M., Lu, C., Reid, K., Spring, B., Pahor, M. 2019; 56 (1): 141–46

  View details for DOI 10.1016/j.amepre.2018.09.006

  View details for Web of Science ID 000453383700020

• High-Intensity Interval Training for Cardiometabolic Disease Prevention. Medicine and science in sports and exercise Campbell, W. W., Kraus, W. E., Powell, K. E., Haskell, W. L., Janz, K. F., Jakicic, J. M., Troiano, R. P., Sprow, K. n., Torres, A. n., Piercy, K. L., Bartlett, D. B. 2019; 51 (6): 1220–26

  Abstract

  The 2018 Physical Activity Guidelines Advisory Committee systematically searched existing literature reviews to assess the relationship between high-intensity interval training (HIIT) and reduction in cardiometabolic disease risk.Duplicate independent screenings of 260 articles identified from PubMed®, Cochrane Library, and CINAHL databases yielded suitable data from one systematic review and two meta-analyses. Search terms included a combination of "high intensity" "physical activity/exercise" and "interval training" and outcome-specific terms. The quality of the included reviews was assessed using a tailored version of the AMSTARExBP report on quality. Exposure Subcommittee members graded scientific evidence strength based on a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable.Moderate evidence indicates that HIIT can improve insulin sensitivity, blood pressure, and body composition in adults with group mean ages ranging from ~20 to ~77 yr. These HIIT-induced improvements in cardiometabolic disease risk factors are comparable with those resulting from moderate-intensity continuous training, and they are more likely to occur in adults at higher risk of cardiovascular disease and diabetes than in healthy adults. Moderate evidence also indicates that adults with overweight or obesity classification are more responsive than adults with normal weight to HIIT-related improvements in insulin sensitivity, blood pressure, and body composition. Insufficient evidence was available to determine whether a dose-response relationship exists between the quantity of HIIT performed and several risk factors for cardiovascular disease and diabetes, or whether the effects of HIIT on cardiometabolic disease risk factors are influenced by age, sex, race/ethnicity, or socioeconomic status.HIIT by adults, especially those with overweight and obesity classification, can improve insulin sensitivity, blood pressure, and body composition, comparable with those resulting from moderate-intensity continuous training.

  View details for DOI 10.1249/MSS.0000000000001934

  View details for PubMedID 31095079

• Physical Activity, All-Cause and Cardiovascular Mortality, and Cardiovascular Disease. Medicine and science in sports and exercise Kraus, W. E., Powell, K. E., Haskell, W. L., Janz, K. F., Campbell, W. W., Jakicic, J. M., Troiano, R. P., Sprow, K. n., Torres, A. n., Piercy, K. L. 2019; 51 (6): 1270–81

  Abstract

  Conduct a systematic umbrella review to evaluate the relationship of physical activity (PA) with all-cause mortality, cardiovascular mortality, and incident cardiovascular disease (CVD); to evaluate the shape of the dose-response relationships; and to evaluate these relationships relative to the 2008 Physical Activity Guidelines Advisory Committee Report.Primary search encompassing 2006 to March, 2018 for existing systematic reviews, meta-analyses, and pooled analyses reporting on these relationships. Graded the strength of evidence using a matrix developed for the Physical Activity Guidelines Advisory Committee.The association of self-reported moderate-to-vigorous physical activity (MVPA) on all-cause mortality, CVD mortality, and atherosclerotic CVD-including incident coronary heart disease, ischemic stroke and heart failure-are very similar. Increasing MVPA to guidelines amounts in the inactive US population has the potential to have an important and substantial positive impact on these outcomes in the adult population. The following points are clear: the associations of PA with beneficial health outcomes begin when adopting very modest (one-third of guidelines) amounts; any MVPA is better than none; meeting the 2008 PA guidelines reduces mortality and CVD risk to about 75% of the maximal benefit obtained by physical activity alone; PA amounts beyond guidelines recommendations amount reduces risk even more, but greater amounts of PA are required to obtain smaller health benefits; and there is no evidence of excess risk over the maximal effect observed at about three to five times the amounts associated with current guidelines. When PA is quantified in terms of energy expenditure (MET·h·wk), these relationships hold for walking, running, and biking.To avoid the risks associated with premature mortality and the development of ischemic heart disease, ischemic stroke, and all-cause heart failure, all adults should strive to reach the 2008 Physical Activity Guidelines for Americans.

  View details for DOI 10.1249/MSS.0000000000001939

  View details for PubMedID 31095084

• Cognitive Function as a Predictor of Major Mobility Disability in Older Adults: Results From the LIFE Study. Innovation in aging Handing, E. P., Chen, H. n., Rejeski, W. J., Rosso, A. L., Balachandran, A. T., King, A. C., Kritchevsky, S. B. 2019; 3 (2): igz010

  Abstract

  Many cross-sectional studies have confirmed a link between gait speed and cognitive function. However, it is unknown whether cognitive function plays a role in the onset of major mobility disability (MMD) and if the effects are independent of physical function. This study examined cognitive and physical function as predictors of MMD across an average of 2.6 years of follow-up in community-dwelling older adults with compromised mobility.Data were collected from 1,635 participants in the Lifestyle Interventions and Independence for Elders (LIFE) study ages 70-89 years free of MMD at baseline. MMD was assessed every 6 months and defined as the inability to walk 400 m in ≤15 min without assistance or sitting. Cognitive function was assessed at baseline, 18 months, and 24 months using a cognitive battery categorized into four domains: global cognitive function, processing speed, verbal memory, and executive function.Across the study duration of 2.6 years, 536 participants (32.8%) developed MMD. Cox Proportional Hazard models indicated a protective relationship for higher baseline processing speed (Hazard Ratio [HR] per standard deviation: 0.86, p = .006), executive function (HR: 0.86, p = .002), and global cognition (HR: 0.85, p = .001) on incidence of MMD adjusted for demographics, intervention, and comorbidities. Results were not significant after adjustment for gait speed. In adjusted longitudinal models, a positive change in processing speed was significantly associated with reduced risk of MMD (HR: 0.52, p < .001) while other domains were not.In the LIFE study, processing speed at baseline and follow-up was a significant predictor of subsequent MMD although the observed association may be explained by physical function as reflected in gait speed. More studies are needed to understand how cognitive function, alone and in combination with physical function, influences risk of MMD.

  View details for PubMedID 31065597

• Neural correlates of perceived physical and mental fatigability in older adults: A pilot study EXPERIMENTAL GERONTOLOGY Wasson, E., Rosso, A. L., Santanasto, A. J., Rosano, C., Butters, M. A., Rejeski, W., Boudreau, R. M., Aizenstein, H., Gmelin, T., Glynn, N. W., Pahor, M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Manini, T. M., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Hadley, E. C., Romashkan, S., Patel, K., Bonds, D., Mcdermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M., McGucken, A., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kim, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Marsiske, M., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Hankinson, J. L., Fragoso, C., Groessl, E. J., Kaplan, R. M., LIFE Study Grp 2019; 115: 139–47

  Abstract

  This pilot work examined associations of brain grey matter volumes (GMV) with perceived fatigability in older adults to elucidate disablement mechanisms. A subsample (n = 29; age = 77.2 ± 5.5; 86% female) of participants from the Lifestyle Interventions and Independence for Elders (LIFE) Study was utilized to quantify GMV for regions of interest in the basal ganglia and limbic system normalized to intracranial volume. The Pittsburgh Fatigability Scale measured physical and mental fatigability (score 0-50; higher physical fatigability ≥ 15; higher mental fatigability ≥ 13). We used an exploratory alpha level of p < 0.1. Nineteen (66%) participants had higher physical fatigability, 19 (66%) had higher mental fatigability, of these, 17 (57%) had both. Right hippocampal volumes/ICV were smaller in participants with higher verses lower physical fatigability (0.261 ± 0.039 vs. 0.273 ± 0.022, p = 0.07); associations were similar for right putamen and bilateral thalamus. Higher mental fatigability was associated with smaller right hippocampus, thalamus, and posterior cingulum and bilateral amygdala. Higher fatigability in older adults may be associated with smaller volumes of the basal ganglia and limbic system, indicating mechanisms for further exploration.

  View details for DOI 10.1016/j.exger.2018.12.003

  View details for Web of Science ID 000455223100016

  View details for PubMedID 30528639

  View details for PubMedCentralID PMC6331252

• Talking the Walk: Perceptions of Neighborhood Characteristics from Users of Open Streets Programs in Latin America and the USA JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE Zieff, S. G., Musselman, E. A., Sarmiento, O. L., Gonzalez, S. A., Aguilar-Farias, N., Winter, S. J., Hipp, J., Quijano, K., King, A. C. 2018; 95 (6): 899–912

  Abstract

  Physical inactivity is estimated to be the fourth leading cause of global mortality. Strategies to increase physical activity (PA) increasingly emphasize environmental and policy changes including the modification of neighborhood environments to promote walking and other forms of healthy activity. Open Streets (OS) initiatives, an important and growing strategy to modify neighborhood environments for PA, create temporary parks for recreational activity by closing streets to motor vehicle traffic, thereby offering health and community building benefits. We used the Stanford Neighborhood Discovery Tool (DT)-photo/voice software on a tablet-to train neighborhood residents to act as "citizen scientist" observers of the local built environment on a non-event day and during an OS initiative. The purposes of this project were as follows: (1) to assess adult residents' perceptions of neighborhood characteristics of the OS initiative in three socioeconomically diverse sites and (2) to test the DT for use in three international urban settings with OS initiatives; Bogota, Colombia; San Francisco, USA; and Temuco, Chile, among a multigenerational, multiethnic sample of adults including, for the first time, a vulnerable population of homeless adults (Bogota). Using the DT, participants walked an OS route taking photos and recording reasons for the photos, then completed a 25-item demographic/environmental observation survey and a 16-item Reflection Survey on perceived environmental changes. A total of 18 themes were reported by participants with areas of overlapping themes (e.g., Community and Social Connectedness) and areas where a single site reported a theme (e.g., Social Isolation in Older Adults). Ten of the 18 themes were identified by at least two sites including "Bike Resources" and "Services", indicating the value of programming at OS initiatives. The themes of "Festive Environment" and "Family Friendly Environment" reflect the quality of the overall environment for participants. Four themes (Community and Social Connectedness, Family Friendly Environment, PA, and Safety) were reported by all sites. Three of the four unifying themes were also ranked among the highest reported categories of "seemed better" on the Reflection Survey (Ease of Walking, Overall Safety of Neighborhood, and Friendliness of Environment), providing additional confirmation of the shared experience of social, health, and psychological benefits from OS initiatives. OS initiatives offer a global strategy for increasing neighborhood opportunities for PA and a potential site for training citizen scientists to document environmental influences on PA.

  View details for PubMedID 29948785

• Meta-analysis identifies mitochondrial DNA sequence variants associated with walking speed GEROSCIENCE Manini, T. M., Buford, T. W., Kairalla, J. A., McDermott, M. M., Fragoso, C., Fielding, R. A., Hsu, F., Johannsen, N., Kritchevsky, S., Harris, T. B., Newman, A. B., Cummings, S. R., King, A. C., Pahor, M., Santanasto, A. J., Tranah, G. J. 2018; 40 (5-6): 497-511

  View details for DOI 10.1007/s11357-018-0043-x

  View details for Web of Science ID 000453351000006

• Older Adults Using Our Voice Citizen Science to Create Change in Their Neighborhood Environment INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Tuckett, A. G., Freeman, A., Hetherington, S., Gardiner, P. A., King, A. C., Burnie Brae Citizen Scientists 2018; 15 (12)

  View details for DOI 10.3390/ijerph15122685

  View details for Web of Science ID 000456527000076

• Theory-Based Health Behavior Interventions for Pediatric Chronic Disease Management A Systeindtic Review JAMA PEDIATRICS Ng, C. Y., Thomas-Uribe, M., Yang, Y. A., Chu, M. Y., Liu, S., Pulendran, U., Lin, B., Lerner, D. S., King, A. C., Wang, C. 2018; 172 (12): 1177–86

  View details for DOI 10.1001/jamapediatrics.2018.3039

  View details for Web of Science ID 000452130600015

• Older Adults Using Our Voice Citizen Science to Create Change in Their Neighborhood Environment. International journal of environmental research and public health Tuckett, A. G., Freeman, A., Hetherington, S., Gardiner, P. A., King, A. C., Burnie Brae Citizen Scientists 2018; 15 (12)

  Abstract

  Physical activity, primarily comprised of walking in older adults, confers benefits for psychological health and mental well-being, functional status outcomes and social outcomes. In many communities, however, access to physical activity opportunities are limited, especially for older adults. This exploratory study engaged a small sample (N = 8) of adults aged 65 or older as citizen scientists to assess and then work to improve their communities. Using a uniquely designed mobile application (the Stanford Healthy Neighborhood Discovery Tool), participants recorded a total of 83 geocoded photos and audio narratives of physical environment features that served to help or hinder physical activity in and around their community center. In a facilitated process the citizen scientists then discussed, coded and synthesized their data. The citizen scientists then leveraged their findings to advocate with local decision-makers for specific community improvements to promote physical activity. These changes focused on: parks/playgrounds, footpaths, and traffic related safety/parking. Project results suggest that the Our Voice approach can be an effective strategy for the global goals of advancing rights and increasing self-determination among older adults.

  View details for PubMedID 30487444

• Effect of Hospitalizations on Physical Activity Patterns in Mobility-Limited Older Adults. Journal of the American Geriatrics Society Wanigatunga, A. A., Gill, T. M., Marsh, A. P., Hsu, F., Yaghjyan, L., Woods, A. J., Glynn, N. W., King, A. C., Newton, R. L., Fielding, R. A., Pahor, M., Manini, T. M., Lifestyles Intervention and Independence for Elders Study Investigators 2018

  Abstract

  OBJECTIVES: To evaluate the effect of hospitalizations on patterns of sedentary and physical activity time in mobility-limited older adults randomized to structured physical activity or health education.DESIGN: Secondary analysis of investigator-blinded, parallel-group, randomized trial conducted at 8 U.S. centers between February 2010 and December 2013.PARTICIPANTS: Sedentary men and women aged 70 to 89 at baseline who wore a hip-fitted accelerometer 7 consecutive days at baseline and 6, 12, and 24 months after randomization (N=1,341).MEASUREMENTS: Participants were randomized to a physical activity (PA; n = 669) intervention that included aerobic, resistance, and flexibility training or to a health education (HE; n = 672) intervention that consisted of workshops on older adult health and light upper-extremity stretching. Accelerometer patterns were characterized as bouts of sedentary (<100 counts/min; ≥1, ≥10, ≥30, ≥60 minute lengths) and activity (≥100 counts/min; ≥1, ≥2, ≥5, ≥10 minute lengths) time. Each participant was categorized as having 0, 1 to 3, or 4 or more cumulative hospital days before each accelerometer assessment.RESULTS: Hospitalization increased sedentary time similarly in both intervention groups (8 min/d for 1-3 cumulative hospital days and 16 min/d for ≥4 cumulative hospital days). Hospitalization was also associated with less physical activity time across all bouts of less than 10 minutes (≥1: -7 min/d for 1-3 cumulative hospital days, -16 min/d for ≥4 cumulative hospital days; ≥2: -5 min/d for 1-3 cumulative hospital days, -11 min/d for ≥4 cumulative hospital days; ≥5: -3 min/d for 1-3 cumulative hospital days, -4 min/d for ≥4 cumulative hospital days). There was no evidence of recovery to prehospitalization levels (time effect p >.41). PA participants had less sedentary time in bouts of less than 30 minutes than HE participants (-8 to -10 min/d) and more total activity (+3 to +6 min/d), although hospital-related changes were similar between the intervention groups (interaction effect p >.26).CONCLUSION: Participating in a PA intervention before hospitalization had expected benefits, but participants remained susceptible to hospitalization's detrimental effects on their daily activity levels. There was no evidence of better activity recovery after hospitalization.

  View details for PubMedID 30452084

• Community-Based Activity and Sedentary Patterns Are Associated With Cognitive Performance in Mobility-Limited Older Adults FRONTIERS IN AGING NEUROSCIENCE Wanigatunga, A. A., Manini, T. M., Cook, D. R., Katula, J., Fielding, R. A., Kramer, A. F., Verghese, J., Rapp, S. R., Sink, K. M., King, A. C., Buford, T. W., Anton, S., Nadkarni, N., Jennings, J. M., Reid, K., Espeland, M. A., Gill, T. M., Pahor, M., Nocera, J. R. 2018; 10

  View details for DOI 10.3389/fnagi.2018.00341

  View details for Web of Science ID 000450246900001

• Community-Based Activity and Sedentary Patterns Are Associated With Cognitive Performance in Mobility-Limited Older Adults. Frontiers in aging neuroscience Wanigatunga, A. A., Manini, T. M., Cook, D. R., Katula, J., Fielding, R. A., Kramer, A. F., Verghese, J., Rapp, S. R., Sink, K. M., King, A. C., Buford, T. W., Anton, S., Nadkarni, N., Jennings, J. M., Reid, K., Espeland, M. A., Gill, T. M., Pahor, M., Nocera, J. R. 2018; 10: 341

  Abstract

  Over the last few decades, considerable evidence shows that greater levels of aerobic exercise and cardiovascular fitness benefit cognitive performance. However, the degree to which free-living activity in community settings is related to cognitive performance remains unclear, particularly in older adults vulnerable to disability. Also, it is unknown whether the manner in which daily physical activity (PA) and sedentary time are accumulated throughout the day is associated with cognition. Cross-sectional associations between accelerometer-characterized PA and sedentary patterns and cognitive performance were examined in 1,274 mobility-limited older adults. Percent time spent in various bout lengths of PA (≥1, ≥2, and ≥5 min) and sedentary (≥1, ≥30, and ≥60 min) was defined as the number of minutes registered divided by total wear time × 100. Percent time was then tertiled for each bout length. Multiple linear regression models were used to estimate the associations between accelerometer bout variables and separate cognitive domains that included processing speed (Digit Symbol Coding; DSC), immediate and delayed recall (Hopkins Verbal Learning Test; HVLT), information processing and selective attention (Flanker), working memory (n-back), reaction time (switch and non-switch reaction time), and a composite score that averaged results from all cognitive tests. After adjusting for demographics, behavioral factors, and morbid conditions, more time spent in PA was associated with higher DSC for all bout lengths (p < 0.03 for all). Higher PA was associated with higher HVLT and global cognition scores but only for longer bout lengths (p < 0.05 for all). The association was largely driven by participants who spent the lowest amount of time performing activity while awake (p < 0.04). An inverse linear relationship was observed between total sedentary time and DSC (p = 0.02), but not for other measures of cognition. These results suggest that, while higher PA was associated with higher cognitive performance, PA's association with memory was sensitive to bout duration. The time, but not the manner, spent in sedentary behaviors showed a minor association with executive function. Further research is warranted to characterize longitudinal changes in daily activity and sedentary patterns as potential biophysical markers of cognitive status in older adults.

  View details for DOI 10.3389/fnagi.2018.00341

  View details for PubMedID 30498440

  View details for PubMedCentralID PMC6249499

• Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial. BMC medicine Liu, Z., Hsu, F., Trombetti, A., King, A. C., Liu, C. K., Manini, T. M., Fielding, R. A., Pahor, M., Newman, A. B., Kritchevsky, S., Gill, T. M., LIFE Study investigators 2018; 16 (1): 185

  Abstract

  BACKGROUND: Whether physical activity can reduce cognitive frailty-a relatively new "compound" phenotype proposed in 2013-and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect.METHODS: We used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single-blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini-Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1635 original randomized sedentary participants (70-89years), this study included 1298 participants with data on both cognitive frailty and IL-6 assessments at baseline.RESULTS: After adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64-0.98) of worsening cognitive frailty over 24months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction=0.919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction=0.835, 0.536, 0.934, and 0.458, respectively).CONCLUSIONS: A 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging.TRIAL REGISTRATION: Clinicaltrials.gov, NCT01072500.

  View details for PubMedID 30352583

• Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial BMC MEDICINE Liu, Z., Hsu, F., Trombetti, A., King, A. C., Liu, C. K., Manini, T. M., Fielding, R. A., Pahor, M., Newman, A. B., Kritchevsky, S., Gill, T. M., LIFE Study Investigators 2018; 16

  View details for DOI 10.1186/s12916-018-1174-8

  View details for Web of Science ID 000448124500001

• Theory-Based Health Behavior Interventions for Pediatric Chronic Disease Management: A Systematic Review. JAMA pediatrics Ng, C. Y., Thomas-Uribe, M., Yang, Y. A., Chu, M. C., Liu, S., Pulendran, U. P., Lin, B., Lerner, D. S., King, A. C., Wang, C. J. 2018

  Abstract

  Importance: Pediatric chronic conditions have become a major public health challenge, and behavioral change plays an important role in overcoming this problem. Many health behavior interventions are described as theory-based, but evidence that such programs properly use theoretical constructs is scant.Objective: To identify effective theory-based behavioral interventions that motivate patients and families to adopt better self-management behaviors for chronic disease, to review theoretical constructs from each theory and identify the common elements for action, and to rate the level of evidence for each theory-based chronic disease intervention.Evidence Review: Medline and PsycINFO electronic databases were searched for relevant randomized clinical trial articles published between January 1, 2000, and June 30, 2016, with English language and article type restrictions. These articles reported original data on children and young adults aged 21 years or younger, measured interventions for a pediatric chronic health problem, and assessed the association between interventions and health behavior, knowledge, and outcomes. The Jadad scale was used to evaluate the methods of each article. Articles that explicitly identified the theoretical basis for the intervention and scored 3 points or higher on the Jadad scale were included in the final analysis.Findings: The database search yielded a total of 36 187 articles, from which duplicates and those that did not meet the inclusion criteria were eliminated, leaving 129 studies for the full review. Of the 129 studies, 29 (22.5%) had higher Jadad scale scores of 3 or 4 points and underwent the final detailed data abstraction and qualitative synthesis. Five chronic conditions were represented, including asthma (55% [16 of 29]), type 1 diabetes (21% [6 of 29]), obesity (14% [4 of 29]), attention-deficit/hyperactivity disorder (7% [2 of 29]), and autistic spectrum disorder (3% [1 of 29]). Most studies (55% [16 of 29]) used Social Cognitive Theory as the theoretical basis for intervention. The following intervention outcomes were reported: 23 (80%) saw a positive association with health-related behaviors (eg, adherence), 8 (28%) with knowledge, 7 (24%) with attitudes, and 26 (90%) with clinical outcomes. Ten studies (34%) showed results in both health behaviors and health outcomes. Twenty-two studies (76%) demonstrated short-term effects (within 6 months), whereas 12 (41%) reported longer-term changes.Conclusions and Relevance: Identifying effective theory-based behavioral interventions can empower those who are involved in the care of children and young adults with chronic conditions.

  View details for PubMedID 30357260

• Meta-analysis identifies mitochondrial DNA sequence variants associated with walking speed. GeroScience Manini, T. M., Buford, T. W., Kairalla, J. A., McDermott, M. M., Vaz Fragoso, C. A., Fielding, R. A., Hsu, F., Johannsen, N., Kritchevsky, S., Harris, T. B., Newman, A. B., Cummings, S. R., King, A. C., Pahor, M., Santanasto, A. J., Tranah, G. J. 2018

  Abstract

  Declines in walking speed are associated with a variety of poor health outcomes including disability, comorbidity, and mortality. While genetic factors are putative contributors to variability in walking, few genetic loci have been identified for this trait. We examined the role of mitochondrial genomic variation on walking speed by sequencing the entire mitochondrial DNA (mtDNA). Data were meta-analyzed from 1758 Lifestyle Interventions and Independence for Elders (LIFE) Study and replication data from 730 Health, Aging, and Body Composition (HABC) Study participants with baseline walking speed information. Participants were 69+years old of diverse racial backgrounds (African, European, and other race/ethnic groups) and had a wide range of mean walking speeds [4-6m (0.78-1.09m/s) and 400m (0.83-1.24m/s)]. Meta-analysis across studies and racial groups showed that m.12705C>T, ND5 variant was significantly associated (p<0.0001) with walking speed at both short and long distances. Replication and meta-analysis also identified statistically significant walking speed associations (p<0.0001) between the m.5460.G>A, ND2 and m.309C>CT, HV2 variants at short and long distances, respectively. All results remained statistically significant after multiple comparisons adjustment for 499 mtDNA variants. The m.12705C>T variant can be traced to the beginnings of human global migration and that cells carrying this variant display altered tRNA expression. Significant pooled effects related to stopping during the long-distance walk test were observed across OXPHOS complexes I (p=0.0017) and III (p=0.0048). These results suggest that mtDNA-encoded variants are associated with differences in walking speed among older adults, potentially identifying those at risk of developing mobility impairments.

  View details for PubMedID 30338417

• Self-Reported Physical Function As a Predictor of Hospitalization in the Lifestyle Interventions and Independence for Elders Study. Journal of the American Geriatrics Society Callahan, K. E., Lovato, L., Miller, M. E., Marsh, A. P., Fielding, R. A., Gill, T. M., Groessl, E. J., Guralnik, J., King, A. C., Kritchevsky, S. B., McDermott, M. M., Manini, T., Newman, A. B., Rejeski, W. J. 2018; 66 (10): 1927–33

  Abstract

  OBJECTIVES: To explore whether baseline scores on the Mobility Assessment Tool-short form (MAT-sf), a brief, animated, computer-based means of assessing mobility that predicts mobility disability, are associated with number of hospitalizations and time to first hospitalization over a median follow-up of 2.7 years.DESIGN: Post hoc analysis of prospectively gathered data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a randomized clinical trial of lifestyle interventions to preserve mobility in older adults.SETTING: Eight U.S. academic medical centers.PARTICIPANTS: Of 1,635 sedentary community-dwelling older adults enrolled in LIFE, 1,574 completed baseline physical function screening including the MAT-sf, with baseline scores ranging from 30.2 (low function) to 69.8 (high function) on a scale from 30 to 80.MEASUREMENTS: Number of hospitalizations and time to first hospitalization, adjusted for age, sex, race, living alone, clinical site, baseline comorbidities, number of prescription medications, and cognition.RESULTS: Of the 1,557 participants with data regarding hospitalization status, 726 (47%) had at least 1 hospitalization; 78% of these had 1 or 2 hospitalizations. For every 10-point lower MAT-sf score, the rate of all hospitalizations was 19% higher in those with lower scores (adjusted rate ratio=1.20, 95% confidence interval (CI)=1.08-1.32, p<.001). Lower baseline MAT-sf scores were also associated with greater risk of first hospitalization (adjusted hazard ratio=1.20, 95% CI=1.09-1.32, p<.01, per 10-point lower MAT-sf score).CONCLUSION: Low MAT-sf scores identify older adults at risk of hospitalization; further study is needed to test interventions to reduce hospitalizations in these individuals.

  View details for PubMedID 30281796

• Self-Reported Physical Function As a Predictor of Hospitalization in the Lifestyle Interventions and Independence for Elders Study JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Callahan, K. E., Lovato, L., Miller, M. E., Marsh, A. P., Fielding, R. A., Gill, T. M., Groessl, E. J., Guralnik, J., King, A. C., Kritchevsky, S. B., McDermott, M. M., Manini, T., Newman, A. B., Rejeski, W. 2018; 66 (10): 1927–33

  View details for DOI 10.1111/jgs.15468

  View details for Web of Science ID 000446992000012

• Building activity-promoting environments that support health across the lifecourse through global citizen science research King, A., Banchoff, A., Winter, S., Hua, J., Dueaas, O., Dagan, A., Aguilar-Farias, N., Stathi, A. HUMAN KINETICS PUBL INC. 2018: S88

  View details for Web of Science ID 000446516100296

• Acting locally while thinking globally to promote physical activity, address inequalities and achieve population change Winter, S., Rosas, L., Buman, M., Sheats, J., Salvo, D., Garber, R., Sarmiento, O., Broderick, B., Banchoff, A., King, A. HUMAN KINETICS PUBL INC. 2018: S1–S2

  View details for Web of Science ID 000446516100004

• Employing the Our Voice citizen science model to support age- and activity-friendly communities in Chile, Brazil, Canada, England, and USA Stathi, A., Aguilar-Farias, N., Porter, M., King, D., Banchoff, A. W., Winter, S. J., King, A. C. HUMAN KINETICS PUBL INC. 2018: S1

  View details for Web of Science ID 000446516100003

• Utilising the Our Voice citizen science model to support and promote active environments at schools and universities in Colombia, New Zealand, South Africa, and the USA Hinckson, E., Schneider, M., Sarmiento, O., Lambert, E., Triana, C., Banchoff, A., Winter, S., King, A. HUMAN KINETICS PUBL INC. 2018: S1

  View details for Web of Science ID 000446516100002

• Mitochondrial DNA Sequence Variants Associated With Blood Pressure Among 2 Cohorts of Older Adults. Journal of the American Heart Association Buford, T. W., Manini, T. M., Kairalla, J. A., McDermott, M. M., Vaz Fragoso, C. A., Chen, H., Fielding, R. A., King, A. C., Newman, A. B., Tranah, G. J. 2018; 7 (18): e010009

  Abstract

  Background Age-related changes in blood pressure are associated with a variety of poor health outcomes. Genetic factors are proposed contributors to age-related increases in blood pressure, but few genetic loci have been identified. We examined the role of mitochondrial genomic variation in blood pressure by sequencing the mitochondrial genome. Methods and Results Mitochondrial DNA (mt DNA ) data from 1755 participants from the LIFE (Lifestyle Interventions and Independence for Elders) studies and 788 participants from the Health ABC (Health, Aging, and Body Composition) study were evaluated using replication analysis followed by meta-analysis. Participants were aged ≥69years, of diverse racial backgrounds, and assessed for systolic blood pressure ( SBP ), diastolic blood pressure, and mean arterial pressure. After meta-analysis across the LIFE and Health ABC studies, statistically significant associations of mt DNA variants with higher SBP (m.3197T>C, 16S rRNA ; P=0.0005) and mean arterial pressure (m.15924A>G, t-RNA-thr; P=0.004) were identified in white participants. Among black participants, statistically significant associations with higher SBP (m.93A>G, HVII ; m.16183A>C, HVI ; both P=0.0001) and mean arterial pressure (m.16172T>C, HVI ; m.16183A>C, HVI ; m.16189T>C, HVI ; m.12705C>T; all P's<0.0004) were observed. Significant pooled effects on SBP were observed across all transfer RNA regions ( P=0.0056) in white participants. The individual and aggregate variant results are statistically significant after multiple comparisons adjustment for the number of mt DNA variants and mitochondrial regions examined. Conclusions These results suggest that mt DNA -encoded variants are associated with variation in SBP and mean arterial pressure among older adults. These results may help identify mitochondrial activities to explain differences in blood pressure in older adults and generate new hypotheses surrounding mt DNA variation and the regulation of blood pressure. Clinical Trial Registration URL : http://www.ClinicalTrials.gov . Unique identifiers: NCT 01072500 and NCT 00116194.

  View details for PubMedID 30371200

• Mitochondrial DNA Sequence Variants Associated With Blood Pressure Among 2 Cohorts of Older Adults JOURNAL OF THE AMERICAN HEART ASSOCIATION Buford, T. W., Manini, T. M., Kairalla, J. A., McDermott, M. M., Fragoso, C., Chen, H., Fielding, R. A., King, A. C., Newman, A. B., Tranah, G. J. 2018; 7 (18)

  View details for DOI 10.1161/JAHA.118.010009

  View details for Web of Science ID 000452805400038

• Stress experiences in neighborhood and social environments (SENSE): a pilot study to integrate the quantified self with citizen science to improve the built environment and health INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS Chrisinger, B. W., King, A. C. 2018; 17

  View details for DOI 10.1186/s12942-018-0140-1

  View details for Web of Science ID 000434348700001

• Multicomponent mHealth Intervention for Large, Sustained Change in Multiple Diet and Activity Risk Behaviors: The Make Better Choices 2 Randomized Controlled Trial JOURNAL OF MEDICAL INTERNET RESEARCH Spring, B., Pellegrini, C., McFadden, H. G., Pfammatter, A., Stump, T. K., Siddique, J., King, A. C., Hedeker, D. 2018; 20 (6): e10528

  Abstract

  Prevalent co-occurring poor diet and physical inactivity convey chronic disease risk to the population. Large magnitude behavior change can improve behaviors to recommended levels, but multiple behavior change interventions produce small, poorly maintained effects.The Make Better Choices 2 trial tested whether a multicomponent intervention integrating mHealth, modest incentives, and remote coaching could sustainably improve diet and activity.Between 2012 and 2014, the 9-month randomized controlled trial enrolled 212 Chicago area adults with low fruit and vegetable and high saturated fat intakes, low moderate to vigorous physical activity (MVPA) and high sedentary leisure screen time. Participants were recruited by advertisements to an open-access website, screened, and randomly assigned to either of two active interventions targeting MVPA simultaneously with, or sequentially after other diet and activity targets (N=84 per intervention) or a stress and sleep contact control intervention (N=44). They used a smartphone app and accelerometer to track targeted behaviors and received personalized remote coaching from trained paraprofessionals. Perfect behavioral adherence was rewarded with an incentive of US $5 per week for 12 weeks. Diet and activity behaviors were measured at baseline, 3, 6, and 9 months; primary outcome was 9-month diet and activity composite improvement.Both simultaneous and sequential interventions produced large, sustained improvements exceeding control (P<.001), and brought all diet and activity behaviors to guideline levels. At 9 months, the interventions increased fruits and vegetables by 6.5 servings per day (95% CI 6.1-6.8), increased MVPA by 24.7 minutes per day (95% CI 20.0-29.5), decreased sedentary leisure by 170.5 minutes per day (95% CI -183.5 to -157.5), and decreased saturated fat intake by 3.6% (95% CI -4.1 to -3.1). Retention through 9-month follow-up was 82.1%. Self-monitoring decreased from 96.3% of days at baseline to 72.3% at 3 months, 63.5% at 6 months, and 54.6% at 9 months (P<.001). Neither attrition nor decline in self-monitoring differed across intervention groups.Multicomponent mHealth diet and activity intervention involving connected coaching and modest initial performance incentives holds potential to reduce chronic disease risk.ClinicalTrials.gov NCT01249989; https://clinicaltrials.gov/ct2/show/NCT01249989 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01249989).

  View details for PubMedID 29921561

• Dopamine-Related Genotypes and Physical Activity Change During an Intervention: The Lifestyle Interventions and Independence for Elders Study JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Rosso, A. L., Metti, A. L., Glynn, N. W., Boudreau, R. M., Rejeski, W., Bohnen, N., Chen, H., Johannsen, N. M., King, A. C., Manini, T. M., Pahor, M., Studenski, S. A., Fragoso, C., Rosano, C., LIFE Study Grp 2018; 66 (6): 1172–79

  Abstract

  To determine whether intervention-induced physical activity (PA) changes in sedentary older adults differed according to dopamine-related genotype.Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial (2010-13)).Multicenter study, 8 U.S.Volunteer sample of sedentary adults aged 70 to 89 at risk of disability (N=1635).Structured PA versus health education (HE) for an average of 2.6 years.Single-nucleotide polymorphisms of dopamine-related genes (dopamine receptor (DR) D1, DRD2, DRD3, and catechol-O-methyltransferase (COMT)) were assessed. Average moderate to vigorous PA (MVPA) was calculated using accelerometry (min/d) at baseline and 6, 12, and 24 months. Between-arm MVPA differences according to genotype and genotype with square root-transformed MVPA separately according to arm were tested, stratified according to race, and adjusted for multiple comparisons.White participants in the PA arm (n=513) had higher average square root transformed MVPA (4.91±1.91)than those in the HE arm (n=538) (4.51±1.82) (p=.001). Between-arm differences were greater for DRD2 Met/Met (high dopamine; HE: 4.76±1.80, PA: 5.53±1.60, p=.03) than Val/Val (low dopamine; HE: 4.58±1.92, PA: 4.81±1.83, p=.16); results were similar for COMT. In the PA arm, DRD2 Met/Met was associated with higher average MVPA (5.39±2.00) than Met/Val (4.46±2.51) (p=.01) and Val/Val (4.65±2.71) (p=.01). There were no associations for other genes. Associations were not significant in blacks but followed similar trends.Higher dopamine signaling may support changes in PA during an intervention. The role of dopamine-related pathways in promoting PA participation and enhancing response to interventions in sedentary older adults should be studied.clinicaltrials.gov Identifier: NCT01072500.

  View details for PubMedID 29637543

• Linking green space to neighborhood social capital in older adults: The role of perceived safety SOCIAL SCIENCE & MEDICINE Hong, A., Sallis, J. F., King, A. C., Conway, T. L., Saelens, B., Cain, K. L., Fox, E. H., Frank, L. D. 2018; 207: 38–45

  Abstract

  This study examines the moderating effect of perceived safety on the association of green space with neighborhood social capital in older adults. Green space may play an important role for promoting neighborhood social capital and health for older adults; however, safety remains a significant challenge in maximizing the benefits of green space. Data were drawn from 647 independent-living seniors who participated in the Senior Neighborhood Quality of Life Study in the Seattle/King County and Baltimore/Washington DC region. The results suggest that certain green space elements, such as natural sights, may be beneficial to neighborhood social capital of older adults. However, other types of green space, such as parks and street trees, may be less advantageous to older adults who perceive their neighborhoods as unsafe for pedestrians. Findings highlight the importance of pedestrian safety in examining associations of green space with neighborhood social capital in older adults. Further studies using a longitudinal design are warranted to confirm the causality of the findings.

  View details for PubMedID 29727748

• Evaluating Accelerometry Thresholds for Detecting Changes in Levels of Moderate Physical Activity and Resulting Major Mobility Disability JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Rejeski, W., Walkup, M. P., Fielding, R. A., King, A. C., Manini, T., Marsh, A. P., McDermott, M., Miller, E. Y., Newman, A. B., Tudor-Locke, C., Axtell, R. S., Miller, M. E., LIFE Study Investigators 2018; 73 (5): 660–67

  Abstract

  An important decision with accelerometry is the threshold in counts per minute (CPM) used to define moderate to vigorous physical activity (MVPA). We explore the ability of different thresholds to track changes in MVPA due to a physical activity (PA) intervention among older adults with compromised function: 760 CPM, 1,041 CPM, and an individualized threshold. We also evaluate the ability of change in accelerometry and self-reported PA to attenuate treatment effects on major mobility disability (MMD).Data from a week of hip worn accelerometers and self-reported PA data (30-day recall) were examined from baseline, 6-, 12-, and 24-months of follow-up on 1,528 older adults. Participants were randomized to either PA or Health Education (HE). MMD was objectively defined by loss of ability to walk 400 m during the follow-up.The three thresholds yielded similar and higher levels of MVPA for PA than HE (p < .001), however, this difference was significantly attenuated in participants with lower levels of physical function. Self-reported PA that captured both walking and strength training totally attenuated the intervention effect for MMD, an 18% reduction to a 3% increase. Accelerometer CPMs showed less attenuation of the intervention effect.Accelerometry assessment within the LIFE study was not sensitive to change in level in physical activity for older adults with very low levels of physical function. A combination of self-report and objective measures are recommended for use in physical activity intervention studies of the elderly; limitations of accelerometry deserve closer attention.

  View details for DOI 10.1093/gerona/glx132

  View details for Web of Science ID 000430696300014

  View details for PubMedID 28977340

  View details for PubMedCentralID PMC5905614

• Gait Speed and Mobility Disability: Revisiting Meaningful Levels in Diverse Clinical Populations JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Miller, M. E., Magaziner, J., Marsh, A. P., Fielding, R. A., Gill, T. M., King, A. C., Kritchevsky, S., Manini, T., McDermott, M. M., Neiberg, R., Orwig, D., Santanasto, A. J., Pahor, M., Guralnik, J., Rejeski, W., LIFE Investigators 2018; 66 (5): 954–61

  Abstract

  To investigate the heterogeneity of clinically meaningful levels of gait speed relative to self-reported mobility disability (SR-MD).Five longitudinal studies with older adults in different health states (onset of acute event, presence of chronic condition, sedentary, community living) were used to explore the relationship between gait speed and SR-MD.Lifestyle Interventions and Independence for Elders Pilot (LIFE-P), LIFE, Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN), Baltimore Hip Fracture Study (BHS2), Invecchiare in Chianti (InCHIANTI).Individuals aged 65 and older (N=3,540): sedentary, community dwelling (LIFE-P/LIFE), with hip fracture (BHS2), random population-based sample (InCHIANTI), high cardiovascular risk (TRAIN).Usual-pace gait speed across 3 to 4 m and SR-MD, defined as inability to walk approximately 1 block or climb 1 flight of stairs.The mean gait speed of participants without SR-MD was greater than 1.0 m/s in InCHIANTI and TRAIN, 0.79 m/s in LIFE-P/LIFE, and 0.46 m/sec in BHS2. Of individuals with SR-MD, mean gait speed was 0.08 m/s slower in LIFE-P/LIFE, 0.19 m/s slower in TRAIN, 0.22 m/s slower in BHS2, and 0.36 m/s slower in InCHIANTI. The optimal gait speed cutpoint for minimizing SR-MD misclassification rates ranged from 0.3 m/s in BHS2 to 1.0 m/s in TRAIN. In longitudinal analyses, development of SR-MD was dependent on initial gait speed and change in gait speed (p<.001).The relationship between absolute levels of gait speed and SR-MD may be context specific, and there may be variations between populations. Across diverse clinical populations, clinical interpretations of how change in usual pace gait speed relates to development of SR-MD depend on where on the gait speed continuum change occurs.

  View details for PubMedID 29608795

  View details for PubMedCentralID PMC5992037

• Maintenance of Physical Function 1 Year After Exercise Intervention in At-Risk Older Adults: Follow-up From the LIFE Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Henderson, R. M., Miller, M. E., Fielding, R. A., Gill, T. M., Glynn, N. W., Guralnik, J. M., King, A., Newman, A. B., Manini, T. M., Marsh, A. P., Pahor, M., McDermott, M. M., Rejeski, J., Tudor-Locke, C., Kritchevsky, S. B., LIFE Study Investigators 2018; 73 (5): 688–94

  Abstract

  Structured physical activity interventions delay the onset of disability for at-risk older adults. However, it is not known if at-risk older adults continue to participate in physical activity or maintain mobility benefits after cessation of structured intervention.One thousand six hundred and thirty-five sedentary men and women aged 70-89 years with Short Physical Performance Battery (SPPB) scores of 9 or less and able to walk 400 m were randomized to a structured, moderate-intensity physical activity (PA) program consisting of center-based (twice/week) and home-based (three to four times per week) aerobic, resistance, and flexibility training or a health education (HE) program combined with upper extremity stretching.Most of the participants (88% of HE and 87% of PA) returned for a follow-up visit (POST) 1 year after cessation of formal intervention. The HE group reported about 1-hour less activity per week than the PA group at end of intervention (LAST TRIAL; -68.9; 95% confidence interval [CI] = -86.5 to -51.3) but similar weekly activity at POST (-13.5; 95% CI = -29.5 to 2.47). SPPB did not differ between the two groups at LAST TRIAL (-0.06; 95% CI = -0.31 to 0.19) nor POST (-0.18; 95% CI = -0.45 to 0.088).Although sedentary at-risk older adults increased their physical activity during a structured physical activity intervention, they did not continue at this level following the cessation of intervention. Future exercise interventions need to include novel methods to support older adults in continued physical activity following structured interventions.

  View details for PubMedID 29490012

  View details for PubMedCentralID PMC5905630

• A Comparison of Self-report Indices of Major Mobility Disability to Failure on the 400-m Walk Test: The LIFE Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Chen, H., Rejeski, W., Gill, T. M., Guralnik, J., King, A. C., Newman, A., Blair, S. N., Conroy, D., Liu, C., Manini, T. M., Pahor, M., Ambrosius, W. T., Miller, M. E., LIFE Study 2018; 73 (4): 513–18

  Abstract

  The objective assessment of major mobility disability (objective MMD) by a 400-m walk test (400 MWT) is important but not always practical. Previous research on the relationship between self-reported MMD (SR MMD) and objective MMD is sparse and limited to cross-sectional data.We evaluated agreement between SR MMD and objective MMD using longitudinal data from the Lifestyle Interventions for Elders (LIFE) study. The SR MMD indices were defined based on having a lot of difficulty or inability to walk a quarter of a mile (SR-1/4MILE), walk several blocks (SR-BLOCKS), and climb one flight of stairs (SR-STAIRS).Using objective MMD as the gold standard, SR-1/4MILE and SR-BLOCKS had relatively low sensitivity (around 0.4) and high specificity (around 0.9) for prevalence. Their overall sensitivity and specificity for cumulative incident objective MMD were approximately 0.6 and 0.8, respectively. While the annual probability of staying MMD free was similar for objective MMD, SR-1/4MILE, and SR-BLOCKS (90% for all), the probability of recovering from SR MMD was higher (50%) than that of objective MMD (22%). The development of objective MMD (439 events), SR-1/4MILE (356 events), and SR-BLOCKS (379 events) had a similar trajectory over time with substantially overlapping survival curves. SR-STAIRS generally did not agree well with objective MMD. Incorporating SR-STAIRS with either SR-1/4MILE or SR-BLOCKS did not significantly improve the agreement between SR MMD and objective MMD.Simple SR-1/4MILE and SR-BLOCKS are reasonable candidates to define MMD if the primary outcome of interest is incident MMD.

  View details for PubMedID 28958023

  View details for PubMedCentralID PMC5861858

• REDUCING SEDENTARY TIME IN YOUTH, ADULTS, AND OFFICE WORKERS Buman, M. P., Napolitano, M., Whitt-Glover, M., Marquez, D., Jakicic, J., King, A. OXFORD UNIV PRESS INC. 2018: S174

  View details for Web of Science ID 000431185200412

• AN SBIR INDUSTRY-ACADEMIA PARTNERSHIP IN EVALUATING A HEAD MOUNTED ACTIVITY MONITOR IN SENIORS Hua, J., Campero, I., Fierros, F., Garcia, D., Sheats, J., Fauci, M., King, A. C. OXFORD UNIV PRESS INC. 2018: S634

  View details for Web of Science ID 000431185201699

• PHYSICAL ACTIVITY PROMOTION USING INFORMATION AND COMMUNICATION TECHNOLOGIES Napolitano, M. A., Buman, M., Marquez, D., Whitt-Glover, M., Jakicic, J., King, A. OXFORD UNIV PRESS INC. 2018: S173

  View details for Web of Science ID 000431185200411

• QUALITATIVE ANALYSIS OF OUR VOICE DISCOVERY TOOL DATA USING NVIVO TO CAPTURE RESIDENTS' PERCEPTIONS OF LOCAL WALKABILITY Keymeulen, S., Chen, J., Banchoff, A., Winter, S. J., King, A. C. OXFORD UNIV PRESS INC. 2018: S777

  View details for Web of Science ID 000431185202274

• EFFECTIVE PHYSICAL ACTIVITY PROMOTION AT INDIVIDUAL AND COMMUNITY LEVELS Marquez, D. X., Whitt-Glover, M., Buman, M., Napolitano, M., Jakicic, J., King, A. OXFORD UNIV PRESS INC. 2018: S173

  View details for Web of Science ID 000431185200410

• LEVERAGING THE POWER OF THE MOBILE HEALTH REVOLUTION TO PROMOTE POPULATION-WIDE PHYSICAL ACTIVITY & REDUCE SEDENTARY BEHAVIOR King, A. C., Althoff, T. OXFORD UNIV PRESS INC. 2018: S385

  View details for Web of Science ID 000431185201143

• Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey. Frontiers in public health Chrisinger, B. W., Ramos, A., Shaykis, F., Martinez, T., Banchoff, A. W., Winter, S. J., King, A. C. 2018; 6: 89

  Abstract

  Over the last 6 years, a coordinated "healthy corner store" network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative's funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list (n = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation.

  View details for DOI 10.3389/fpubh.2018.00089

  View details for PubMedID 29632857

  View details for PubMedCentralID PMC5879453

• Effect of Physical Activity on Frailty Secondary Analysis of a Randomized Controlled Trial ANNALS OF INTERNAL MEDICINE Trombetti, A., Hars, M., Hsu, F., Reid, K. F., Church, T. S., Gill, T. M., King, A. C., Liu, C. K., Manini, T. M., McDermott, M. M., Newman, A. B., Rejeski, W., Guralnik, J. M., Pahor, M., Fielding, R. A., LIFE Study Investigators 2018; 168 (5): 309-+

  Abstract

  Limited evidence suggests that physical activity may prevent frailty and associated negative outcomes in older adults. Definitive data from large long-term randomized trials are lacking.To determine whether a long-term, structured, moderate-intensity physical activity program is associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability (MMD) risk.Multicenter, single-blind, randomized trial.8 centers in the United States.1635 community-dwelling adults, aged 70 to 89 years, with functional limitations.A structured, moderate-intensity physical activity program incorporating aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercises.Frailty, as defined by the SOF (Study of Osteoporotic Fractures) index, at baseline and 6, 12, and 24 months, and MMD, defined as the inability to walk 400 m, for up to 3.5 years.Over 24 months of follow-up, the risk for frailty (n = 1623) was not statistically significantly different in the physical activity versus the health education group (adjusted prevalence difference, -0.021 [95% CI, -0.049 to 0.007]). Among the 3 criteria of the SOF index, the physical activity intervention was associated with improvement in the inability to rise from a chair (adjusted prevalence difference, -0.050 [CI, -0.081 to -0.020]). Baseline frailty status did not modify the effect of physical activity on reducing incident MMD (P for interaction = 0.91).Frailty status was neither an entry criterion nor a randomization stratum.A structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over 2 years among sedentary, community-dwelling older adults. The beneficial effect of physical activity on the incidence of MMD did not differ between frail and nonfrail participants.National Institute on Aging, National Institutes of Health.

  View details for PubMedID 29310138

• The built environment and older adults: A literature review and an applied approach to engaging older adults in built environment improvements for health INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING Tuckett, A. G., Banchoff, A. W., Winter, S. J., King, A. C. 2018; 13 (1)

  View details for DOI 10.1111/opn.12171

  View details for Web of Science ID 000425184600007

• The built environment and older adults: A literature review and an applied approach to engaging older adults in built environment improvements for health. International journal of older people nursing Tuckett, A. G., Banchoff, A. W., Winter, S. J., King, A. C. 2018; 13 (1)

  Abstract

  This paper presents a review of the literature about the built environment as it impacts the health of older people. It then introduces the gerontological nurse and researcher to the Our Voice framework for engaging older people as citizen scientists in order to empower them as agents of change in improving their local built environment and ultimately advancing community health.Community-level strategies to promote successful ageing in place are critical both to optimising health outcomes and containing healthcare costs. Such strategies must take into account the influence of the built environment both on individual health behaviours and on overall community health. At the same time, the perspectives and experiences of older people themselves ought to inform policies and practices in a systematic way.Integrative literature review.A wide scan of English language articles published in the EMBASE, PubMed and CINAHL bibliographic databases was conducted. Additional articles were sourced by mining relevant reference lists (i.e., snowball sampling). Papers included were published between 2005 and 2016.Three distinct components emerged from the review: the impact of the built environment on health-in particular the health of older persons; citizen science and its applicability for older people research; and the promise of the Our Voice citizen science framework to activate changes in the built environment that improve older peoples' health.The ageing of the world's population brings with it an increased population-level risk of chronic disease and disability. We present the Our Voice framework, developed by researchers at Stanford University, as a promising strategy for engaging and empowering older people as citizen scientists, as a framework to apply to gerontological nursing and improving community health.Gerontology nurses are encouraged to: (i) Recognise the impact of the built environment and other community-level factors on the health of their patients. (ii) Encourage older adults to take an active role in documenting features of their environments that promote or hinder healthy living. (iii) Support policies and programmes that promote healthy environments.

  View details for DOI 10.1111/opn.12171

  View details for PubMedID 28940674

• Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion The DIETFITS Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J. A., Desai, M., King, A. C. 2018; 319 (7): 667–79

  Abstract

  Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets.To determine the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss.The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial included 609 adults aged 18 to 50 years without diabetes with a body mass index between 28 and 40. The trial enrollment was from January 29, 2013, through April 14, 2015; the date of final follow-up was May 16, 2016. Participants were randomized to the 12-month HLF or HLC diet. The study also tested whether 3 single-nucleotide polymorphism multilocus genotype responsiveness patterns or insulin secretion (INS-30; blood concentration of insulin 30 minutes after a glucose challenge) were associated with weight loss.Health educators delivered the behavior modification intervention to HLF (n = 305) and HLC (n = 304) participants via 22 diet-specific small group sessions administered over 12 months. The sessions focused on ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality.Primary outcome was 12-month weight change and determination of whether there were significant interactions among diet type and genotype pattern, diet and insulin secretion, and diet and weight loss.Among 609 participants randomized (mean age, 40 [SD, 7] years; 57% women; mean body mass index, 33 [SD, 3]; 244 [40%] had a low-fat genotype; 180 [30%] had a low-carbohydrate genotype; mean baseline INS-30, 93 μIU/mL), 481 (79%) completed the trial. In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was -5.3 kg for the HLF diet vs -6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, -0.2 to 1.6 kg]). There was no significant diet-genotype pattern interaction (P = .20) or diet-insulin secretion (INS-30) interaction (P = .47) with 12-month weight loss. There were 18 adverse events or serious adverse events that were evenly distributed across the 2 diet groups.In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss. In the context of these 2 common weight loss diet approaches, neither of the 2 hypothesized predisposing factors was helpful in identifying which diet was better for whom.clinicaltrials.gov Identifier: NCT01826591.

  View details for PubMedID 29466592

• Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey Frontiers in Public Health Chrisinger, B. W., Ramos, A., Shaykis, F., Martinez, T., Banchoff, A. W., Winter, S. J., King, A. C. 2018: 89

  Abstract

  Over the last 6 years, a coordinated "healthy corner store" network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative's funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list (n = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation.

  View details for DOI 10.3389/fpubh.2018.00089

  View details for PubMedCentralID PMC5879453

• Effect of Physical Activity on Frailty: A Secondary Analysis of the LIFE Randomized Controlled Trial. Trombetti, A., Hars, M., Hsu, F., Reid, K., Church, T., Gill, T., King, A., Liu, C., Manini, T., McDermott, M., Newman, A., Rejeski, W., Guralnik, J., Pahor, M., Fielding, R. WILEY. 2017: S119

  View details for Web of Science ID 000418869201164

• Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study JOURNAL OF THE AMERICAN HEART ASSOCIATION Cochrane, S. K., Chen, S., Fitzgerald, J. D., Dodson, J. A., Fielding, R. A., King, A. C., McDermott, M. M., Manini, T. M., Marsh, A. P., Newman, A. B., Pahor, M., Tudor-Locke, C., Ambrosius, W. T., Buford, T. W. 2017; 6 (12)

  Abstract

  Data are sparse regarding the value of physical activity (PA) surveillance among older adults-particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study.Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home-based activity data were collected by hip-worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84-0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65-0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow-up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85-0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63-0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates.Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data.URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.

  View details for PubMedID 29197830

• Effects of a Long-Term Physical Activity Program on Activity Patterns in Older Adults MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Wanigatunga, A. A., Tudor-Locke, C., Axtell, R. S., Glynn, N. W., King, A. C., Mcdermott, M. M., Fielding, R. A., Lu, X., Pahor, M., Manini, T. M. 2017; 49 (11): 2167–75

  Abstract

  To examine the effect of a long-term structured physical activity (PA) intervention on accelerometer-derived metrics of activity pattern changes in mobility-impaired older adults.Participants were randomized to either a PA or health education (HE) program. The PA intervention included a walking regimen with strength, flexibility, and balance training. The HE program featured health-related discussions and a brief upper body stretching routine. Participants (n = 1341) wore a hip-worn accelerometer for ≥10 h·d for ≥3 d at baseline and again at 6, 12, and 24 months postrandomization. Total PA (TPA)-defined as movements registering 100+ counts per minute-was segmented into the following intensities: low-light PA (LLPA; 100-759 counts per minute), high light PA (HLPA; 760-1040 counts per minute), low moderate PA (LMPA; 1041-2019 counts per minute), and high moderate and greater PA (HMPA; 2020+ counts per minute). Patterns of activity were characterized as bouts (defined as the consecutive minutes within an intensity).Across groups, TPA decreased an average of 74 min·wk annually. The PA intervention attenuated this effect (PA = -68 vs HE: -112 min·wk, P = 0.002). This attenuation shifted TPA composition by increasing time in LLPA (10+ bouts increased 6 min·wk), HLPA (1+, 2+, 5+, and 10+ bouts increased 6, 3, 2, and 1 min·wk, respectively), LMPA (1+, 2+, 5+, and 10+ bouts increased: 19, 17,16, and 8 min·wk, respectively), and HMPA (1+, 2+, 5+, and 10+ bouts increased 23, 21, 17, and 14 min·wk, respectively).The PA intervention increased PA by shifting the composition of activity toward higher-intensity activity in longer-duration bouts. However, a long-term structured PA intervention did not completely eliminate overall declines in total daily activity experienced by mobility-impaired older adults.

  View details for PubMedID 29045323

  View details for PubMedCentralID PMC5653284

• Testing the comparative effects of physical activity advice by humans vs. computers in underserved populations: The COMPASS trial design, methods, and baseline characteristics CONTEMPORARY CLINICAL TRIALS King, A. C., Campero, I., Sheats, J. L., Sweet, C., Garcia, D., Chazaro, A., Blanco, G., Hauser, M., Fierros, F., Ahn, D. K., Diaz, J., Done, M., Fernandez, J., Bickmore, T. 2017; 61: 115–25

  Abstract

  While physical inactivity is a key risk factor for a range of chronic diseases and conditions associated with aging, a significant proportion of midlife and older adults remain insufficiently active. This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. The major objective of this 12-month cluster-randomized controlled trial is to test the comparative effectiveness of two linguistically and culturally adapted, community-based physical activity interventions with the potential for broad reach and translation. Ten local community centers serving a sizable number of Latino residents were randomized to receive one of two physical activity interventions. The Virtual Advisor program employs a computer-based embodied conversational agent named "Carmen" to deliver interactive, individually tailored physical activity advice and support. A similar intervention program is delivered by trained Peer Advisors. The target population consists of generally healthy, insufficiently active Latino adults ages 50years and older living within proximity to a designated community center. The major outcomes are changes in walking and other forms of physical activity measured via self-report and accelerometry. Secondary outcomes include physical function and well-being variables. In addition to these outcome analyses, comparative cost analysis of the two programs, potential mediators of intervention success, and baseline moderators of intervention effects will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yield as well as study baseline characteristics.clinicaltrial.gov Identifier=NCT02111213.

  View details for PubMedID 28739541

• Device-Measured Physical Activity As a Predictor of Disability in Mobility-Limited Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Mankowski, R. T., Anton, S. D., Axtell, R., Chen, S., Fielding, R. A., Glynn, N. W., Hsu, F., King, A. C., Layne, A. S., Leeuwenburgh, C., Manini, T. M., Marsh, A. P., Pahor, M., Tudor-Locke, C., Conroy, D. E., Buford, T. W., LIFE Res Grp 2017; 65 (10): 2251–56

  Abstract

  To examine associations between objectively measured physical activity (PA) and incidence of major mobility disability (MMD) and persistent MMD (PMMD) in older adults in the Lifestyle Interventions and Independence for Elders (LIFE) Study.Prospective cohort of individuals aged 65 and older undergoing structured PA intervention or health education.The LIFE Study was a multicenter (eight sites) randomized controlled trial designed to compare the efficacy of a long-term structured PA intervention with that of a health education (HE) program in reducing the incidence of MMD in mobility-limited older adults.LIFE Study participants (n = 1,590) had a mean age±standard deviation of 78.9 ± 5.2, low levels of PA, and measured mobility-relevant functional impairment at baseline.Activity data were collected using hip-worn 7-day accelerometers at baseline and 6, 12, and 24 months after randomization to test for associations with incident MMD and PMMD (≥2 consecutive instances of MMD).At baseline, every 30 minutes spent being sedentary (<100 accelerometry counts per minute) was associated with higher rate of subsequent MMD (10%) and PMMD (11%) events. Every 500 steps taken was associated with lower rate of MMD (15%) and PMMD (18%). Similar associations were observed when fitting accelerometry-based PA as a time-dependent variable.Accelerometry-based PA levels were strongly associated with MMD and PMMD events in older adults with limited mobility. These results support the importance of daily PA and lower amounts of sedentary time levels in this population and suggest that accelerometry may be a useful tool for assessing risk of mobility disability.

  View details for PubMedID 28799216

  View details for PubMedCentralID PMC5657432

• Dose of physical activity, physical functioning and disability risk in mobility-limited older adults: Results from the LIFE study randomized trial PLOS ONE Fielding, R. A., Guralnik, J. M., King, A. C., Pahor, M., McDermott, M. M., Tudor-Locke, C., Manini, T. M., Glynn, N. W., Marsh, A. P., Axtell, R. S., Hsu, F., Rejeski, W., LIFE Study Grp 2017; 12 (8): e0182155

  Abstract

  Understanding the minimal dose of physical activity required to achieve improvement in physical functioning and reductions in disability risk is necessary to inform public health recommendations. To examine the effect of physical activity dose on changes in physical functioning and the onset of major mobility disability in The Lifestyle Interventions and Independence for Elders (LIFE) Study. We conducted a multicenter single masked randomized controlled trial that enrolled participants in 2010 and 2011 and followed them for an average of 2.6 years. 1,635 sedentary men and women aged 70-89 years who had functional limitations were randomized to a structured moderate intensity walking, resistance, and flexibility physical activity program or a health education program. Physical activity dose was assessed by 7-day accelerometry and self-report at baseline and 24 months. Outcomes included the 400 m walk gait speed, the Short Physical Performance Battery (SPPB), assessed at baseline, 6, 12, and 24 months, and onset of major mobility disability (objectively defined by loss of ability to walk 400 m in 15 min). When the physical activity arm or the entire sample were stratified by change in physical activity from baseline to 24 months, there was a dose-dependent increase in the change in gait speed and SPPB from baseline at 6, 12, and 24 months. In addition, the magnitude of change in physical activity over 24 months was related to the reduction in the onset of major mobility disability (overall P < 0.001) (highest versus the lowest quartile of physical activity change HR 0.23 ((95% CI:0.10-0.52) P = 0.001) in the physical activity arm. We observed a dose-dependent effect of objectively monitored physical activity on physical functioning and onset of major mobility disability. Relatively small increases (> 48 minutes per week) in regular physical activity participation had significant and clinically meaningful effects on these outcomes.ClinicalsTrials.gov NCT00116194.

  View details for PubMedID 28820909

• Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Santanasto, A. J., Glynn, N. W., Lovato, L. C., Blair, S. N., Fielding, R. A., Gill, T. M., Guralnik, J. M., Hsu, F., King, A. C., Strotmeyer, E. S., Manini, T. M., Marsh, A. P., McDermott, M. M., Goodpaster, B. H., Pahor, M., Newman, A. B., LIFE Study Grp 2017; 65 (7): 1427–33

  Abstract

  Physical activity (PA) reduces the rate of mobility disability, compared with health education (HE), in at risk older adults. It is important to understand aspects of performance contributing to this benefit.To evaluate intervention effects on tertiary physical performance outcomes.The Lifestyle Interventions and Independence for Elders (LIFE) was a multi-centered, single-blind randomized trial of older adults.Eight field centers throughout the United States.1635 adults aged 78.9 ± 5.2 years, 67.2% women at risk for mobility disability (Short Physical Performance Battery [SPPB] <10).Moderate PA including walking, resistance and balance training compared with HE consisting of topics relevant to older adults.Grip strength, SPPB score and its components (balance, 4 m gait speed, and chair-stands), as well as 400 m walking speed.Total SPPB score was higher in PA versus HE across all follow-up times (overall P = .04) as was the chair-stand component (overall P < .001). No intervention effects were observed for balance (overall P = .12), 4 m gait speed (overall P = .78), or grip strength (overall P = .62). However, 400 m walking speed was faster in PA versus HE group (overall P =<.001). In separate models, 29% of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score, while 39% was explained by change in the chair stand component.Lower extremity performance (SPPB) was significantly higher in the PA compared with HE group. Changes in chair-stand score explained a considerable portion of the effect of PA on the reduction of major mobility disability-consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability.

  View details for PubMedID 28221668

  View details for PubMedCentralID PMC5507738

• Distance mentoring of health researchers: Three case studies across the career-development trajectory HEALTH PSYCHOLOGY OPEN Xu, X., Schneider, M., DeSorbo-Quinn, A. L., King, A. C., Allegrante, J. P., Nigg, C. R. 2017; 4 (2): 2055102917734388

  Abstract

  Despite the crucial role of mentoring, little literature exists that addresses distance mentoring among health researchers. This article provides three case studies showcasing protégés at different stages of career development (one in graduate school, one as an early-stage researcher, and one as an established researcher). Each case study provides a brief history of the relationship, examines the benefits and challenges of working together at a distance, and discusses the lessons learned from both the mentor and the protégé over the course of these relationships. A mentoring model, examples of mentoring communications, and potential promising practices are also provided and discussed.

  View details for PubMedID 29379623

• Exercise's effect on mobility disability in older adults with and without obesity: The LIFE study randomized clinical trial OBESITY Kritchevsky, S. B., Lovato, L., Handing, E. P., Blair, S., Botoseneanu, A., Guralnik, J. M., Liu, C., King, A., Marsh, A. P., Pahor, M., Rejeski, W., Spring, B., Manini, T. 2017; 25 (7): 1199–1205

  Abstract

  Some data suggest that obesity blunts the benefits of exercise on mobility in older adults. This study tested the homogeneity of the effect of a physical activity intervention on major mobility disability (MMD) across baseline obesity classifications in the Lifestyle Interventions and Independence for Elders (LIFE) Study. LIFE randomized 1,635 sedentary men and women aged 70 to 89 years to a moderate-intensity physical activity (PA) or health education program.MMD, defined as the inability to walk 400 m, was determined over an average follow-up of 2.6 years. Participants were divided into four subgroups: (1) nonobese (BMI < 30 kg/m2 ; n = 437); (2) nonobese with high waist circumference (WC > 102 cm [men], > 88 cm [women]; n = 434); (3) class 1 obesity (30 kg/m2  ≤ BMI < 35 kg/m2 ; n = 430); and (4) class 2 + obesity (BMI ≥ 35 kg/m2 ; n = 312). Cox proportional hazard modeling was used to test an obesity by intervention interaction.The PA intervention had the largest benefit in participants with class 2 + obesity (hazard ratio 0.69, 95% confidence interval 0.48, 0.98). However, there was no statistically significant difference in benefit across obesity categories.A structured PA program reduced the risk of MMD even in older adults with extreme obesity.

  View details for PubMedID 28653499

  View details for PubMedCentralID PMC5567861

• Effects of Physical Activity Intervention on Physical and Cognitive Function in Sedentary Adults With and Without Diabetes JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Espeland, M. A., Lipska, K., Miller, M. E., Rushing, J., Cohen, R. A., Verghese, J., McDermott, M. M., King, A. C., Strotmeyer, E. S., Blair, S. N., Pahor, M., Reid, K., Demons, J., Kritchevsky, S. B., LIFE Study Investigator 2017; 72 (6): 861–66

  Abstract

  Type 2 diabetes mellitus may alter the effect of physical activity on physical and cognitive function.The Lifestyle Interventions and Independence for Elders (LIFE) trial randomized controlled clinical trial of physical activity intervention (walking, resistance training, and flexibility exercises) enrolled adults aged 70-89 years who were sedentary and non-demented and who had functional limitations. Standardized measures of physical and cognitive function were collected an average of 2 years post-randomization. Differences between the intervention and control groups from 415 individuals with diabetes and 1,061 individuals without diabetes were contrasted with analyses of covariance.At 24 months, assignment to the physical activity intervention resulted in 0.019 m/s relatively faster average 400-meter gait speeds (p = .007 overall) both for individuals with and without diabetes (intervention × diabetes interaction p = .99). No benefits were seen on scores from a physical performance battery. Performance on cognitive tests was better among participants assigned to the physical activity intervention compared with control only for those with diabetes, particularly for global cognitive function (p = .02) and delayed memory (p = .005), with mean [95% confidence intervals] for benefit from physical activity intervention of 0.114 [0.007,0.111] and 0.208 [0.030,0.387] standard deviations, respectively.Physical activity intervention improved the gait speed of older, sedentary individuals with and without diabetes. The cognitive function benefits occurred among participants with, but not without, diabetes. The mechanisms through which physical activity affects physical and cognitive function in older adults may differ for individuals by diabetes status.

  View details for PubMedID 27590629

• Developing and validating an abbreviated version of the Microscale Audit for Pedestrian Streetscapes (MAPS-Abbreviated) JOURNAL OF TRANSPORT & HEALTH Cain, K. L., Gavand, K. A., Conway, T. L., Geremia, C. M., Millstein, R. A., Frank, L. D., Saelens, B. E., Adams, M. A., Glanz, K., King, A. C., Sallis, J. F. 2017; 5: 84–96

  Abstract

  Macroscale built environment factors (e.g., street connectivity) are correlated with physical activity. Less-studied but more modifiable microscale elements (e.g., sidewalks) may also influence physical activity, but shorter audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of an abbreviated 54-item streetscape audit tool with multiple measures of physical activity in four age groups.We developed a 54-item version from the original 120-item Microscale Audit of Pedestrian Streetscapes (MAPS). Audits were conducted on 0.25-0.45 mile routes from participant residences toward the nearest nonresidential destination for children (N=758), adolescents (N=897), younger adults (N=1,655), and older adults (N=367). Active transport and leisure physical activity were measured with surveys, and objective physical activity was measured with accelerometers. Items to retain from original MAPS were selected primarily by correlations with physical activity. Mixed linear regression analyses were conducted for MAPS-Abbreviated summary scores, adjusting for demographics, participant clustering, and macroscale walkability.MAPS-Abbreviated and original MAPS total scores correlated r=.94 The MAPS-Abbreviated tool was related similarly to physical activity outcomes as the original MAPS. Destinations and land use, streetscape and walking path characteristics, and overall total scores were significantly related to active transport in all age groups. Street crossing characteristics were related to active transport in children and older adults. Aesthetics and social characteristics were related to leisure physical activity in children and younger adults, and cul-de-sacs were related with physical activity in youth. Total scores were related to accelerometer-measured physical activity in children and older adults.MAPS-Abbreviated is a validated observational measure for use in research. The length and related cost of implementation has been cited as a barrier to use of microscale instruments, so availability of this shorter validated measure could lead to more widespread use of streetscape audits in health research.

  View details for PubMedID 29270361

• Social Participation Modifies the Effect of a Structured Physical Activity Program on Major Mobility Disability Among Older Adults: Results From the LIFE Study. journals of gerontology. Series B, Psychological sciences and social sciences Corbett, D. B., Rejeski, W. J., Tudor-Locke, C., Glynn, N. W., Kritchevsky, S. B., McDermott, M. M., Church, T. S., Fielding, R. A., Gill, T. M., King, A. C., Miller, M. E., chen, H., Pahor, M., Manini, T. M. 2017

  Abstract

  To investigate whether baseline social participation modifies the effect of a long-term structured physical activity (PA) program on major mobility disability (MMD).1,635 sedentary adults (70-89 years) with physical limitations were randomized to either a structured PA or health education (HE) intervention. Social participation was defined categorically at baseline. High social participation was defined as attending organized group functions at least once per week and visiting with noncohabitating friends and family ≥7 hr per week. Anything less was considered limited social participation. Participants performed a standardized walking test at baseline and every 6 months for up to 42 months. MMD was defined as the loss in the ability to walk 400 m.There was a significant intervention by social participation interaction (p = .003). Among individuals with high levels of social participation, those randomized to PA had significantly lower incidence of MMD (hazard ratio [HR], 0.43 [95% confidence interval (CI), 0.27-0.68]; p < .01) than those randomized to HE. Individuals with limited social participation showed no mobility benefit of the PA intervention when compared with their HE counterparts (HR, 0.92 [95% CI, 0.77-1.11]; p = .40).Our findings suggest that baseline social participation is an important factor for the success of a PA intervention aimed at delaying mobility disability.

  View details for DOI 10.1093/geronb/gbx051

  View details for PubMedID 28482106

• Effects of a Long-Term Physical Activity Program on Activity Patterns in Mobility Impaired Older Adults Wanigatunga, A. A., Axtell, R. S., Fielding, R. A., Glynn, N. W., King, A. C., McDermott, M. M., Tudor-Locke, C., Pahor, M., Manini, T. LIPPINCOTT WILLIAMS & WILKINS. 2017: 863

  View details for DOI 10.1249/01.mss.0000519333.90420.32

  View details for Web of Science ID 000415216000133

• Physical Activity in Older Adults: an Ecological Approach ANNALS OF BEHAVIORAL MEDICINE Thornton, C. M., Kerr, J., Conway, T. L., Saelens, B. E., Sallis, J. F., Ahn, D. K., Frank, L. D., Cain, K. L., King, A. C. 2017; 51 (2): 159-169

  Abstract

  Studies identifying correlates of physical activity (PA) at all levels of the ecological model can provide an empirical basis for designing interventions to increase older adults' PA.Applying ecological model principles, this study concurrently examined individual, psychosocial, and environmental correlates of older adults' PA to determine whether built environment factors contribute to PA over and above individual/demographic and psychosocial variables.Using a cross-sectional observational design, 726 adults, aged ≥66 years, were recruited from two US regions. Explanatory variables included demographics, self-efficacy, social support, barriers, and environmental variables measured by using geographic information systems (GIS) and self-report. Outcomes included reported walking for errands and leisure/exercise and accelerometer-measured daily moderate to vigorous PA (MVPA). Analyses employed mixed-model regressions with backward elimination.For daily MVPA, the only significant environmental variable was GIS-based proximity to a park (p < 0.001) after controlling for individual/demographic and psychosocial factors. Walking for errands was positively related to four environmental variables: reported walking/cycling facilities (p < 0.05), GIS-based intersection density (p < 0.01), mixed land use (p < 0.01), and private recreation facilities (p < 0.01). Walking for leisure/exercise was negatively related to GIS-based mixed land use (p < 0.05). Non-Hispanic white race/ethnicity, self-efficacy, and social support positively related to all three PA outcomes (p < 0.05).Correlates of older adults' PA were found at all ecological levels, supporting multiple levels of influence and need for multilevel interventions. Environmental correlates varied by PA outcome. Walking for errands exhibited the most environmental associations.

  View details for DOI 10.1007/s12160-016-9837-1

  View details for Web of Science ID 000398940700002

• Dynapenia and Metabolic Health in Obese and Nonobese Adults Aged 70 Years and Older: The LIFE Study JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Aubertin-Leheudre, M., Anton, S., Beavers, D. P., Manini, T. M., Fielding, R., Newman, A., Church, T., Kritchevsky, S. B., Conroy, D., McDermott, M. M., Botoseneanu, A., Hauser, M. E., Pahor, M. 2017; 18 (4): 312-319

  Abstract

  The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults.A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions.A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = 92.2 ± 11.2, P ≤ .01); and higher in NDYN-O compared with DYN-O (P = .008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared with DYN-O (70.9 ± 10.1 vs 67.7 ± 9.7, P ≤ .001). No significant differences were found across dynapenia and obesity status for all other metabolic components (P > .05). The odds of having MetS or its individual components were similar in obese and nonobese, combined or not with dynapenia (nonsignificant odds ratio [95% confidence interval]).Nonobese dynapenic older adults had fewer metabolic disease risk factors than nonobese and nondynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting MetS criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or nonobese older adults.

  View details for DOI 10.1016/j.jamda.2016.10.001

  View details for Web of Science ID 000398947400007

• Effect of Metabolic Syndrome on the Mobility Benefit of a Structured Physical Activity Intervention-The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial. Journal of the American Geriatrics Society Botoseneanu, A., chen, H., Ambrosius, W. T., Allore, H. G., Anton, S., Folta, S. C., King, A. C., Nicklas, B. J., Spring, B. J., Strotmeyer, E. S., Gill, T. M. 2017

  Abstract

  To test whether structured physical activity (PA) is associated with a greater reduction in major mobility disability (MMD) in older persons with metabolic syndrome (MetS) than in those without.Data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter randomized trial of 1,635 persons with assessments every 6 months (average 2.7 years).Eight U.S. centers.Sedentary men and women aged 70 to 89 with functional limitations (N = 1,535); 100 participants were excluded because of missing MetS data.Participants were randomized to a moderate-intensity PA program (n = 766) or a health education program (n = 769).MetS was defined according to the 2009 multiagency harmonized criteria. Outcomes included incident MMD (loss of ability to walk 400 m) and persistent MMD (two consecutive MMD diagnoses or one MMD diagnosis followed by death).Seven hundred sixty-three (49.7%) participants met criteria for MetS. PA reduced incident MMD more than health education did in participants with MetS (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.57-0.91, P = .007) but not in those without MetS (HR = 0.96, 95% CI = 0.73-1.25, P = .75); the test for statistical interaction was not significant (P = .13). PA reduced the risk of persistent MMD in participants with MetS (HR = 0.57, 95% CI = 0.41-0.79, P < .001) but not in those without MetS (HR = 0.97, 95% CI = 0.67-1.41, P = .87). The test for statistical interaction was significant (P = .04).Moderate-intensity PA substantially reduces the risk of persistent MMD in older persons with functional limitations with MetS but not in those without MetS. Comparable results were observed for incident MMD. The LIFE PA program may be an effective strategy for reducing mobility disability in vulnerable older persons with MetS.

  View details for DOI 10.1111/jgs.14793

  View details for PubMedID 28369670

• EXPLORATION OF PHYSICAL ACTIVITY BEHAVIORS AMONG MEXICAN SENIORS IN THE US AND MEXICO: IMPLICATIONS FOR RESEARCH AND PRACTICE Campero, I., Sheats, J., Blanco, G., Escobar, M., Poma, B., Chazaro, A., King, A. C. SPRINGER. 2017: S2798–S2799

  View details for Web of Science ID 000398947203436

• AN IN-HOME VIRTUAL COACHING PROGRAM TO PROMOTE PHYSICAL ACTIVITY IN DIVERSE POPULATIONS: USER TESTING AND ACCEPTABILITY Chazaro, A., Winter, S., ChangChien, V., Hou, B., King, A. C. SPRINGER. 2017: S593–S594

  View details for Web of Science ID 000398947200380

• Effect of Physical Activity on Self-Reported Disability in Older Adults: Results from the LIFE Study. Journal of the American Geriatrics Society Manini, T. M., Beavers, D. P., Pahor, M., Guralnik, J. M., Spring, B., Church, T. S., King, A. C., Folta, S. C., Glynn, N. W., Marsh, A. P., Gill, T. M. 2017

  Abstract

  To test the hypothesis that a long-term structured, moderate intensity physical activity (PA) program is more effective than a health education (HE) program in reducing the risk of s elf-reported dependency and disability in basic activities of daily living (BADLs), disability in instrumental ADLs (IADL), and mobility disability.The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single-blinded randomized trial.University-based research clinic.Thousand six hundred and thirty five sedentary men and women aged 70-89 years, who had functional limitations, defined as a score ≤9 on the Short Physical Performance Battery.Participants were randomized to a structured, moderate intensity PA program (n = 818) that included aerobic, resistance, and flexibility exercises or to a HE program (n = 817).All outcomes were derived by self-report using periodic interviews that asked about the degree of difficulty and receipt of help during the past month. Dependency was defined as "receiving assistance" or "unable" to do ≥1 activities. Disability was defined as having "a lot of difficulty" or "unable" doing ≥1 activities. Severe disability was defined as reporting difficulty or being unable to perform ≥3 activities.Over an average follow-up of 2.6 years, the cumulative incidence of BADL dependency was 15.2% among PA and 15.1% among HE participants (HR = 1.0, 95% CI = 0.78-0.1.3). Intervention groups had similar rates of incident BADL disability, IADL disability and reported mobility disability. Reporting severe mobility disability (HR = 0.78, 95% CI = 0.64-0.96) and ratings of difficulty on mobility tasks were reduced in the PA group.A structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not BADL and IADL disability in older adults with functional limitations.

  View details for DOI 10.1111/jgs.14742

  View details for PubMedID 28168689

• DIETFITS study (diet intervention examining the factors interacting with treatment success) - Study design and methods. Contemporary clinical trials Stanton, M. V., Robinson, J. L., Kirkpatrick, S. M., Farzinkhou, S., Avery, E. C., Rigdon, J., Offringa, L. C., Trepanowski, J. F., Hauser, M. E., Hartle, J. C., Cherin, R. J., King, A. C., Ioannidis, J. P., Desai, M., Gardner, C. D. 2017; 53: 151-161

  Abstract

  Numerous studies have attempted to identify successful dietary strategies for weight loss, and many have focused on Low-Fat vs. Low-Carbohydrate comparisons. Despite relatively small between-group differences in weight loss found in most previous studies, researchers have consistently observed relatively large between-subject differences in weight loss within any given diet group (e.g., ~25kg weight loss to ~5kg weight gain). The primary objective of this study was to identify predisposing individual factors at baseline that help explain differential weight loss achieved by individuals assigned to the same diet, particularly a pre-determined multi-locus genotype pattern and insulin resistance status. Secondary objectives included discovery strategies for further identifying potential genetic risk scores. Exploratory objectives included investigation of an extensive set of physiological, psychosocial, dietary, and behavioral variables as moderating and/or mediating variables and/or secondary outcomes. The target population was generally healthy, free-living adults with BMI 28-40kg/m(2) (n=600). The intervention consisted of a 12-month protocol of 22 one-hour evening instructional sessions led by registered dietitians, with ~15-20 participants/class. Key objectives of dietary instruction included focusing on maximizing the dietary quality of both Low-Fat and Low-Carbohydrate diets (i.e., Healthy Low-Fat vs. Healthy Low-Carbohydrate), and maximally differentiating the two diets from one another. Rather than seeking to determine if one dietary approach was better than the other for the general population, this study sought to examine whether greater overall weight loss success could be achieved by matching different people to different diets. Here we present the design and methods of the study.

  View details for DOI 10.1016/j.cct.2016.12.021

  View details for PubMedID 28027950

• DEVELOPING SUSTAINABLE WALKING INTERVENTIONS: INTEGRATING BEHAVIOURAL, ECOLOGICAL AND SYSTEMS SCIENCE TO PROMOTE POPULATION HEALTH WALKING: CONNECTING SUSTAINABLE TRANSPORT WITH HEALTH Rovniak, L. S., King, A. C., Mulley, C., Gebel, K., Ding, D. 2017; 9: 249–73

  View details for DOI 10.1108/S2044-994120170000009015

  View details for Web of Science ID 000440554600013

• Predictors of Change in Physical Function in Older Adults in Response to Long-Term, Structured Physical Activity: The LIFE Study. Archives of physical medicine and rehabilitation Layne, A. S., Hsu, F. C., Blair, S. N., Chen, S. H., Dungan, J., Fielding, R. A., Glynn, N. W., Hajduk, A. M., King, A. C., Manini, T. M., Marsh, A. P., Pahor, M., Pellegrini, C. A., Buford, T. W. 2017; 98 (1): 11-24.e3

  Abstract

  To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability.Secondary analysis.Multicenter institutions.A volunteer sample (N=1635) of sedentary men and women aged 70 to 89 years who were able to walk 400m but had physical limitations, defined as a Short Physical Performance Battery (SPPB) score of ≤9.Moderate-intensity physical activity (n=818) consisting of aerobic, resistance, and flexibility exercises performed both center-based (2times/wk) and home-based (3-4times/wk) sessions or health education program (n=817) consisting of weekly to monthly workshops covering relevant health information.Physical function (gait speed over 400m) and lower extremity function (SPPB score) assessed at baseline and 6, 12, and 24 months.Greater baseline physical function (gait speed, SPPB score) was negatively associated with change in gait speed (regression coefficient β=-.185; P<.001) and change in SPPB score (β=-.365; P<.001), whereas higher number of steps per day measured by accelerometry was positively associated with change in gait speed (β=.035; P<.001) and change in SPPB score (β=.525; P<.001). Other baseline factors associated with positive change in gait speed and/or SPPB score include younger age (P<.001), lower body mass index (P<.001), and higher self-reported physical activity (P=.002).Several demographic and physical activity-related factors were associated with the extent of change in functional outcomes in participants in the LIFE study. These factors should be considered when designing interventions for improving physical function in older adults with limited mobility.

  View details for DOI 10.1016/j.apmr.2016.07.019

  View details for PubMedID 27568165

  View details for PubMedCentralID PMC5183463

• Predictors of Change in Physical Function in Older Adults in Response to Long-Term, Structured Physical Activity: The LIFE Study ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Layne, A. S., Hsu, F., Blair, S. N., Chen, S., Dungan, J., Fielding, R. A., Glynn, N. W., Hajduk, A. M., King, A. C., Manini, T. M., Marsh, A. P., Pahor, M., Pellegrini, C. A., Buford, T. W. 2017; 98 (1): 11-24

  Abstract

  To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability.Secondary analysis.Multicenter institutions.A volunteer sample (N=1635) of sedentary men and women aged 70 to 89 years who were able to walk 400m but had physical limitations, defined as a Short Physical Performance Battery (SPPB) score of ≤9.Moderate-intensity physical activity (n=818) consisting of aerobic, resistance, and flexibility exercises performed both center-based (2times/wk) and home-based (3-4times/wk) sessions or health education program (n=817) consisting of weekly to monthly workshops covering relevant health information.Physical function (gait speed over 400m) and lower extremity function (SPPB score) assessed at baseline and 6, 12, and 24 months.Greater baseline physical function (gait speed, SPPB score) was negatively associated with change in gait speed (regression coefficient β=-.185; P<.001) and change in SPPB score (β=-.365; P<.001), whereas higher number of steps per day measured by accelerometry was positively associated with change in gait speed (β=.035; P<.001) and change in SPPB score (β=.525; P<.001). Other baseline factors associated with positive change in gait speed and/or SPPB score include younger age (P<.001), lower body mass index (P<.001), and higher self-reported physical activity (P=.002).Several demographic and physical activity-related factors were associated with the extent of change in functional outcomes in participants in the LIFE study. These factors should be considered when designing interventions for improving physical function in older adults with limited mobility.

  View details for DOI 10.1016/j.apmr.2016.07.019

  View details for Web of Science ID 000392460000002

  View details for PubMedCentralID PMC5183463

• Effect of Structured Physical Activity on Overall Burden and Transitions Between States of Major Mobility Disability in Older Persons Secondary Analysis of a Randomized Trial ANNALS OF INTERNAL MEDICINE Gill, T. M., Guralnik, J. M., Pahor, M., Church, T., Fielding, R. A., King, A. C., Marsh, A. P., Newman, A. B., Pellegrini, C. A., Chen, S., Allore, H. G., Miller, M. E. 2016; 165 (12): 833-?

  Abstract

  The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone.To compare the effect of a long-term, structured physical activity program with that of a health education intervention on the proportion of patient assessments indicating major mobility disability (MMD) (that is, MMD burden) and on the risk for transitions into and out of MMD.Single-blinded, parallel-group, randomized trial. (ClinicalTrials.gov: NCT01072500).8 U.S. centers between February 2010 and December 2013.1635 sedentary persons, aged 70 to 89 years, who had functional limitations but could walk 400 m.Physical activity (n = 818) and health education (n = 817).MMD, defined as the inability to walk 400 m, was assessed every 6 months for up to 3.5 years.During a median follow-up of 2.7 years, the proportion of assessments showing MMD was substantially lower in the physical activity (0.13 [95% CI, 0.11 to 0.15]) than the health education (0.17 [CI, 0.15 to 0.19]) group, yielding a risk ratio of 0.75 (CI, 0.64 to 0.89). In a multistate model, the hazard ratios for comparisons of physical activity with health education were 0.87 (CI, 0.73 to 1.03) for the transition from no MMD to MMD; 0.52 (CI, 0.10 to 2.67) for no MMD to death; 1.33 (CI, 0.99 to 1.77) for MMD to no MMD; and 1.92 (CI, 1.15 to 3.20) for MMD to death.The intention-to-treat principle was maintained for MMD burden and first transition out of no MMD, but not for subsequent transitions.A structured physical activity program reduced the MMD burden for an extended period, in part through enhanced recovery after the onset of disability and diminished risk for subsequent disability episodes.National Institute on Aging, National Institutes of Health.

  View details for DOI 10.7326/M16-0529

  View details for Web of Science ID 000391236900011

  View details for PubMedID 27669457

• Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis. Journal of aging and physical activity Moran, M. R., Werner, P., Doron, I., HaGani, N., Benvenisti, Y., King, A. C., Winter, S. J., Sheats, J. L., Garber, R., Motro, H., Egron, S. 2016: 1-36

  Abstract

  Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

  View details for PubMedID 27992252

• Disparities in Pedestrian Streetscape Environments by Income and Race/Ethnicity. SSM - population health Thornton, C. M., Conway, T. L., Cain, K. L., Gavand, K. A., Saelens, B. E., Frank, L. D., Geremia, C. M., Glanz, K., King, A. C., Sallis, J. F. 2016; 2: 206-216

  Abstract

  Growing evidence suggests that microscale pedestrian environment features, such as sidewalk quality, crosswalks, and neighborhood aesthetics, may affect residents' physical activity. This study examined whether disparities in microscale pedestrian features existed between neighborhoods of differing socioeconomic and racial/ethnic composition. Using the validated Microscale Audit of Pedestrian Streetscapes (MAPS), pedestrian environment features were assessed by trained observers along ¼-mile routes (N = 2117) in neighborhoods in three US metropolitan regions (San Diego, Seattle, and Baltimore) during 2009 to 2010. Neighborhoods, defined as Census block groups, were selected to maximize variability in median income and macroscale walkability factors (e.g., density). Mixed-model linear regression analyses explored main and interaction effects of income and race/ethnicity separately by region. Across all three regions, low-income neighborhoods and neighborhoods with a high proportion of racial/ethnic minorities had poorer aesthetics and social elements (e.g., graffiti, broken windows, litter) than neighborhoods with higher median income or fewer racial/ethnic minorities (p<.05). However, there were also instances where neighborhoods with higher incomes and fewer racial/ethnic minorities had worse or absent pedestrian amenities such as sidewalks, crosswalks, and intersections (p<.05). Overall, disparities in microscale pedestrian features occurred more frequently in residential as compared to mixed-use routes with one or more commercial destination. However, considerable variation existed between regions as to which microscale pedestrian features were unfavorable and whether the unfavorable features were associated with neighborhood income or racial/ethnic composition. The variation in pedestrian streetscapes across cities suggests that findings from single-city studies are not generalizable. Local streetscape audits are recommended to identify disparities and efficiently allocate pedestrian infrastructure resources to ensure access and physical activity opportunities for all residents, regardless of race, ethnicity, or income level.

  View details for PubMedID 27314057

• GIS-measured walkability, transit, and recreation environments in relation to older Adults' physical activity: A latent profile analysis PREVENTIVE MEDICINE Todd, M., Adams, M. A., Kurka, J., Conway, T. L., Cain, K. L., Buman, M. P., Frank, L. D., Sallis, J. F., King, A. C. 2016; 93: 57-63

  Abstract

  An infrequently studied question is how diverse combinations of built environment (BE) features relate to physical activity (PA) for older adults. We derived patterns of geographic information systems- (GIS) measured BE features and explored how they accounted for differences in objective and self-reported PA, sedentary time, and BMI in a sample of older adults. Senior Neighborhood Quality of Life Study participants (N=714, aged 66-97years, 52.1% women, 29.7% racial/ethnic minority) were sampled in 2005-2008 from the Seattle-King County, WA and Baltimore, MD-Washington, DC regions. Participants' home addresses were geocoded, and net residential density, land use mix, retail floor area ratio, intersection density, public transit density, and public park and private recreation facility density measures for 1-km network buffers were derived. Latent profile analyses (LPAs) were estimated from these GIS-based measures. In multilevel regression models, profiles were compared on accelerometer-measured moderate-to-vigorous PA (MVPA) and sedentary time and self-reported PA, adjusting for covariates and clustering. Analyses were conducted in 2014-2015. LPAs yielded three profiles: low walkability/transit/recreation (L-L-L); mean walkability/transit/recreation (M-M-M); and high walkability/transit/recreation (H-H-H). Three PA outcomes were more favorable in the HHH than the LLL profile group (difference of 7.2min/day for MVPA, 97.8min/week for walking for errands, and 79.2min/week for walking for exercise; all ps<0.02). The most and least activity-supportive BE profiles showed greater differences in older adults' PA than did groupings based solely on a 4-component walkability index, suggesting that diverse BE features are important for healthy aging.

  View details for DOI 10.1016/j.ypmed.2016.09.019

  View details for Web of Science ID 000388383700010

  View details for PubMedID 27663428

• Development of a dynamic computational model of social cognitive theory TRANSLATIONAL BEHAVIORAL MEDICINE Riley, W. T., Martin, C. A., Rivera, D. E., Hekler, E. B., Adams, M. A., Buman, M. P., Pavel, M., King, A. C. 2016; 6 (4): 483-495

  Abstract

  Social cognitive theory (SCT) is among the most influential theories of behavior change and has been used as the conceptual basis of health behavior interventions for smoking cessation, weight management, and other health behaviors. SCT and other behavior theories were developed primarily to explain differences between individuals, but explanatory theories of within-person behavioral variability are increasingly needed as new technologies allow for intensive longitudinal measures and interventions adapted from these inputs. These within-person explanatory theoretical applications can be modeled as dynamical systems. SCT constructs, such as reciprocal determinism, are inherently dynamical in nature, but SCT has not been modeled as a dynamical system. This paper describes the development of a dynamical system model of SCT using fluid analogies and control systems principles drawn from engineering. Simulations of this model were performed to assess if the model performed as predicted based on theory and empirical studies of SCT. This initial model generates precise and testable quantitative predictions for future intensive longitudinal research. Dynamic modeling approaches provide a rigorous method for advancing health behavior theory development and refinement and for guiding the development of more potent and efficient interventions.

  View details for DOI 10.1007/s13142-015-0356-6

  View details for Web of Science ID 000393296000001

  View details for PubMedID 27848208

  View details for PubMedCentralID PMC5110484

• Actigraphy features for predicting mobility disability in older adults PHYSIOLOGICAL MEASUREMENT Kheirkhahan, M., Tudor-Locke, C., Axtell, R., Buman, M. P., Fielding, R. A., Glynn, N. W., Guralnik, J. M., King, A. C., White, D. K., Miller, M. E., Siddique, J., Brubaker, P., Rejeski, W. J., Ranshous, S., Pahor, M., Ranka, S., Manini, T. M. 2016; 37 (10): 1813-1833

  Abstract

  Actigraphy has attracted much attention for assessing physical activity in the past decade. Many algorithms have been developed to automate the analysis process, but none has targeted a general model to discover related features for detecting or predicting mobility function, or more specifically, mobility impairment and major mobility disability (MMD). Men (N  =  357) and women (N  =  778) aged 70-89 years wore a tri-axial accelerometer (Actigraph GT3X) on the right hip during free-living conditions for 8.4  ±  3.0 d. One-second epoch data were summarized into 67 features. Several machine learning techniques were used to select features from the free-living condition to predict mobility impairment, defined as 400 m walking speed  <0.80 m s(-1). Selected features were also included in a model to predict the first occurrence of MMD-defined as the loss in the ability to walk 400 m. Each method yielded a similar estimate of 400 m walking speed with a root mean square error of ~0.07 m s(-1) and an R-squared values ranging from 0.37-0.41. Sensitivity and specificity of identifying slow walkers was approximately 70% and 80% for all methods, respectively. The top five features, which were related to movement pace and amount (activity counts and steps), length in activity engagement (bout length), accumulation patterns of activity, and movement variability significantly improved the prediction of MMD beyond that found with common covariates (age, diseases, anthropometry, etc). This study identified a subset of actigraphy features collected in free-living conditions that are moderately accurate in identifying persons with clinically-assessed mobility impaired and significantly improve the prediction of MMD. These findings suggest that the combination of features as opposed to a specific feature is important to consider when choosing features and/or combinations of features for prediction of mobility phenotypes in older adults.

  View details for DOI 10.1088/0967-3334/37/10/1813

  View details for Web of Science ID 000385497200013

  View details for PubMedID 27653966

• Physical Activity in Older Adults: an Ecological Approach. Annals of behavioral medicine Thornton, C. M., Kerr, J., Conway, T. L., Saelens, B. E., Sallis, J. F., Ahn, D. K., Frank, L. D., Cain, K. L., King, A. C. 2016: -?

  Abstract

  Studies identifying correlates of physical activity (PA) at all levels of the ecological model can provide an empirical basis for designing interventions to increase older adults' PA.Applying ecological model principles, this study concurrently examined individual, psychosocial, and environmental correlates of older adults' PA to determine whether built environment factors contribute to PA over and above individual/demographic and psychosocial variables.Using a cross-sectional observational design, 726 adults, aged ≥66 years, were recruited from two US regions. Explanatory variables included demographics, self-efficacy, social support, barriers, and environmental variables measured by using geographic information systems (GIS) and self-report. Outcomes included reported walking for errands and leisure/exercise and accelerometer-measured daily moderate to vigorous PA (MVPA). Analyses employed mixed-model regressions with backward elimination.For daily MVPA, the only significant environmental variable was GIS-based proximity to a park (p < 0.001) after controlling for individual/demographic and psychosocial factors. Walking for errands was positively related to four environmental variables: reported walking/cycling facilities (p < 0.05), GIS-based intersection density (p < 0.01), mixed land use (p < 0.01), and private recreation facilities (p < 0.01). Walking for leisure/exercise was negatively related to GIS-based mixed land use (p < 0.05). Non-Hispanic white race/ethnicity, self-efficacy, and social support positively related to all three PA outcomes (p < 0.05).Correlates of older adults' PA were found at all ecological levels, supporting multiple levels of influence and need for multilevel interventions. Environmental correlates varied by PA outcome. Walking for errands exhibited the most environmental associations.

  View details for PubMedID 27680568

• Socioeconomic differences in the benefits of structured physical activity compared with health education on the prevention of major mobility disability in older adults: the LIFE study. Journal of epidemiology and community health Bann, D., chen, H., Bonell, C., Glynn, N. W., Fielding, R. A., Manini, T., King, A. C., Pahor, M., Mihalko, S. L., Gill, T. M. 2016; 70 (9): 930-933

  Abstract

  Evidence is lacking on whether health-benefiting community-based interventions differ in their effectiveness according to socioeconomic characteristics. We evaluated whether the benefit of a structured physical activity intervention on reducing mobility disability in older adults differs by education or income.The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicentre, randomised trial that compared a structured physical activity programme with a health education programme on the incidence of mobility disability among at-risk community-living older adults (aged 70-89 years; average follow-up of 2.6 years). Education (≤ high school (0-12 years), college (13-17 years) or postgraduate) and annual household income were self-reported (<$24 999, $25 000 to $49 999 and ≥$50 000). The risk of disability (objectively defined as loss of ability to walk 400 m) was compared between the 2 treatment groups using Cox regression, separately by socioeconomic group. Socioeconomic group×intervention interaction terms were tested.The effect of reducing the incidence of mobility disability was larger for those with postgraduate education (0.72, 0.51 to 1.03; N=411) compared with lower education (high school or less (0.93, 0.70 to 1.24; N=536). However, the education group×intervention interaction term was not statistically significant (p=0.54). Findings were in the same direction yet less pronounced when household income was used as the socioeconomic indicator.In the largest and longest running trial of physical activity amongst at-risk older adults, intervention effect sizes were largest among those with higher education or income, yet tests of statistical interactions were non-significant, likely due to inadequate power.NCT01072500.

  View details for DOI 10.1136/jech-2016-207321

  View details for PubMedID 27060177

  View details for PubMedCentralID PMC5013156

• Iterative development of Vegethon: a theory-based mobile app intervention to increase vegetable consumption INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Mummah, S. A., King, A. C., Gardner, C. D., Sutton, S. 2016; 13

  Abstract

  Mobile technology may serve as a cost-effective and scalable tool for delivering behavioral nutrition interventions. This research sought to iteratively develop a theory-driven mobile app, Vegethon, to increase vegetable consumption.Development of Vegethon followed phases outlined by the IDEAS framework: 1) empathize with users (qualitative interviews, n = 18); 2) specify target behavior; 3) ground in behavioral theory; 4) ideate implementation strategies; 5) prototype potential products; 6) gather user feedback (qualitative interviews, n = 14; questionnaire, n = 41); 7) build minimum viable product; and 8) pilot potential efficacy and usability (pilot RCT, n = 17). Findings from each phase informed subsequent phases. The target population that informed intervention development was 18-50 years of age, had BMIs of 28-40 kg/m(2), and lived in the geographical area surrounding Stanford University. A full description of the final version of Vegethon is included in the paper.Qualitative findings that shaped initial intervention conception were: participants' interests in accountability without judgment; their desire for simple and efficient dietary self-monitoring; and the importance of planning meals in advance. Qualitative findings identified during intervention refinement were the need for a focus on vegetable self-monitoring; inclusion of vegetable challenges; simplification of features; advice and inspiration for eating vegetables; reminder notifications; and peer comparison. Pilot RCT findings suggested the initial efficacy, acceptance, and feasibility of the intervention. The final version of Vegethon enabled easy self-monitoring of vegetable consumption and included a range of features designed to engage the user (e.g., surprise challenges; leaderboard; weekly reports). Vegethon was coded for its inclusion of 18 behavior change techniques (BCTs) (e.g., goal setting; feedback; social comparison; prompts/cues; framing/reframing; identity).Vegethon is a theory-based, user-informed mobile intervention that was systematically developed using the IDEAS framework. Vegethon targets increased vegetable consumption among overweight adults and is currently being evaluated in a randomized controlled efficacy trial.Clinical Trials.gov: NCT01826591.

  View details for DOI 10.1186/s12966-016-0400-z

  View details for Web of Science ID 000381567700001

  View details for PubMedID 27501724

  View details for PubMedCentralID PMC4977881

• Caregiving, Transport-Related, and Demographic Correlates of Sedentary Behavior in Older Adults: The Senior Neighborhood Quality of Life Study JOURNAL OF AGING AND HEALTH White, M. N., King, A. C., Sallis, J. F., Frank, L. D., Saelens, B. E., Conway, T. L., Cain, K. L., Kerr, J. 2016; 28 (5): 812-833

  Abstract

  Excess sedentary time predicts negative health outcomes independent of physical activity. The present investigation examined informal caregiving duties and transportation-related factors as potential correlates of sedentary behavior in older adults.Average daily sedentary time was measured via accelerometer in adults ages 66 years and older (N = 861). Caregiving variables included dog ownership and informal family caregiving status. Transportation variables included driver status, walking distance to public transit, and reported presence of pedestrians and bicyclists in one's neighborhood.In multivariate models, owning a dog and being a driver were associated with less sedentary time (p ≤ .01). Educational status and geographic region modified the association between dog ownership and sedentary time, and age modified the association between driver status and sedentary time.This study identified that older adult dog owners and drivers were less sedentary. Both factors may create opportunities for older adults to get out of their homes.

  View details for DOI 10.1177/0898264315611668

  View details for Web of Science ID 000379512600005

  View details for PubMedID 26538268

• Beyond Borders and Boundaries: Promoting Active Ageing in the 21st Century King, A. C. HUMAN KINETICS PUBL INC. 2016: S89

  View details for Web of Science ID 000381554400223

• Hospitalizations During a Physical Activity Intervention in Older Adults at Risk of Mobility Disability: Analyses from the Lifestyle Interventions and Independence for Elders Randomized Clinical Trial JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Marsh, A. P., Applegate, W. B., Guralnik, J. M., Rejeski, W. J., Church, T. S., Fielding, R. A., Gill, T. M., King, A. C., Kritchevsky, S. B., Manini, T. M., McDermott, M. M., Newman, A. B., Stowe, C. L., Walkup, M. P., Pahor, M., Miller, M. E. 2016; 64 (5): 933-943

  Abstract

  To determine whether moderate-intensity physical activity (PA) and health education (HE) are differentially associated with categories of hospitalizations or subgroups of participants.Multicenter randomized controlled trial in which participants were randomized to a PA or HE program for an average of 2.6 years.Eight field centers.Sedentary men and women aged 70-89 with lower extremity physical limitations but able to walk 400-m in 15 minutes or less (N = 1,635).Structured, moderate-intensity PA (n =  818) at a center (2×/wk) and at home (3-4×/wk) that included aerobic, strength, balance, and flexibility training or HE (n =  817) of educational workshops and upper extremity stretching exercises.All-cause inpatient hospitalizations ascertained at 6-month intervals.There were 1,458 hospitalizations (49.1% of PA, 44.4% of HE; risk difference = 4.68%, 95% confidence interval (CI) = -0.18-9.54; hazard ratio (HR) = 1.16, 95% CI = 1.00-1.34). The intervention effect on incident hospitalization did not differ according to race, sex, Short Physical Performance Battery score, age, or history of cardiovascular disease or diabetes mellitus. PA was associated with higher rates of hospitalization in the middle baseline gait speed category, than HE (<0.8 m/s: HR = 0.93, 95% CI = 0.76-1.14; 0.8-1.0 m/s: HR = 1.54, 95% CI = 1.23-1.94; >1.0 m/s: HR = 1.05, 95% CI = 0.67-1.65; interaction P = .005).A PA program in older adults at risk for mobility disability did not lead to a different risk of specific types of hospitalizations than a HE program overall. Baseline gait speed may be a marker for risk of hospitalization during a PA intervention, because individuals with moderate baseline gait speed in the PA group had slightly higher rates of hospitalization than those in the HE group.ClinicalTrials.gov identifier: NCT01072500.

  View details for DOI 10.1111/jgs.14114

  View details for PubMedID 27225353

• Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Groessl, E. J., Kaplan, R. M., Sweet, C. M., Church, T., Espeland, M. A., Gill, T. M., Glynn, N. W., King, A. C., Kritchevsky, S., Manini, T., McDermott, M. M., Reid, K. F., Rushing, J., Pahor, M. 2016; 71 (5): 656-662

  Abstract

  Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.

  View details for DOI 10.1093/gerona/glw001

  View details for Web of Science ID 000376398400015

• Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability. journals of gerontology. Series A, Biological sciences and medical sciences Groessl, E. J., Kaplan, R. M., Castro Sweet, C. M., Church, T., Espeland, M. A., Gill, T. M., Glynn, N. W., King, A. C., Kritchevsky, S., Manini, T., McDermott, M. M., Reid, K. F., Rushing, J., Pahor, M. 2016; 71 (5): 656-662

  Abstract

  Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.

  View details for DOI 10.1093/gerona/glw001

  View details for PubMedID 26888433

• EFFECTS OF THREE DIFFERENT MOTIVATIONALLY TARGETED MOBILE DEVICE APPLICATIONS ON INITIAL PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR CHANGE IN MIDLIFE AND OLDER ADULTS King, A., Hekler, E., Grieco, L., Winter, S., Sheats, J., Buman, M., Banerjee, B., Robinson, T., Cirimele, J. OXFORD UNIV PRESS INC. 2016: S170

  View details for Web of Science ID 000526998300663

• MENTORING AT A DISTANCE Xu, X., DeSorbo-Quinn, A., Schneider, M., King, A., Allegrante, J., Nigg, C. OXFORD UNIV PRESS INC. 2016: S178

  View details for Web of Science ID 000526998300698

• NOVEL INTERVENTION STRATEGIES FOR REDUCING SEDENTARY BEHAVIOR IN THE WORKPLACE Mailey, E. L., Buman, M., Carr, L., King, A. OXFORD UNIV PRESS INC. 2016: S40

  View details for Web of Science ID 000526998300153

• INNOVATIVE STRATEGIES TO ASSESS AND TARGET SEDENTARY BEHAVIOR ACROSS THE LIFESPAN Dunton, G. F., Bond, D. S., King, A., Napolitano, M., Lewis, B. OXFORD UNIV PRESS INC. 2016: S169

  View details for Web of Science ID 000526998300660

• Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ (Clinical research ed.) Gill, T. M., Pahor, M., Guralnik, J. M., McDermott, M. M., King, A. C., Buford, T. W., Strotmeyer, E. S., Nelson, M. E., Sink, K. M., Demons, J. L., Kashaf, S. S., Walkup, M. P., Miller, M. E. 2016; 352: i245-?

  Abstract

  To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional limitations.Multicenter, single blinded randomized trial (Lifestyle Interventions and Independence for Elders (LIFE) study).Eight centers across the United States, February 2010 to December 2011.1635 sedentary adults aged 70-89 years with functional limitations, defined as a short physical performance battery score ≤ 9, but who were able to walk 400 m.A permuted block algorithm stratified by field center and sex was used to allocate interventions. Participants were randomized to a structured, moderate intensity physical activity program (n=818) conducted in a center (twice a week) and at home (3-4 times a week) that included aerobic, strength, flexibility, and balance training activities, or to a health education program (n=817) consisting of workshops on topics relevant to older people and upper extremity stretching exercises.Serious fall injuries, defined as a fall that resulted in a clinical, non-vertebral fracture or that led to a hospital admission for another serious injury, was a prespecified secondary outcome in the LIFE Study. Outcomes were assessed every six months for up to 42 months by staff masked to intervention assignment. All participants were included in the analysis.Over a median follow-up of 2.6 years, a serious fall injury was experienced by 75 (9.2%) participants in the physical activity group and 84 (10.3%) in the health education group (hazard ratio 0.90, 95% confidence interval 0.66 to 1.23; P=0.52). These results were consistent across several subgroups, including sex. However, in analyses that were not prespecified, sex specific differences were observed for rates of all serious fall injuries (rate ratio 0.54, 95% confidence interval 0.31 to 0.95 in men; 1.07, 0.75 to 1.53 in women; P=0.043 for interaction), fall related fractures (0.47, 0.25 to 0.86 in men; 1.12, 0.77 to 1.64 in women; P=0.017 for interaction), and fall related hospital admissions (0.41, 0.19 to 0.89 in men; 1.10, 0.65 to 1.88 in women; P=0.039 for interaction).In this trial, which was underpowered to detect small, but possibly important reductions in serious fall injuries, a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations. These null results were accompanied by suggestive evidence that the physical activity program may reduce the rate of fall related fractures and hospital admissions in men.Trial registration ClinicalsTrials.gov NCT01072500.

  View details for DOI 10.1136/bmj.i245

  View details for PubMedID 26842425

  View details for PubMedCentralID PMC4772786

• GENETIC MODERATORS OF THE IMPACT OF PHYSICAL ACTIVITY ON DEPRESSIVE SYMPTOMS JOURNAL OF FRAILTY & AGING Dotson, V. M., Hsu, F. C., Langaee, T. Y., McDonough, C. W., King, A. C., Cohen, R. A., Newman, A. B., Kritchevsky, S. B., Myers, V., Manini, T. M., Pahor, M., LIFE Study Grp 2016; 5 (1): 6–14

  Abstract

  Converging evidence suggests that physical activity is an effective intervention for both clinical depression and sub-threshold depressive symptoms; however, findings are not always consistent. These mixed results might reflect heterogeneity in response to physical activity, with some subgroups of individuals responding positively, but not others.1) To examine the impact of genetic variation and sex on changes in depressive symptoms in older adults after a physical activity (PA) intervention, and 2) to determine if PA differentially improves particular symptom dimensions of depression.Randomized controlled trial.Four field centers (Cooper Institute, Stanford University, University of Pittsburgh, and Wake Forest University).396 community-dwelling adults aged 70-89 years who participated in the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P).12-month PA intervention compared to an education control.Polymorphisms in the serotonin transporter (5-HTT), brain-derived neurotrophic factor (BDNF), and apolipoprotein E (APOE) genes; 12-month change in the Center for Epidemiologic Studies Depression Scale total score, as well as scores on the depressed affect, somatic symptoms, and lack of positive affect subscales.Men randomized to the PA arm showed the greatest decreases in somatic symptoms, with a preferential benefit in male carriers of the BDNF Met allele. Symptoms of lack of positive affect decreased more in men compared to women, particularly in those possessing the 5-HTT L allele, but the effect did not differ by intervention arm. APOE status did not affect change in depressive symptoms.Results of this study suggest that the impact of PA on depressive symptoms varies by genotype and sex, and that PA may mitigate somatic symptoms of depression more than other symptoms. The results suggest that a targeted approach to recommending PA therapy for treatment of depression is viable.

  View details for DOI 10.14283/jfa.2016.76

  View details for Web of Science ID 000449826700002

  View details for PubMedID 26980363

  View details for PubMedCentralID PMC4905714

• From sedentary to active: Shifting the movement paradigm in workplaces WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION Das, B. M., Mailey, E., Murray, K., Phillips, S. M., Torres, C., King, A. C. 2016; 54 (2): 481-487

  Abstract

  Increased sedentary behavior and reduced physical activity are risk factors for morbidity and mortality. As adults spend a significant portion of their time at work where the default is to spend the majority of the day sitting, shifting workplace norms to decrease sedentary time and increase active time could have a public health impact. Workplaces offer a unique setting for multi-level interventions that can reach diverse populations. Traditional worksite wellness initiatives have produced equivocal results in terms of increasing physical activity. One reason for this may be the focus on corporate-fitness type programs and health education with little change in workplace culture. More innovative approaches combining theory-based worksite wellness components with behavioral economics approaches promoting incidental physical activity at the workplace to make activity the default may be necessary. This article discusses strategies to shift the workplace paradigm from being sedentary to more active using a range of approaches.

  View details for DOI 10.3233/WOR-162330

  View details for Web of Science ID 000381121000023

  View details for PubMedID 27286083

• Mobile Technology for Vegetable Consumption: A Randomized Controlled Pilot Study in Overweight Adults. JMIR mHealth and uHealth Mummah, S. A., Mathur, M., King, A. C., Gardner, C. D., Sutton, S. 2016; 4 (2)

  Abstract

  Mobile apps present a potentially cost-effective tool for delivering behavior change interventions at scale, but no known studies have tested the efficacy of apps as a tool to specifically increase vegetable consumption among overweight adults.The purpose of this pilot study was to assess the initial efficacy and user acceptability of a theory-driven mobile app to increase vegetable consumption.A total of 17 overweight adults aged 42.0 (SD 7.3) years with a body mass index (BMI) of 32.0 (SD 3.5) kg/m(2) were randomized to the use of Vegethon (a fully automated theory-driven mobile app enabling self-monitoring of vegetable consumption, goal setting, feedback, and social comparison) or a wait-listed control condition. All participants were recruited from an ongoing 12-month weight loss trial (parent trial). Researchers who performed data analysis were blinded to condition assignment. The primary outcome measure was daily vegetable consumption, assessed using an adapted version of the validated Harvard Food Frequency Questionnaire administered at baseline and 12 weeks after randomization. An analysis of covariance was used to assess differences in 12-week vegetable consumption between intervention and control conditions, controlling for baseline. App usability and satisfaction were measured via a 21-item post-intervention questionnaire.Using intention-to-treat analyses, all enrolled participants (intervention: 8; control: 9) were analyzed. Of the 8 participants randomized to the intervention, 5 downloaded the app and logged their vegetable consumption a mean of 0.7 (SD 0.9) times per day, 2 downloaded the app but did not use it, and 1 never downloaded it. Consumption of vegetables was significantly greater among the intervention versus control condition at the end of the 12-week pilot study (adjusted mean difference: 7.4 servings; 95% CI 1.4-13.5; P=.02). Among secondary outcomes defined a priori, there was significantly greater consumption of green leafy vegetables, cruciferous vegetables, and dark yellow vegetables (adjusted mean difference: 2.6, 1.6, and 0.8 servings; 95% CI 0.1-5.0, 0.1-3.2, and 0.3-1.4; P=.04, P=.04, and P=.004, respectively). Participants reported positive experiences with the app, including strong agreement with the statements "I have found Vegethon easy to use" and "I would recommend Vegethon to a friend" (mean 4.6 (SD 0.6) and 4.2 (SD 0.8), respectively, (on a 5-point scale).Vegethon demonstrated initial efficacy and user acceptability. A mobile app intervention may be useful for increasing vegetable consumption among overweight adults. The small sample size prevented precise estimates of effect sizes. Given the improved health outcomes associated with increases in vegetable consumption, these findings indicate the need for larger, longer-term evaluations of Vegethon and similar technologies among overweight adults and other suitable target groups.ClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591 (Archived by WebCite at http://www.webcitation.org/6hYDw2AOB).

  View details for DOI 10.2196/mhealth.5146

  View details for PubMedID 27193036

  View details for PubMedCentralID PMC4889871

• A pilot study combining Go4Life® materials with an interactive voice response system to promote physical activity in older women. Journal of women & aging Saquib, J., King, A. C., Castro, C. M., Tinker, L. F., Sims, S., Shikany, J. M., Bea, J. W., LaCroix, A. Z., Van Horn, L., Stefanick, M. L. 2016; 28 (5): 454-462

  Abstract

  Telephone-based interactive voice response (IVR) systems could be an effective tool for promotion of physical activity among older women. To test IVR feasibility, we enrolled 30 older women in a 10-week physical activity intervention designed around National Institute on Aging (NIA) Go4Life® educational materials with IVR coaching. Participants (mean age = 76 years) significantly increased physical activity by a mean 79 ± 116 (SD) minutes/week (p < .001). Participants reported that the Go4Life® materials, pedometer, and IVR coaching (70% reported easy technology) were useful tools for change. This pilot study demonstrates IVR acceptability as an evidence-based physical activity program for older women.

  View details for DOI 10.1080/08952841.2015.1018065

  View details for PubMedID 27387264

• An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter? INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY King, A. C., Salvo, D., Banda, J. A., Ahn, D. K., Gill, T. M., Miller, M., Newman, A. B., Fielding, R. A., Siordia, C., Moore, S., Folta, S., Spring, B., Manini, T., Pahor, M. 2015; 12

  Abstract

  Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability.The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence.Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4 %) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4 %) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis.The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation.Clinicaltrials.gov Identifier =  NCT01072500.

  View details for DOI 10.1186/s12966-015-0322-1

  View details for Web of Science ID 000366820000001

  View details for PubMedID 26684894

  View details for PubMedCentralID PMC4683911

• Predictors of Change in Physical Function Among Older Adults in Response to Long-Term Exercise Layne, A., Hsu, F., Blair, S. N., Chen, S., Fielding, R., Hajduk, A. M., King, A. C., Buford, T. W. OXFORD UNIV PRESS INC. 2015

  View details for Web of Science ID 000374222704551

• Sedentary time is associated with the metabolic syndrome in older adults with mobility limitations - The LIFE Study EXPERIMENTAL GERONTOLOGY Mankowski, R. T., Aubertin-Leheudre, M., Beavers, D. P., Botoseneanu, A., Buford, T. W., Church, T., Glynn, N. W., King, A. C., Liu, C., Manini, T. M., Marsh, A. P., McDermott, M., Nocera, J. R., Pahor, M., Strotmeyer, E. S., Anton, S. D. 2015; 70: 32-36

  Abstract

  Epidemiological and objective studies report an association between sedentary time and lower risk of the metabolic syndrome (MetS) and its risk factors in young and middle-age adults. To date, there is a lack of objective data on the association between sedentary time and MetS among older adults.The association between objectively measured sedentary time (accelerometry) with MetS and MetS components was examined in a large sample of older adults with mobility limitations (N=1198; mean age=78.7 ± 5.3 years) enrolled in the Lifestyle Interventions and Independence for Elders (LIFE) study. Participants were divided into tertiles according to percentage of daily sedentary time, and the relation between sedentary time with MetS and MetS components was examined after adjusting for age, sex, ethnicity, and BMI.Participants in the highest sedentary time tertile had significantly higher odds of MetS (OR=1.54) (95% CI 1.13 to 2.11) in comparison with participants in the lowest tertile (p=0.03). Participants in the highest sedentary time tertile had larger waist circumference (p=0.0001) and lower HDL-C (p=0.0003) than participants in the lowest sedentary time tertile.Sedentary time was strongly related to higher odds of MetS. These results, based on objectively measured sedentary time, suggest that sedentary time may represent an important risk factor for the development of MetS in older adults with high likelihood for disability.

  View details for DOI 10.1016/j.exger.2015.06.018

  View details for PubMedID 26130060

• Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults The LIFE Randomized Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Sink, K. M., Espeland, M. A., Castro, C. M., Church, T., Cohen, R., Dodson, J. A., Guralnik, J., Hendrie, H. C., Jennings, J., Katula, J., Lopez, O. L., McDermott, M. M., Pahor, M., Reid, K. F., Rushing, J., Verghese, J., Rapp, S., Williamson, J. D. 2015; 314 (8): 781-790

  Abstract

  Epidemiological evidence suggests that physical activity benefits cognition, but results from randomized trials are limited and mixed.To determine whether a 24-month physical activity program results in better cognitive function, lower risk of mild cognitive impairment (MCI) or dementia, or both, compared with a health education program.A randomized clinical trial, the Lifestyle Interventions and Independence for Elders (LIFE) study, enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011. Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m.A structured, moderate-intensity physical activity program (n = 818) that included walking, resistance training, and flexibility exercises or a health education program (n = 817) of educational workshops and upper-extremity stretching.Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding (DSC) task subtest of the Wechsler Adult Intelligence Scale (score range: 0-133; higher scores indicate better function) and the revised Hopkins Verbal Learning Test (HVLT-R; 12-item word list recall task) assessed in 1476 participants (90.3%). Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months.At 24 months, DSC task and HVLT-R scores (adjusted for clinic site, sex, and baseline values) were not different between groups. The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group (mean difference, -0.01 points [95% CI, -0.80 to 0.77 points], P = .97). The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group (mean difference, -0.03 words [95% CI, -0.29 to 0.24 words], P = .84). No differences for any other cognitive or composite measures were observed. Participants in the physical activity group who were 80 years or older (n = 307) and those with poorer baseline physical performance (n = 328) had better changes in executive function composite scores compared with the health education group (P = .01 for interaction for both comparisons). Incident MCI or dementia occurred in 98 participants (13.2%) in the physical activity group and 91 participants (12.1%) in the health education group (odds ratio, 1.08 [95% CI, 0.80 to 1.46]).Among sedentary older adults, a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function.clinicaltrials.gov Identifier: NCT01072500.

  View details for DOI 10.1001/jama.2015.9617

  View details for Web of Science ID 000360017200018

  View details for PubMedCentralID PMC4698980

• Associations Between Ankle-Brachial Index and Cognitive Function: Results From the Lifestyle Interventions and Independence for Elders Trial JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Espeland, M. A., Newman, A. B., Sink, K., Gill, T. M., King, A. C., Miller, M. E., Guralnik, J., Katula, J., Church, T., Manini, T., Reid, K. F., McDermott, M. M. 2015; 16 (8): 682-689

  Abstract

  The objective of this study was to evaluate cross-sectional and longitudinal associations between ankle-brachial index (ABI) and indicators of cognitive function.Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial).Eight US academic centers.A total of 1601 adults ages 70-89 years, sedentary, without dementia, and with functional limitations.Baseline ABI and interviewer- and computer-administered cognitive function assessments were obtained. These assessments were used to compare a physical activity intervention with a health education control. Cognitive function was reassessed 24 months later (interviewer-administered) and 18 or 30 months later (computer-administered) and central adjudication was used to classify individuals as having mild cognitive impairment, probable dementia, or neither.Lower ABI had a modest independent association with poorer cognitive functioning at baseline (partial r = 0.09; P < .001). Although lower baseline ABI was not associated with overall changes in cognitive function test scores, it was associated with higher odds for 2-year progression to a composite of either mild cognitive impairment or probable dementia (odds ratio 2.60 per unit lower ABI; 95% confidence interval 1.06-6.37). Across 2 years, changes in ABI were not associated with changes in cognitive function.In an older cohort sedentary individuals with dementia and with functional limitations, lower baseline ABI was independently correlated with cognitive function and associated with greater 2-year risk for progression to mild cognitive impairment or probable dementia.

  View details for DOI 10.1016/j.jamda.2015.03.010

  View details for Web of Science ID 000358423400010

  View details for PubMedCentralID PMC4516564

• Associations Between Ankle-Brachial Index and Cognitive Function: Results From the Lifestyle Interventions and Independence for Elders Trial. Journal of the American Medical Directors Association Espeland, M. A., Newman, A. B., Sink, K., Gill, T. M., King, A. C., Miller, M. E., Guralnik, J., Katula, J., Church, T., Manini, T., Reid, K. F., McDermott, M. M. 2015; 16 (8): 682-9

  Abstract

  The objective of this study was to evaluate cross-sectional and longitudinal associations between ankle-brachial index (ABI) and indicators of cognitive function.Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial).Eight US academic centers.A total of 1601 adults ages 70-89 years, sedentary, without dementia, and with functional limitations.Baseline ABI and interviewer- and computer-administered cognitive function assessments were obtained. These assessments were used to compare a physical activity intervention with a health education control. Cognitive function was reassessed 24 months later (interviewer-administered) and 18 or 30 months later (computer-administered) and central adjudication was used to classify individuals as having mild cognitive impairment, probable dementia, or neither.Lower ABI had a modest independent association with poorer cognitive functioning at baseline (partial r = 0.09; P < .001). Although lower baseline ABI was not associated with overall changes in cognitive function test scores, it was associated with higher odds for 2-year progression to a composite of either mild cognitive impairment or probable dementia (odds ratio 2.60 per unit lower ABI; 95% confidence interval 1.06-6.37). Across 2 years, changes in ABI were not associated with changes in cognitive function.In an older cohort sedentary individuals with dementia and with functional limitations, lower baseline ABI was independently correlated with cognitive function and associated with greater 2-year risk for progression to mild cognitive impairment or probable dementia.

  View details for DOI 10.1016/j.jamda.2015.03.010

  View details for PubMedID 25869993

  View details for PubMedCentralID PMC4516564

• Comparative Effectiveness Research: A Roadmap for Physical Activity and Lifestyle MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Jakicic, J. M., Sox, H., Blair, S. N., Bensink, M., Johnson, W. G., King, A. C., Lee, I., Nahum-Shani, I., Sallis, J. F., Sallis, R. E., Craft, L., Whitehead, J. R., Ainsworth, B. E. 2015; 47 (8): 1747-1754

  Abstract

  Comparative effectiveness research (CER) is designed to support informed decision making at both the individual, population, and policy levels. The American College of Sports Medicine and partners convened a conference with the focus of building an agenda for CER within the context of physical activity and nonpharmacological lifestyle approaches in the prevention and treatment of chronic disease. This report summarizes the conference content and consensus recommendations that culminated in a CER roadmap for physical activity and lifestyle approaches to reducing the risk of chronic disease.This conference focused on presentations and discussion around the following topic areas: 1) defining CER, 2) identifying the current funding climate to support CER, 3) summarizing methods for conducting CER, and 4) identifying CER opportunities for physical activity.This conference resulted in consensus recommendations to adopt a CER roadmap for physical activity and lifestyle approaches to reducing the risk of chronic disease. In general, this roadmap provides a systematic framework by which CER for physical activity can move from a planning phase to a phase of engagement in CER related to lifestyle factors with particular emphasis on physical activity to a societal change phase that results in changes in policy, practice, and health.It is recommended that physical activity researchers and health care providers use the roadmap developed from this conference as a method to systematically engage in and apply CER to the promotion of physical activity as a key lifestyle behavior that can be effective at making an impact on a variety of health-related outcomes.

  View details for DOI 10.1249/MSS.0000000000000590

  View details for Web of Science ID 000357942200024

  View details for PubMedID 25426735

• Effect of Structured Physical Activity on Sleep-Wake Behaviors in Sedentary Elderly Adults with Mobility Limitations. Journal of the American Geriatrics Society Vaz Fragoso, C. A., Miller, M. E., King, A. C., Kritchevsky, S. B., Liu, C. K., Myers, V. H., Nadkarni, N. K., Pahor, M., Spring, B. J., Gill, T. M. 2015; 63 (7): 1381-1390

  Abstract

  To evaluate the effect of structured physical activity on sleep-wake behaviors in sedentary community-dwelling elderly adults with mobility limitations.Multicenter, randomized trial of moderate-intensity physical activity versus health education, with sleep-wake behaviors prespecified as a tertiary outcome over a planned intervention period ranging from 24 to 30 months.Lifestyle Interventions and Independence for Elders Study.Community-dwelling persons aged 70 to 89 who were initially sedentary and had a Short Physical Performance Battery score less than 10 (N = 1,635).Sleep-wake behaviors were evaluated using the Insomnia Severity Index (ISI) (≥8 defined insomnia), Epworth Sleepiness Scale (ESS) (≥10 defined daytime drowsiness), and Pittsburgh Sleep Quality Index (PSQI) (>5 defined poor sleep quality) administered at baseline and 6, 18, and 30 months.The randomized groups were similar in terms of baseline demographic variables, including mean age (79) and sex (67% female). Structured physical activity resulted in a significantly lower likelihood of having poor sleep quality (adjusted odds ratios (aOR) for PSQI >5 = 0.80, 95% confidence interval (CI) = 0.68-0.94), including fewer new cases (aOR for PSQI >5 = 0.70, 95% CI = 0.54-0.89), than health education but not in resolution of prevalent cases (aOR for PSQI ≤5 = 1.13, 95% CI = 0.90-1.43). No significant intervention effects were observed for the ISI or ESS.Structured physical activity resulted in a lower likelihood of developing poor sleep quality (PSQI >5) over the intervention period than health education but had no effect on prevalent cases of poor sleep quality or on sleep-wake behaviors evaluated using the ISI or ESS. These results suggest that the benefit of physical activity in this sample was preventive and limited to sleep-wake behaviors evaluated using the PSQI.

  View details for DOI 10.1111/jgs.13509

  View details for PubMedID 26115386

• Effect of Structured Physical Activity on Sleep-Wake Behaviors in Sedentary Elderly Adults with Mobility Limitations JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Fragoso, C. A., Miller, M. E., King, A. C., Kritchevsky, S. B., Liu, C. K., Myers, V. H., Nadkarni, N. K., Pahor, M., Spring, B. J., Gill, T. M. 2015; 63 (7): 1381-1390

  Abstract

  To evaluate the effect of structured physical activity on sleep-wake behaviors in sedentary community-dwelling elderly adults with mobility limitations.Multicenter, randomized trial of moderate-intensity physical activity versus health education, with sleep-wake behaviors prespecified as a tertiary outcome over a planned intervention period ranging from 24 to 30 months.Lifestyle Interventions and Independence for Elders Study.Community-dwelling persons aged 70 to 89 who were initially sedentary and had a Short Physical Performance Battery score less than 10 (N = 1,635).Sleep-wake behaviors were evaluated using the Insomnia Severity Index (ISI) (≥8 defined insomnia), Epworth Sleepiness Scale (ESS) (≥10 defined daytime drowsiness), and Pittsburgh Sleep Quality Index (PSQI) (>5 defined poor sleep quality) administered at baseline and 6, 18, and 30 months.The randomized groups were similar in terms of baseline demographic variables, including mean age (79) and sex (67% female). Structured physical activity resulted in a significantly lower likelihood of having poor sleep quality (adjusted odds ratios (aOR) for PSQI >5 = 0.80, 95% confidence interval (CI) = 0.68-0.94), including fewer new cases (aOR for PSQI >5 = 0.70, 95% CI = 0.54-0.89), than health education but not in resolution of prevalent cases (aOR for PSQI ≤5 = 1.13, 95% CI = 0.90-1.43). No significant intervention effects were observed for the ISI or ESS.Structured physical activity resulted in a lower likelihood of developing poor sleep quality (PSQI >5) over the intervention period than health education but had no effect on prevalent cases of poor sleep quality or on sleep-wake behaviors evaluated using the ISI or ESS. These results suggest that the benefit of physical activity in this sample was preventive and limited to sleep-wake behaviors evaluated using the PSQI.

  View details for DOI 10.1111/jgs.13509

  View details for Web of Science ID 000358254200013

• Interventions to Reduce Sedentary Behavior MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Manini, T. M., Carr, L. J., King, A. C., Marshall, S., Robinson, T. N., Rejeski, W. J. 2015; 47 (6): 1306-1310

  Abstract

  This article reports on the presentations and discussion from the working group on "Influences on Sedentary Behavior and Interventions To Reduce Sedentary Behavior" as part of the Sedentary Behavior: Identifying Research Priorities workshop.Interventions were discussed in the context of targeting sedentary behavior (SB) as a concept distinct from physical activity. It was recommended that interventions targeting SB should consider a life course perspective, a position predicated on the assumption that SB is age and life stage dependent. In addition, targeting environments where individuals have high exposure to SB-such as workplace sitting-could benefit from new technology (e.g., computer-based prompting to stand or move), environmental changes (e.g., active workstations), policies targeting reduced sedentary time (e.g., allowing employees regular desk breaks), or by changing norms surrounding prolonged sitting (e.g., standing meetings).There are limited data about the minimal amount of SB change required to produce meaningful health benefits. In addition to developing relevant scientific and public health definitions of SB, it is important to further delineate the scope of health and quality-of-life outcomes associated with reduced SB across the life course and to clarify what behavioral alternatives to SB can be used to optimize health gains. SB interventions will benefit from having more clarity about the potential physiological and behavioral synergies with current physical activity recommendations, developing multilevel interventions aimed at reducing SB across all life phases and contexts, harnessing relevant and effective strategies to extend the reach of interventions to all sectors of society, as well as applying state-of-the-science adaptive designs and methods to accelerate advances in the science of SB interventions.

  View details for DOI 10.1249/MSS.0000000000000519

  View details for Web of Science ID 000354745500027

  View details for PubMedID 25222818

  View details for PubMedCentralID PMC4362870

• The MAT-sf: Identifying Risk for Major Mobility Disability JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Rejeski, W. J., Rushing, J., Guralnik, J. M., Ip, E. H., King, A. C., Manini, T. M., Marsh, A. P., McDermott, M. M., Fielding, R. A., Newman, A. B., Tudor-Locke, C., Gill, T. M. 2015; 70 (5): 641-646

  Abstract

  The assessment of mobility is essential to both aging research and clinical geriatric practice. A newly developed self-report measure of mobility, the mobility assessment tool-short form (MAT-sf), uses video animations as an innovative method to improve measurement accuracy/precision. The primary aim of the current study was to evaluate whether MAT-sf scores can be used to identify risk for major mobility disability (MMD).This article is based on data collected from the Lifestyle Interventions and Independence for Elders study and involved 1,574 older adults between the ages of 70-89. The MAT-sf was administered at baseline; MMD, operationalized as failure to complete the 400-m walk ≤ 15 minutes, was evaluated at 6-month intervals across a period of 42 months. The outcome of interest was the first occurrence of MMD or incident MMD.After controlling for age, sex, clinic site, and treatment arm, baseline MAT-sf scores were found to be effective in identifying risk for MMD (p < .0001). Partitioning the MAT-sf into four groups revealed that persons with scores <40, 40-49, 50-59, and 60+ had failure rates across 42 months of follow-up of 66%, 52%, 35%, and 22%, respectively.The MAT-sf is a quick and efficient way of identifying older adults at risk for MMD. It could be used to clinically identify older adults that are in need of intervention for MMD and provides a simple means for monitoring the status of patients' mobility, an important dimension of functional health.

  View details for DOI 10.1093/gerona/glv003

  View details for PubMedID 25680917

• Role of Fatigue on the Effectiveness of a Physical Activity Intervention Aimed at Preventing Mobility Disability Glynn, N. W., Lovato, L. C., Santanasto, A. J., Lange-Maia, B., Nicklas, B., Fielding, R. A., Manini, T. M., Myers, V. H., de Rekeneire, N., Spring, B. J., Pahor, M., King, A. C., Rejeski, W. LIPPINCOTT WILLIAMS & WILKINS. 2015: 63

  View details for DOI 10.1249/01.mss.0000476572.23791.ef

  View details for Web of Science ID 000414071200181

• Accelerometer Compliance Rates And Sample Demographics: What Is The Impact Of Requesting "Rewears"? Cain, K. L., Gavand, K. A., Conway, T. L., Saelens, B. E., Frank, L. D., Kerr, J., King, A. C., Schipperijn, J., Sallis, J. F. LIPPINCOTT WILLIAMS & WILKINS. 2015: 109–10

  View details for DOI 10.1249/01.mss.0000476708.76299.cf

  View details for Web of Science ID 000414071200328

• Effects Of A Long-term Physical Activity Program On Accelerometry-based Sedentary Time In Older Adults Wanigatunga, A. A., Ambrosius, W. T., McDermott, M. M., King, A. C., Fielding, R. A., Glynn, N. W., Guralnik, J. M., Tudor-Locke, C. E., Gill, T. M., Hire, D. G., Pahor, M., Manini, T. M. LIPPINCOTT WILLIAMS & WILKINS. 2015: 515–16

  View details for DOI 10.1249/01.mss.0000477849.39535.d3

  View details for Web of Science ID 000415220100717

• Food and Physical Activity Environments An Energy Balance Approach for Research and Practice AMERICAN JOURNAL OF PREVENTIVE MEDICINE Economos, C. D., Hatfield, D. P., King, A. C., Ayala, G. X., Pentz, M. A. 2015; 48 (5): 620-629

  Abstract

  Increases in the prevalence of overweight and obesity are a function of chronic, population-level energy imbalance, whereby energy intakes exceed energy expenditures. Although sometimes viewed in isolation, energy intakes and expenditures in fact exist in a dynamic interplay: energy intakes may influence energy expenditures and vice versa. Obesogenic environments that promote positive energy balance play a central role in the obesity epidemic, and reducing obesity prevalence will require re-engineering environments to promote both healthy eating and physical activity. There may be untapped synergies in addressing both sides of the energy balance equation in environmentally focused obesity interventions, yet food/beverage and physical activity environments are often addressed separately. The field needs design, evaluation, and analytic methods that support this approach. This paper provides a rationale for an energy balance approach and reviews and describes research and practitioner work that has taken this approach to obesity prevention at the environmental and policy levels. Future directions in research, practice, and policy include moving obesity prevention toward a systems approach that brings both nutrition and physical activity into interdisciplinary training, funding mechanisms, and clinical and policy recommendations/guidelines.

  View details for DOI 10.1016/j.amepre.2014.12.007

  View details for Web of Science ID 000353069300020

  View details for PubMedID 25891062

• LATENT PROFILE ANALYSIS OF GIS-MEASURED ENVIRONMENTS FOR PHYSICAL ACTIVITY IN OLDER ADULTS Todd, M., Adams, M. A., Kurka, J., Conway, T., Cain, K., Frank, L., Sallis, J., King, A. SPRINGER. 2015: S171

  View details for Web of Science ID 000367825002159

• Novel Assessment of Built Environment Assets and Barriers to Healthy Eating and Active Living in Rural Communities Messing, J., Connor, L., King, A., Sheats, J., Winter, S., Buman, M., Seguin, R. FEDERATION AMER SOC EXP BIOL. 2015

  View details for Web of Science ID 000361470502283

• MULTI-LEVEL BEHAVIORAL CHANGE APPROACHES TO FALL PREVENTION: INDIVIDUAL, COMMUNITY AND POLICY Mielenz, T., Winter, S. J., Ory, M. G., Schneider, E., Smith, M., Altpeter, M., Bomberger, S., Shubert, T., Kharrazi, R. J., Fauci, M. A., Castro, C., King, A., Stevens, J. A., Caffarelli, A. I. SPRINGER. 2015: S126

  View details for Web of Science ID 000367825001495

• Light Intensity Physical Activity and Sedentary Behavior in Relation to Body Mass Index and Grip Strength in Older Adults: Cross-Sectional Findings from the Lifestyle Interventions and Independence for Elders (LIFE) Study PLOS ONE Bann, D., Hire, D., Manini, T., Cooper, R., Botoseneanu, A., McDermott, M. M., Pahor, M., Glynn, N. W., Fielding, R., King, A. C., Church, T., Ambrosius, W. T., Gill, T. 2015; 10 (2)

  Abstract

  Identifying modifiable determinants of fat mass and muscle strength in older adults is important given their impact on physical functioning and health. Light intensity physical activity and sedentary behavior are potential determinants, but their relations to these outcomes are poorly understood. We evaluated associations of light intensity physical activity and sedentary time-assessed both objectively and by self-report-with body mass index (BMI) and grip strength in a large sample of older adults.We used cross-sectional baseline data from 1130 participants of the Lifestyle Interventions and Independence for Elders (LIFE) study, a community-dwelling sample of relatively sedentary older adults (70-89 years) at heightened risk of mobility disability. Time spent sedentary and in light intensity activity were assessed using an accelerometer worn for 3-7 days (Actigraph GT3X) and by self-report. Associations between these exposures and measured BMI and grip strength were evaluated using linear regression.Greater time spent in light intensity activity and lower sedentary times were both associated with lower BMI. This was evident using objective measures of lower-light intensity, and both objective and self-reported measures of higher-light intensity activity. Time spent watching television was positively associated with BMI, while reading and computer use were not. Greater time spent in higher but not lower intensities of light activity (assessed objectively) was associated with greater grip strength in men but not women, while neither objectively assessed nor self-reported sedentary time was associated with grip strength.In this cross-sectional study, greater time spent in light intensity activity and lower sedentary times were associated with lower BMI. These results are consistent with the hypothesis that replacing sedentary activities with light intensity activities could lead to lower BMI levels and obesity prevalence among the population of older adults. However, longitudinal and experimental studies are needed to strengthen causal inferences.

  View details for DOI 10.1371/journal.pone.0116058

  View details for PubMedID 25647685

• Association of objectively measured physical activity with cardiovascular risk in mobility-limited older adults. Journal of the American Heart Association Fitzgerald, J. D., Johnson, L., Hire, D. G., Ambrosius, W. T., Anton, S. D., Dodson, J. A., Marsh, A. P., McDermott, M. M., Nocera, J. R., Tudor-Locke, C., White, D. K., Yank, V., Pahor, M., Manini, T. M., Buford, T. W. 2015; 4 (2)

  Abstract

  Data are sparse regarding the impacts of habitual physical activity (PA) and sedentary behavior on cardiovascular (CV) risk in older adults with mobility limitations.This study examined the baseline, cross-sectional association between CV risk and objectively measured PA among participants in the Lifestyle Interventions and Independence for Elders (LIFE) study. The relationship between accelerometry measures and predicted 10-year Hard Coronary Heart Disease (HCHD) risk was modeled by using linear regression, stratified according to CVD history. Participants (n=1170, 79±5 years) spent 642±111 min/day in sedentary behavior (ie, <100 accelerometry counts/min). They also spent 138±43 min/day engaging in PA registering 100 to 499 accelerometry counts/min and 54±37 min/day engaging in PA ≥500 counts/min. Each minute per day spent being sedentary was associated with increased HCHD risk among both those with (0.04%, 95% CI 0.02% to 0.05%) and those without (0.03%, 95% CI 0.02% to 0.03%) CVD. The time spent engaging in activities 100 to 499 as well as ≥500 counts/min was associated with decreased risk among both those with and without CVD (P<0.05). The mean number of counts per minute of daily PA was not significantly associated with HCHD risk in any model (P>0.05). However, a significant interaction was observed between sex and count frequency (P=0.036) for those without CVD, as counts per minute was related to HCHD risk in women (β=-0.94, -1.48 to -0.41; P<0.001) but not in men (β=-0.14, -0.59 to 0.88; P=0.704).Daily time spent being sedentary is positively associated with predicted 10-year HCHD risk among mobility-limited older adults. Duration, but not intensity (ie, mean counts/min), of daily PA is inversely associated with HCHD risk score in this population-although the association for intensity may be sex specific among persons without CVD.www.clinicaltrials.gov Unique identifier: NCT01072500.

  View details for DOI 10.1161/JAHA.114.001288

  View details for PubMedID 25696062

• Prevalence of Metabolic Syndrome and Its Association with Physical Capacity, Disability, and Self-Rated Health in Lifestyle Interventions and Independence for Elders Study Participants JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Botoseneanu, A., Ambrosius, W. T., Beavers, D. P., De Rekeneire, N., Anton, S., Church, T., Folta, S. C., Goodpaster, B. H., King, A. C., Nicklas, B. J., Spring, B., Wang, X., Gill, T. M. 2015; 63 (2): 222-232

  Abstract

  To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self-rated health in older adults at high risk of mobility disability, including those with and without diabetes mellitus.Cross-sectional analysis.Lifestyle Interventions and Independence for Elders (LIFE) Study.Community-dwelling sedentary adults aged 70 to 89 at high risk of mobility disability (Short Physical Performance Battery (SPPB) score ≤9; mean 7.4 ± 1.6) (N = 1,535).Metabolic syndrome was defined according to the 2009 multiagency harmonized criteria; outcomes were physical capacity (400-m walk time, grip strength, SPPB score), disability (composite 19-item score), and self-rated health (5-point scale ranging from excellent to poor).The prevalence of MetS was 49.8% in the overall sample (83.2% of those with diabetes mellitus, 38.1% of those without). MetS was associated with stronger grip strength (mean difference (Δ) = 1.2 kg, P = .01) in the overall sample and in participants without diabetes mellitus and with poorer self-rated health (Δ = 0.1 kg, P < .001) in the overall sample only. No significant differences were found in 400-m walk time, SPPB score, or disability score between participants with and without MetS, in the overall sample or diabetes mellitus subgroups.Metabolic dysfunction is highly prevalent in older adults at risk of mobility disability, yet consistent associations were not observed between MetS and walking speed, lower extremity function, or self-reported disability after adjusting for known and potential confounders. Longitudinal studies are needed to investigate whether MetS accelerates declines in functional status in high-risk older adults and to inform clinical and public health interventions aimed at preventing or delaying disability in this group.

  View details for DOI 10.1111/jgs.13205

  View details for Web of Science ID 000349893300002

  View details for PubMedID 25645664

  View details for PubMedCentralID PMC4333053

• An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter? international journal of behavioral nutrition and physical activity King, A. C., Salvo, D., Banda, J. A., Ahn, D. K., Gill, T. M., Miller, M., Newman, A. B., Fielding, R. A., Siordia, C., Moore, S., Folta, S., Spring, B., Manini, T., Pahor, M. 2015; 12 (1): 157-?

  Abstract

  Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability.The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence.Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4 %) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4 %) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis.The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation.Clinicaltrials.gov Identifier =  NCT01072500.

  View details for DOI 10.1186/s12966-015-0322-1

  View details for PubMedID 26684894

• Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013-2014. Preventing chronic disease Seguin, R. A., Morgan, E. H., Connor, L. M., Garner, J. A., King, A. C., Sheats, J. L., Winter, S. J., Buman, M. P. 2015; 12: E102-?

  Abstract

  A community's built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement.Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change.Twenty-four adults (mean age, 69.4 y (standard deviation, 13.2 y), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use.An electronic tablet-based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

  View details for DOI 10.5888/pcd12.150147

  View details for PubMedID 26133645

• Effect of Exercise and Cognitive Activity on Self-Reported Sleep Quality in Community-Dwelling Older Adults with Cognitive Complaints: A Randomized Controlled Trial JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Pa, J., Goodson, W., Bloch, A., King, A. C., Yaffe, K., Barnes, D. E. 2014; 62 (12): 2319-2326

  Abstract

  To compare the effects of different types of physical and mental activity on self-reported sleep quality over 12 weeks in older adults with cognitive and sleep complaints.Randomized controlled trial.General community.Seventy-two inactive community-dwelling older adults with self-reported sleep and cognitive problems (mean age 73.3 ± 6.1; 60% women).Random allocation to four arms using a two-by-two factorial design: aerobic+cognitive training, aerobic+educational DVD, stretching+cognitive training, and stretching+educational DVD arms (60 min/d, 3 d/wk for physical and mental activity for 12 weeks).Change in sleep quality using seven questions from the Sleep Disorders Questionnaire on the 2005 to 2006 National Health and Nutrition Examination Survey (range 0-28, with higher scores reflecting worse sleep quality). Analyses used intention-to-treat methods.Sleep quality scores did not differ at baseline, but there was a significant difference between the study arms in change in sleep quality over time (P < .005). Mean sleep quality scores improved significantly more in the stretching+educational DVD arm (5.1 points) than in the stretching+cognitive training (1.2 points), aerobic+educational DVD (1.1 points), or aerobic+cognitive training (0.25 points) arms (all P < .05, corrected for multiple comparisons). Differences between arms were strongest for waking at night (P = .02) and taking sleep medications (P = .004).Self-reported sleep quality improved significantly more with low-intensity physical and mental activities than with moderate- or high-intensity activities in older adults with self-reported cognitive and sleep difficulties. Future longer-term studies with objective sleep measures are needed to corroborate these results.

  View details for DOI 10.1111/jgs.13158

  View details for Web of Science ID 000346497600011

  View details for PubMedID 25516028

• Low-Intensity Walking Activity Is Associated With Better Health JOURNAL OF APPLIED GERONTOLOGY Varma, V. R., Tan, E. J., Wang, T., Xue, Q., Fried, L. P., Seplaki, C. L., King, A. C., Seeman, T. E., Rebok, G. W., Carlson, M. C. 2014; 33 (7): 870–87

  Abstract

  Recommended levels of physical activity may represent challenging targets for many older adults at risk for disability, leading to the importance of evaluating whether low-intensity activity is associated with health benefits. We examined the cross-sectional association between low-intensity walking activity (<100 steps/min) and health and physical function in a group of older adults. Participants (N = 187; age = 66.8; 91.4% African American; 76.5% female) wore a StepWatch Activity Monitor to measure components of low-intensity walking activity. Only 7% of participants met physical activity guidelines and moderate-intensity activity (≥100 steps/min) contributed only 10% of the total steps/day and 2% of the total min/day. Greater amount, frequency, and duration of low-intensity activity were associated with better self-report and performance-based measures of physical function, better quality of life, and fewer depressive symptoms (ps < .05). The cross-sectional relationship between low-intensity activity and health outcomes important to independent function suggests that we further explore the longitudinal benefits of low-intensity activity.

  View details for PubMedID 24652915

  View details for PubMedCentralID PMC4053519

• Combined Reduced Forced Expiratory Volume in 1 Second (FEV1) and Peripheral Artery Disease in Sedentary Elders With Functional Limitations JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Fragoso, C. A., Hsu, F., Brinkley, T., Church, T., Liu, C. K., Manini, T., Newman, A. B., Stafford, R. S., McDermott, M. M., Gill, T. M. 2014; 15 (9): 665-670

  Abstract

  Because they are potentially modifiable and may coexist, we evaluated the combined occurrence of a reduced forced expiratory volume in 1 second (FEV1) and peripheral artery disease (PAD), including its association with exertional symptoms, physical inactivity, and impaired mobility, in sedentary elders with functional limitations.Cross sectional.Lifestyle Interventions and Independence in Elder (LIFE) Study.A total of 1307 sedentary community-dwelling persons, mean age 78.9, with functional limitations (Short Physical Performance Battery [SPPB] <10).A reduced FEV1 was defined by a z-score less than -1.64 (

  View details for DOI 10.1016/j.jamda.2014.05.008

  View details for Web of Science ID 000341167700011

  View details for PubMedID 24973990

  View details for PubMedCentralID PMC4145029

• Contribution of streetscape audits to explanation of physical activity in four age groups based on the Microscale Audit of Pedestrian Streetscapes (MAPS) SOCIAL SCIENCE & MEDICINE Cain, K. L., Millstein, R. A., Sallis, J. F., Conway, T. L., Gavand, K. A., Frank, L. D., Saelens, B. E., Geremia, C. M., Chapman, J., Adams, M. A., Glanz, K., King, A. C. 2014; 116: 82-92

  Abstract

  Ecological models of physical activity emphasize the effects of environmental influences. "Microscale" streetscape features that may affect pedestrian experience have received less research attention than macroscale walkability (e.g., residential density). The Microscale Audit of Pedestrian Streetscapes (MAPS) measures street design, transit stops, sidewalk qualities, street crossing amenities, and features impacting aesthetics. The present study examined associations of microscale attributes with multiple physical activity (PA) measures across four age groups. Areas in the San Diego, Seattle, and the Baltimore metropolitan areas, USA, were selected that varied on macro-level walkability and neighborhood income. Participants (n = 3677) represented four age groups (children, adolescents, adults, older adults). MAPS audits were conducted along a 0.25 mile route along the street network from participant residences toward the nearest non-residential destination. MAPS data were collected in 2009-2010. Subscale and overall summary scores were created. Walking/biking for transportation and leisure/neighborhood PA were measured with age-appropriate surveys. Objective PA was measured with accelerometers. Mixed linear regression analyses were adjusted for macro-level walkability. Across all age groups 51.2%, 22.1%, and 15.7% of all MAPS scores were significantly associated with walking/biking for transport, leisure/neighborhood PA, and objectively-measured PA, respectively. Supporting the ecological model principle of behavioral specificity, destinations and land use, streetscape, street segment, and intersection variables were more related to transport walking/biking, while aesthetic variables were related to leisure/neighborhood PA. The overall score was related to objective PA in children and older adults. Present findings provide strong evidence that microscale environment attributes are related to PA across the lifespan. Improving microscale features may be a feasible approach to creating activity-friendly environments.

  View details for DOI 10.1016/j.socscimed.2014.06.042

  View details for Web of Science ID 000340695700010

  View details for PubMedID 24983701

  View details for PubMedCentralID PMC4153433

• Sociodemographic Moderators of Relations of Neighborhood Safety to Physical Activity MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Carlson, J. A., Bracy, N. L., Sallis, J. F., Millstein, R. A., Saelens, B. E., Kerr, J., Conway, T. L., Frank, L. D., Cain, K. L., King, A. C. 2014; 46 (8): 1554-1563

  Abstract

  This study aimed to investigate gender, race/ethnicity, education, and income as moderators of relations of perceived neighborhood crime, pedestrian, and traffic safety to physical activity.Participants were from two samples: adults (N = 2199, age = 25-65 yr) and older adults (N = 718, age = 66+ yr) from high- and low-walkable neighborhoods in the Washington, DC, and Seattle, Washington, areas. Neighborhood safety and transportation and leisure walking were assessed via survey, and moderate to vigorous physical activity was assessed using accelerometers. Sociodemographic moderators were investigated using interaction terms and follow-up within-group tests from mixed-effects regression models.Overall direct effects of safety on physical activity were not found, with one exception. Seven interactions were found in each sample. Interactions were found for all physical activity outcomes, although total moderate to vigorous physical activity was involved in more interactions in adults than older adults. Half of the interactions revealed significant positive relations of pedestrian and traffic safety to physical activity in the more affluent/advantaged group (i.e., high education, high income, and non-Hispanic white) and null associations in the less affluent/advantaged group. Race/ethnicity was a moderator only in older adults. One-third of the interactions involved gender; half of these involved crime safety. Interactions involving crime safety showed nonsignificant positive trends in the more affluent/advantaged group and women and nonsignificant negative trends in the less affluent/advantaged group and men.Sociodemographic moderators of neighborhood safety explained some of the variation in adults' and older adults' physical activity. Patterns suggested positive associations between safety and physical activity in participants with more affluent/advantaged sociodemographic characteristics, although some patterns were inconsistent, particularly for gender. More refined conceptualizations and measures of safety are needed to understand if and how these constructs influence physical activity.

  View details for DOI 10.1249/MSS.0000000000000274

  View details for Web of Science ID 000339259700010

  View details for PubMedID 25029166

  View details for PubMedCentralID PMC4101912

• Neighborhood Environment and Physical Activity Among Older Adults: Do the Relationships Differ by Driving Status? JOURNAL OF AGING AND PHYSICAL ACTIVITY Ding, D., Sallis, J. F., Norman, G. J., Frank, L. D., Saelens, B. E., Kerr, J., Conway, T. L., Cain, K., Hovell, M. F., Hofstetter, C. R., King, A. C. 2014; 22 (3): 421-431

  Abstract

  Some attributes of neighborhood environments are associated with physical activity among older adults. This study examined whether the associations were moderated by driving status. Older adults from neighborhoods differing in walkability and income completed written surveys and wore accelerometers (N = 880, mean age = 75 years, 56% women). Neighborhood environments were measured by geographic information systems and validated questionnaires. Driving status was defined on the basis of a driver's license, car ownership, and feeling comfortable to drive. Outcome variables included accelerometer-based physical activity and self-reported transport and leisure walking. Multilevel generalized linear regression was used. There was no significant Neighborhood Attribute × Driving Status interaction with objective physical activity or reported transport walking. For leisure walking, almost all environmental attributes were positive and significant among driving older adults but not among nondriving older adults (five significant interactions at p < .05). The findings suggest that driving status is likely to moderate the association between neighborhood environments and older adults' leisure walking.

  View details for DOI 10.1123/JAPA.2012-0332

  View details for Web of Science ID 000337998800016

  View details for PubMedCentralID PMC4653066

• Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA-the journal of the American Medical Association Pahor, M., Guralnik, J. M., Ambrosius, W. T., Blair, S., Bonds, D. E., Church, T. S., Espeland, M. A., Fielding, R. A., Gill, T. M., Groessl, E. J., King, A. C., Kritchevsky, S. B., Manini, T. M., McDermott, M. M., Miller, M. E., Newman, A. B., Rejeski, W. J., Sink, K. M., Williamson, J. D. 2014; 311 (23): 2387-2396

  Abstract

  In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability.To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability.The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m.Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises.The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m.Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]).A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults.clinicaltrials.gov Identifier: NCT01072500.

  View details for DOI 10.1001/jama.2014.5616

  View details for PubMedID 24866862

• Sleep-Wake Disturbances in Sedentary Community-Dwelling Elderly Adults with Functional Limitations JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Fragoso, C. A., Miller, M. E., Fielding, R. A., King, A. C., Kritchevsky, S. B., McDermott, M. M., Myers, V., Newman, A. B., Pahor, M., Gill, T. M. 2014; 62 (6): 1064-1072

  Abstract

  To evaluate sleep-wake disturbances in sedentary community-dwelling elderly adults with functional limitations.Cross-sectional.Lifestyle Interventions and Independence in Elder (LIFE) Study.Community-dwelling persons (mean age 78.9) who spent fewer than 20 min/wk in the previous month engaged in regular physical activity and fewer than 125 min/wk of moderate physical activity, and had a Short Physical Performance Battery (SPPB) score of <10 (N = 1,635).Mobility was evaluated according to 400-m walk time (slow gait speed defined as <0.8 m/s) and SPPB score (≤ 7 defined moderate to severe mobility impairment). Physical inactivity was defined according to sedentary time, as a percentage of accelerometry wear time with activity of <100 counts/min; participants in the top quartile of sedentary time were classified as having a high sedentary time. Sleep-wake disturbances were evaluated using the Insomnia Severity Index (ISI) (range 0-28; ≥ 8 defined insomnia), Epworth Sleepiness Scale (ESS) (range 0-24; ≥ 10 defined daytime drowsiness), Pittsburgh Sleep Quality Index (PSQI) (range 0-21; >5 defined poor sleep quality), and Berlin Questionnaire (high risk of sleep apnea).Prevalence rates were 43.5% for slow gait speed and 44.7% for moderate to severe mobility impairment, with 77.0% of accelerometry wear time spent as sedentary time. Prevalence rates were 33.0% for insomnia, 18.1% for daytime drowsiness, 47.8% for poor sleep quality, and 32.9% for high risk of sleep apnea. Participants with insomnia had a mean ISI score of 12.1, those with daytime drowsiness had a mean ESS score of 12.5, and those with poor sleep quality had a mean PSQI score of 9.2. In adjusted models, measures of mobility and physical inactivity were generally not associated with sleep-wake disturbances, using continuous or categorical variables.In a large sample of sedentary community-dwelling elderly adults with functional limitations, sleep-wake disturbances were prevalent but only mildly severe and were generally not associated with mobility impairment or physical inactivity.

  View details for DOI 10.1111/jgs.12845

  View details for Web of Science ID 000337624300008

  View details for PubMedID 24889836

  View details for PubMedCentralID PMC4057978

• Respiratory Impairment and Dyspnea and Their Associations with Physical Inactivity and Mobility in Sedentary Community-Dwelling Older Persons JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Fragoso, C. A., Beavers, D. P., Hankinson, J. L., Flynn, G., Berra, K., Kritchevsky, S. B., Liu, C. K., McDermott, M., Manini, T. M., Rejeski, W. J., Gill, T. M. 2014; 62 (4): 622-628

  Abstract

  To evaluate the prevalence of respiratory impairment and dyspnea and their associations with objectively measured physical inactivity and performance-based mobility in sedentary older persons.Cross-sectional.Lifestyle Interventions and Independence for Elders Study.Community-dwelling older persons (n = 1,635, mean age 78.9) who reported being sedentary (<20 min/wk of regular physical activity and <125 min/wk of moderate physical activity in past month).Respiratory impairment was defined as low ventilatory capacity (forced expiratory volume in 1 second less than lower limit of normal (LLN)) and respiratory muscle weakness (maximal inspiratory pressure

  View details for DOI 10.1111/jgs.12738

  View details for Web of Science ID 000334289900004

  View details for PubMedCentralID PMC3989438

• PHYSICAL ACTIVITY THROUGH THE LENS OF A SMARTPHONE Schmalbach, P., Bershadsky, S., Dunton, G. F., King, A. C., Norman, G. J., Patrick, K. SPRINGER. 2014: S75

  View details for Web of Science ID 000334408300285

• HARNESSING THE POTENTIAL OF MOBILE DEVICES IN PROMOTING HEALTHY LIFESTYLES: HIGHLIGHTING CURRENT EVIDENCE AND PERSPECTIVES King, A. C., Hekler, E. B., Winter, S. J., Grieco, L. A., Sheats, J. L., Buman, M. P. SPRINGER. 2014: S75

  View details for Web of Science ID 000334408300286

• STREET CONSTRUCTION TO POP-UP PARK: TURNING A TEMPORARILY CLOSED STREET INTO A VIBRANT DOWNTOWN PARK Banda, J. A., Winter, S. J., Salvo, D., Sheats, J. L., Hesketh, M., Umeh, N., King, A. C. SPRINGER. 2014: S91

  View details for Web of Science ID 000334408300348

• GLOBAL COMPARISONS OF WORKSITE FOOD PROGRAM PREFERENCES IN A MULTI-NATIONAL CORPORATE ENVIRONMENT King, A. C., Kloeckner, R. S., Hatzis, M., Grieco, L. A., Winter, S. J., Sheats, J. L., Evans, R., Castro, C. M. SPRINGER. 2014: S114

  View details for Web of Science ID 000334408300435

• TIME ELASTICITY: USING AN ECONOMIC MEASURE TO EXAMINE TIME-ALLOCATION CHANGES IN RESPONSE TO A TEMPORARY PARK IN CALIFORNIA Salvo, D., Sheats, J. L., Banda, J. A., Winter, S. J., Hesketh, M. A., Umeh, N., King, A. C. SPRINGER. 2014: S129

  View details for Web of Science ID 000334408300495

• THE DEVELOPMENT OF A CONTROL SYSTEMS MODEL OF SOCIAL COGNITIVE THEORY Riley, W., Martin, C., Rivera, D., Hekler, E., Buman, M., Adams, M., King, A., Pavel, M. SPRINGER. 2014: S149

  View details for Web of Science ID 000334408300572

• DO URBAN POP-UP PARKS HURT BUSINESS? ASSOCIATION OF PROXIMITY TO A POP-UP PARK ON SALES AND CUSTOMER FOOT TRAFFIC Winter, S. J., Salvo, D., Banda, J. A., Sheats, J. L., Hesketh, M., Umeh, N., King, A. C. SPRINGER. 2014: S221

  View details for Web of Science ID 000334408301098

• WHY DO PEOPLE VISIT TEMPORARY URBAN POP-UP PARKS AND DO THE REASONS VARY WITH TIME OF DAY? Winter, S. J., Salvo, D., Banda, J. A., Sheats, J. L., Hesketh, M., Umeh, N., King, A. C. SPRINGER. 2014: S221

  View details for Web of Science ID 000334408301099

• PROFILE OF A COMMUNITY CENTER-BASED PEER-LED PRODUCE MARKET FOR LOW-INCOME ASIAN IMMIGRANTS Sheats, J. L., Winter, S. J., Umeh, N., Hesketh, M., King, A. C. SPRINGER. 2014: S264

  View details for Web of Science ID 000334408301264

• RELATIONS OF CAREGIVER STATUS, PERCEIVED STRESS, AND BODY MASS INDEX ON CORTISOL PATTERNS AMONG OLDER ADULTS Scheyer, K. E., Miller, K., Urizar, G., Castro, C., King, A. LIPPINCOTT WILLIAMS & WILKINS. 2014: A92

  View details for Web of Science ID 000334235100386

• FEAST (FOOD ENVIRONMENT ASSESSMENT USING THE STANFORD TOOL): DEVELOPMENT OF A MOBILE APPLICATION TO CROWD-SOURCE RESIDENT INTERACTIONS WITH THE FOOD ENVIRONMENT Sheats, J. L., Winter, S. J., Padilla-Romero, P., King, A. C. SPRINGER. 2014: S264

  View details for Web of Science ID 000334408301263

• Genetic influence on exercise-induced changes in physical function among mobility-limited older adults PHYSIOLOGICAL GENOMICS Buford, T. W., Hsu, F., Brinkley, T. E., Carter, C. S., Church, T. S., Dodson, J. A., Goodpaster, B. H., McDermott, M. M., Nicklas, B. J., Yank, V., Johnson, J. A., Pahor, M. 2014; 46 (5): 149-158

  Abstract

  To date, physical exercise is the only intervention consistently demonstrated to attenuate age-related declines in physical function. However, variability exists in seniors' responsiveness to training. One potential source of variability is the insertion (I allele) or deletion (D allele) of a 287 bp fragment in intron 16 of the angiotensin-converting enzyme (ACE) gene. This polymorphism is known to influence a variety of physiological adaptions to exercise. However, evidence is inconclusive regarding the influence of this polymorphism on older adults' functional responses to exercise. This study aimed to evaluate the association of ACE I/D genotypes with changes in physical function among Caucasian older adults (n = 283) following 12 mo of either structured, multimodal physical activity or health education. Measures of physical function included usual-paced gait speed and performance on the Short Physical Performance Battery (SPPB). After checking Hardy-Weinberg equilibrium, we used using linear regression to evaluate the genotype*treatment interaction for each outcome. Covariates included clinic site, body mass index, age, sex, baseline score, comorbidity, and use of angiotensin receptor blockers or ACE inhibitors. Genotype frequencies [II (19.4%), ID (42.4%), DD (38.2%)] were in Hardy-Weinberg equilibrium (P > 0.05). The genotype*treatment interaction was statistically significant for both gait speed (P = 0.002) and SPPB (P = 0.020). Exercise improved gait speed by 0.06 ± 0.01 m/sec and SPPB score by 0.72 ± 0.16 points among those with at least one D allele (ID/DD carriers), but function was not improved among II carriers. Thus, ACE I/D genotype appears to play a role in modulating functional responses to exercise training in seniors.

  View details for DOI 10.1152/physiolgenomics.00169.2013

  View details for Web of Science ID 000332245700001

  View details for PubMedID 24423970

  View details for PubMedCentralID PMC3949106

• Is the relationship between the built environment and physical activity moderated by perceptions of crime and safety? INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Bracy, N. L., Millstein, R. A., Carlson, J. A., Conway, T. L., Sallis, J. F., Saelens, B. E., Kerr, J., Cain, K. L., Frank, L. D., King, A. C. 2014; 11

  Abstract

  Direct relationships between safety concerns and physical activity have been inconsistently patterned in the literature. To tease out these relationships, crime, pedestrian, and traffic safety were examined as moderators of built environment associations with physical activity.Exploratory analyses used two cross-sectional studies of 2068 adults ages 20-65 and 718 seniors ages 66+ with similar designs and measures. The studies were conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington regions during 2001-2005 (adults) and 2005-2008 (seniors). Participants were recruited from areas selected to sample high- and low- income and walkability. Independent variables perceived crime, traffic, and pedestrian safety were measured using scales from validated instruments. A GIS-based walkability index was calculated for a street-network buffer around each participant's home address. Outcomes were total physical activity measured using accelerometers and transportation and leisure walking measured with validated self-reports (IPAQ-long). Mixed effects regression models were conducted separately for each sample.Of 36 interactions evaluated across both studies, only 5 were significant (p< .05). Significant interactions did not consistently support a pattern of highest physical activity when safety was rated high and environments were favorable. There was not consistent evidence that safety concerns reduced the beneficial effects of favorable environments on physical activity. Only pedestrian safety showed evidence of a consistent main effect with physical activity outcomes, possibly because pedestrian safety items (e.g., crosswalks, sidewalks) were not as subjective as those on the crime and traffic safety scales.Clear relationships between crime, pedestrian, and traffic safety with physical activity levels remain elusive. The development of more precise safety variables and the use of neighborhood-specific physical activity outcomes may help to elucidate these relationships.

  View details for DOI 10.1186/1479-5868-11-24

  View details for Web of Science ID 000332934900002

  View details for PubMedID 24564971

  View details for PubMedCentralID PMC3942774

• A Dynamical Systems Model of Social Cognitive Theory American Control Conference Martin, C. A., Rivera, D. E., Riley, W. T., Hekler, E. B., Buman, M. P., Adams, M. A., King, A. C. IEEE. 2014

  View details for Web of Science ID 000346492602158

• Cohort Profile: The Resilience for Eating and Activity Despite Inequality (READI) study INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Ball, K., Cleland, V., Salmon, J., Timperio, A. F., McNaughton, S., Thornton, L., Campbell, K., Jackson, M., Baur, L. A., Mishra, G., Brug, J., Jeffery, R. W., King, A., Kawachi, I., Crawford, D. A. 2013; 42 (6): 1629-1639

  Abstract

  The Resilience for Eating and Activity Despite Inequality (READI) cohort was established to address the following two key aims: to investigate the pathways (personal, social and structural) by which socio-economic disadvantage influences lifestyle choices associated with obesity risk (physical inactivity, poor dietary choices) and to explore mechanisms underlying 'resilience' to obesity risk in socio-economically disadvantaged women and children. A total of 4349 women aged 18-46 years and 685 children aged 5-12 years were recruited from 80 socio-economically disadvantaged urban and rural neighbourhoods of Victoria, Australia, and provided baseline (T1: 2007-08) measures of adiposity, physical activity, sedentary and dietary behaviours; socio-economic and demographic factors; and psychological, social and perceived environmental factors that might impact on obesity risk. Audits of the 80 neighbourhoods were undertaken at baseline to provide objective neighbourhood environmental data. Three-year follow-up data (2010-11) have recently been collected from 1912 women and 382 children. Investigators welcome enquiries regarding data access and collaboration.

  View details for DOI 10.1093/ije/dys165

  View details for Web of Science ID 000329870400024

  View details for PubMedID 23255533

• Disability and Chronic Disease Among Older Adults in India: Detecting Vulnerable Populations Through the WHO SAGE Study AMERICAN JOURNAL OF EPIDEMIOLOGY Basu, S., King, A. C. 2013; 178 (11): 1620-1628

  Abstract

  Chronic noncommunicable diseases (NCDs) are now prevalent in many low- and middle-income countries and confer a heightened risk of disability. It is unclear how public health programs can identify the older adults at highest risk of disability related to NCDs within diverse developing country populations. We studied nationally representative survey data from 7,150 Indian adults older than 50 years of age who participated in the World Health Organization Study on Global Aging and Adult Health (2007-2010) to identify population subgroups who are highly disabled. Using machine-learning algorithms, we identified sociodemographic correlates of disability. Although having 2 or more symptomatic NCDs was a key correlate of disability, the prevalence of symptomatic, undiagnosed NCDs was highest among the lowest 2 wealth quintiles of Indian adults, contrary to prior hypotheses of increased NCDs with wealth. Women and persons from rural populations were also disproportionately affected by nondiagnosed NCDs, with high out-of-pocket health care expenditures increasing the probability of remaining symptomatic from NCDs. These findings also indicate that NCD prevalence surveillance studies in low- and middle-income countries should expand beyond self-reported diagnoses to include more extensive symptom- and examination-based surveys, given the likely high rate of surveillance bias due to barriers to diagnosis among vulnerable populations.

  View details for DOI 10.1093/aje/kwt191

  View details for Web of Science ID 000327717600004

  View details for PubMedID 24049156

  View details for PubMedCentralID PMC3842902

• The MAT-sf: Clinical Relevance and Validity JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Rejeski, W. J., Marsh, A. P., Anton, S., Chen, S., Church, T., Gill, T. M., Guralnik, J. M., Glynn, N. W., King, A. C., Rushing, J., Ip, E. H. 2013; 68 (12): 1567-1574

  Abstract

  The measurement of mobility is essential to both aging research and clinical practice. A newly developed self-report measure of mobility, the mobility assessment tool-short form (MAT-sf), uses video animations to improve measurement accuracy/precision. Using a large baseline data set, we recalibrated the items, evaluated the extent to which older patients' self-efficacy (i.e., confidence) for walking was related to MAT-sf scores beyond their actual 400-m walk time, and assessed the relationship of the MAT-sf with body mass index and other clinical variables.The analyses employed baseline data from the Lifestyle Interventions and Independence for Elders Study.Item recalibration demonstrated that the MAT-sf scoring algorithm was robust. In an analysis with 400-m walk time and self-efficacy regressed on the MAT-sf, both variables shared unique variance with the MAT-sf (p < .001). The MAT-sf was inversely related to several comorbidities, most notably hypertension and arthritis (p < .001), and scores were lowest when body mass index ≥ 35 kg/m(2). Finally, MAT-sf scores were directly related to Short Physical Performance Battery scores, inversely related to difficulty with activities of daily living (p < .001) and higher for men than for women (p < .001).The findings extend the validity and clinical utility of this innovative tool for assessing self-reported mobility in older adults. Longitudinal data on the MAT-sf from the Lifestyle Interventions and Independence for Elders Study will enable us to evaluate the relative contributions of self-report and performance-based measures of mobility on important health outcomes.

  View details for DOI 10.1093/gerona/glt068

  View details for Web of Science ID 000326675000014

  View details for PubMedID 23685766

  View details for PubMedCentralID PMC3814234

• Performance of a computer-based assessment of cognitive function measures in two cohorts of seniors INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Espeland, M. A., Katula, J. A., Rushing, J., Kramer, A. F., Jennings, J. M., Sink, K. M., Nadkarni, N. K., Reid, K. F., Castro, C. M., Church, T., Kerwin, D. R., Williamson, J. D., Marottoli, R. A., Rushing, S., Marsiske, M., Rapp, S. R. 2013; 28 (12): 1239-1250

  Abstract

  Computer-administered assessment of cognitive function is being increasingly incorporated in clinical trials; however, its performance in these settings has not been systematically evaluated.The Seniors Health and Activity Research Program pilot trial (N = 73) developed a computer-based tool for assessing memory performance and executive functioning. The Lifestyle Interventions and Independence for Elders investigators incorporated this battery in a full-scale multicenter clinical trial (N = 1635). We describe relationships that test scores have with those from interviewer-administered cognitive function tests and risk factors for cognitive deficits and describe performance measures (completeness, intraclass correlations [ICC]).Computer-based assessments of cognitive function had consistent relationships across the pilot and full-scale trial cohorts with interviewer-administered assessments of cognitive function, age, and a measure of physical function. In the Lifestyle Interventions and Independence for Elders cohort, their external validity was further demonstrated by associations with other risk factors for cognitive dysfunction: education, hypertension, diabetes, and physical function. Acceptable levels of data completeness (>83%) were achieved on all computer-based measures; however, rates of missing data were higher among older participants (odds ratio = 1.06 for each additional year; p < 0.001) and those who reported no current computer use (odds ratio = 2.71; p < 0.001). ICCs among clinics were at least as low (ICC < 0.013) as for interviewer measures (ICC < 0.023), reflecting good standardization. All cognitive measures loaded onto the first principal component (global cognitive function), which accounted for 40% of the overall variance.Our results support the use of computer-based tools for assessing cognitive function in multicenter clinical trials of older individuals.

  View details for DOI 10.1002/gps.3949

  View details for Web of Science ID 000326466800004

  View details for PubMedID 23589390

  View details for PubMedCentralID PMC3775886

• Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Hekler, E. B., Buman, M. P., Otten, J., Castro, C. M., Grieco, L., Marcus, B., Friedman, R. H., Napolitano, M. A., King, A. C. 2013; 10

  Abstract

  Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions.Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12).Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

  View details for DOI 10.1186/1479-5868-10-109

  View details for Web of Science ID 000325452800001

  View details for PubMedCentralID PMC3849440

• Promoting Healthy Weight With "Stability Skills First": A Randomized Trial JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Kiernan, M., Brown, S. D., Schoffman, D. E., Lee, K., King, A. C., Taylor, C. B., Schleicher, N. C., Perri, M. G. 2013; 81 (2): 336-346

  Abstract

  Although behavioral weight-loss interventions produce short-term weight loss, long-term maintenance remains elusive. This randomized trial examined whether learning a novel set of "stability skills" before losing weight improved long-term weight management. Stability skills were designed to optimize individuals' current satisfaction with lifestyle and self-regulatory habits while requiring the minimum effort and attention necessary.Overweight/obese women (N = 267) were randomly assigned to one of two 6-month interventions and assessed at baseline and at 6, 12, and 18 months. Maintenance First women participated first in an 8-week stability skills maintenance module and then in a standard 20-week behavioral weight-loss program. Weight Loss First women participated first in a standard 20-week behavioral weight-loss program and then in a standard 8-week problem-solving skills maintenance module. There was no intervention staff contact during the 12-month follow-up period (6-18 months).As designed, Maintenance First participants lost the same percentage of initial weight during the 6-month intervention period as Weight Loss First participants (M = -8.6%, SD = 5.7, vs. M = -9.1%, SD = 6.9; t = -0.6, p = .52). However, Maintenance First participants regained significantly less weight during the 12-month follow-up period (6-18 months) than Weight Loss First participants (M = 3.2 lb, SD = 10.4, vs. M = 7.3 lb, SD = 9.9 [M = 1.4 kg, SD = 4.7, vs. M = 3.3 kg, SD = 4.5]; t = 3.3, p = .001, d = 0.4).Learning stability skills before losing weight was successful in helping women to maintain weight loss without intervention staff contact during follow-up. These results can inform the study design of future innovative interventions.

  View details for DOI 10.1037/a0030544

  View details for Web of Science ID 000316908500012

  View details for PubMedID 23106759

• IMPACT OF TELEPHONE-BASED, HEALTH BEHAVIOR CHANGE PROGRAMS ON CORTISOL REGULATION AMONG OLDER ADULTS Urizar, G. G., Cuomo, J., Thoman, D., Castro, C. M., King, A. C. LIPPINCOTT WILLIAMS & WILKINS. 2013: A37–A38

  View details for Web of Science ID 000330467400122

• Physical Activity Increases Gains in and Prevents Loss of Physical Function: Results From the Lifestyle Interventions and Independence for Elders Pilot Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Ip, E. H., Church, T., Marshall, S. A., Zhang, Q., Marsh, A. P., Guralnik, J., King, A. C., Rejeski, W. J. 2013; 68 (4): 426-432

  Abstract

  Physical activity (PA) appears to have a positive effect on physical function, however, studies have not examined multiple indices of physical function jointly nor have they conceptualized physical functioning as a state rather than a trait.About 424 men and women aged 70-89 were randomly assigned to complete a PA or a successful aging (SA) education program. Balance, gait speed, chair stand performance, grip strength, and time to complete the 400-m walk were assessed at baseline and at 6 and 12 months. Using hidden Markov model, empiric states of physical functioning were derived based on these performance measures of balance, strength, and mobility. Rates of gain and loss in physical function were compared between PA and SA.Eight states of disability were identified and condensed into four clinically relevant states. State 1 represented mild disability with physical functioning, states 2 and 3 were considered intermediate states of disability, and state 4 severe disability. About 30.1% of all participants changed states at 6 months, 24.1% at 12 months, and 11.0% at both time points. The PA group was more likely to regain or sustain functioning and less likely to lose functioning when compared with SA. For example, PA participants were 20% more likely than the SA participants to remain in state 1.PA appears to have a favorable effect on the dynamics of physical functioning in older adults.

  View details for DOI 10.1093/gerona/gls186

  View details for Web of Science ID 000316273000012

  View details for PubMedID 22987794

  View details for PubMedCentralID PMC3593616

• THE EFFECT OF MORNINGNESS/EVENINGNESS AND SLEEP QUALITY ON DEPRESSION Shen, J., Urizar, G. G., King, A. C. SPRINGER. 2013: S236

  View details for Web of Science ID 000209928001498

• WHAT DID YOU CHANGE YOUR MIND ABOUT?: SCIENCE AND THE ROLE OF KNOWLEDGE, REASON AND DATA Stefanek, M., Keefe, F., King, A., Emmons, K. SPRINGER. 2013: S69

  View details for Web of Science ID 000209928000271

• Promoting physical activity for elders with compromised function: the Lifestyle Interventions and Independence for Elders (LIFE) Study physical activity intervention CLINICAL INTERVENTIONS IN AGING Rejeski, W. J., Axtell, R., Fielding, R., Katula, J., King, A. C., Manini, T. M., Marsh, A. P., Pahor, M., Rego, A., Tudor-Locke, C., Newman, M., Walkup, M. P., Miller, M. E. 2013; 8: 1119-1131

  Abstract

  The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase III randomized controlled clinical trial (Clinicaltrials.gov identifier: NCT01072500) that will provide definitive evidence regarding the effect of physical activity (PA) on major mobility disability in older adults (70-89 years old) who have compromised physical function. This paper describes the methods employed in the delivery of the LIFE Study PA intervention, providing insight into how we promoted adherence and monitored the fidelity of treatment. Data are presented on participants' motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training. Prior to the onset of training, 31.4% of participants noted slight conflict with being able to meet the demands of the program and 6.4% indicated that the degree of conflict would be moderate. Accelerometry data collected during PA training revealed that the average intensity - 1,555 counts/minute for men and 1,237 counts/minute for women - was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults. Also, a sizable subgroup required one or more rest stops. These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function. Moreover, the concept of what constitutes "moderate" exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription.

  View details for DOI 10.2147/CIA.S49737

  View details for Web of Science ID 000324170300001

  View details for PubMedID 24049442

  View details for PubMedCentralID PMC3775623

• SLEEP-WAKE COMPLAINTS AND SLEEP-APNEA RISK AMONG OLDER PERSONS WITH FUNCTIONAL LIMITATIONS (LIFE STUDY) Fragoso, C., Miller, M. E., Endeshaw, Y., Rice, T. B., King, A., Kritchevsky, S. B., Gill, T. M. OXFORD UNIV PRESS INC. 2012: 305–305

  View details for Web of Science ID 000312888202576

• Outdoor physical activity and self rated health in older adults living in two regions of the US INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Kerr, J., Sallis, J. F., Saelens, B. E., Cain, K. L., Conway, T. L., Frank, L. D., King, A. C. 2012; 9

  Abstract

  Older adults spend little time outdoors and many are physically inactive. The relationship between outdoor physical activity and self rated health has not been studied in older adults. This paper aimed to assess the relation of location of physical activity to self rated health and physical activity minutes. This was an observational study of ambulatory adults 66 years and older conducted in 2005-2008. Participants (N = 754) completed survey measures of physical activity location and self rated health, and wore an accelerometer to objectively assess physical activity. A mixed model linear regression procedure adjusted for neighborhood clustering effects. Differences in self rated health and physical activity minutes were compared across three physical activity settings (indoor only, outdoor only, both indoor and outdoor).Minutes of moderate to vigorous physical activity were significantly greater in those who were physically active at least once a week outdoors compared with those who were physically active indoors only. Self rated health was significantly related to being physically active but did not vary by location of activity.Older adults who were physically active outdoors accumulated significantly more physical activity, but self-rated health was not significantly greater than those being physically active indoors.

  View details for DOI 10.1186/1479-5868-9-89

  View details for Web of Science ID 000309218500001

  View details for PubMedID 22846594

  View details for PubMedCentralID PMC3464785

• Minority recruitment into clinical trials: Experimental findings and practical implications CONTEMPORARY CLINICAL TRIALS Brown, S. D., Lee, K., Schoffman, D. E., King, A. C., Crawley, L. M., Kiernan, M. 2012; 33 (4): 620-623

  Abstract

  Racial and ethnic minorities in the US suffer disproportionately from obesity and related comorbidities, yet remain underrepresented in health research. To date, research on practical strategies to improve minority reach and recruitment into clinical trials is primarily descriptive rather than experimental. Within a randomized behavioral weight management trial for obese women, this recruitment experiment examined whether two characteristics of direct mail letters, an ethnically-targeted statement and personalization, increased the response rate among minority women. The ethnically-targeted statement noted ethnic-specific information about health risks of obesity. Personalized letters included recipients' names/addresses in the salutation and a handwritten signature on high-quality letterhead. Of women sent direct mail letters (N=30,000), those sent letters with the ethnically-targeted statement were more likely to respond than women sent letters with the generic statement, 0.8% (n=121) vs. 0.6% (n=90) respectively, p=.03, a 34.4% increase. Women sent personalized letters were no more likely to respond than women sent non-personalized letters, p=.53. In the weight management trial itself, of 267 women randomized into the trial, 33.7% (n=90) were minorities. Of minority women randomized into the trial, 68.9% (n=62) were recruited by direct mail letters: 75.8% (n=47) of those were sent a letter and 24.2% (n=15) were referred by friends/family who were sent a letter. The results indicate that a simple modification to a standard recruitment letter can have a meaningful impact on minority reach and recruitment rates. Practical implications include using ethnically-targeted, non-personalized direct mail letters and recruiting through friends/family at no additional cost.

  View details for DOI 10.1016/j.cct.2012.03.003

  View details for Web of Science ID 000305711700010

  View details for PubMedID 22449836

  View details for PubMedCentralID PMC3361553

• Resilience to obesity among socioeconomically disadvantaged women: the READI study INTERNATIONAL JOURNAL OF OBESITY Ball, K., Abbott, G., Cleland, V., Timperio, A., Thornton, L., Mishra, G., Jeffery, R. W., Brug, J., King, A., Crawford, D. 2012; 36 (6): 855-865

  Abstract

  This cross-sectional study aimed to identify sociodemographic and behavioural characteristics of 'overweight-resilient' women, that is, women who were in a healthy body weight range, despite living in socioeconomically disadvantaged neighbourhoods that place them at increased risk of obesity. The study also aimed to test a comprehensive theoretically derived model of the associations between intrapersonal, social and environmental factors and obesity among this target group.A total of 3235 women aged 18-45 years from 80 urban and rural neighbourhoods throughout Victoria, Australia, participated in the Resilience for Eating and Activity Despite Inequality study.Women reported height, weight, sociodemographic characteristics, leisure-time physical activity, dietary behaviours and a range of theoretically derived cognitive, social and neighbourhood environmental characteristics hypothesized to influence obesity risk. A theoretical model predicting body mass index (BMI) was tested using structural equation models.Women classified as 'resilient' to obesity tended to be younger, born overseas, more highly educated, unmarried and to have higher or undisclosed household incomes. They engaged in more leisure-time physical activity and consumed less fast foods and soft drinks than overweight/obese women. Neighbourhood characteristics, social characteristics and cognitive characteristics all contributed to explaining variation in BMI in the hypothesized directions.These results demonstrate several characteristics of women appearing 'resilient' to obesity, despite their increased risk conferred by residing in socioeconomically disadvantaged neighbourhoods. Acknowledging the cross-sectional study design, the results advance theoretical frameworks aimed at investigating obesity risk by providing evidence in support of a comprehensive model of direct and indirect effects on obesity of neighbourhood, as well as social, cognitive and behavioural characteristics.

  View details for DOI 10.1038/ijo.2011.183

  View details for Web of Science ID 000305282400013

  View details for PubMedID 21931326

• Do User Intentions and Health Feedback Influence Exergame Duration of Use and Measured Exertion? 59th Annual Meeting of the American-College-of-Sports-Medicine Hekler, E. B., Chen, F. X., King, A. C. LIPPINCOTT WILLIAMS & WILKINS. 2012: 846–847

  View details for Web of Science ID 000310363304402

• Do the Individual, Social, and Environmental Correlates of Physical Activity Differ Between Urban and Rural Women? ENVIRONMENT AND BEHAVIOR Cleland, V. J., Ball, K., King, A. C., Crawford, D. 2012; 44 (3): 350-373

  View details for DOI 10.1177/0013916510393275

  View details for Web of Science ID 000302953100003

• Social Support for Healthy Behaviors: Scale Psychometrics and Prediction of Weight Loss Among Women in a Behavioral Program OBESITY Kiernan, M., Moore, S. D., Schoffman, D. E., Lee, K., King, A. C., Taylor, C. B., Kiernan, N. E., Perri, M. G. 2012; 20 (4): 756-764

  Abstract

  Social support could be a powerful weight-loss treatment moderator or mediator but is rarely assessed. We assessed the psychometric properties, initial levels, and predictive validity of a measure of perceived social support and sabotage from friends and family for healthy eating and physical activity (eight subscales). Overweight/obese women randomized to one of two 6-month, group-based behavioral weight-loss programs (N = 267; mean BMI 32.1 ± 3.5; 66.3% White) completed subscales at baseline, and weight loss was assessed at 6 months. Internal consistency, discriminant validity, and content validity were excellent for support subscales and adequate for sabotage subscales; qualitative responses revealed novel deliberate instances not reflected in current sabotage items. Most women (>75%) "never" or "rarely" experienced support from friends or family. Using nonparametric classification methods, we identified two subscales-support from friends for healthy eating and support from family for physical activity-that predicted three clinically meaningful subgroups who ranged in likelihood of losing ≥5% of initial weight at 6 months. Women who "never" experienced family support were least likely to lose weight (45.7% lost weight) whereas women who experienced both frequent friend and family support were more likely to lose weight (71.6% lost weight). Paradoxically, women who "never" experienced friend support were most likely to lose weight (80.0% lost weight), perhaps because the group-based programs provided support lacking from friendships. Psychometrics for support subscales were excellent; initial support was rare; and the differential roles of friend vs. family support could inform future targeted weight-loss interventions to subgroups at risk.

  View details for DOI 10.1038/oby.2011.293

  View details for Web of Science ID 000302143300008

  View details for PubMedID 21996661

• RESPONSE OF FAST FOOD RESTAURANTS TO THE FIRST US TOY ORDINANCE: YEAR ONE RESULTS Otten, J., Hekler, E., Buman, M. P., Saelens, B. E., Krukowski, R. A., King, A. C. SPRINGER. 2012: S85

  View details for Web of Science ID 000302092400328

• ADVANCING AN EVIDENCE-BASED POPULATION-LEVEL PHYSICAL ACTIVITY PROGRAM FOR THE EXERCISE IS MEDICINE (R) INITIATIVE Buman, M. P., Goodrich, D. E., Richardson, C. R., Ainsworth, B. E., King, A. C. SPRINGER. 2012: S139

  View details for Web of Science ID 000302092400540

• PROMOTING HEALTHY WEIGHT WITH 'STABILITY FIRST': 18-MONTH MAINTENANCE RESULTS Kiernan, M., Moore, S. D., SchoffmanBs, D. E., Lee, K., King, A. C., Taylor, C., Perri, M. G. SPRINGER. 2012: S137

  View details for Web of Science ID 000302092400533

• MOBILE PHONE APPLICATIONS TO PROMOTE PHYSICAL ACTIVITY INCREASES: PRELIMINARY RESULTS King, A. C., Hekler, E., Grieco, L., Winter, S., Buman, M., Banerjee, B., Cirimele, J., Robinson, T. N., Mezias, B., Chen, F. SPRINGER. 2012: S204–S204

  View details for Web of Science ID 000302092400795

• COMPARISON OF CUSTOM SMARTPHONE APPLICATIONS VERSUS COMMERCIALLY AVAILABLE OPTIONS FOR TESTING MECHANISMS OF BEHAVIOR CHANGE Hekler, E. B., Chen, F. X., Shapiro, S., King, A. SPRINGER. 2012: S139–S139

  View details for Web of Science ID 000302092400538

• TEACHING OLD DOGS NEW TRICKS: PERCEPTIONS OF SMARTPHONE-NAIVE MIDLIFE AND OLDER ADULTS ON USING SMARTPHONES TO IMPROVE HEALTH BEHAVIORS Winter, S., Hekler, E. B., Grieco, L. A., Chen, F., Pollitt, S., Youngman, K., King, A. C. SPRINGER. 2012: S41–S41

  View details for Web of Science ID 000302092400159

• Reliability and Validity of CHAMPS Self-Reported Sedentary-to-Vigorous Intensity Physical Activity in Older Adults JOURNAL OF PHYSICAL ACTIVITY & HEALTH Hekler, E. B., Buman, M. P., Haskell, W. L., Conway, T. L., Cain, K. L., Sallis, J. F., Saelens, B. E., Frank, L. D., Kerr, J., King, A. C. 2012; 9 (2): 225-236

  Abstract

  Recent research highlights the potential value of differentiating between categories of physical activity intensities as predictors of health and well-being. This study sought to assess reliability and concurrent validity of sedentary (ie, 1 METs), low-light (ie, >1 and ≤2 METs; eg, playing cards), high-light (ie, >2 and <3 METs; eg, light walking), moderate-to-vigorous physical activity (MVPA, ≥3 METs), and "total activity" (≥2 METs) from the CHAMPS survey. Further, this study explored over-reporting and double-reporting.CHAMPS data were gathered from the Seniors Neighborhood Quality of Life Study, an observational study of adults aged 65+ years conducted in 2 US regions.Participants (N = 870) were 75.3 ± 6.8 years old, with 56% women and 71% white. The CHAMPS sedentary, low-light, high-light, total activity, and MVPA variables had acceptable test-retest reliability (ICCs 0.56-0.70). The CHAMPS high-light (ρ = 0.27), total activity (ρ = 0.34), and MVPA (ρ = 0.37) duration scales were moderately associated with accelerometry minutes of corresponding intensity, and the sedentary scale (ρ = 0.12) had a lower, but significant correlation. Results suggested that several CHAMPS items may be susceptible to over-reporting (eg, walking, housework).CHAMPS items effectively measured high-light, total activity, and MVPA in seniors, but further refinement is needed for sedentary and low-light activity.

  View details for Web of Science ID 000300960800008

  View details for PubMedID 22368222

• The CHOICE Study: A "taste-test" of Utilitarian vs. Leisure Walking Among Older Adults HEALTH PSYCHOLOGY Hekler, E. B., Castro, C. M., Buman, M. P., King, A. C. 2012; 31 (1): 126-129

  Abstract

  Utilitarian walking (e.g., walking for transport) and leisure walking (e.g., walking for health/recreation) are encouraged to promote health, yet few studies have explored specific preferences for these two forms of physical activity or factors that impact such preferences. A quasi-experimental crossover design was used to evaluate how training underactive midlife and older adults in each type of walking impacted total steps taken and how it was linked to their subsequent choice of walking types.Participants (N = 16) were midlife and older adults (M age = 64 ± 8 years) who were mostly women (81%) and white (75%). To control for order effects, participants were randomized to instruction in either utilitarian or leisure walking for 2 weeks and then the other type for 2 weeks. Participants then entered a 2-week "free choice" phase in which they chose any mixture of the walking types. Outcome variables included walking via OMRON pedometer and the ratio of utilitarian versus leisure walking during the free-choice phase. Participants completed surveys about their neighborhood (NEWS) and daily travel to multiple locations.Instruction in leisure-only, utilitarian-only, and a freely chosen mixture of the two each resulted in significant increases in steps taken relative to baseline (ps < 0.05). Having to go to multiple locations daily and traveling greater distances to locations were associated with engagement in more utilitarian walking. In contrast, good walking paths, neighborhood aesthetics, easy access to exercise facilities, and perceiving easier access to neighborhood services were associated with more leisure walking.Results from this pilot study suggest that midlife and older adults may most easily meet guidelines through either leisure only or a mixture of leisure and utilitarian walking, and tailored suggestions based on the person's neighborhood may be useful.

  View details for DOI 10.1037/a0025567

  View details for Web of Science ID 000299261200018

  View details for PubMedID 21928901

  View details for PubMedCentralID PMC3254726

• Neighborhood Environment Profiles for Physical Activity Among Older Adults AMERICAN JOURNAL OF HEALTH BEHAVIOR Adams, M. A., Sallis, J. F., Conway, T. L., Frank, L. D., Saelens, B. E., Kerr, J., Cain, K. L., King, A. C. 2012; 36 (6): 757-769

  Abstract

  To explore among older adults whether multivariate neighborhood profiles were associated with physical activity (PA) and BMI.Adults (66-97 years) were recruited from Baltimore-Washington, DC (n=360), and Seattle-King County, Washington (n=368), regions. Latent profile analyses were conducted using the Neighborhood Environment Walkability Scale. ANCOVA models tested for criterion validity of profiles by examining relationships to PA and BMI.Neighborhood profiles differed significantly by as much as 10 minutes/day for moderate-to-vigorous PA, 1.1 hours/week for walking for errands, and almost 50 minutes/week for leisure PA.Environmental variables resulted in meaningful neighborhood patterns that explained large differences in seniors' health outcomes.

  View details for DOI 10.5993/AJHB.36.6.4

  View details for Web of Science ID 000309358000004

  View details for PubMedID 23026035

• Interactions between psychosocial and built environment factors in explaining older adults' physical activity PREVENTIVE MEDICINE Carlson, J. A., Sallis, J. F., Conway, T. L., Saelens, B. E., Frank, L. D., Kerr, J., Cain, K. L., King, A. C. 2012; 54 (1): 68-73

  Abstract

  To evaluate ecological model predictions of cross-level interactions among psychosocial and environmental correlates of physical activity in 719 community-dwelling older adults in the Baltimore, Maryland and Seattle, Washington areas during 2005-2008.Walkability, access to parks and recreation facilities and moderate-to-vigorous physical activity (MVPA) minutes per week (min/week) were measured objectively. Neighborhood aesthetics, walking facilities, social support, self-efficacy, barriers and transportation and leisure walking min/week were self-reported.Walkability interacted with social support in explaining total MVPA (B=13.71) and with social support (B=7.90), self-efficacy (B=7.66) and barriers (B=-8.26) in explaining walking for transportation. Aesthetics interacted with barriers in explaining total MVPA (B=-12.20) and walking facilities interacted with self-efficacy in explaining walking for leisure (B=-10.88; Ps<.05). Summarizing across the interactions, living in a supportive environment (vs. unsupportive) was related to 30-59 more min/week of physical activity for participants with more positive psychosocial attributes, but only 0-28 more min/week for participants with less positive psychosocial attributes.Results supported synergistic interactions between built environment and psychosocial factors in explaining physical activity among older adults. Findings suggest multilevel interventions may be most effective in increasing physical activity.

  View details for DOI 10.1016/j.ypmed.2011.10.004

  View details for Web of Science ID 000299455500016

  View details for PubMedID 22027402

  View details for PubMedCentralID PMC3254837

• Are daily fluctuations in perceived environment associated with walking? PSYCHOLOGY & HEALTH Hekler, E. B., Buman, M. P., Ahn, D., Dunton, G., Atienza, A. A., King, A. C. 2012; 27 (9): 1009-1020

  Abstract

  The physical environment is thought to influence walking; however, daily variations in perceived environment have received little attention. The current study sought to examine if key within-person factors (i.e., implementation intentions, social support, affect and self-efficacy) would be associated with walking and if perceived access to supportive environments (e.g., access to nice walking paths) and perceived environmental barriers (e.g., bad weather and safety issues) were uniquely associated with walking after controlling for other constructs. Participants (N = 14, 50.0% men, 78.6% White, M age = 59.4 ± 6.4) were in the intervention arm of an 8-week controlled trial promoting walking via personal digital assistants. Participants completed electronic surveys twice a day (total entries = 804) in which they reported brisk walking levels and psychosocial and environmental factors. Multilevel modelling was used to examine within-person variations in constructs as determinants of walking. Results suggested that daily variations in implementation intentions, social support and positive affect were positively associated with walking. Further, perceived access to supportive environments, though not perceived environmental barriers, was positively associated with walking after controlling for other constructs (p < 0.05). Future research should explore intervention components that target context-specific information about perceived access to supportive environments as part of a broader perspective on intervention development.

  View details for DOI 10.1080/08870446.2011.645213

  View details for Web of Science ID 000307941100001

  View details for PubMedID 22214492

• The Lifestyle Interventions and Independence for Elders Study: Design and Methods JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Fielding, R. A., Rejeski, W. J., Blair, S., Church, T., Espeland, M. A., Gill, T. M., Guralnik, J. M., Hsu, F., Katula, J., King, A. C., Kritchevsky, S. B., McDermott, M. M., Miller, M. E., Nayfield, S., Newman, A. B., Williamson, J. D., Bonds, D., Romashkan, S., Hadley, E., Pahor, M. 2011; 66 (11): 1226-1237

  Abstract

  As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap.The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years.LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness.Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

  View details for DOI 10.1093/gerona/glr123

  View details for Web of Science ID 000296102100011

  View details for PubMedID 21825283

• Moderators and Mediators of Exercise-Induced Objective Sleep Improvements in Mid life and Older Adults With Sleep Complaints HEALTH PSYCHOLOGY Buman, M. P., Hekler, E. B., Bliwise, D. L., King, A. C. 2011; 30 (5): 579-587

  Abstract

  Exercise can improve sleep quality, but for whom and by what means remains unclear. We examined moderators and mediators of objective sleep improvements in a 12-month randomized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints.Participants (N = 66, 67% women, 55-79 years) were randomized to moderate-intensity exercise or health education control. Putative moderators were gender, age, physical function, self-reported global sleep quality, and physical activity levels. Putative mediators were changes in BMI, depressive symptoms, and physical function at 6 months. Objective sleep outcomes measured by in-home polysomnography were percent time in Stage I sleep, percent time in Stage II sleep, and number of awakenings during the first third of sleep at 12 months.Baseline physical function and sleep quality moderated changes in Stage I sleep; individuals with higher initial physical function (p = .01) and poorer sleep quality (p = .03) had greater improvements. Baseline physical activity level moderated changes in Stage II sleep (p = .04) and number of awakenings (p = .01); more sedentary individuals had greater improvements. Decreased depressive symptoms (CI:-1.57 to -0.02) mediated change in Stage I sleep. Decreased depressive symptoms (CI:-0.75 to -0.01), decreased BMI (CI:-1.08 to -0.06), and increased physical function (CI: 0.01 to 0.72) mediated change in number of awakenings.Initially less active individuals with higher initial physical function and poorer sleep quality improved the most. Affective, functional, and metabolic mediators specific to sleep architecture parameters were suggested. These results indicate strategies to more efficiently treat poor sleep through exercise in older adults.

  View details for DOI 10.1037/a0024293

  View details for Web of Science ID 000294876100009

  View details for PubMedID 21688915

  View details for PubMedCentralID PMC3210555

• The Society of Behavioral Medicine (SBM) and public policy advocacy: a call to action. Translational behavioral medicine Estabrooks, P., Pagoto, S., Otten, J., Pbert, L., Stone, A., King, A., Goggin, K., Emmons, K. 2011; 1 (3): 492-496

  Abstract

  In 2010, the Society of Behavioral Medicine heightened its priority to take an even more active role in influencing health-related public policy. Here we discuss the importance of behavioral medicine presence in public policy initiatives, review a brief history of SBM's involvement in public policy, describe steps SBM is now taking to increase its involvement in health-related public policy, and finally, put forth a call to action for SBM members to increase their awareness of and become involved in public policy initiatives.

  View details for DOI 10.1007/s13142-011-0073-8

  View details for PubMedID 24073068

• The Society of Behavioral Medicine (SBM) and public policy advocacy: a call to action TRANSLATIONAL BEHAVIORAL MEDICINE Estabrooks, P., Pagoto, S., Otten, J., Pbert, L., Stone, A., King, A., Goggin, K., Emmons, K. 2011; 1 (3): 492-496

  Abstract

  In 2010, the Society of Behavioral Medicine heightened its priority to take an even more active role in influencing health-related public policy. Here we discuss the importance of behavioral medicine presence in public policy initiatives, review a brief history of SBM's involvement in public policy, describe steps SBM is now taking to increase its involvement in health-related public policy, and finally, put forth a call to action for SBM members to increase their awareness of and become involved in public policy initiatives.

  View details for DOI 10.1007/s13142-011-0073-8

  View details for Web of Science ID 000209412100019

  View details for PubMedCentralID PMC3717633

• Assessing health-related resources in senior living residences JOURNAL OF AGING STUDIES Kerr, J., Carlson, J. A., Sallis, J. F., Rosenberg, D., Leak, C. R., Saelens, B. E., Chapman, J. E., Frank, L. D., Cain, K. L., Conway, T. L., King, A. C. 2011; 25 (3): 206-214

  Abstract

  This study evaluated a new tool, "The Audit of Physical Activity Resources for Seniors" (APARS), which assesses the physical activity environment in Senior Living Residences (SLRs). Audits were conducted in 29 SLRs and inter-rater reliability was assessed. Pearson correlations were examined between APARS items and objectively measured physical activity and sedentary time, and self-rated health, collected from residents at a subset of 12 SLRs (N=147). Eighty-nine of the 90 items (98.9%) demonstrated Kappa or ICC values above .70 and/or percent agreement above 80%. The 90 items were summarized into nine scales. Two scales (outside supportive physical activity features/functionality and outside exercise facilities) were related to greater physical activity and less sedentary time. Four scales (inside social facilities, onsite services, exercise programs, and social activities) were related to greater sedentary time and better self-rated health. APARS items demonstrated adequate inter-rater reliability and some evidence for construct validity to assess health-related environments in retirement facilities. Social activities in SLRs could benefit residents by incorporating more physical activity. Use of APARS could inform more health-promoting designs of senior living facilities.

  View details for DOI 10.1016/j.jaging.2011.03.004

  View details for Web of Science ID 000292664400003

  View details for PubMedCentralID PMC4860260

• Assessing health-related resources in senior living residences. Journal of aging studies Kerr, J., Carlson, J. A., Sallis, J. F., Rosenberg, D., Leak, C. R., Saelens, B. E., Chapman, J. E., Frank, L. D., Cain, K. L., Conway, T. L., King, A. C. 2011; 25 (3): 206-214

  Abstract

  This study evaluated a new tool, "The Audit of Physical Activity Resources for Seniors" (APARS), which assesses the physical activity environment in Senior Living Residences (SLRs). Audits were conducted in 29 SLRs and inter-rater reliability was assessed. Pearson correlations were examined between APARS items and objectively measured physical activity and sedentary time, and self-rated health, collected from residents at a subset of 12 SLRs (N=147). Eighty-nine of the 90 items (98.9%) demonstrated Kappa or ICC values above .70 and/or percent agreement above 80%. The 90 items were summarized into nine scales. Two scales (outside supportive physical activity features/functionality and outside exercise facilities) were related to greater physical activity and less sedentary time. Four scales (inside social facilities, onsite services, exercise programs, and social activities) were related to greater sedentary time and better self-rated health. APARS items demonstrated adequate inter-rater reliability and some evidence for construct validity to assess health-related environments in retirement facilities. Social activities in SLRs could benefit residents by incorporating more physical activity. Use of APARS could inform more health-promoting designs of senior living facilities.

  View details for DOI 10.1016/j.jaging.2011.03.004

  View details for PubMedID 27168700

  View details for PubMedCentralID PMC4860260

• Does Tailoring on Additional Theoretical Constructs Enhance the Efficacy of a Print-Based Physical Activity Promotion Intervention? HEALTH PSYCHOLOGY Williams, D. M., Papandonatos, G. D., Jennings, E. G., Napolitano, M. A., Lewis, B. A., Whiteley, J. A., Bock, B. C., Albrecht, A. E., Dunsiger, S., Parisi, A. F., King, A. C., Marcus, B. H. 2011; 30 (4): 432-441

  Abstract

  To enhance a previously efficacious individually tailored physical activity (PA) promotion intervention by adding theoretical constructs to the tailored feedback.We randomly assigned 248 healthy, underactive (moderate to vigorous physical activity [MVPA] min/week < 90) adults (mean age = 48.8 years, SD = 10.0) to receive either (a) a theoretically tailored (based on 5 constructs from the transtheoretical model and social-cognitive theory [SCT]) print-based PA promotion intervention (print) or (b) the same theoretically tailored print-based PA promotion intervention plus enhanced tailoring addressing 5 additional SCT constructs (enhanced print).The 7-day physical activity recall administered at baseline, Month 6, and Month 12, with outcomes operationalized as percentage achieving 150 min/week of MVPA.When controlling for covariates, there was a nonsignificant trend in favor of the enhanced print condition reflecting 46% and 50% greater odds of achieving 150 min/week of MVPA at Month 6 and Month 12, respectively.Enhanced tailoring based on additional theoretical constructs may result in marginal improvements in physical activity outcomes.

  View details for DOI 10.1037/a0023084

  View details for Web of Science ID 000292809100008

  View details for PubMedID 21574710

• Promoting culturally targeted chronic disease prevention research through an adapted participatory research approach: The Qassim-Stanford Universities project. Translational behavioral medicine Winter, S. J., King, A. C., Stafford, R. S., Winkleby, M. A., Haskell, W. L., Farquhar, J. W. 2011; 1 (2): 289-298

  Abstract

  The Kingdom of Saudi Arabia (KSA), similar to other countries in the Eastern Mediterranean, has been experiencing a recent rapid increase in the prevalence of chronic diseases and associated risk factors. To begin to take advantage of the chronic disease prevention and health promotion (CDPHP) knowledge available from other nations, researchers at a newly established University in the Qassim Province of the KSA have partnered with Stanford University in the United States of America. To ensure that CDPHP research and interventions are culturally relevant and appropriate, a participatory research approach has been adopted where local researchers are the target "community." Contextual challenges of conducting CDPHP research in the KSA, at the individual, social/cultural, organizational and environmental/policy levels, are identified, as well as examples of CDPHP intervention strategies that may be culturally appropriate at each level.

  View details for DOI 10.1007/s13142-011-0033-3

  View details for PubMedID 24073051

  View details for PubMedCentralID PMC3717657

• Promoting culturally targeted chronic disease prevention research through an adapted participatory research approach: The Qassim-Stanford Universities project TRANSLATIONAL BEHAVIORAL MEDICINE Winter, S. J., King, A. C., Stafford, R. S., Winkleby, M. A., Haskell, W. L., Farquhar, J. W. 2011; 1 (2): 289-298

  Abstract

  The Kingdom of Saudi Arabia (KSA), similar to other countries in the Eastern Mediterranean, has been experiencing a recent rapid increase in the prevalence of chronic diseases and associated risk factors. To begin to take advantage of the chronic disease prevention and health promotion (CDPHP) knowledge available from other nations, researchers at a newly established University in the Qassim Province of the KSA have partnered with Stanford University in the United States of America. To ensure that CDPHP research and interventions are culturally relevant and appropriate, a participatory research approach has been adopted where local researchers are the target "community." Contextual challenges of conducting CDPHP research in the KSA, at the individual, social/cultural, organizational and environmental/policy levels, are identified, as well as examples of CDPHP intervention strategies that may be culturally appropriate at each level.

  View details for DOI 10.1007/s13142-011-0033-3

  View details for Web of Science ID 000209412000013

  View details for PubMedCentralID PMC3717657

• Effects of Exercise on Mobility in Obese and Nonobese Older Adults (vol 18, pg 1168, 2010) OBESITY Manini, T. M., Newman, A. B., Fielding, R., Blair, S. N., Perri, M. G., Anton, S. D., Goodpaster, B. C., Katula, J. A., Rejeski, W. J., Kritchevsky, S. B., Hsu, F., Pahor, M., King, A. C. 2011; 19 (5): 1106-1106

  View details for Web of Science ID 000289933300037

• Differences in Neighborhood Characteristics and Physical Activity Between Older Adults in Metropolitan and Micropolitan Counties Papadopoulos, C., Berdis, M., Madlem, M., Saelens, B. E., Sallis, J. F., Frank, L. D., Conway, T. L., King, A. C. LIPPINCOTT WILLIAMS & WILKINS. 2011: 720

  View details for DOI 10.1249/01.MSS.0000401998.72546.3b

  View details for Web of Science ID 000209079503075

• LACK OF SOCIAL SUPPORT FROM FRIENDS PREDICTS SUCCESSFUL WEIGHT LOSS IN A GROUP-BASED PROGRAM Kieman, M., Moore, S. D., Schoffman, D., Lee, K., King, A., Taylor, C., Perri, M. G. SPRINGER. 2011: S217

  View details for Web of Science ID 000289297701336

• CHANGES AT FAST-FOOD RESTAURANTS IN RESPONSE TO THE 2010 SANTA CLARA COUNTY, CA TOY ORDINANCE Otten, J., Buman, M., Krukowski, R. A., Hekler, E., Saelens, B. E., Gardner, C., King, A. SPRINGER. 2011: S25

  View details for Web of Science ID 000289297700095

• EMPLOYING 'VIRTUAL ADVISORS' TO PROMOTE PHYSICAL ACTIVITY IN UNDERSERVED COMMUNITIES: RESULTS FROM THE COMPASS STUDY King, A. C., Bickmore, T. W., Campero, I., Pruitt, L., Yin, L. SPRINGER. 2011: S58

  View details for Web of Science ID 000289297700224

• RECRUITMENT EFFORTS TO ATTRACT OLDER LATINO ADULTS TO PHYSICAL ACTIVITY TRIALS Castro, C. M., Pruitt, L. A., Campero, M., King, A. C. SPRINGER. 2011: S126

  View details for Web of Science ID 000289297700496

• IMPROVED PHYSICAL FUNCTION AND QUALITY OF LIFE AMONG CANCER SURVIVORS PARTICIPATING IN A COMMUNITY-BASED "LIVING STRONG LIVING WELL" PROGRAM Buman, M. P., Hanna, J., Anderson, J., Kim, S., Stefanick, M., King, A. SPRINGER. 2011: S8

  View details for Web of Science ID 000289297700029

• LINKS BETWEEN PERCEIVED SOCIAL AND BUILT ENVIRONMENTS IN A SAMPLE OF OLDER ADULTS LIVING IN LOW-INCOME COMMUNAL SENIOR HOUSING Winter, S., Buman, M., Otten, J., Hekler, E., King, A. C. SPRINGER. 2011: S183

  View details for Web of Science ID 000289297701202

• PSYCHOSOCIAL BY BUILT ENVIRONMENT INTERACTIONS ASSOCIATED WITH OLDER ADULTS' PHYSICAL ACTIVITY Carlson, J. A., Sallis, J. F., Conway, T. L., Saelens, B. E., Frank, L. D., Kerr, J., Kain, K., King, A. C. SPRINGER. 2011: S182

  View details for Web of Science ID 000289297701200

• PROMOTING HEALTHY WEIGHT WITH 'STABILITY FIRST' Kiernan, M., Moore, S. D., Schoffman, D., Lee, K., King, A., Taylor, C., Perri, M. G. SPRINGER. 2011: S48

  View details for Web of Science ID 000289297700187

• USING DIRECT MAIL TO ENHANCE MINORITY RECRUITMENT TO CLINICAL TRIALS: EXPERIMENTAL FINDINGS AND PRACTICAL RECOMMENDATIONS Moore, S. D., Lee, K., Schoffman, D., King, A., Crawley, L. M., Kiernan, M. SPRINGER. 2011: S127

  View details for Web of Science ID 000289297700498

• Exercise effects on night-to-night fluctuations in self-rated sleep among older adults with sleep complaints JOURNAL OF SLEEP RESEARCH Buman, M. P., Hekler, E. B., Bliwise, D. L., King, A. C. 2011; 20 (1): 28-37

  Abstract

  Sleep interventions have rarely explored reductions in night-to-night fluctuations [i.e. intra-individual variability (IIV)] in sleep, despite the negative impacts of such fluctuations on affective states and cognitive and physical symptoms. In a community-based randomized controlled trial we evaluated whether physical exercise reduced IIV in self-rated sleep outcomes among middle-aged and older adults with sleep complaints. Under-active adults 55 years and older (n = 66, 67% women) with mild to moderate sleep complaints were randomized to 12 months of a moderate-intensity endurance exercise (n = 36) or a health education control group (n = 30). Daily sleep logs, Pittsburgh Sleep Quality Index (PSQI) and in-home polysomnographic sleep recordings (PSG) were collected at baseline, 6 months and 12 months. Sleep log-derived means and IIV were computed for sleep-onset latency (SOL), time in bed, feeling rested in the morning, number of nighttime awakenings, and wake after final awakening (WAFA). Using intent-to-treat methods, at 6 months no differences in IIV were observed by group. At 12 months, SOL-based IIV was reduced in the exercise group compared with the control (difference = 23.11, 95% CI: 3.04-47.18, P = 0.025, Cohen's d = 0.57). This change occurred without mean-level or IIV changes in sleep-wake schedules. For all sleep variables, except SOL and WAFA, IIV changes and mean-level changes in each variable were negatively correlated (r = -0.312 to -0.691, P < 0.05). Sleep log-derived IIV changes were modestly correlated with mean-level PSQI and PSG-based changes at 12 months. Twelve months of moderate-intensity exercise reduced night-to-night fluctuations in self-rated time to fall asleep, and this relationship was independent of mean-level time to fall asleep.

  View details for DOI 10.1111/j.1365-2869.2010.00866.x

  View details for Web of Science ID 000287199200004

  View details for PubMedID 20629937

  View details for PubMedCentralID PMC2958223

• Outcome expectations and realizations as predictors of weight regain among dieters EATING BEHAVIORS Moore, S. D., King, A. C., Kiernan, M., Gardner, C. D. 2011; 12 (1): 60-63

  Abstract

  This prospective study tested whether (a) baseline outcome expectations regarding the benefits of a weight-loss diet, (b) 6-month outcome realizations regarding perceived benefits actually experienced, and/or (c) the interaction between them predicted 6-12-month weight regain among overweight/obese women randomized to one of four popular weight-loss diets (N=311). Positive 6-month realizations regarding improvements in physical shape and appearance predicted less 6-12-month weight regain among Atkins diet participants only (n=70), controlling for baseline expectations, the expectations-realization interaction, and initial weight loss. Atkins participants displayed three distinct patterns of regain based on levels of 6-month realizations and initial weight loss. Experimental research should investigate whether improving realizations leads to reduced weight regain in response to this popular diet.

  View details for DOI 10.1016/j.eatbeh.2010.08.007

  View details for Web of Science ID 000286845700010

  View details for PubMedID 21184975

  View details for PubMedCentralID PMC3053006

• Changes in CVD risk factors in the activity counseling trial. International journal of general medicine Baruth, M., Wilcox, S., Sallis, J. F., King, A. C., Marcus, B. H., Blair, S. N. 2011; 4: 53-62

  Abstract

  Primary care facilities may be a natural setting for delivering interventions that focus on behaviors that improve cardiovascular disease (CVD) risk factors. The purpose of this study was to examine the 24-month effects of the Activity Counseling Trial (ACT) on CVD risk factors, to examine whether changes in CVD risk factors differed according to baseline risk factor status, and to examine whether changes in fitness were associated with changes in CVD risk factors. ACT was a 24-month multicenter randomized controlled trial to increase physical activity. Participants were 874 inactive men and women aged 35-74 years. Participants were randomly assigned to one of three arms that varied by level of counseling, intensity, and resource requirements. Because there were no significant differences in change over time between arms on any of the CVD risk factors examined, all arms were combined, and the effects of time, independent of arm, were examined separately for men and women. Time × Baseline risk factor status interactions examined whether changes in CVD risk factors differed according to baseline risk factor status. Significant improvements in total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, the ratio of total cholesterol to HDL-C, and triglycerides were seen in both men and women who had high (or low for HDL-C) baseline levels of risk factors, whereas significant improvements in diastolic blood pressure were seen only in those men with high baseline levels. There were no improvements in any risk factors among participants with normal baseline levels. Changes in fitness were associated with changes in a number of CVD risk factors. However, most relationships disappeared after controlling for changes in body weight. Improvements in lipids from the ACT interventions could reduce the risk of coronary heart disease in people with already high levels of lipids by 16%-26% in men and 11%-16% in women. Interventions that can be implemented in health care settings nationwide and result in meaningful population-wide changes in CVD risk factors are needed. The ACT physical activity interventions produced substantial improvements among men and women with elevated CVD risk factors.

  View details for DOI 10.2147/IJGM.S15686

  View details for PubMedID 21403793

  View details for PubMedCentralID PMC3048340

• Communicating Health: Harnessing Communication Technologies to Promote Health International Innovation King, A.C. 2011; May
• Physical Activity for an Aging Population PUBLIC HEALTH REVIEWS King, A. C., King, D. K. 2010; 32 (2): 401–26

  View details for DOI 10.1007/BF03391609

  View details for Web of Science ID 000215039500004

• Objective Light-Intensity Physical Activity Associations With Rated Health in Older Adults AMERICAN JOURNAL OF EPIDEMIOLOGY Buman, M. P., Hekler, E. B., Haskell, W. L., Pruitt, L., Conway, T. L., Cain, K. L., Sallis, J. F., Saelens, B. E., Frank, L. D., King, A. C. 2010; 172 (10): 1155-1165

  Abstract

  The extent to which light-intensity physical activity contributes to health in older adults is not well known. The authors examined associations between physical activity across the intensity spectrum (sedentary to vigorous) and health and well-being variables in older adults. Two 7-day assessments of accelerometry from 2005 to 2007 were collected 6 months apart in the observational Senior Neighborhood Quality of Life Study of adults aged >65 years in Baltimore, Maryland, and Seattle, Washington. Self-reported health and psychosocial variables (e.g., lower-extremity function, body weight, rated stress) were also collected. Physical activity based on existing accelerometer thresholds for moderate/vigorous, high-light, low-light, and sedentary categories were examined as correlates of physical health and psychosocial well-being in mixed-effects regression models. Participants (N = 862) were 75.4 (standard deviation, 6.8) years of age, 56% female, 71% white, and 58% overweight/obese. After adjustment for study covariates and time spent in moderate/vigorous physical activity and sedentary behavior, low-light and high-light physical activity were positively related to physical health (all P < 0.0001) and well-being (all P < 0.001). Additionally, replacing 30 minutes/day of sedentary time with equal amounts of low-light or high-light physical activity was associated with better physical health (all P < 0.0001). Objectively measured light-intensity physical activity is associated with physical health and well-being variables in older adults.

  View details for DOI 10.1093/aje/kwq249

  View details for Web of Science ID 000283918700008

  View details for PubMedID 20843864

  View details for PubMedCentralID PMC3004766

• Exercise as a Treatment to Enhance Sleep AMERICAN JOURNAL OF LIFESTYLE MEDICINE Buman, M. P., King, A. C. 2010; 4 (6): 500–514

  View details for DOI 10.1177/1559827610375532

  View details for Web of Science ID 000446665500005

• Relationship Between Physical Functioning and Physical Activity in the Lifestyle Interventions and Independence for Elders Pilot JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Chale-Rush, A., Guralnik, J. M., Walkup, M. P., Miller, M. E., Rejeski, W. J., Katula, J. A., King, A. C., Glynn, N. W., Manini, T. M., Blair, S. N., Fielding, R. A. 2010; 58 (10): 1918-1924

  Abstract

  To determine whether participation in usual moderate-intensity or more-vigorous physical activity (MVPA) is associated with physical function performance and to identify sociodemographic, psychosocial, and disease-related covariates that may also compromise physical function performance.Cross-sectional analysis of baseline variables of a randomized controlled intervention trial.Four academic research centers.Four hundred twenty-four older adults aged 70 to 89 at risk for mobility disability (scoring <10 on the Short Physical Performance Battery (SPPB)) and able to complete the 400-m walk test within 15 minutes.Minutes of MVPA (dichotomized according to above or below 150 min/wk of MVPA) assessed according to the Community Healthy Activities Model Program for Seniors questionnaire, SPPB score, 400-m walk test, sex, body mass index (BMI), depressive symptoms, age, and number of medications.The SPPB summary score was associated with minutes of MVPA (ρ=0.16, P=.001). In multiple regression analyses, age, minutes of MVPA, number of medications, and depressive symptoms were associated with performance on the composite SPPB (P<.05). There was an association between 400-m walk time and minutes of MVPA (ρ=-0.18; P<.001). In multiple regression analyses, age, sex, minutes of MVPA, BMI, and number of medications were associated with performance on the 400-m walk test (P<.05).Minutes of MVPA, sex, BMI, depressive symptoms, age, and number of medications are associated with physical function performance and should all be taken into consideration in the prevention of mobility disability.

  View details for DOI 10.1111/j.1532-5415.2010.03008.x

  View details for Web of Science ID 000282690900012

  View details for PubMedID 20738437

  View details for PubMedCentralID PMC2952066

• NEIGHBORHOOD DESIGN, PHYSICAL FUNCTION, AND HEALTHFUL LIFESTYLES IN OLDER ADULTS: RESULTS FROM THE SENIORS NEIGHBORHOOD QUALITY OF LIFE STUDY King, A., Sallis, J., Frank, L., Saelens, B., Ahn, D., Conway, T., Cain, K. SPRINGER. 2010: 252–253

  View details for Web of Science ID 000280088500575

• NEIGHBORHOOD DESIGN, PHYSICAL FUNCTION, AND HEALTHFUL LIFESTYLES IN OLDER ADULTS: RESULTS FROM THE SENIORS NEIGHBORHOOD QUALITY OF LIFE STUDY King, A., Sallis, J., Frank, L., Saelens, B., Ahn, D., Conway, T., Cain, K. SPRINGER. 2010: 252-253

  View details for Web of Science ID 000520367100575

• Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults JOURNAL OF AGING AND PHYSICAL ACTIVITY Taylor-Piliae, R. E., Newell, K. A., Cherin, R., Lee, M. J., King, A. C., Haskell, W. L. 2010; 18 (3): 261-279

  Abstract

  To compare the effects of Tai Chi (TC, n = 37) and Western exercise (WE, n = 39) with an attention-control group (C, n = 56) on physical and cognitive functioning in healthy adults age 69 +/- 5.8 yr, in a 2-phase randomized trial.TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis.At 6 mo, WE had greater improvements in upper body flexibility (F = 4.67, p = .01) than TC and C. TC had greater improvements in balance (F = 3.36, p = .04) and a cognitive-function measure (F = 7.75, p < .001) than WE and C. The differential cognitive-function improvements observed in TC were maintained through 12 mo.The TC and WE interventions resulted in differential improvements in physical functioning among generally healthy older adults. TC led to improvement in an indicator of cognitive functioning that was maintained through 12 mo.

  View details for Web of Science ID 000279052900002

  View details for PubMedID 20651414

• Maintaining physical activity among older adults: 24-month outcomes of the Keep Active Minnesota randomized controlled trial PREVENTIVE MEDICINE Martinson, B. C., Sherwood, N. E., Crain, A. L., Hayes, M. G., King, A. C., Pronk, N. P., O'Connor, P. J. 2010; 51 (1): 37-44

  Abstract

  To evaluate the efficacy at 6-, 12-, and 24-month follow-up of Keep Active Minnesota (KAM), a telephone and mail-based intervention designed to promote physical activity (PA) maintenance among currently active adults age 50 to 70.Participants who reported having recently increased their MVPA to a minimum of 2d/wk, 30 min/bout, (N=1049) were recruited in 2004 and 2005 from one large managed care organization in Minnesota, and randomly assigned to either treatment (KAM; N=523), or Usual Care (UC; N=526) with PA assessed using the CHAMPS questionnaire, and expressed as kcal/wk energy expenditure.We find a sustained, significant benefit of the intervention at 6, 12 and 24 months. kcal/wk expenditure in moderate or vigorous activities was higher at 6 (p<.03, Cohen's d(6m)=.16), 12 (p<.04, d(12 m)=.13) and 24 months (p<.01, d(24 m)=.16) for KAM participants, compared to UC participants.The KAM telephone- and mail-based PA maintenance intervention was effective at maintaining PA in both the short-term (6 months) and longer-term (12 and 24 months) relative to usual care.

  View details for DOI 10.1016/j.ypmed.2010.04.002

  View details for Web of Science ID 000279157600007

  View details for PubMedID 20382179

  View details for PubMedCentralID PMC2885533

• Psychosocial Mediators of Physical Activity and Fitness Changes in the Activity Counseling Trial ANNALS OF BEHAVIORAL MEDICINE Baruth, M., Wilcox, S., Dunn, A. L., King, A. C., Marcus, B. H., Rejeski, W. J., Sallis, J. F., Blair, S. N. 2010; 39 (3): 274-289

  Abstract

  Improved understanding of the mediators of physical activity (PA) interventions could lead to improvements in theory and programs.To examine the 24-month mediating effects of psychosocial variables on PA and cardiorespiratory fitness (CRF) outcomes in 878 initially sedentary adults aged 35-75 participating in the Activity Counseling Trial.Participants were assigned to one of three intervention arms: physician advice, assistance, or counseling. MacKinnon's product of coefficients was used to test for longitudinal and contemporaneous mediation.Changes in behavioral processes of change from baseline to 24 months significantly mediated the relationship between the active intervention arms and improvements in PA and CRF from baseline to 24 months in both men and women. None of the other psychosocial variables tested met criteria for mediation.Results indicate that behavioral interventions should incorporate methods to encourage participants to use these behavioral strategies as they attempt to become more active.

  View details for DOI 10.1007/s12160-010-9178-4

  View details for Web of Science ID 000282082000007

  View details for PubMedID 20431975

• Individual, social and environmental correlates of physical activity among women living in socioeconomically disadvantaged neighbourhoods SOCIAL SCIENCE & MEDICINE Cleland, V., Ball, K., Hume, C., Timperio, A., King, A. C., Crawford, D. 2010; 70 (12): 2011-2018

  Abstract

  Women living in socioeconomically disadvantaged neighbourhoods are at heightened risk for physical inactivity, but little is known about the correlates of physical activity among this group. Using a social-ecological framework, this study aimed to determine the individual, social and neighbourhood environmental correlates of physical activity amongst women living in such neighbourhoods. During 2007-2008 women (n = 4108) aged 18-45 years randomly selected from urban and rural neighbourhoods of low socioeconomic status in Victoria, Australia completed the International Physical Activity Questionnaire (long). They reported on individual (self-efficacy, enjoyment, intentions, outcome expectancies, skills), social (childcare, social support from family and friends/colleagues, dog ownership) and neighbourhood environmental (neighbourhood cohesion, aesthetics, personal safety, 'walking environment') factors. Multinomial logistic regression was used to examine the odds of increasing categories of leisure time physical activity (LTPA) and transport-related physical activity (TRPA) for each individual, social and environmental factor. In partially adjusted analyses, all individual, social and environmental variables were positively associated with LTPA, while all individual factors, family and friend support and the walking environment were positively associated with TRPA. In fully adjusted multivariable models, all individual and social factors remained significantly associated with LTPA, while self-efficacy, enjoyment, intentions, social support, and neighbourhood 'walking environment' variables remained significantly associated with TRPA. In conclusion, individual and social factors were most important for LTPA, while individual, social and neighbourhood environmental factors were all associated with TRPA. Acknowledging the cross-sectional design, the findings highlight the importance of different levels of potential influence on physical activity in different domains, which should be considered when developing strategies to promote physical activity amongst women living in socioeconomically disadvantaged neighbourhoods.

  View details for DOI 10.1016/j.socscimed.2010.02.028

  View details for Web of Science ID 000278574300020

  View details for PubMedID 20362380

• OUTCOME EXPECTATIONS AND REALIZATIONS AS PREDICTORS OF WEIGHT LOSS AMONG WOMEN IN A RANDOMIZED TRIAL Moore, S. D., King, A., Kiernan, M., Gardner, C. SPRINGER. 2010: 210

  View details for Web of Science ID 000275841700820

• Healthy Aging and Where You Live: Community Design Relationships With Physical Activity and Body Weight in Older Americans JOURNAL OF PHYSICAL ACTIVITY & HEALTH Frank, L., Kerr, J., Rosenberg, D., King, A. 2010; 7: S82-S90

  Abstract

  Suburban development patterns may impede physical activity (PA) and mobility and affect healthy aging. This paper investigates the relationships between neighborhood design and walking, driving, PA, and obesity in adults over age 65 years.Data from the SMARTRAQ (Atlanta region) survey provided measures of PA, BMI, SES, and travel patterns. Neighborhood design was measured using a walkability index (residential density, street connectivity, retail density, and land use mix). Chi square and regression was used to evaluate relationships.Increased walkability was related with more walking (OR 2.02), less time spent traveling in a car (OR .53), and lower odds of being overweight (OR .68). Those with 1 or no cars were more likely to walk (OR 2.9) and spend less time in cars (OR .53); but also less likely to get recommended levels of PA (OR .55). Visiting a fast food outlet was associated with increased odds of obesity (OR 1.81).Policies are needed to bring older Americans closer to shops and services and healthy food outlets as a means of encouraging regular walking and healthy body weight. Incentives to encourage neighborhood grocery stores and affordable housing in central areas along with regulatory reform through zoning can encourage PA and healthy body weight in the elderly.

  View details for Web of Science ID 000280738300014

  View details for PubMedID 20440017

• Interruption of Physical Activity Because of Illness in the Lifestyle Interventions and Independence for Elders Pilot Trial JOURNAL OF AGING AND PHYSICAL ACTIVITY Phillips, E. M., Katula, J., Miller, M. E., Walkup, M. P., Brach, J. S., King, A. C., Rejeski, W. J., Church, T., Fielding, R. A. 2010; 18 (1): 61-74

  Abstract

  To examine baseline characteristics and change in gait speed and Short Physical Performance Battery (SPPB) scores in participants medically suspended (MS) from a physical activity intervention (PA).Randomized controlled trial.University and community centers.Sedentary older adults (N = 213) randomized to PA in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P).MS was defined as missing 3 consecutive PA sessions in adoption and transition phases or 2 wk in maintenance phase because of a health event.In all, 122 participants completed PA without MS (NMS subgroup), 48 participants underwent MS and resumed PA (SR subgroup), and 43 participants underwent MS and did not complete PA (SNR subgroup). At baseline, SNR walked slower (p = .03), took more prescribed medications (p = .02), and had lower SPPB scores than NMS and SR (p = .02). Changes from baseline to Month 12 SPPB scores were affected by suspension status, adjusted mean (SE) SPPB change: SNR 0.0957 (0.3184), SR 0.9413 (0.3063), NMS 1.0720 (0.1871); p = .03.MS participants unable to return to complete the PA in a trial of mobility-limited sedentary older adults had slower walking speeds, lower SPPB scores, and a higher number of prescribed medications at baseline. Change in SPPB scores at 12 months was related to suspension status.

  View details for Web of Science ID 000274030100005

  View details for PubMedID 20181994

  View details for PubMedCentralID PMC3191494

• Using Ecological Momentary Assessment to Examine Antecedents and Correlates of Physical Activity Bouts in Adults Age 50+Years: A Pilot Study ANNALS OF BEHAVIORAL MEDICINE Dunton, G. F., Atienza, A. A., Castro, C. M., King, A. C. 2009; 38 (3): 249-255

  Abstract

  National recommendations supporting the promotion of multiple short (10+ minute) physical activity bouts each day to increase overall physical activity levels in middle-aged and older adults underscore the need to identify antecedents and correlates of such daily physical activity episodes.This pilot study used Ecological Momentary Assessment to examine the time-lagged and concurrent effects of empirically supported social, cognitive, affective, and physiological factors on physical activity among adults age 50+ years.Participants (N = 23) responded to diary prompts on a handheld computer four times per day across a 2-week period. Moderate-to-vigorous physical activity (MVPA), self-efficacy, positive and negative affect, control, demand, fatigue, energy, social interactions, and stressful events were assessed during each sequence.Multivariate results showed that greater self-efficacy and control predicted greater MVPA at each subsequent assessment throughout the day (p < 0.05). Also, having a positive social interaction was concurrently related to higher levels of MVPA (p = 0.052).Time-varying multidimensional individual processes predict within daily physical activity levels.

  View details for DOI 10.1007/s12160-009-9141-4

  View details for Web of Science ID 000275425100008

  View details for PubMedID 20052568

• Evaluation of lifestyle interventions to treat elevated cardiometabolic risk in primary care (E-LITE): a randomized controlled trial BMC FAMILY PRACTICE Ma, J., King, A. C., Wilson, S. R., Xiao, L., Stafford, R. S. 2009; 10

  Abstract

  Efficacy research has shown that intensive individual lifestyle intervention lowers the risk for developing type 2 diabetes mellitus and the metabolic syndrome. Translational research is needed to test real-world models of lifestyle interventions in primary care settings.E-LITE is a three-arm randomized controlled clinical trial aimed at testing the feasibility and potential effectiveness of two lifestyle interventions: information technology-assisted self-management, either alone or in combination with care management by a dietitian and exercise counselor, in comparison to usual care. Overweight or obese adults with pre-diabetes and/or metabolic syndrome (n = 240) recruited from a community-based primary care clinic are randomly assigned to one of three treatment conditions. Treatment will last 15 months and involves a three-month intensive treatment phase followed by a 12-month maintenance phase. Follow-up assessment occurs at three, six, and 15 months. The primary outcome is change in body mass index. The target sample size will provide 80% power for detecting a net difference of half a standard deviation in body mass index at 15 months between either of the self-management or care management interventions and usual care at a two-sided alpha level of 0.05, assuming up to a 20% rate of loss to 15-month follow-up. Secondary outcomes include glycemic control, additional cardiovascular risk factors, and health-related quality of life. Potential mediators (e.g., treatment adherence, caloric intake, physical activity level) and moderators (e.g., age, gender, race/ethnicity, baseline mental status) of the intervention's effect on weight change also will be examined.This study will provide objective evidence on the extent of reductions in body mass index and related cardiometabolic risk factors from two lifestyle intervention programs of varying intensity that could be implemented as part of routine health care.

  View details for DOI 10.1186/1471-2296-10-71

  View details for Web of Science ID 000272354600001

  View details for PubMedID 19909549

  View details for PubMedCentralID PMC2779786

• A Cost Analysis of a Physical Activity Intervention for Older Adults JOURNAL OF PHYSICAL ACTIVITY & HEALTH Groessl, E. J., Kaplan, R. M., Blair, S. N., Rejeski, W. J., Katula, J. A., King, A. C., Fielding, R. A., Glynn, N. W., Pahor, M. 2009; 6 (6): 767-774

  Abstract

  We examined the costs of a physical activity (PA) and an educational comparison intervention. 424 older adults at risk for mobility disability were randomly assigned to either condition. The PA program consisted of center-based exercise sessions 3x weekly for 8 weeks, 2x weekly for weeks 9 to 24 and weekly behavioral counseling for 10 weeks. Optional sessions were offered during maintenance weeks (25-52). The comparison intervention consisted of weekly education meetings for 24 weeks, and then monthly for 6 months. Cost analyses were conducted from the "payer's" perspective, with a 1-year time horizon. Intervention costs were estimated by tracking personnel activities and materials used for each intervention and multiplying by national unit cost averages. The average cost/participant was $1134 and $175 for the PA and the comparison interventions, respectively. A preliminary cost/effectiveness analysis gauged the cost/disability avoided to be $28,206. Costs for this PA program for older adults are comparable to those of other PA interventions. The results are preliminary and a longer study is required to fully assess the costs and health benefits of these interventions.

  View details for Web of Science ID 000282842100012

  View details for PubMedID 20101920

  View details for PubMedCentralID PMC3091594

• Changes in Cognitive Function in a Randomized Trial of Physical Activity: Results of the Lifestyle Interventions and Independence for Elders Pilot Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Williamson, J. D., Espeland, M., Kritchevsky, S. B., Newman, A. B., King, A. C., Pahor, M., Guralnik, J. M., Pruitt, L. A., Miller, M. E. 2009; 64 (6): 688-694

  Abstract

  Cognitive impairment is an important contributor to disability. Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function (CF). We report results of a pilot study to provide estimates of the relative impact of physical activity (PA) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability.Sedentary persons (102) at increased risk for disability (aged 70-89 years) were randomized to moderate-intensity PA or health education. Participants were administered the Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), modified Stroop test, and Modified Mini-Mental State Examination at baseline and 1 year.Group differences were not significant but improvements in cognitive scores were associated with improvements in physical function. Specifically, the DSST significantly correlated with change in the Short Physical Performance Battery score (r = .38, p = .0002), in chair stand score (r = .26, p = .012), in balance score (r = .21, p = .046), and in 400-m gait speed (r = .15, p = .147). Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair stand and balance, respectively.These results provide further support for the benefits of exercise on CF in older adults. An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to expand the indications for prescribing exercise for prevention of decline in brain function.

  View details for DOI 10.1093/gerona/glp014

  View details for Web of Science ID 000268247100011

  View details for PubMedID 19244157

  View details for PubMedCentralID PMC2679423

• What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study) JOURNAL OF NUTRITION HEALTH & AGING Kwon, S., Perera, S., Pahor, M., Katula, J. A., King, A. C., Groessl, E. J., Studenski, S. A. 2009; 13 (6): 538-544

  Abstract

  Performance measures provide important information, but the meaning of change in these measures is not well known. The purpose of this research is to 1) examine the effect of treatment assignment on the relationship between self-report and performance; 2) to estimate the magnitude of meaningful change in 400-meter walk time (400MWT), 4-meter gait speed (4MGS), and Short Physical Performance Battery (SPPB) and 3) to evaluate the effect of direction of change on estimates of magnitude.This is a secondary analysis of data from the LIFE-P study, a single blinded randomized clinical trial. Using change over one year, we applied distribution-based and anchor-based methods for self-reported mobility to estimate minimally important and substantial change in 400MWT, 4MGS and SPPB.Four university-based clinical research sites.Sedentary adults aged 70-89 whose SPPB scores were less than 10 and who were able to complete a 400MW at baseline (n=424).A structured exercise program versus health education.400MWT, 4MGS, SPPB.Relationships between self-report and performance measures were consistent between treatment arms. Minimally significant change estimates were 400MWT: 20-30 seconds, 4MGS: 0.03-0.05m/s and SPPB: 0.3 - 0.8 points. Substantial changes were 400MWT: 50-60 seconds, 4MGS: 0.08m/s, SPPB: 0.4 - 1.5 points. Magnitudes of change for improvement and decline were not significantly different.The magnitude of clinically important change in physical performance measures is reasonably consistent using several analytic techniques and appears to be achievable in clinical trials of exercise. Due to limited power, the effect of direction of change on estimates of magnitude remains uncertain.

  View details for DOI 10.1007/s12603-009-0104-z

  View details for Web of Science ID 000267681900008

  View details for PubMedID 19536422

• Can Individuals Meet Multiple Physical Activity and Dietary Behavior Goals? AMERICAN JOURNAL OF HEALTH BEHAVIOR Young, D. R., Vollmer, W. M., King, A. C., Brown, A. J., Stevens, V. J., Elmer, P. J., Craddick, S., Sturtevant, D. L., Harsha, D. W., Appel, L. J. 2009; 33 (3): 277-286

  Abstract

  To examine whether participants with the most behavioral goals to achieve were more likely to meet more goals than those given fewer goals.Eight hundred ten participants were randomly assigned to advice-only, established guidelines for blood pressure control (reduced sodium, increased physical activity), or established guidelines plus the DASH diet (increased fruits, vegetables, low-fat dairy, reduced fat).At 6 months, 11.7% of Advice-Only, 19.3% of Established, and 44.6% of Established plus DASH met at least 3 goals (P<0.0001). At 18 months, 33.5% of Established plus DASH met at least 3 goals.Those with the most goals to achieve reached the most goals.

  View details for Web of Science ID 000265657400006

  View details for PubMedID 19063649

• Feasibility and outcomes of a multilevel place-based walking intervention for seniors: A pilot study HEALTH & PLACE Rosenberg, D., Kerr, J., Sallis, J. F., Patrick, K., Moore, D. J., King, A. 2009; 15 (1): 173-179

  Abstract

  This pilot study tested the feasibility and acceptability of a novel multilevel walking intervention for older adults in a continuing care retirement community (CCRC). The intervention included site-specific walking route maps, pedometers, and individualized goal setting. Pedometers were worn for self-monitoring and for the primary outcome (steps per day). Surveys at pre- and post-intervention assessed daily activities, benefits, barriers, route use, quality of life, and satisfaction. Steps per day were very low at baseline and increased significantly at post-test. The findings indicate that a multilevel site-specific intervention is feasible and acceptable for increasing steps among seniors living in a CCRC.

  View details for DOI 10.1016/j.healthplace.2008.03.010

  View details for Web of Science ID 000261636300020

  View details for PubMedID 18502164

• Age Differences in the Relation of Perceived Neighborhood Environment to Walking MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Shigematsu, R., Sallis, J. F., Conway, T. L., Saelens, B. E., Frank, L. D., Cain, K. L., Chapman, J. E., King, A. C. 2009; 41 (2): 314-321

  Abstract

  The strength of the relationship of environment to physical activity may differ by age group. Older adults were expected to be more affected by environmental attributes than younger adults. The present study examined age-related differences in associations between perceived neighborhood environment and physical activity.Participants were 1623 adults aged 20 to 97 yr divided into five groups: ages 20-39, 40-49, 50-65, 66-75, and 76+. They were recruited from King County/Seattle, WA, neighborhoods selected to vary in land use and median income. Participants completed questionnaires about neighborhood environment attributes and walking for transportation and for leisure purposes. Neighborhood environment, within a 15- to 20-min walk from home, was measured on nine attributes with the validated Neighborhood Environment Walkability Scale questionnaire: residential density, proximity to nonresidential land uses, ease of access to nonresidential uses, street connectivity, walking/cycling facilities, esthetics, pedestrian traffic safety, crime safety, and proximity to recreation facilities. Participants reported frequency and duration of walking using the validated International Physical Activity Questionnaire and the Community Healthy Activities Model Program for Seniors. Partial correlations were computed, adjusting for demographics.Walking for transportation was significantly related to multiple perceived neighborhood attributes in all age groups, although walking for leisure was not. Walking for transportation was significantly related to almost all neighborhood environment variables in the youngest age group. In contrast, only two environmental attributes, proximity to nonresidential uses (like shops) and recreation facilities, were moderately correlated with walking for transportation in the two oldest groups.Communities need to be designed with many favorable environmental attributes to support walking for transportation among younger adults. Having nonresidential destinations and recreation facilities within walking distance may be among the most important attributes to support older adults' physical activity.

  View details for DOI 10.1249/MSS.0b013e318185496c

  View details for Web of Science ID 000262601200008

  View details for PubMedID 19127195

• Sleep Patterns and Sleep-Related Factors Between Caregiving and Non-Caregiving Women BEHAVIORAL SLEEP MEDICINE Castro, C. M., Lee, K. A., Bliwise, D. L., Urizar, G. G., Woodward, S. H., King, A. C. 2009; 7 (3): 164-179

  Abstract

  This exploratory study compared objective sleep patterns and sleep-related factors between caregiving and non-caregiving women with sleep impairments, and compared the sleep patterns of the caregivers with their care recipients. Nine women caring for adults with dementia and a comparison sample of 34 non-caregiving women provided three nights of in-home polysomnography (PSG) and self-report questionnaires of sleep quality and physical and emotional well-being. Care recipients' sleep was monitored with actigraphy on the same nights of the caregivers' PSG. Caregivers and non-caregivers' sleep patterns were similar across most PSG-measured parameters. Caregivers perceived more sleep disturbances, but PSG showed minimal differences compared to non-caregivers. Caregivers reported more depressive symptoms, and depression was strongly correlated with longer sleep latency. Caregiver's sleep quantity was highly correlated with the sleep quantity of their care recipient. The results suggest that, in this sample, caregivers' sleep was not significantly different from the non-caregiving women, despite differences in perceptions. Although the sample is small, this exploratory study supports the use of multiple nights of in-home PSG to assess caregiver sleep and provides more data on sleep patterns of female dementia caregivers and their relatives.

  View details for DOI 10.1080/15402000902976713

  View details for Web of Science ID 000274049100003

  View details for PubMedID 19568966

• Predictors of increased physical activity in the Active for Life program. Preventing chronic disease Wilcox, S., Dowda, M., Dunn, A., Ory, M. G., Rheaume, C., King, A. C. 2009; 6 (1): A25-?

  Abstract

  Targeting of evidence-based programs can be improved by knowing who benefits least and most. We examined pretest predictors of increased physical activity among participants enrolled in Active for Life.Participants (N = 1,963) from 9 community-based organizations took part in a 6-month telephone-based or a 20-week group-based behavioral physical activity program and completed a pretest survey; 1,335 participants returned posttest surveys. Interactions tested whether increases in physical activity differed over time, according to baseline characteristics.In the telephone-based program, participants who were younger and less active at pretest and those who had higher pretest social support showed greater intervention effects. In the group-based program, younger participants, those less active at pretest, women, Hispanics/Latinos, heavier participants, and those who reported more health conditions and osteoporosis showed greater intervention effects.Participant response to the 2 programs varied by age, baseline activity level, and other factors. For 6 of the 8 variables associated with differential outcomes, the least active group improved the most, which suggests that the programs worked especially well for participants most in need. Participants who were older than 75 years (both groups) and those who reported lower physical activity social support (in the telephone-based program) on entry did not respond as well and may require alternative or more intensive intervention strategies.

  View details for PubMedID 19080031

• Decrease in heart rate after longitudinal participation in the Groningen Active Living Model (GALM) recreational sports programme JOURNAL OF SPORTS SCIENCES de Jong, J., Lemmink, K., Scherder, E., Stewart, R., King, A., Stevens, M. 2009; 27 (9): 975-983

  Abstract

  The aim of this study was to investigate changes in heart rate during submaximal exercise as an index of cardiovascular function in older adults participating in the Groningen Active Living Model recreational sports programme who were sedentary or underactive at baseline. A repeated measurement design was conducted; 151 participants were included, providing 398 heart rate files over a period of 18 months. Multi-level analyses were conducted; growth and final models were developed. Significant decreases in mean heart rate over time were observed for all walking speeds. The covariates of sex and body mass index (BMI) were significantly related to mean heart rate at each walking speed, except for BMI at 7 km x h(-1). No significant relationships were observed between energy expenditure for recreational sports activities and leisure-time physical activities and mean heart rate, except for energy expenditure for leisure-time physical activities at 7 km x h(-1). From baseline to December 2002, decreases in predicted mean heart rate were 5.5, 6.0, 10.0, and 9.0 beats x min(-1) at walking speeds of 4, 5, 6, and 7 km x h(-1); relative decreases ranged from 5.1 to 7.4%. Significant decreases in heart rate observed during submaximal exercise reflected a potential increase in cardiovascular function after 18 months of participation in the Groningen Active Living Model recreational sports programme.

  View details for DOI 10.1080/02640410903008749

  View details for Web of Science ID 000268277900012

  View details for PubMedID 19629846

• Predictors of Increased Physical Activity in the Active for Life Program PREVENTING CHRONIC DISEASE Wilcox, S., Dowda, M., Dunn, A., Ory, M. G., Rheaume, C., King, A. C. 2009; 6 (1)

  Abstract

  Targeting of evidence-based programs can be improved by knowing who benefits least and most. We examined pretest predictors of increased physical activity among participants enrolled in Active for Life.Participants (N = 1,963) from 9 community-based organizations took part in a 6-month telephone-based or a 20-week group-based behavioral physical activity program and completed a pretest survey; 1,335 participants returned posttest surveys. Interactions tested whether increases in physical activity differed over time, according to baseline characteristics.In the telephone-based program, participants who were younger and less active at pretest and those who had higher pretest social support showed greater intervention effects. In the group-based program, younger participants, those less active at pretest, women, Hispanics/Latinos, heavier participants, and those who reported more health conditions and osteoporosis showed greater intervention effects.Participant response to the 2 programs varied by age, baseline activity level, and other factors. For 6 of the 8 variables associated with differential outcomes, the least active group improved the most, which suggests that the programs worked especially well for participants most in need. Participants who were older than 75 years (both groups) and those who reported lower physical activity social support (in the telephone-based program) on entry did not respond as well and may require alternative or more intensive intervention strategies.

  View details for Web of Science ID 000208157900025

  View details for PubMedCentralID PMC2644611

• Use of Accelerometry to Measure Physical Activity in Older Adults at Risk for Mobility Disability JOURNAL OF AGING AND PHYSICAL ACTIVITY Pruitt, L. A., Glynn, N. W., King, A. C., Guralnik, J. M., Aiken, E. K., Miller, G., Haskell, W. L. 2008; 16 (4): 416-434

  Abstract

  The authors explored using the ActiGraph accelerometer to differentiate activity levels between participants in a physical activity (PA, n = 54) or "successful aging" (SA) program (n = 52). The relationship between a PA questionnaire for older adults (CHAMPS) and accelerometry variables was also determined. Individualized accelerometry-count thresholds (ThreshIND) measured during a 400-m walk were used to identify "meaningful activity." Participants then wore the ActiGraph for 7 days. Results indicated more activity bouts/day > or =10 min above ThreshIND in the PA group than in the SA group (1.1 +/- 2.0 vs 0.5 +/- 0.8, p = .05) and more activity counts/day above ThreshIND for the PA group (28,101 +/- 27,521) than for the SA group (17,234 +/- 15,620, p = .02). Correlations between activity counts/hr and CHAMPS ranged from .27 to .42, p < .01. The ActiGraph and ThreshIND might be useful for differentiating PA levels in older adults at risk for mobility disability.

  View details for Web of Science ID 000260272700005

  View details for PubMedID 19033603

• Measuring physical activity in older adults - Use of the community health activities model program for seniors physical activity questionnaire and the yale physical activity survey in three Behavior Change Consortium studies WESTERN JOURNAL OF NURSING RESEARCH Resnick, B., King, A., Riebe, D., Ory, M. 2008; 30 (6): 673-689

  Abstract

  The purpose of this study was to use data from three Behavior Change Consortium intervention studies to consider the practicality of use of two surveys of physical activity (PA) relevant for older adults, provide support for the validity of these surveys, and provide guidance to researchers for decisions on use of one survey as opposed to the other. The samples included 218 participants in the Community Health Advice by Telephone Study, 150 participants in the Study of Exercise and Nutrition in Older Rhode Islanders, and 150 participants from the Testing the Effectiveness of the Exercise Plus Program. PA surveys included the Yale PA Survey and the Community Health Activities Model Program for Seniors PA Questionnaire. Older adults were able to complete either survey, although for frailer participants, an interview format is recommended. The Community Health Activities Model Program for Seniors PA Questionnaire was more likely to elicit information about moderate-intensity physical activities and was more likely to be related to vitality. Conversely, the Yale PA Survey may more comprehensively describe overall PA and provide information about moderate-intensity physical activity.

  View details for DOI 10.1177/0193945907311320

  View details for Web of Science ID 000259196400003

  View details for PubMedID 18195079

• Active for Life - Final results from the translation of two physical activity programs AMERICAN JOURNAL OF PREVENTIVE MEDICINE Wilcox, S., Dowda, M., Leviton, L. C., Bartlett-Prescott, J., Bazzarre, T., Campbell-Voytal, K., Carpenter, R. A., Castro, C. M., Dowdy, D., Dunn, A. L., Griffin, S. F., Guerra, M., King, A. C., Ory, M. G., Rheaume, C., Tobnick, J., Wegley, S. 2008; 35 (4): 340-351

  Abstract

  Most evidence-based programs are never translated into community settings and thus never make a public health impact.Active for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008.Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white).In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4.Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure.Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites.Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adult's health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

  View details for DOI 10.1016/j.amepre.2008.07.001

  View details for Web of Science ID 000259308900004

  View details for PubMedID 18779028

• Multilevel modeling of walking behavior: Advances in understanding the interactions of people, place, and time Conference on Walking for Health - Measurement and Research Issues and Challenges King, A. C., Satariano, W. A., Marti, J., Zhu, W. LIPPINCOTT WILLIAMS & WILKINS. 2008: S584–S593

  Abstract

  It has become increasingly clear that the influences on walking as well as other forms of regular physical activity are complex and require an increased understanding of factors across multiple levels of influence. Ecological frameworks have provided the field with a heuristic means of capturing potential impacts on behavior across diverse domains, including personal, behavioral, social or cultural, and environmental. We discuss advances in both understanding and applying this framework through the inclusion of previously ignored dimensions of impact (e.g., time), the application of state-of-the-art statistical methods for understanding interactions among multiple domains (e.g., signal detection), and the development of computer technologies (e.g., agent-based modeling) aimed at simulating the complex relationships between multiple levels of impact and walking behavior. We conclude with suggestions for future research in this emerging field.

  View details for DOI 10.1249/MSS.0b013e31817c66b7

  View details for Web of Science ID 000257192300010

  View details for PubMedID 18562976

• Mediators of physical activity behavior change: A multivariate approach 26th Annual Meeting of the Society-for-Behavioral-Medicine Napolitano, M. A., Lewis, B. A., Williams, D. M., Bock, B. C., Pinto, B., Papandonatos, G. D., Whiteley, J. A., King, A. C., Marcus, B. H. AMER PSYCHOLOGICAL ASSOC. 2008: 409–18

  Abstract

  Using a multivariate extension of the Baron and Kenny (1986) mediation framework, we examined the simultaneous effect of variables hypothesized to mediate the relationship between a motivationally tailored physical activity intervention, and 6-month physical activity behavior in 239 healthy, underactive adults (M age = 47.5; 82% women).Participants were randomly assigned to (a) print-based feedback; (b) telephone-based feedback; or (c) contact control.Psychosocial variables, including self-efficacy, decisional balance, and processes of change.All mediation criteria were satisfied for both intervention arms. A moderate indirect effect of print (0.39, 95% CI = 0.21, 0.57) was found due to increases in behavioral processes (0.54, 95% CI = 0.29, 0.80) being attenuated by decreases due to cognitive processes (-0.17, 95%CI = 0.31,-.03). A moderate indirect effect was observed for telephone (0.47, 95% CI = 0.28, 0.66), with increases due to behavioral processes (0.61, 95% CI = 0.34, 0.87) attenuated by decreases due to cognitive processes (0.15, 95% CI = -0.27, -0.02); self-efficacy and decisional balance mediational paths did not attain statistical significance.These findings highlight the importance of studies that deconstruct the theoretical components of interventions to determine which combination produces the greatest behavior changes at the lowest cost.

  View details for DOI 10.1037/0278-6133.27.4.409

  View details for Web of Science ID 000257849200002

  View details for PubMedID 18642998

  View details for PubMedCentralID PMC2692944

• Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study INTERNATIONAL JOURNAL OF OBESITY Alhassan, S., Kim, S., Bersamin, A., King, A. C., Gardner, C. D. 2008; 32 (6): 985-991

  Abstract

  Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce.We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success.Secondary analysis was performed using data from 181 free-living overweight/obese women (mean+/-s.d. age=43+/-5 years, body mass index=31+/-4 kg m(-2)) participating in a 1-year randomized clinical trial (the A TO Z study) comparing popular weight loss diets (Atkins, Zone and Ornish). Participants' dietary adherence was assessed as the difference between their respective assigned diet's recommended macronutrient goals and their self-reported intake. Association between dietary adherence and 12-month weight change was computed using Spearman's correlations. Differences in baseline characteristics and macronutrient intake between the most and least adherent tertiles for diet groups were compared using t-tests.Within each diet group, adherence score was significantly correlated with 12-month weight change (Atkins, r(s)=0.42, P=0.0003; Zone, r(s)=0.34, P=0.009 and Ornish, r(s)=0.38, P=0.004). Twelve-month weight change in the most vs least adherent tertiles, respectively, was -8.3+/-5.6 vs -1.9+/-5.8 kg, P=0.0006 (Atkins); -3.7+/-6.3 vs -0.4+/-6.8 kg, P=0.12 (Zone) and -6.5+/-6.8 vs -1.7+/-7.9 kg, P=0.06 (Ornish).Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.

  View details for DOI 10.1038/ijo.2008.8

  View details for Web of Science ID 000256788500014

  View details for PubMedID 18268511

• Using hand-held computer technologies to improve dietary intake AMERICAN JOURNAL OF PREVENTIVE MEDICINE Atienza, A. A., King, A. C., Oliveira, B. M., Ahn, D. K., Gardner, C. D. 2008; 34 (6): 514-518

  Abstract

  Portable hand-held information technology offers much promise not only in assessing dietary intake in the real world, but also in providing dietary feedback to individuals. However, stringent research designs have not been employed to examine whether it can be effective in modifying dietary behaviors. The purpose of this pilot study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing vegetable and whole-grain intake over 8 weeks in mid-life and older adults, using a randomized study design.Twenty-seven healthy adults aged > or =50 were randomized and completed the 8-week study. Intervention participants received an instructional session and a PDA programmed to monitor their vegetable and whole-grain intake levels twice per day and to provide daily individualized feedback, goal-setting, and support. Controls received standard, age-appropriate, written nutritional education materials. Dietary intake was assessed via the Block Food Frequency Questionnaire at baseline and 8 weeks.Relative to controls, intervention participants reported significantly greater increases in vegetable servings (1.5-2.5 servings/day; p=0.02), as well as a trend toward greater intake of dietary fiber from grains (3.7-4.5 servings/day; p=0.10).This study's findings provide preliminary evidence that using portable hand-held technology to provide daily individualized feedback on dietary behavior in the real world can increase the dietary intake of healthy food groups.

  View details for DOI 10.1016/j.amepre.2008.01.034

  View details for Web of Science ID 000256169500009

  View details for PubMedID 18471588

• Interruption of Physical Activity Due to Illness: Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Trial Phillips, E. M., Katula, J., Miller, M. E., Walkup, M. P., King, A. C., Rejeski, W. J., Church, T., Fielding, R. A. LIPPINCOTT WILLIAMS & WILKINS. 2008: S8–S8

  View details for Web of Science ID 000208070901031

• A lifestyle physical activity intervention for caregivers of persons with Alzheimer's disease AMERICAN JOURNAL OF ALZHEIMERS DISEASE AND OTHER DEMENTIAS Farran, C. J., Staffileno, B. A., Gilley, D. W., McCann, J. J., Li, Y., Castro, C. M., King, A. C. 2008; 23 (2): 132-142

  Abstract

  The purpose of this pilot study was to examine the effects of lifestyle physical activity in caregivers (CGs) of persons with Alzheimer's disease.Fifteen CGs engaged in lifestyle physical activity during a 6-month, home-based health promotion program. Mean changes in self-reported physical activity were compared using repeated-measures analysis of variance.Fifty percent of CGs increased total self-reported minutes and 42% increased total moderate minutes of physical activity from preintervention to postintervention; however, no CG engaged in vigorous physical activity and there were no significant improvements in self-reported physical activity for the total group. Hot summer weather, heavy non-caregiving responsibilities, heavy caregiving responsibilities, and feelings of anxiety, depressive symptoms, and fatigue were the most frequently identified physical activity barriers.Incorporating an individualized, home-based program of lifestyle physical activity appears feasible; however, attention needs to be given in the future to physical activity barriers identified by this select group of CGs.

  View details for DOI 10.1177/1533317507312556

  View details for Web of Science ID 000258957000003

  View details for PubMedID 18174315

  View details for PubMedCentralID PMC2758783

• Successful peer mentoring for physical activity: 12-month results of the team trial Castro, C. M., Pruitt, L. A., French, S. H., King, A. C. OXFORD UNIV PRESS INC. 2008: S81

  View details for Web of Science ID 000259245500314

• Mediators of physical activity behavior change: A multivariate approach Papandonatos, G. D., Napolitano, M. A., Lewis, B. A., Whiteley, J. A., Williams, D. M., King, A. C., Bock, B. C., Pinto, B. M., Marcus, B. H. OXFORD UNIV PRESS INC. 2008: S94

  View details for Web of Science ID 000259245500365

• Exploring physical activity preferences ANNALS OF BEHAVIORAL MEDICINE King, A. C., Wilcox, S. 2008; 35 (1): 123-124

  View details for DOI 10.1007/s12160-007-9012-9

  View details for Web of Science ID 000253573900015

  View details for PubMedID 18347913

• Metabolic syndrome: do clinical criteria identify similar individuals among overweight premenopausal women? METABOLISM-CLINICAL AND EXPERIMENTAL Alhassan, S., Kiazand, A., Balise, R. R., King, A. C., Reaven, G. M., Gardner, C. D. 2008; 57 (1): 49-56

  Abstract

  The purpose of this analysis was to determine to what extent the clinical criteria for metabolic syndrome (MetSyn) proposed by the World Health Organization (WHO), the European Group for Study of Insulin Resistance (EGIR), the National Cholesterol Education Program Adult Treatment Panel III (ATP III), and the International Diabetes Foundation (IDF); triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio >/=3.0; and enlarged waist circumference (>/=88 cm) and elevated TG (>/=129 mg/dL) (EWET) identified similar or different overweight women and, secondarily, to examine the effect of 7% weight reduction on MetSyn status. Metabolic syndrome was determined among 256 premenopausal women (age = 41 +/- 6 years, body mass index [BMI] = 32 +/- 4 kg/m(2)) participating in a dietary weight loss clinical trial based on the clinical criteria proposed by WHO, EGIR, ATP III, and IDF. The prevalence of TG/HDL-C ratio >/=3.0 and EWET was determined and compared with MetSyn status. Based on the clinical criteria, 16.1% (EGIR), 20.7% (WHO), 31.0% (ATP III), and 31.8% (IDF) of participants met the criteria for MetSyn; 30.3% and 31.8% had TG/HDL-C >/=3.0 and EWET, respectively. Between 77% and 99% of participants were similarly classified across the clinical criteria. The highest and lowest agreements were between ATP III and IDF (kappa = 0.98; 95% confidence interval, 0.96-1.0) and WHO and IDF (kappa = 0.39; 95% confidence interval, 0.26-0.51), respectively. The TG/HDL-C ratio >/=3.0 and EWET moderately agreed with all 4 clinical criteria for MetSyn (kappa range, 0.36-0.59). Among those diagnosed with MetSyn at baseline, 64.0% to 75.0% of the participants who lost >/=7% and 25.8% to 55.6% of participants who lost <7% of their baseline body weight in 6 months no longer met the various clinical criteria for MetSyn, TG/HDL-C >/=3.0, or EWET. Our findings indicate that MetSyn varies substantially between clinical criteria, which raise questions about the clinical utility of these criteria. Regardless of MetSyn clinical criteria, >/=7% reduction in body weight has a beneficial impact on variables used to define MetSyn.

  View details for DOI 10.1016/j.metabol.2007.08.006

  View details for Web of Science ID 000251929400006

  View details for PubMedID 18078858

  View details for PubMedCentralID PMC2254306

• Physical activity in prefrail older adults: Confidence and satisfaction related to physical function JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Rejeski, W. J., King, A. C., Katula, J. A., Kritchevsky, S., Miller, M. E., Walkup, M. P., Glynn, N. W., Pahor, M. 2008; 63 (1): P19-P26

  Abstract

  We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70+ years of age who have deficits in mobility. We randomized a total of 412 adults aged 70-89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months. Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention. Gender, age, and scores on a short physical performance battery did not moderate these effects. Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning. This is an important finding in light of the importance of these process variables in behavior change and quality of life.

  View details for Web of Science ID 000255893500005

  View details for PubMedID 18332190

• BASELINE MODERATORS OF PHYSICAL ACTIVITY OUTCOMES: RESULTS FROM ACTIVE FOR LIFE (R) Wilcox, S., Dowda, M., Ory, M., King, A. C., Dunn, A. L. SPRINGER. 2007: S122–S122

  View details for Web of Science ID 000261185300478

• THE USE OF OLDER ADULT PEERS TO PROMOTE PHYSICAL ACTIVITY: PRELIMINARY RESULTS OF THE TEAM STUDY Castro, C. M., Pruitt, L. A., French, S. H., Cassayre, C. L., King, A. C. OXFORD UNIV PRESS INC. 2007: S22

  View details for Web of Science ID 000261185300081

• QUALITY OF LIFE IN SEDENTARY OLDER ADULTS PARTICIPATING IN A PHYSICAL ACTIVITY INTERVENTION Groessl, E. J., Kaplan, R. M., Rejeski, W., Katula, J. A., King, A. C., Frierson, G., Hsu, F., Walkup, M., Pahor, M. SPRINGER. 2007: S36

  View details for Web of Science ID 000261185300136

• THE IMPACT OF PHYSICAL ACTIVITY ON SELF-EFFICACY IN OLDER ADULTS AT RISK FOR MOBILITY DISABILITY: THE LIFE-P STUDY Katula, J. A., Rejeski, W. J., Miller, M. E., Walkup, M., King, A., Glynn, N., Frierson, G., Kritchevsky, S. SPRINGER. 2007: S190–S190

  View details for Web of Science ID 000261185300742

• Activity adherence and physical function in older adults with functional limitations MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Fielding, R. A., Katula, J., Miller, M. E., Abbott-Pillola, K., Jordan, A., Glynn, N. W., Goodpaster, B., Walkup, M. P., King, A. C., Rejesk, W. J. 2007; 39 (11): 1997-2004

  Abstract

  Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) was a trial to examine the effects of a physical activity intervention (PA) compared with a health education control (SA) on measures of disability risk in sedentary older adults (N = 424). We examined adherence to the LIFE-P PA intervention for the first 12 months of the trial.The PA intervention consisted of walking, strength, flexibility, and balance training supplemented with behavioral skills training modules, and it used a phased, center-based schedule of adoption (3x wk(-1), weeks 1-8), transition (2x wk(-1), weeks 9-24), and maintenance (1x wk(-1), weeks 25 to end of trial) while transitioning to primarily home-based physical activity. SA consisted of weekly (weeks 1-26) transitioning to monthly health education workshops.Participation in moderate-intensity physical activity increased from baseline to months 6 and 12 in PA compared with SA (P < 0.001). At 12 months, PA participants who reported > or = 150 min x wk(-1) of moderate activity demonstrated a significantly greater improvement in their Short Physical Performance Battery score compared with participants who reported < 150 min.wk of moderate activity (P < 0.017). For the PA arm, center-based attendance was 76.3 +/- 24.5, 65.4 +/- 28.6, and 49.8 +/- 35.8% in the adoption, transition, and maintenance phases, respectively.Adherence to physical activity in LIFE-P was associated with greater improvement in SPPB score and was consistent with adherence in physical activity trials of shorter duration in this subgroup of older adults. Older individuals at risk for disability can adhere to a regular program of physical activity in a long-term randomized trial.

  View details for DOI 10.1249/mss.0b013e318145348d

  View details for Web of Science ID 000250903100015

  View details for PubMedID 17986908

• Perceived environmental predictors of physical activity over 6 months in adults: Activity counseling trial HEALTH PSYCHOLOGY Sallis, J. F., King, A. C., Sirard, J. R., Albright, C. L. 2007; 26 (6): 701-709

  Abstract

  In the present study, the authors extend previous cross-sectional findings by using a prospective design to determine whether physical and social environmental characteristics predict physical activity over 6 months.Inactive adults were recruited to the Activity Counseling Trial, a multicenter, randomized, controlled trial of physical activity intervention in primary care. Participants were 387 women and 474 men aged 35-75 years in 3 regions; 1/3 were minorities; 56% had some college education. Baseline perceived environmental variables were used to predict physical activity at 6 months, adjusting for experimental condition and other potential moderators.The validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. A standardized survey was used to measure social and physical environmental variables around the home and neighborhood.Women reporting no unattended dogs and low crime in their neighborhoods and men reporting frequently seeing people being active in their neighborhoods did 50-75 more minutes of physical activity per week than did those with different environmental characteristics. Interactions of environmental variables with age group suggested that older adults may be more affected by environmental variables than are younger adults.Self-reported social and physical environmental variables were significantly related to moderate to vigorous physical activity among a diverse sample of adults living in 3 regions of the United States. These prospective findings strengthen the conclusion from previous cross-sectional studies that environmental variables are important correlates of physical activity.

  View details for DOI 10.1037/0278-6133.26.6.701

  View details for Web of Science ID 000250861700009

  View details for PubMedID 18020842

• Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome Annual Fall Conference of the American-Heart-Association-Council on High Blood Pressure Research Lien, L. F., Brown, A. J., Ard, J. D., Loria, C., Erlinger, T. P., Feldstein, A. C., Lin, P., Champagne, C. M., King, A. C., McGuire, H. L., Stevens, V. J., Brantley, P. J., Harsha, D. W., McBurnie, M. A., Appel, L. J., Svetkey, L. P. LIPPINCOTT WILLIAMS & WILKINS. 2007: 609–16

  Abstract

  Lifestyle modification can reduce blood pressure and lower cardiovascular risk. Established recommendations include weight loss, sodium reduction, and increased physical activity. PREMIER studied the effects of lifestyle interventions based on established recommendations alone and with the addition of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern. This analysis aimed to assess the interventions' impact on cardiometabolic variables in participants with, compared with those without, metabolic syndrome. The primary outcome was 6-month change in systolic blood pressure. Participants with prehypertension or stage-1 hypertension were randomly assigned to an advice only control group, a 6-month intensive behavioral intervention group of established recommendations (EST), or an established recommendations plus DASH group (EST+DASH). Metabolic syndrome was defined per National Cholesterol and Education Program Adult Treatment Panel III. We used general linear models to test intervention effects on change in blood pressure, lipids, and insulin resistance (homeostasis model assessment), in subgroups defined by the presence or absence of metabolic syndrome. Of 796 participants, 399 had metabolic syndrome. Both EST and EST+DASH reduced the primary outcome variable, systolic blood pressure. Within the EST+DASH group, those with and without metabolic syndrome responded similarly (P=0.231). However, within EST, those with metabolic syndrome had a poorer response, with a decrease in systolic blood pressure of 8.4 mm Hg versus 12.0 mm Hg in those without metabolic syndrome (P=0.002). Thus, metabolic syndrome attenuated the systolic blood pressure reduction of EST, but this attenuation was overcome in EST+DASH. Finally, diastolic blood pressure, lipids, and homeostasis model assessment responded similarly to both interventions regardless of metabolic syndrome status. Our data suggest that strategies for lowering BP in individuals with metabolic syndrome may be enhanced by recommendations to adopt the DASH dietary pattern.

  View details for DOI 10.1161/HYPERTENSIONAHA.107.089458

  View details for Web of Science ID 000249586900007

  View details for PubMedID 17698724

• Health-related quality of life in older adults at risk for disability AMERICAN JOURNAL OF PREVENTIVE MEDICINE Groessl, E. J., Kaplan, R. M., Rejeski, W. J., Katula, J. A., King, A. C., Frierson, G., Glynn, N. W., Hsu, F., Walkup, M., Pahor, M. 2007; 33 (3): 214-218

  Abstract

  The number of older adults living in the United States continues to increase, and recent research has begun to target interventions to older adults who have mobility limitations and are at risk for disability. The objective of this study is to describe and examine correlates of health-related quality of life in this population subgroup using baseline data from a larger intervention study.The Lifestyle Interventions and Independence for Elders-Pilot study (LIFE-P) was a randomized controlled trial that compared a physical activity intervention to a non-exercise educational intervention among 424 older adults at risk for disability. Baseline data (collected in April-December 2004, analyzed in 2006) included demographics, medical history, the Quality of Well-Being Scale (QWB-SA), a timed 400-m walk, and the Short Physical Performance Battery (SPPB). Descriptive health-related quality of life (HRQOL) data are presented. Hierarchical linear regression models were used to examine correlates of HRQOL.The mean QWB-SA score for the sample was 0.630 on an interval scale ranging from 0.0 (death) to 1.0 (asymptomatic, optimal functioning). The mean of 0.630 is 0.070 lower than a comparison group of healthy older adults. The variables associated with lower HRQOL included white ethnicity, more comorbid conditions, slower 400-m walk times, and lower SPPB balance and chair stand scores.Older adults who are at risk for disability had reduced HRQOL. Surprisingly, however, mobility was a stronger correlate of HRQOL than an index of comorbidity, suggesting that interventions addressing mobility limitations may provide significant health benefits to this population.

  View details for DOI 10.1016/j.amerpe.2007.04.031

  View details for Web of Science ID 000249452700008

  View details for PubMedID 17826582

  View details for PubMedCentralID PMC1995005

• Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., Macera, C. A., Castaneda-Sceppa, C. 2007; 39 (8): 1435-1445

  Abstract

  To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature.After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

  View details for DOI 10.1249/mss.0b013e3180616aa2

  View details for Web of Science ID 000248581500028

  View details for PubMedID 17762378

• Comparison of weight-loss diets - Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Gardner, C. D., Stafford, R. S., King, A. C. 2007; 298 (2): 174–75

  View details for DOI 10.1001/jama.298.2.174-b

  View details for Web of Science ID 000247910600015

• Telephone versus print delivery of an individualized motivationally tailored physical activity intervention: Project STRIDE HEALTH PSYCHOLOGY Marcus, B. H., Napolitano, M. A., King, A. C., Lewis, B. A., Whiteley, J. A., Albrecht, A., Parisi, A., Bock, B., Pinto, B., Sciamanna, C., Jakicic, J., Papandonatos, G. D. 2007; 26 (4): 401-409

  Abstract

  Given that only 25% of Americans meet physical activity recommendations, there is a need to develop and disseminate effective, evidence-based interventions to promote physical activity. The authors tested 2 delivery channels, telephone and print, to determine whether one was more effective in promoting physical activity.The authors randomly assigned 239 healthy, sedentary adults to (a) telephone-based individualized feedback, (b) print-based individualized feedback, or (c) contact control. Both intervention arms were guided by a motivationally tailored, theoretically driven computer expert system.Physical activity as measured by the 7-day Physical Activity Recall interview.At 6 months, both telephone and print arms significantly increased in minutes of moderate intensity physical activity compared with control, with no differences between the intervention arms. At 12 months, print participants reported a significantly greater number of moderate intensity minutes than both telephone and control participants, who did not differ.Results suggest that both telephone and print enhance the adoption of physical activity among sedentary adults; however, print interventions may be particularly effective in maintaining physical activity in the longer term.

  View details for DOI 10.1037/0278-6133.26.4.401

  View details for Web of Science ID 000247829100003

  View details for PubMedID 17605559

• Twelve-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65 PATIENT EDUCATION AND COUNSELING de Jong, J., Lemmink, K. A., King, A. C., Huisman, M., Stevens, M. 2007; 66 (2): 167-176

  Abstract

  To determine the effects on energy expenditure, health and fitness outcomes after 12 months of GALM.Subjects from matched neighbourhoods were assigned to an intervention (IG) (n=79) or a waiting-list control group (CG) (n=102). During the 12 months the IG attended two series of 15 moderately intensive GALM sessions once a week and the CG attended one series after a 6-month waiting-list period.Significant time effects were found for energy expenditure for recreational sports activities (EE(RECSPORT)), other leisure-time physical activity (EE(LTPA)) and total physical activity (EE(TOTAL)). EE(RECSPORT) increased over 12 months for both groups while the significant time x group interaction for EE(LTPA) revealed that the CG continuously increased over 12 months and the IG improved in the first 6 months but decreased from 6 to 12 months. Further significant time effects were found for performance-based fitness but no group effects.Participation in GALM improved EE(RECSPORT) after 12 months, which was reflected in increases in performance-based fitness. The increase in EE(LTPA) seemed to be a short-term effect (6 months), which may explain the lack of improvement in other health indicators.To further increase EE(LTPA), more attention should be paid to behavioural skill-building during the GALM program.

  View details for DOI 10.1016/j.pec.2006.11.008

  View details for Web of Science ID 000248139700008

  View details for PubMedID 17329061

• Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Gardner, C. D., Kiazand, A., Alhassan, S., Kim, S., Stafford, R. S., Balise, R. R., Kraemer, H. C., King, A. C. 2007; 297 (9): 969-977

  Abstract

  Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets [corrected] While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.clinicaltrials.gov Identifier: NCT00079573.

  View details for Web of Science ID 000244697900026

  View details for PubMedID 17341711

• Rural family caregivers and health behaviors - Results from an epidemiologic survey JOURNAL OF AGING AND HEALTH Castro, C. M., King, A. C., Housemann, R., Bacak, S. J., McMullen, K. M., Brownson, R. C. 2007; 19 (1): 87-105

  Abstract

  This study examined health behaviors in a sample of rural family caregivers. In a community telephone survey of rural Missouri, Arkansas, and Tennessee, respondents were asked about their health, physical activity, nutrition, health providers, and family caregiving. Among 1,234 survey respondents, 12% self-identified as family caregivers. Caregivers reported lower fruit intake, more walking for exercise, and more provider advice about stress, fruits, and vegetables than noncaregivers. Groups did not differ in smoking, dietary fat, obesity, or self-rated health. Women caregivers reported more favorable patterns of physical activity, smoking, and provider interactions than men caregivers, and White caregivers had healthier reports of physical activity and body mass index than Black caregivers. These results provide new information about rural caregivers' health habits. Apart from nutritional intake, caregivers were not significantly different in most health behaviors. However, health providers seemed more attentive to caregivers regarding nutrition and stress.

  View details for DOI 10.1177/0898264306296870

  View details for Web of Science ID 000243528700005

  View details for PubMedID 17215203

• Physical activity and weight management across the lifespan ANNUAL REVIEW OF PUBLIC HEALTH Goldberg, J. H., King, A. C. 2007; 28: 145-170

  Abstract

  This review discusses key findings and recommendations related to the role of physical activity in weight gain prevention, weight loss, and weight-loss maintenance across the lifespan. For weight gain prevention, epidemiological and clinical studies suggest that regular physical activity is critical, with increases above the recommended 30 min daily for health (e.g., to 45 to 60 min daily) potentially desirable for curtailing weight gain. For weight loss, clinical studies suggest that physical activity interventions alone usually produce only modest results. Combining physical activity with dietary interventions increases the chance of success, especially at higher levels of physical activity (e.g., 200 to 300 min or more weekly). For weight-loss maintenance, high levels of physical activity (e.g., 40 to 90 min daily) may be necessary. To manage weight across the lifespan, a comprehensive approach to physical activity is needed supported by public policy interventions that help make physical activity a part of daily life.

  View details for DOI 10.1146/annurev.publhealth.28.021406.144105

  View details for Web of Science ID 000246436700011

  View details for PubMedID 17168638

• Examination of print and telephone channels for physical activity promotion: Rationale, design, and baseline data from Project STRIDE CONTEMPORARY CLINICAL TRIALS Marcus, B. H., Napolitano, M. A., King, A. C., Lewis, B. A., Whiteley, J. A., Albrecht, A. E., Parisi, A. F., Bock, B. C., Pinto, B. M., Sciamanna, C. A., Jakicic, J. M., Papandonatos, G. D. 2007; 28 (1): 90-104

  Abstract

  Project STRIDE is a 4-year randomized controlled trial comparing two computer-based expert system guided intervention delivery channels (phone vs. print) for physical activity adoption and short-term maintenance among previously sedentary adults.Sedentary adults (n=239) were randomized to one of the following (1) telephone-based, individualized motivationally-tailored feedback; (2) print-based, individualized motivationally-tailored feedback; (3) contact-control delayed treatment group (received intervention after 12 months as control). This paper: (1) outlines the study design, rationale, and participant sample; and (2) describes relationships between baseline variables to better understand their influence on the efficacy of the intervention.Participants averaged 19.8+/-25.0 min of physical activity/week that was at least of moderate intensity, with no group differences. The average estimated VO(2) at 85% of maximum heart rate was 25.6 ml/kg/min. Body fat was 34.1% for women and 23.2% for men and the BMI of the sample averaged 28.5 kg/m(2).Project STRIDE examines non face-to-face approaches for promoting physical activity behavior. It has unique features including a direct comparison of an expert system guided intervention delivered via phone or print. Future analyses will examine the cost-effectiveness of the interventions and this will likely yield important information for policy-makers.

  View details for DOI 10.1016/j.cct.2006.04.003

  View details for Web of Science ID 000242981600010

  View details for PubMedID 16839823

• Predictors of adherence to physical activity in the Lifestyle Interventions and Independence for Elders pilot study (LIFE-P) CLINICAL INTERVENTIONS IN AGING Rejeski, W. J., Miller, M. E., King, A. C., Studenski, S. A., Katula, J. A., Fielding, R. A., Glynn, N. W., Walkup, M. P., Ashmore, J. A. 2007; 2 (3): 485-494

  Abstract

  A prospective design was used to examine predictors of adherence to a physical activity intervention in older adults with compromised function.The sample included 213 men (31.1%) and women (68.9%) with an average age of 76.53 years.The predictor variables accounted for 10% of the variance in percent attendance during adoption and transition, respectively. Adding percent attendance during adoption to the prediction of percent attendance during transition increased the explained variance in this phase to 21%. During maintenance, the predictors accounted for 13% of the variance in frequency of physical activity; this estimate increased to 46% when adding in percent attendance from the transition phase.These results are encouraging in that the physical activity intervention appears to have been well tolerated by diverse subgroups of older adults. The role of prior behavior in predicting downstream adherence underscores the importance of developing proactive interventions for treating nonadherence in older adult populations.

  View details for Web of Science ID 000208238500022

  View details for PubMedID 18044198

  View details for PubMedCentralID PMC2685266

• Identifying sedentary subgroups - The National Cancer Institute's Health Information National Trends Survey AMERICAN JOURNAL OF PREVENTIVE MEDICINE Atienza, A. A., Yaroch, A. L., Masse, L. C., Moser, R. P., Hesse, B. W., King, A. C. 2006; 31 (5): 383-390

  Abstract

  Developing effective interventions for the 24% to 28% of U.S. adults who are sedentary requires a better understanding of the factors related to sedentary lifestyles as well as the communication channels to reach various subgroups. This study identified key sociodemographic and health communication characteristics of various subgroups with high rates of inactivity using signal detection methodology.The sample from the nationally representative Health Information National Trends Survey 2003 (n=6369) was randomly split into two samples. Exploratory analyses (conducted 2004 and 2005) were employed on the first sample to identify various subgroups, and the stability of inactivity rates in those subgroups was examined in the second sample.Eight subgroups with varying levels of inactivity were identified. Three subgroups had inactivity levels of 40% or higher, while the lowest subgroup had a level of less than 15%. The highest inactivity subgroup consisted of individuals with at least some college education who were in fair/poor health and who watched 4 or more hours of television per day. The second-highest inactivity subgroup was composed of those without a college education who tended not to use or attend to many communication channels. The third highest inactive subgroup consisted of those without a college education who read the newspaper and were obese. Levels of inactivity in the second independent sample subgroups were not significantly different from those found in the exploratory sample.This study identified empirically based, physically inactive subgroups that differed on sociodemographic and health communication characteristics. This information should be useful in creating future evidence-based, targeted, and tailored intervention strategies.

  View details for DOI 10.1016/j.ampere.2006.07.024

  View details for Web of Science ID 000241541600005

  View details for PubMedID 17046409

  View details for PubMedCentralID PMC1934418

• Metabolic syndrome: Does definition determine prevalence? Alhassan, S., Kiazand, A., Balise, R. R., Stafford, R. S., King, A. C., Gardner, C. D. LIPPINCOTT WILLIAMS & WILKINS. 2006: 873

  View details for Web of Science ID 000241792805522

• Perceived environments as physical activity correlates and moderators of intervention in five studies AMERICAN JOURNAL OF HEALTH PROMOTION King, A. C., Toobert, D., Ahn, D., Resnicow, K., Coday, M., Riebe, D., Garber, C. E., Hurtz, S., Morton, J., Sallis, J. F. 2006; 21 (1): 24-35

  Abstract

  Few studies have explored how relationships of perceived environment and physical activity vary across different activity domains and populations. This question was explored in five physical activity intervention trials funded by the National Institutes of Health Behavior Change Consortium.Observational.San Francisco peninsula, California (N = 94); Eugene, Oregon (N = 122); Atlanta, Georgia (N = 256); Kingston, Rhode Island (N = 109); Memphis, Tennessee (N = 64).Ethnically diverse community adults ages 18 to 85 years.The Neighborhood Environment Walkability Scale and CHAMPS physical activity questionnaire. Response rate among those invited to complete these measures was 90%.Cross-sectional pooled signal detection analysis indicated that people who reported living in neighborhoods with more attractive scenery and ease of walking were more likely to meet national physical activity recommendations (67%) compared with those without these neighborhood attributes (36%; chi2 = 13.04, p = .0003). Within-site multiple regression identified two additional variables--seeing others when walking and encountering loose dogs that make it difficult to walk--as correlates across multiple sites and activity domains (i.e., minutes of weekly moderate or more vigorous activity, walking for errands, walking leisurely) (incremental R2 = 2.0-7.5; p < .05). Analyses of covariance suggested that traffic safety might be particularly important in facilitating or impeding physical activity in response to a formal intervention (for traffic-arm assignment interactions, F = 3.8-7.0, p < or = .05).Relationships between perceived environments and physical activity may differ depending upon population groups and activity domains and merit investigation by using stronger prospective designs.

  View details for PubMedID 16977910

• Results of the first year of active for life: Translation of 2 evidence-based physical activity programs for older adults into community settings AMERICAN JOURNAL OF PUBLIC HEALTH Wilcox, S., Dowda, M., Griffin, S. F., Rheaume, C., Ory, M. G., Leviton, L., King, A. C., Dunn, A., Buchner, D. M., Bazzarre, T., Estabrooks, P. A., Campbell-Voytal, K., Bartlett-Prescott, J., Dowdy, D., Castro, C. M., Carpenter, R. A., Dzewaltowski, D. A., Mockenhaupt, R. 2006; 96 (7): 1201-1209

  Abstract

  Translating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults.Four community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys.Participants (n=838) were aged an average of 68.4 +/-9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index.The first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials.

  View details for DOI 10.2105/AJPH.2005.074690

  View details for Web of Science ID 000238658900020

  View details for PubMedID 16735619

  View details for PubMedCentralID PMC1483857

• Six-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65 PATIENT EDUCATION AND COUNSELING de Jong, J., Lemmink, K. A., Stevens, M., de Greef, M. H., Rispens, P., King, A. C., Mulder, T. 2006; 62 (1): 132-141

  Abstract

  To determine the effects on energy expenditure, health and fitness outcomes in sedentary older adults aged 55-65 after 6-month participation in the GALM program.In three Dutch communities, subjects from matched neighbourhoods were assigned to an intervention (n = 79) or a waiting-list control group (n = 102). The GALM program consisted of fifteen 60 min sessions once a week emphasising moderate-intensity recreational sports activities.The intervention group showed significant increases in energy expenditure for recreational sports activities, other leisure-time physical activity, health indicators, and perceived and performance-based fitness. Contrary to our expectations, the same increases were found for the control group. Consequently, only significant between-group differences, favouring the intervention group, were obtained for sleep, diastolic blood pressure, perceived fitness score and grip strength.The increases in energy expenditure for physical activity from the GALM program, especially for the more intensive recreational sports activities, look promising and are in line with the expected amounts necessary to improve health. Further research is needed to evaluate long-term effects of participation in the GALM program.These results underline that GALM can be considered successful in stimulating leisure-time physical activity and improving health and fitness in older adults.

  View details for DOI 10.1016/j.pec.2005.06.017

  View details for Web of Science ID 000238917600019

  View details for PubMedID 16098704

• Using Electronic Diaries to Examine Physical Activity and Other Health Behaviors of Adults Age 50+ JOURNAL OF AGING AND PHYSICAL ACTIVITY Atienza, A. A., Oliveira, B., Fogg, B. J., King, A. C. 2006; 14 (2): 192-202

  Abstract

  This pilot investigation used portable electronic diaries to assess the physical activity and other health behaviors of 20 adults age 50+ (mean age = 61 years). Study aims were to examine whether computerized cognitive-behavioral strategies could increase adherence to the assessments, the acceptability of electronic diaries to assess everyday health, and the relationship between computerized physical activity assessments with a standardized physical activity measure. Although approximately two thirds of participants had never used an electronic diary, results indicated that a large majority (83%) reported enjoying the use of the electronic diaries, and most (72%) reported enjoying answering all of the health questions. The cognitive-behavioral strategies employed did not enhance assessment adherence, but electronic-diary-based activity levels corresponded more strongly with the poststudy standardized activity measure than the baseline standardized measure, providing evidence of temporal convergence. Findings suggest that the use of portable electronic technology in physical activity assessment of middle-aged and older adults deserves further study.

  View details for Web of Science ID 000205795700006

  View details for PubMedID 19462549

• Modest 1-year changes in weight and percent body fat among overweight women assigned to Atkins, Zone, Ornish, or LEARN diets Gardner, C. D., Morris, J. L., Kim, S. W., Kiazand, A., Alhassan, S., King, A. LIPPINCOTT WILLIAMS & WILKINS. 2006: E305

  View details for Web of Science ID 000235620100043

• Modifying physical activity in a multiethnic sample of low-income women: One-year results from the IMPACT (increasing motivation for physical activity) project ANNALS OF BEHAVIORAL MEDICINE Albright, C. L., Pruitt, L., Castro, C., Gonzalez, A., Woo, S., King, A. C. 2005; 30 (3): 191-200

  Abstract

  Ethnic minorities or those with low socioeconomic status (SES) are at increased risk of cardiovascular disease, type 2 diabetes, and all-cause mortality, compared to higher SES Whites. National surveys also indicate that low-income, ethnic minority women have the highest rates of inactivity in the United States.This study (the Increasing Motivation for Physical ACTivity or IMPACT study) promoted adoption and maintenance of physical activity (PA) in sedentary, low-income women participating in federally funded job training programs.The study consisted of 2 months of weekly 1-hr classes, then random assignment to 10 months of either home-based telephone counseling for PA plus information and feedback via mailed newsletters (Phone + Mail Counseling condition) or just the mailed newsletters (Mail Support condition). The IMPACT intervention included behavior change strategies for PA as well as discussions related to motivational readiness for PA change. Participants completed surveys and physiological assessments at baseline after the classes ended (i.e., at 10 weeks) and at 6 and 12 months postbaseline. Seventy-three percent of randomized participants (n = 72) were Latina, with a mean age of 32 +/- 10 years. More than half the women had not completed high school, and 73% had an annual income less than 20,000 dollars.After 10 months of a home-based intervention, women in the phone + mail counseling condition had significantly greater increases in estimated total energy expenditure compared to women in the mail support condition (p < .05).Regular PA counseling delivered via the telephone and through the mail appears effective for encouraging regular PA among low-income women transitioning from welfare or job training to the workforce.

  View details for Web of Science ID 000234009600003

  View details for PubMedID 16336070

• Comparing self-reported versus objectively measured physical activity behavior: A preliminary investigation of older Filipino American women RESEARCH QUARTERLY FOR EXERCISE AND SPORT Atienza, A. A., King, A. C. 2005; 76 (3): 358-362

  View details for Web of Science ID 000232263800013

  View details for PubMedID 16270713

• The California active aging community grant program: Translating science into practice to promote physical activity in older adults ANNALS OF BEHAVIORAL MEDICINE Hooker, S. P., Seavey, W., Weidmer, C. E., Harvey, D. J., Stewart, A. L., Gillis, D. E., Nicholl, K. L., King, A. C. 2005; 29 (3): 155–65

  Abstract

  Attempts to study the translation of evidence-based physical activity interventions in community settings are scarce.This project was an investigation of whether 13 diverse local lead agencies could effectively implement a choice-based, telephone-assisted physical activity promotion program for older adults based on intervention models proven efficacious in research settings.At baseline, participants developed their own physical activity programs through an individualized planning session based on preference, health status, readiness to change, and available community resources. Thereafter, participants received regular telephone calls over a 1-year period from a trained staff member or volunteer support buddy. Additional program components consisted of health education workshops, newsletters, and group-based physical activities. Self-report data on caloric expenditure due to all and moderate or greater intensity physical activities were collected from 447 participants (M age = 68 +/- 8.6 years).A significant increase (p < or = .0001) from baseline to midintervention and intervention endpoint was observed for total weekly caloric expenditure (Mdn change = 644-707 kcal/week) and moderate or greater weekly caloric expenditure (Mdn change = 149-265 kcal/week), as well as for weekly physical activity duration and frequency. These changes were observed in participants across all sites.The increases in weekly caloric expenditure were commensurate with findings from several previous randomized clinical trials. The utilization of community agency staff and volunteers receiving basic training to implement essential program components proved feasible. Very favorable levels of program satisfaction expressed by community staff, volunteer support buddies, and participants, combined with the significant increases in physical activity, warrant further dissemination of the intervention model.

  View details for DOI 10.1207/s15324796abm2903_1

  View details for Web of Science ID 000230013000001

  View details for PubMedID 15946109

• Effects of lifestyle interventions on physical activity and fitness 45th Annual Conference on Cardiovascular Disease Epidemiology and Prevention Young, D. R., Simons-Morton, S., Brown, A. J., King, A. C., Stevens, V. J., Elmer, P. J., Craddick, S., Larson, D., Appel, L. J., Vollmer, W. M., Aickin, M., Harsha, D. W. LIPPINCOTT WILLIAMS & WILKINS. 2005: E249–E249

  View details for Web of Science ID 000228280900335

• Participatory research to promote physical activity at congregate-meal sites JOURNAL OF AGING AND PHYSICAL ACTIVITY Estabrooks, P. A., Fox, E. H., Doerksen, S. E., Bradshaw, M. H., King, A. C. 2005; 13 (2): 121-144

  Abstract

  The purpose of this study was to determine the feasibility and effectiveness of an on-site physical activity (PA) program offered with congregate meals. Study 1 surveyed meal-site users on their likelihood to participate. Study 2 used meal-site-manager interviews and site visits to determine organizational feasibility. Study 3, a controlled pilot study, randomized meal sites to a 12-week group-based social-cognitive (GBSC) intervention or a standard-care control. Studies 1 and 2 indicated that most meal-site users would participate in an on-site PA program, and meal sites had well-suited physical resources and strong organizational support for this type of program. In Study 3, GBSC participants increased their weekly PA over those in the control condition (p < .05, ES = .79). Results indicated that changes in task cohesion might have mediated intervention effectiveness. These studies demonstrate that a PA program offered in this venue is feasible, is effective in promoting PA, and could have a strong public health impact.

  View details for Web of Science ID 000228426300001

  View details for PubMedID 15995260

• Influence of maternal stress on successful participation in a physical activity intervention: The IMPACT project WOMEN & HEALTH Urizar, G. G., Hurtz, S. Q., Albright, C. L., Ahn, D. K., Atienza, A. A., King, A. C. 2005; 42 (4): 63-82

  Abstract

  Few studies have examined the impact of motherhood on successful participation in physical activity (PA) interventions. The current study focused on mothers in the Increasing Motivation for Physical Activity or IMPACT study, which aimed to promote PA in sedentary, low-income, ethnically diverse women (74% Latina). The aim of this study was to determine whether certain maternal variables (e.g., number of children, number and intensity of maternal stressors) influenced successful participation in an 8-week, class-based, PA intervention. PA consisted of accumulating 30 minutes or more of moderate-intensity activities (e.g., walking) five or more days a week. Sixty-eight mothers (average age = 32 years) were assessed at baseline and 10 weeks. Paired comparison t-tests demonstrated a significant increase in PA-related energy expenditure from baseline to 10 weeks (p < 0.05). Furthermore, this increase in PA was significantly associated with a decrease in the number of maternal stressors reported over this time period (p < 0.01). Simultaneous regression analyses indicated that (1) having a higher number of maternal stressors at baseline was associated with lower class attendance (p

  View details for DOI 10.1300/J013v42n04_04

  View details for Web of Science ID 000241149800004

  View details for PubMedID 16782676

• Depression and the metabolic syndrome in young adults: Findings from the third national health and nutrition examination survey PSYCHOSOMATIC MEDICINE Kinder, L. S., Carnethon, M. R., Palaniappan, L. P., King, A. C., Fortmann, S. P. 2004; 66 (3): 316-322

  Abstract

  Previous reports have suggested that depression may lead to the development of cardiovascular disease through its association with the metabolic syndrome; however, little is known about the relationship between depression and the metabolic syndrome. The aim of this study was to establish an association between depression and the metabolic syndrome in a nationally representative sample.The Third National Health and Nutrition Examination Survey is a population-based health survey of noninstitutionalized US citizens completed between 1988 and 1994. Three thousand one hundred eighty-six men and 3003 women, age 17 to 39, free of coronary heart disease and diabetes, completed the depression module from the Diagnostic Interview Schedule and a medical examination that provided clinical data needed to establish the presence of the metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults.Women with a history of a major depressive episode were twice as likely to have the metabolic syndrome compared with those with no history of depression. The relationship between depression and metabolic syndrome remained after controlling for age, race, education, smoking, physical inactivity, carbohydrate consumption, and alcohol use. Men with a history of depression were not significantly more likely to have the metabolic syndrome.The prevalence of the metabolic syndrome is elevated among women with a history of depression. It is important to better understand the role depression may play in the effort to reduce the prevalence of the metabolic syndrome and its health consequences.

  View details for DOI 10.1097/01.psy.0000124755.91880.f4

  View details for Web of Science ID 000221548300005

  View details for PubMedID 15184689

• Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture AMERICAN JOURNAL OF EPIDEMIOLOGY Keegan, T. H., Kelsey, J. L., King, A. C., Quesenberry, C. P., Sidney, S. 2004; 159 (2): 192-203

  Abstract

  This case-control study examined the relation of circumstances of falls and characteristics of fallers with risk of fractures at five sites among persons 45 years of age or older from five Kaiser Permanente Medical Centers in Northern California from 1996 to 2001. Included were distal forearm (n = 1,016), foot (n = 574), proximal humerus (n = 467), pelvis (n = 150), and shaft of the tibia/fibula (n = 141) cases who fell at the time of their fracture, and controls (n = 512) who reported falling in the year before the interview but did not fracture. Interviewers collected information by using a standardized questionnaire. Medium-/high-heeled shoes and shoes with a narrow heel increased the risk of all fractures, and slip-on shoes (adjusted odds ratio = 2.3, 95% confidence interval: 1.4, 4.0) and sandals (adjusted odds ratio = 3.1, 95% confidence interval: 1.5, 6.3) increased the risk of foot fractures. Falling from more than a standing height increased the risk of all fractures by two- to fivefold, while breaking the fall was associated with lower risks of all fractures except the distal forearm. Physical activity and hormone therapy were associated with lower risks of most fractures. These results suggest ways in which risks of fractures in older persons can be reduced.

  View details for DOI 10.1093/aje/kwh026

  View details for Web of Science ID 000188189100013

  View details for PubMedID 14718222

• The relationship between depressive symptoms and participation in an exercise-based telephone counseling intervention Cassayre, C., Morris, S., Castro, C., Woo, S., King, A. OXFORD UNIV PRESS INC. 2003: 333–333

  View details for Web of Science ID 000186078100919

• Meaning and knowledge of health among older adult immigrants from Russia: a phenomenological study HEALTH EDUCATION RESEARCH Benisovich, S. V., King, A. C. 2003; 18 (2): 135-144

  Abstract

  This qualitative study examined the meaning and knowledge of health among older adult Russians who have immigrated to the US. Prior studies have shown that this group has a high rate of chronic disease and low compliance with preventative health behaviors. However, little is known about the knowledge and beliefs about health among Russian immigrants that may be driving their low participation in health behaviors. The goal of the present study was to use a phenomenological approach to gain a deeper understanding of the experience of health in this population. Twelve older adults were recruited through English language classes, and interviewed in focus groups about their experience with health and health care. Qualitative analysis using the phenomenological approach revealed a number of important health themes: participants (1) define health as the absence of disease, (2) feel distrust toward media information about health, (3) experience alienation from their current health care system, and (4) experience a sense of stress and helplessness in the US because they do not understand the English language or the US health care system. These themes may underlie the immigrants' lack of participation in health practices and in seeking out information about health. Information about the Russian immigrants' knowledge about health behavior is also reported. This study represents a first step toward better understanding the barriers facing older adult Russian immigrants in learning about and practicing health behaviors. The study also draws attention to the ways in which beliefs about health may impact health behavior.

  View details for Web of Science ID 000182392400001

  View details for PubMedID 12729173

• Discretionary time among older adults: How do physical activity promotion interventions affect sedentary and active behaviors? ANNALS OF BEHAVIORAL MEDICINE Lee, R. E., King, A. C. 2003; 25 (2): 112–19

  Abstract

  Investigation goals were to document discretionary time activities among older adults, determine whether time spent in discretionary activities varied by gender, and investigate whether participation in a prescribed physical activity (P) intervention increased the time that older adults spend in discretionary time physical activities that were not specifically prescribed by interventions. Longitudinal data were drawn from 2 published studies of older adults. Study 1 compared 2 PA interventions in healthy older men and women (N = 103, M =70.2 years), and Study 2 compared a PA intervention with a nutrition intervention in healthy older women (N =93, M =63.1 years). Participants in both studies completed similar assessments of their discretionary time activities using the Community Healthy Activities Model Program for Seniors questionnaire. Across both studies, at baseline, over 95% of participants reported talking on the telephone and reading as frequent sedentary discretionary time activities; over 80% reported visiting with friends and watching television or listening to the radio. Women engaged in significantly greater hours of social activities and household maintenance activities than did men (p <.05). From baseline to 12-month posttest, social, recreational, and household activities remained stable by gender and across time after participating in a PA intervention. Despite previously documented 2- to 3-hr increases in physical activities occurring in response to the study interventions, increases did not generalize for most participants to activities not prescribed by the intervention. Older adults are participating in numerous sedentary social and recreational activities that appear to remain stable across time and in the face of PA intervention prescriptions.

  View details for DOI 10.1207/S15324796ABM2502_07

  View details for Web of Science ID 000182978600007

  View details for PubMedID 12704013

• Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project HEALTH EDUCATION RESEARCH King, A. C., Friedman, R., Marcus, B., Castro, C., Forsyth, L., Napolitano, M., Pinto, B. 2002; 17 (5): 627-636

  Abstract

  Physical inactivity among middle- and older-aged adults is pervasive, and is linked with numerous chronic conditions that diminish health and functioning. Counselor-directed physical activity programs may enhance extrinsic motivation (reflected in social influence theories, such as self-presentation theory) and, in turn, physical activity adherence, while the counselor is in charge of program delivery. However, external influences can undermine intrinsic motivation, making it more difficult to maintain physical activity once counselor-initiated contact ends. In contrast, programs that diminish the socially evaluative and controlling aspects of the counseling interchange may promote intrinsic motivation (described in cognitive evaluation theory), and, thus, physical activity maintenance, even when counselor-initiated contact ceases. The objective of the Community Health Advice by Telephone (CHAT) project is to compare these two theories by conducting a randomized controlled trial evaluating the effects of a telephone-administered counseling program delivered by a person (social influence enhancement) or computer (cognitive evaluation enhancement) on physical activity adoption and maintenance over 18 months. Healthy, sedentary adults (n = 225) aged 55 years and older are randomized to one of these programs or to a control arm. This study will contribute to advancing motivational theory as well as provide information on the sustained effectiveness of interventions with substantial public health applicability.

  View details for Web of Science ID 000178557500015

  View details for PubMedID 12408207

• Intervention-related cognitive versus social mediators of exercise adherence in the elderly AMERICAN JOURNAL OF PREVENTIVE MEDICINE Brassington, G. S., Atienza, A. A., Perczck, R. E., DiLorenzo, T. N., King, A. C. 2002; 23 (2): 80-86

  Abstract

  Participation in regular physical activity is recognized as one of the most important health behaviors associated with the prevention of chronic disease and the promotion of health and well-being among the elderly. Although a number of cross-sectional studies have reported predictors of physical activity participation, few studies have assessed changes in intervention-related mediators associated with physical activity adherence in the elderly.The purpose of this study was to compare the relative abilities of cognitive mediating variables (i.e., self-efficacy beliefs and outcome expectancies/realizations) versus a social mediating variable (i.e., exercise-related social support) to examine mediators of a telephone-based, exercise-counseling intervention on exercise adherence during months 7 to 12 of an exercise intervention.Participants were 103 community-dwelling, healthy, sedentary, older adults (67 women and 36 men). Self-efficacy for exercise, outcome expectancies/realizations, and social support for exercise were assessed at baseline, 6 months, and 12 months. Participants received telephone-based exercise counseling to promote exercise adherence during the course of two 12-month exercise programs (i.e., aerobic/strength or flexibility exercises).Changes in cognitive mediators (i.e., self-efficacy and fitness outcome realizations) were associated with 7- to 12-month exercise adherence while exercise-related social support was not.Attention should be given to increasing confidence in the elderly to overcome barriers to exercise and achieve relevant fitness outcomes in exercise programs.

  View details for Web of Science ID 000177181500012

  View details for PubMedID 12133741

• An exercise program for women who are caring for relatives with dementia PSYCHOSOMATIC MEDICINE Castro, C. M., Wilcox, S., O'Sullivan, P., Baumann, K., King, A. C. 2002; 64 (3): 458-468

  Abstract

  This study describes factors related to retention and adherence to an exercise program for women caregivers.One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization.Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence.This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.

  View details for Web of Science ID 000175791700010

  View details for PubMedID 12021419

• Telephone-assisted Counseling for physical activity EXERCISE AND SPORT SCIENCES REVIEWS Castro, C. M., King, A. C. 2002; 30 (2): 64-68

  Abstract

  Different methods of intervention have been tested to promote physical activity at the individual level. The telephone is an excellent form of media for delivering exercise counseling and advice. This review highlights important clinical trials that have documented the success of telephone-assisted exercise counseling for promoting physical activity in a variety of populations.

  View details for Web of Science ID 000178735200004

  View details for PubMedID 11991539

• Community-based health intervention trials: An overview of methodological issues EPIDEMIOLOGIC REVIEWS Atienza, A. A., King, A. C. 2002; 24 (1): 72-79

  View details for Web of Science ID 000176581000009

  View details for PubMedID 12119859

• Physiological and affective responses to family caregiving in the natural setting in wives versus daughters INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE King, A. C., Atienza, A., Castro, C., Collins, R. 2002; 9 (3): 176-194

  Abstract

  This study examined differences in hemodynamic responses to usual caregiving duties undertaken in the natural setting by caregiving wives versus daughters. Participants were 88 women (36 daughters, 52 wives), 50 years of age or older, caring for a relative with dementia. Participants underwent 2 standard laboratory challenges (1 physical and 1 emotional) and ambulatory monitoring in the natural setting. Although wives and daughters showed similar physiological responses to the laboratory challenges, daughters evidenced greater hemodynamic responses in the natural setting relative to wives when the care recipient was present (p < .02). The increases in hemodynamic responses were accompanied by increased negative interactions with the care recipient as well as other family members (p < .0009). The results add to the small body of research indicating that family caregiving may have negative acute effects on psychosocial and physiological responses in the natural setting, particularly in daughters.

  View details for Web of Science ID 000178126900002

  View details for PubMedID 12360836

• Men gain additional psychological benefits by adding exercise to a weight-loss program OBESITY RESEARCH Kiernan, M., King, A. C., Stefanick, M. L., Killen, J. D. 2001; 9 (12): 770-777

  Abstract

  Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits. This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment-only control group.This study was part of a larger 1-year randomized weight-loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year.Men and women in either weight-loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program. Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program, despite increases in aerobic capacity.The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint, less disinhibition, and less hunger-is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.

  View details for Web of Science ID 000172892000006

  View details for PubMedID 11743061

• Telephone versus mail interventions for maintenance of physical activity in older adults HEALTH PSYCHOLOGY Castro, C. M., King, A. C., Brassington, G. S. 2001; 20 (6): 438-444

  Abstract

  Although telephone and mail are often used to promote physical activity adoption, their ability to produce long-term maintenance is unclear. In this study, 140 men and women aged 50-65 years received 1 year of telephone counseling to adopt higher (i.e., more vigorous) versus lower intensity (i.e., moderate) exercise. After 1 year, participants were rerandomized to a 2nd year of contact via (a) telephone and mail or (b) predominantly mail. Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail. Both strategies were similarly effective in promoting maintenance in the lower intensity condition. Results suggest that after successful adoption of physical activity with the help of telephone counseling, less intensive interventions are successful for physical activity maintenance in older adults.

  View details for DOI 10.1037//0278-6133.20.6.438

  View details for Web of Science ID 000172002200006

  View details for PubMedID 11714186

• Gender differences in cardiovascular response to dementia caregiving GERONTOLOGIST Atienza, A. A., Henderson, P. C., Wilcox, S., King, A. C. 2001; 41 (4): 490-498

  Abstract

  This study examined gender differences in cardiovascular responses to laboratory-based stress, as well as in ambulatory hemodynamic (i.e., blood pressure and heart rate) functioning among caregivers of persons with dementia.Participants were 25 men and 25 women caregivers, matched on age, type of care recipient's dementia, and relationship to the care recipient. After cardiovascular reactivity to a laboratory-based caregiving stressor was assessed, the ambulatory hemodynamic functioning levels of caregivers were measured in caregivers' natural environments.Female caregivers displayed greater systolic and diastolic blood pressure reactivity to a laboratory-based stress task (i.e., discussing caregiving difficulties) compared with male caregivers (p < or =.01). In contrast, no gender differences were found for ambulatory hemodynamic functioning when aggregated overall or when in the presence of the care recipient.Laboratory-based findings suggest that female caregivers experience greater blood pressure reactivity to caregiving-related stress than do male caregivers. However, these laboratory-based gender differences may not generalize to differences in hemodynamic functioning in caregivers' daily lives.

  View details for Web of Science ID 000170248300007

  View details for PubMedID 11490047

• An evaluation of three self-report physical activity instruments for older adults MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Harada, N. D., Chiu, V., King, A. C., Stewart, A. L. 2001; 33 (6): 962-970

  Abstract

  To assess the known-groups and construct validity of measures from the CHAMPS Physical Activity Questionnaire, Physical Activity Survey for the Elderly (PASE), and the Yale Physical Activity Survey (YPAS).The three questionnaires were administered to a convenience sample of older adults (N = 87) recruited from community centers and retirement homes. Validation measures included the SF-36 measures of physical functioning, general health, mental health, and pain; body mass index; performance-based tests of lower body functioning and endurance; and Mini-Logger activity monitor data from ankle and waist sensors. Validity was estimated by testing hypotheses about associations between physical activity and validation measures.As hypothesized, differences in activity levels on all measures were found between older adults in retirement homes (less active) and community centers (more active) (P-values < 0.0001). Correlations of physical activity measures with performance-based measures ranged from 0.44 to 0.68, conforming to hypotheses; hypotheses regarding associations with the SF-36 measures were also confirmed. Body mass index was not correlated with any of the physical activity measures, contrary to hypotheses. Correlations of physical activity measures with Mini-Logger counts ranged from 0.36 to 0.59 (ankle) and 0.42 to 0.61 (waist) as hypothesized. Correlations among the measures from the three instruments ranged from 0.58 to 0.68.The PASE, YPAS, and CHAMPS each demonstrated acceptable validity, as all measures met nearly all hypotheses. Higher validity coefficients were found for subgroups (men, 65-74 yr, retirement home), suggesting that these instruments may perform better for certain segments of the older adult population.

  View details for Web of Science ID 000169135900016

  View details for PubMedID 11404662

• The mediating effects of situational control on social support and mood following a stressor: A prospective study of dementia caregivers in their natural environments JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Atienza, A. A., Collins, R., King, A. C. 2001; 56 (3): S129-S139

  Abstract

  The present study examined, prospectively and within the context of stress experienced in the natural environment, whether situational control served as a mediator between perceived social support and caregiver's mood.Data came from baseline assessments of individuals participating in health promotion interventions for women caregivers. Participants were 49 female caregivers of dementia patients who monitored their own acute psychological states during the day.Results revealed that although the occurrence of a situational stressor increased negative mood, greater perceived support reduced the detrimental impact of a stressor on negative mood. Moreover, path analyses revealed that changes in situational control partially mediated the relationship between perceived support and stress-induced negative mood changes. However, changes in control did not serve as a mediator in analyses focused on happiness.Results suggest that caregivers with greater perceived support were less emotionally reactive to stress occurring in their natural environments because of, in part, sustained or increased situational control.

  View details for Web of Science ID 000168341400009

  View details for PubMedID 11316838

• The Mediating Effects of Situational Control on Social Support and Mood Following a Stressor. journals of gerontology. Series B, Psychological sciences and social sciences Atienza, A. A., Collins, R., King, A. C. 2001; 56 (3): S129-S139

  View details for DOI 10.1093/geronb/56.3.S129

  View details for PubMedID 28158773

• Do logistic regression and signal detection identify different subgroups at risk? Implications for the design of tailored interventions PSYCHOLOGICAL METHODS Kiernan, M., Kraemer, H. C., Winkleby, M. A., King, A. C., Taylor, C. B. 2001; 6 (1): 35-48

  Abstract

  Identifying subgroups of high-risk individuals can lead to the development of tailored interventions for those subgroups. This study compared two multivariate statistical methods (logistic regression and signal detection) and evaluated their ability to identify subgroups at risk. The methods identified similar risk predictors and had similar predictive accuracy in exploratory and validation samples. However, the 2 methods did not classify individuals into the same subgroups. Within subgroups, logistic regression identified individuals that were homogeneous in outcome but heterogeneous in risk predictors. In contrast, signal detection identified individuals that were homogeneous in both outcome and risk predictors. Because of the ability to identify homogeneous subgroups, signal detection may be more useful than logistic regression for designing distinct tailored interventions for subgroups of high-risk individuals.

  View details for DOI 10.1037//1082-989X.6.1.35

  View details for Web of Science ID 000170728000004

  View details for PubMedID 11285811

• How and why do individuals make food and physical activity choices? Conference on Summit on Promoting Health Eating and Active Living: Developing a Framework for Progress Wetter, A. C., Goldberg, J. P., King, A. C., Sigman-Grant, M., Baer, R., Crayton, E., Devine, C., Drewnowski, A., Dunn, A., Johnson, G., Pronk, N., Saelens, B., Snyder, D., Novelli, P., Walsh, K., Warland, R. WILEY-BLACKWELL PUBLISHING, INC. 2001: S11–S20

  View details for Web of Science ID 000168248900005

  View details for PubMedID 11330629

• Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years 48th Annual Meeting of the Gerontological-Society-of-America Brassington, G. S., King, A. C., Bliwise, D. L. BLACKWELL PUBLISHING. 2000: 1234–40

  Abstract

  The purpose of this study was to determine if reported nighttime sleep problems and daytime sleepiness were associated with reported falling during the previous 12 months in a representatively sampled older adult population.Random-digit dial telephone survey.Representatively sampled older adult population living in northern California.Participants were 971 women and 555 men, aged 64 to 99 years.Twenty-minute telephone interview adapted from the National Health Interview Survey.Two hundred and eighty-four participants reported falling during the previous 12 months (19% of the sample). Significantly more women fell than men (20% and 14%, respectively, P < .001). The following variables were significant risk factors for falling in univariate analyses: female gender, being unmarried, living alone, income less than $15,000 per year, difficulty walking, having more than one chronic medical condition, history of cardiovascular disease, hypertension, arthritis, sensory impairment, psychological difficulties, and nighttime sleep problems. All of the nighttime sleep problem variables remained significant risk factors for falling after controlling for other risk factors for falling.The results provide support for an independent association between reported sleep problems and falls in an older population. One of the implications of these data is that behavioral research focusing on the effectiveness of insomnia treatment in old age should not only examine typical sleep-related outcomes (e.g., total time asleep, number of awakenings) but also the occurrence of falls as well.

  View details for Web of Science ID 000089821600008

  View details for PubMedID 11037010

• The use of refusal postcards in recruiting older adults ANNALS OF BEHAVIORAL MEDICINE Verboncoeur, C. J., Stewart, A. L., King, A. C., Rush, S., McLellan, B. Y., Mills, K. 2000; 22 (4): 330-333

  Abstract

  This article examines whether a refusal postcard makes recruitment more efficient or instead reduces response rates to a telephone survey of older adults. Medicare health maintenance organization (HMO) members were randomly sampled in sequential phases. All samples received an initial contact letter from a HMO geriatrician. A refusal postcard was included in the first sample (N = 178); however, the remaining six samples did not receive this postcard (N = 1,003). An overall refusal rate of 32% was observed when postcards were included versus a 14% rate of refusal when postcards were excluded (p < .001). When potential respondents were reached by telephone, refusal rates were similar (9% versus 10%). Despite the higher refusal rate among the sample receiving the refusal postcard, no significant differences in demographics, health, and health behaviors were observed between the two final sample groups completing the survey. We conclude that refusal postcards greatly increase the refusal rates without offering any prescreening advantage in the recruitment process of older adults and could increase the costs of recruitment for a telephone survey. Furthermore, use of a refusal postcard precludes individuals from making fully informed decisions about participating in research.

  View details for Web of Science ID 000167076300009

  View details for PubMedID 11253445

• Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Wilcox, S., Castro, C., King, A. C., Housemann, R., Brownson, R. C. 2000; 54 (9): 667-672

  Abstract

  Determinants of leisure time physical activity (LTPA) in rural middle aged and older women of diverse racial and ethnic groups are not well understood. This study examined: (1) urban-rural differences in LTPA by sociodemographic factors, (2) urban-rural differences in LTPA determinants, and (3) the pattern of relations between LTPA determinants and LTPA.A modified version of the sampling plan of the Behavioral Risk Factor Surveillance Survey (BRFSS) was used. Zip codes were selected with 20% or more of each of the following race/ethnic groups: African American, American Indian/Alaskan Native (AI/AN), and Hispanic. A comparison group of white women were also surveyed using standard BRFSS techniques.Rural (n=1242) and urban (n=1096) women aged 40 years and older from the US Women's Determinants Study.Rural women, especially Southern and less educated women, were more sedentary than urban women. Rural women reported more personal barriers to LTPA, cited caregiving duties as their top barrier (compared with lack of time for urban women), and had greater body mass indices. Rural women were less likely to report sidewalks, streetlights, high crime, access to facilities, and frequently seeing others exercise in their neighbourhood. Multivariate correlates of sedentary behaviour in rural women were AI/AN and African American race, older age, less education, lack of enjoyable scenery, not frequently seeing others exercise, greater barriers, and less social support (p<0.05); and in urban women, older age, greater barriers, less social support (p<0.05), and less education (p<0.09).Rural and urban women seem to face different barriers and enablers to LTPA, and have a different pattern of determinants, thus providing useful information for designing more targeted interventions.

  View details for Web of Science ID 000088819800010

  View details for PubMedID 10942445

  View details for PubMedCentralID PMC1731735

• Exercise counseling in health promotion The Western journal of medicine King, A. C. 2000; 173 (1): 5-6

  View details for PubMedID 10903270

  View details for PubMedCentralID PMC1070952

• Anger expression and natural killer cell activity in family caregivers participating in a physical activity trial. Journal of health psychology Wilcox, S., King, A. C., Vitaliano, P. P., Brassington, G. S. 2000; 5 (4): 431-440

  Abstract

  Associations between psychological functioning and natural killer cell activity (NKA) were examined in 23 older (62.2 ± 7.5 years) family caregivers randomized to a moderate intensity four-month exercise program or to a wait-list control condition. At baseline, although NKA was related to anger-control (r = -.42; trend p < .06) and anger-out (r = .50; p < .03), it was not related to depression, anxiety, perceived stress, or caregiver burden. After controlling for baseline NKA, changes in anger-control explained 14 percent of the variance in NKA four months later. Decreases in anger-control predicted increases in NKA. Group assignment (exercise vs control) was unrelated to changes in NKA over the four-month period; however, the study was not powered to detect this effect. These results are consistent with reported relationships of anger expression with other physiological measures, and extend the importance of anger expression to immune functioning in older family caregivers.

  View details for DOI 10.1177/135910530000500403

  View details for PubMedID 22049187

• Role of exercise counselling in health promotion BRITISH JOURNAL OF SPORTS MEDICINE King, A. C. 2000; 34 (2): 80-81

  View details for Web of Science ID 000086374400005

  View details for PubMedID 10786859

• Using direct mail to recruit hispanic adults into a dietary intervention: An experimental study ANNALS OF BEHAVIORAL MEDICINE Kiernan, M., Phillips, K., Fair, J. M., King, A. C. 2000; 22 (1): 89-93

  Abstract

  Identifying strategies for successful recruitment of ethnic minorities into scientific studies is critical. Without effective methods, investigators may fail to recruit the desired sample size, take longer to recruit than planned, and delay progress for research in minority health. Direct mail is an appealing recruitment method because of the potential for reaching large target populations and producing a high volume of inquiries about a study with relatively little staff effort. To determine which of three direct mail strategies yielded higher recruitment, 561 Hispanic employees were randomly assigned to receive either: (a) a flyer about a worksite dietary intervention; (b) the same flyer plus a personalized hand-signed letter containing heart disease risk statistics for the general American population; or (c) the flyer plus a personalized hand-signed letter containing statistics for Hispanics. Two orthogonal chi-square comparisons were examined. The personalized letters plus flyer yielded a significantly higher response rate (7.8%) than the flyer alone (2.1%), X2(1, N = 561) = 7.5, p = .006. However, the personalized letter with Hispanic heart disease risk statistics did not yield a statistically significant higher response rate (9.1%) than the letter with the general population risk statistics (6.5%), X2(1, N = 370) = 0.9, p > .34. These findings suggest that personalized approaches can increase the effectiveness of direct mail efforts for recruiting ethnic minorities into interventions and may be particularly helpful for large-scale interventions.

  View details for Web of Science ID 000088802800011

  View details for PubMedID 10892533

• Sleep complaints in older women who are family caregivers JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Wilcox, S., King, A. C. 1999; 54 (3): P189-P198

  Abstract

  Providing care to a family member with dementia has significant psychological and physical consequences. Sleep quality is likely affected by caregiving, yet this domain has received surprisingly little empirical study. In this study, sleep complaints were examined in 90 older women who were family caregivers of adults with dementia. Caregivers reported more sleep complaints than similarly aged healthy adults on all seven components of the Pittsburgh Sleep Quality Index, and a similar level of sleep complaints to those of sleep-impaired women and depressives on 6 and 4 components, respectively. Sleep medication was used by 38% of caregivers in the past month. The most common sleep complaints that occurred at least weekly were waking up in the night or early morning (84%), bathroom needs (83%), and sleep onset difficulties (41%). Sixty percent of the sample reporting nighttime care recipient disruptions stated that these disruptions occurred 3 or more times per week. Caregiver relationship and care recipient diagnosis were unrelated to sleep complaints. Lower levels of education, less internalized anger, care recipient disruptions, and psychological distress were related to poorer overall sleep quality. Sleep complaints are a common yet understudied problem in family caregivers.

  View details for Web of Science ID 000080570300008

  View details for PubMedID 10363041

• Managing job strain: A randomized, controlled trial of an intervention conducted by mail and telephone JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE Pelletier, K. R., Rodenburg, A., Vinther, A., Chikamoto, Y., King, A. C., Farquhar, J. W. 1999; 41 (4): 216-223

  Abstract

  A randomized, clinical intervention focused on alleviating job strain was conducted over 6 months by mail and/or telephone with a total of 136 employees of Bank of America. Both the mail and mail plus telephone interventions evidenced positive results, with the mail plus telephone intervention being the more effective. Given the relative low cost of such mediated interventions, the results provide a basis for the further development of interventions that may demonstrate both clinical and cost effectiveness.

  View details for Web of Science ID 000079795000003

  View details for PubMedID 10224587

• Key informant surveys as a tool to implement and evaluate physical activity interventions in the community HEALTH EDUCATION RESEARCH Eyler, A. A., Mayer, J., Rafii, R., Housemann, R., Brownson, R. C., King, A. C. 1999; 14 (2): 289-298

  Abstract

  Key informant surveys are important tools for planning and evaluating community health programs. A survey was conducted to gather views on policies toward physical activity from four sets of key informants: physicians, church leaders, business leaders and civic leaders. Surveys were mailed to 797 key informants who were selected from 12 southeastern Missouri counties. For comparison, data from a telephone survey of 2106 persons in the general population were also analyzed. The majority (> 85%) in all four key informant groups were very supportive of required physical education in schools, but less supportive (< 69%) of government funding for places where community members can exercise. Physicians perceived community members as having somewhat greater access to places to exercise relative to the other key informant groups. Comparisons of the key informant surveys to the population survey indicated similar levels of support for physical activity policy. The information from this survey has been useful in identifying support for physical activity policy and gaining access to potential influences for community change. Since key informant research in the area of physical activity policy and cardiovascular disease prevention is sparse, there is a need for future studies.

  View details for Web of Science ID 000079905200013

  View details for PubMedID 10387507

• A Modified Exercise-induced Feeling Inventory for Chronic Training and Baseline Profiles of Participants in the Activity Counseling Trial. Journal of health psychology Rejeski, W. J., Reboussin, B. A., Dunn, A. L., King, A. C., Sallis, J. F. 1999; 4 (1): 97-108

  Abstract

  An earlier study reported on the development of a scale to measure feeling states during acute bouts of exercise: the Exercise-induced Feeling Inventory (EFI-A). The present study reports on the psychometric properties of a revised scale to assess responses to habitual or chronic physical activity: the EFI-C. The EFI-C was administered during baseline testing to 830 sedentary men and women patients with a mean age of 51.5 years. Factor analytic procedures revealed that the EFI-C consisted of two factors, one assessing pleasant feeling states and a second that taps the unpleasant experience of physical exhaustion. Both subscales have excellent internal consistency reliability coefficients (0.90) and are reasonably stable over time, having test-retest coefficients in excess of 0.70. The scales correlated in expected directions with related constructs and in preliminary analyses showed an anticipated pattern of sensitivity to physical activity interventions. Mean scores for various demographic groups are reported. Future research should examine whether the EFI-C is a predictor of adherence to physical activity and its potential role in mediating the positive mental health effects of physical activity.

  View details for DOI 10.1177/135910539900400107

  View details for PubMedID 22021437

• How to promote physical activity in a community: research experiences from the US highlighting different community approaches International Workshop on Promotion of Health Related Physical Activity Among Adults King, A. C. ELSEVIER IRELAND LTD. 1998: S3–S12

  Abstract

  Much of the research investigating methods for promoting physical activity has occurred on an individual or group level of analysis. Yet, the substantial prevalence of physical inactivity in most developed countries coupled with the public health significance of becoming more regularly active provides a compelling rationale for expanding interventions to higher levels of impact. By targeting the community, the possibility of reaching a greater percentage of the underactive population with potentially lower costs per person becomes more likely. When the target of intervention becomes the community, as opposed to the individual, a shift in the methods by which the physical inactivity problem is both conceptualized and addressed is required. Successful intervention strategies that have occurred at each level of impact (i.e. personal/interpersonal, institutional, environmental, legislative/policy-level) are highlighted. Suggested future directions are summarized.

  View details for Web of Science ID 000073359400003

  View details for PubMedID 10889741

• The effects of marital transitions on changes in physical activity: Results from a 10-year community study ANNALS OF BEHAVIORAL MEDICINE King, A. C., Kiernan, M., Ahn, D. K., Wilcox, S. 1998; 20 (2): 64-69

  Abstract

  The potential effects of making a marital transition on subsequent physical activity were evaluated across a ten-year period in a population-based sample of 302 women and 256 men ages 25 to 75 years. Subjects completed a structured interview at five timepoints throughout the ten-year period during which they reported on their physical activity level as well as marital status. The transition from a married to a single state did not affect physical activity relative to remaining married when analyses of either slopes or mean values were used. In contrast, the transition from a single to a married state resulted in significant positive changes in physical activity relative to remaining single throughout the study period when physical activity slopes, though not means, were compared. The results suggest that marriage may potentially set the stage for natural changes in physical activity that could be capitalized on through appropriate intervention, but additional research is needed to verify this in light of the inconsistent pattern of findings.

  View details for Web of Science ID 000078467900003

  View details for PubMedID 9989310

• Managing job strain: A randomized controlled trial of an intervention conducted by mail and telephone AMERICAN JOURNAL OF HEALTH PROMOTION Pelletier, K. R., Rodenburg, A., Chikamoto, Y., Vinther, A., King, A. C., Farquhar, J. W. 1998; 12 (3): 166-169

  View details for Web of Science ID 000075033100004

  View details for PubMedID 10176090

• Characteristics of successful and unsuccessful dieters: An application of signal detection methodology ANNALS OF BEHAVIORAL MEDICINE Kiernan, M., King, A. C., Kraemer, H. C., Stefanick, M. L., Killen, J. D. 1998; 20 (1): 1-6

  Abstract

  Signal detection methods were used to identify predictors of successful weight loss in 177 mildly to moderately overweight women and men assigned to one of two weight-loss programs. Predictors included initial demographic, physiological, behavioral, and psychosocial characteristics, and program type (e.g. diet-only and diet-plus-exercise). Successful weight loss was defined as a loss of at least two units of body mass index at one year. Four subgroups were identified. Participants in the diet-plus-exercise program who were initially more satisfied with their bodies and did not have a history of repeated weight loss were most likely to succeed (63% succeeded). In contrast, participants assigned to the diet-plus-exercise program who were either extremely dissatisfied with their bodies or who had a history of repeated weight loss were at similar risk for failure as participants in the diet-only program (only 26% to 35% succeeded). The results underscore the potential utility of exploring these subgroups further to inform the development of new treatment strategies to increase the likelihood of success.

  View details for Web of Science ID 000075741800001

  View details for PubMedID 9755345

• Evaluation of CHAMPS, a physical activity promotion program for older adults ANNALS OF BEHAVIORAL MEDICINE Stewart, A. L., Mills, K. M., Sepsis, P. G., King, A. C., McLellan, B. Y., Roitz, K., Ritter, P. L. 1997; 19 (4): 353-361

  Abstract

  We evaluated physical activity changes resulting from a six-month public health model intervention that encouraged seniors (N = 89) 62-91 years of age (mean = 76) living in two low-income congregate housing facilities to increase their physical activity by participating in existing community-based physical activity classes and programs of their choice. The program was offered to everyone regardless of their health problems. Enrollees were encouraged to adopt activities tailored to their preferences, physical abilities, health status, income, and transportation resources. Using a comparison-group design, the intervention group was more active for all comparison months of the intervention period (p values < .05). The intervention also was associated with improvements in self-esteem (p < .05), though not with an array of other measures of health-related quality-of-life. Those who adopted and maintained a new physical activity over the six-month intervention period experienced improvements in anxiety, depression, and overall psychological well-being relative to those who did not. The intervention was subsequently replicated through a senior center (N = 22). A much larger proportion of the senior center sample adopted and maintained a new activity for six months (68%) compared to the congregate facilities sample (35%), which may have been due to differences in recruitment methods and sample characteristics in the two settings. An intervention promoting increased physical activity through the use of existing community resources may help increase physical activity in older adults.

  View details for Web of Science ID 000075216900007

  View details for PubMedID 9706362

• Enhancing physical and psychological functioning in older family caregivers: The role of regular physical activity ANNALS OF BEHAVIORAL MEDICINE King, A. C., Brassington, G. 1997; 19 (2): 91-100

  Abstract

  Although informal caregiving among older adults creates a range of physical and psychological burdens for the caregiver, little research has been directed at evaluating strategies for preserving caregivers physical functioning in addition to their psychological well-being. The purpose of the current research was to examine, through population-based survey sampling procedures, levels of physical activity and related health practices and preferences among a random sample of older family caregivers; evaluate, using an experimental design, the feasibility of initiating a four-month supervised home-based moderate-intensity physical activity regimen among older family caregivers; and explore the potential effects of physical activity on anger expression, caregiver burden, and related psychological outcomes in this population. The results suggest that: (a) physical inactivity is a prevalent risk factor among family caregivers that requires systematic attention; (b) a significant proportion of family caregivers of both sexes are interested in improving their physical activity levels, especially through programs that do not require ongoing attendance at a class or group; and (c) supervised home-based programs that focus on brisk walking and similar moderate-intensity physical activities appear to be both feasible and potentially beneficial in health (e.g. ambulatory blood pressure) as well as mental health (e.g. anger expression) areas.

  View details for Web of Science ID A1997XX31000004

  View details for PubMedID 9603683

• Intervention strategies and determinants of physical activity and exercise behavior in adult and older adult men and women 3rd International Conference on Nutrition and Fitness King, A. C. KARGER. 1997: 148–158

  View details for Web of Science ID A1997BJ41E00009

  View details for PubMedID 9270318

• Lifestyle activity - Current recommendations SPORTS MEDICINE Phillips, W. T., Pruitt, L. A., King, A. C. 1996; 22 (1): 1-7

  Abstract

  An accumulation of international scientific evidence indicates that physical inactivity is detrimental to health and that moderate levels of physical activity confer significant health benefits. Unfortunately, in countries where major surveys of physical activity have been conducted, the prevalence of sedentary behaviour has been found to be as high as 40%. In the US, where approximately 30% of adults report little or no physical activity, the Centers for Disease Control and the American College of Sports Medicine recently issued guidelines and recommendations on the amount and frequency of moderate levels of physical activity necessary to elicit health benefits in predominantly sedentary adults. These guidelines utilise a physical activity-health paradigm and, uniquely, recommend the potential effectiveness of activities of daily living or "lifestyle activity' for achieving health benefits. This article briefly reviews the rationale behind these guidelines and, in view of the historical association of the exercise training-fitness model to health, highlights some challenges and potential problems in applying these new guidelines to the general population.

  View details for Web of Science ID A1996UW56700001

  View details for PubMedID 8819236

• Sleepiness in clinical and nonclinical populations NEUROEPIDEMIOLOGY Bliwise, D. L., King, A. C. 1996; 15 (3): 161-165

  Abstract

  Sleepiness is a commonplace experience for all individuals at some point in their daily lives. Whether such a ubiquitous experience has utility in discriminating a diseased population from the general population has yet to be determined. The purpose of this study was to determine the accuracy of reports of sleepiness across different situations by identifying individuals with sleep apnea. We compared a clinical population of 630 patients aged 50-65 with polysomnographically diagnosed sleep apnea with a randomly sampled population of 1,877 individuals of similar age from a nearby community. Sleepiness while watching television was the most prevalent behavior (about 36% of the reference population and 90% of the apnea patients), but potentially better discrimination occurred with items inquiring about sleepiness in other situations. The data suggest that discrimination between diseased and nondiseased populations may be more successful with sleepiness items involving relatively low, rather than high, rates of endorsement.

  View details for Web of Science ID A1996UJ79600006

  View details for PubMedID 8700308

• Environmental and policy approaches to cardiovascular disease prevention through physical activity: Issues and opportunities HEALTH EDUCATION QUARTERLY King, A. C., Jeffery, R. W., Fridinger, F., DUSENBURY, L., PROVENCE, S., Hedlund, S. A., SPANGLER, K. 1995; 22 (4): 499-511

  Abstract

  The majority of Americans remain inactive despite evidence of significant health benefits from even moderately intense activity. Previous intervention efforts have generally focused on changing individual behavior. This article discusses the use of policy, legislative and regulatory, and environmental interventions in promoting physical activity to prevent cardiovascular disease (CVD) and other chronic diseases. The authors present evidence on the need, formulation, description, and effectiveness of policy and environmental intervention approaches. Types of approaches addressed to promote physical activity include federal, state, and local legislation and regulation, policy development and implementation, and environmental support. They also describe opportunities for state and local health departments to initiate and participate in environmental and policy approaches.

  View details for Web of Science ID A1995UD81300007

  View details for PubMedID 8550373

• Sources of social support as predictors of exercise adherence in women and men ages 50 to 65 years. Women's health (Hillsdale, N.J.) Oka, R. K., King, A. C., Young, D. R. 1995; 1 (2): 161-175

  Abstract

  Examines types of social support that best predicts adherence at different time points during a 1-year endurance exercise program in 269 women and men ages 50 to 65 years. Results indicate that social support had similar effects on exercise participation for women and men, and support specific to exercise was a better predictor of exercise adherence than general social support. A preference for receiving a lesser amount of initial support from exercise staff was the strongest social support-related predictor of exercise adherence during the initial 6 months of the program. Support currently received from family and friends and exercise staff at Month 6 was found to be the strongest predictor of adherence during Months 7 to 12. Format of exercise was also a strong predictor of exercise adherence with home-based programs related to greater adherence. Additionally, divorced nonsmokers appear to be at increased risk for poor early exercise adherence and should be targeted in interventions to promote exercise participation.

  View details for PubMedID 9373378

• DETERMINANTS OF EXERCISE LEVEL IN THE SEDENTARY VERSUS UNDERACTIVE OLDER ADULT - IMPLICATIONS FOR PHYSICAL-ACTIVITY PROGRAM-DEVELOPMENT JOURNAL OF AGING AND PHYSICAL ACTIVITY Young, D. R., King, A. C., Oka, R. K. 1995; 3 (1): 4-25

  View details for Web of Science ID A1995QA35800002

• COMMUNITY AND PUBLIC-HEALTH APPROACHES TO THE PROMOTION OF PHYSICAL-ACTIVITY MEDICINE AND SCIENCE IN SPORTS AND EXERCISE King, A. C. 1994; 26 (11): 1405-1412

  Abstract

  Research in the exercise adherence area over the past several decades has resulted in the identification of a number of promising methods for influencing physical activity on the individual level. The substantial prevalence of underactivity across most sectors of the American population, however, demands that higher-level approaches to physical activity promotion that include environmental, organizational, and policy-level strategies be increasingly brought to bear on this problem. This paper compares individual and community approaches to physical activity intervention and provides examples of how the community/public health approach to physical activity promotion can be implemented to facilitate increases in population-wide physical activity.

  View details for Web of Science ID A1994PQ03300017

  View details for PubMedID 7837963

• AMBULATORY BLOOD-PRESSURE AND HEART-RATE RESPONSES TO THE STRESS OF WORK AND CAREGIVING IN OLDER WOMEN JOURNALS OF GERONTOLOGY King, A. C., Oka, R. K., Young, D. R. 1994; 49 (6): M239-M245

  Abstract

  Although the informal caregiving role is associated with a range of stressors that are both chronic and severe, little is known concerning the acute physical and psychological effects of caregiving in the natural setting. This study evaluated the hemodynamic and psychological responses of five women identified as family caregivers who also worked outside the home and five matched working noncaregivers.Subjects wore an ambulatory blood pressure monitor that recorded blood pressure and heart rate on an hourly basis throughout a one- to two-day period. They also completed hourly logs evaluating psychological, physical, and health-related variables through use of a preprogrammed pocket computer. Within- and between-group responses were compared in clinical, work, and postwork settings.Caregivers and noncaregivers showed comparable ambulatory blood pressure levels in the clinic and work settings. However, in contrast to noncaregivers, who showed the expected decrease in blood pressure level upon leaving the work setting (p values < .03), caregivers demonstrated a significant increase in systolic blood pressure levels following work when they were in the presence of the care recipient (p < .0002). The differences observed in blood pressure responses between the two groups were similarly reflected in the patterns of affective response recorded in the work and postwork settings.The results provide initial evidence of the acute iatrogenic effects of caregiving on physiological as well as psychological response systems.

  View details for Web of Science ID A1994PR34200017

  View details for PubMedID 7963275

• Effect of recruitment strategy on types of subjects entered into a primary prevention clinical trial. Annals of epidemiology King, A. C., Harris, R. B., Haskell, W. L. 1994; 4 (4): 312-320

  Abstract

  Clinical trials typically recruit subjects through referrals or media promotion, with generalizability of the results often uncertain. As part of a primary prevention trial to evaluate strategies for increasing physical activity in sedentary men and women, two recruitment sources, a random-digit-dial telephone survey and a community media campaign, were used to identify subjects. Baseline characteristics of 357 randomized men and women aged 50 to 65 years were compared by recruitment source. Whereas there were few differences between recruitment sources for demographic variables, telephone survey recruitment was particularly successful in recruiting smokers and persons with other cardiovascular risk factors into the trial. Counter to expectations, subsequent exercise adherence rates did not differ by recruitment source. The results suggest that the survey method, while more expensive, may be particularly useful for locating higher-risk subjects who could especially benefit from increases in physical activity but who rarely are recruited through more traditional approaches.

  View details for PubMedID 7921321

• ENHANCING THE SELF-REPORT OF ALCOHOL-CONSUMPTION IN THE COMMUNITY - 2 QUESTIONNAIRE FORMATS AMERICAN JOURNAL OF PUBLIC HEALTH King, A. C. 1994; 84 (2): 294-296

  Abstract

  Two questionnaire formats for assessing alcohol consumption in a community sample were compared. Subjects completed the Semi-Quantitative Food Frequency Questionnaire and a questionnaire specifically targeting alcohol use. Across all alcoholic beverages, subjects reported lower consumption on the alcohol questionnaire than on the food frequency questionnaire. The results suggest that food frequency questionnaires may provide a better means for enhancing self-report of alcohol use than questionnaires that target solely alcohol intake.

  View details for Web of Science ID A1994NB62800028

  View details for PubMedID 8296958

  View details for PubMedCentralID PMC1615001

• HABITUAL SLEEP DURATIONS AND HEALTH IN A 50-65 YEAR-OLD POPULATION JOURNAL OF CLINICAL EPIDEMIOLOGY Bliwise, D. L., King, A. C., Harris, R. B. 1994; 47 (1): 35-41

  Abstract

  Several studies have suggested that individuals with long or short sleep durations are at greater risk for adverse outcomes relative to individuals sleeping 7-8 hours a night. The mechanisms leading to these results have never been fully explained, but individual differences in how long an individual sleeps are usually considered to reflect lifestyle rather than disease. Alternatively, individuals may sleep a particular amount because of characteristics of their sleep physiology. In this study, we examined population-based data on the associations between sleep duration and several symptoms of sleep-related disease, reported snoring and daytime sleepiness. Results from 1877 independently living individuals between the ages of 50 and 65 years suggested that long, but not short, sleep durations were related to greater reported snoring. Higher levels of reported snoring and daytime sleepiness, but not habitual sleep duration, were related to measures of disease and lower psychosocial function. We suggest that future epidemiologic studies use such additional items as potential indicators of sleep-related disease.

  View details for Web of Science ID A1994MT27800004

  View details for PubMedID 8283193

• METABOLIC AND BEHAVIORAL COVARIATES OF HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL AND TRIGLYCERIDE CONCENTRATIONS IN POSTMENOPAUSAL WOMEN JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Laws, A., King, A. C., Haskell, W. L., Reaven, G. M. 1993; 41 (12): 1289-1294

  Abstract

  To determine predictors of high-density lipoprotein cholesterol (HDL) and triglyceride (TG) concentrations in postmenopausal women.Cross-sectional study.Clinical research facility.One hundred twenty-seven healthy, relatively sedentary, postmenopausal women not on estrogen replacement, mean age 57 years.Alcohol intake, cigarette smoking, aerobic fitness (VO2max), body mass index (BMI), percent body fat, waist-hip ratio, lipids and lipoproteins, fasting plasma glucose (FPG), and insulin (FPI) concentrations.In univariate analyses, HDL was significantly (P < 0.05) inversely related to BMI, waist-hip ratio, smoking, FPG, and FPI, and directly related to VO2max and alcohol intake. Triglycerides were related directly to BMI, waist-hip ratio, percent body fat, FPG, and FPI, and inversely to VO2max. In stepwise multiple regressions, BMI, waist-hip ratio, alcohol, smoking, and FPG were significantly associated with HDL (R2 for the model = 0.43). Addition of TG to these models reduced relations of BMI and waist-hip ratio, but not the other variables, to insignificance. For triglycerides, waist-hip ratio, alcohol, smoking, FPG, and FPI were significant predictors (R2 = 0.33). VO2max and percent body fat did not contribute to any model.Obesity, abdominal obesity, smoking, alcohol intake, and measures of carbohydrate metabolism predict HDL and triglyceride concentrations in postmenopausal women.

  View details for Web of Science ID A1993MK55900001

  View details for PubMedID 8227909

• DETERMINANTS OF PHYSICAL-ACTIVITY AND INTERVENTIONS IN ADULTS MEDICINE AND SCIENCE IN SPORTS AND EXERCISE King, A. C., Blair, S. N., Bild, D. E., Dishman, R. K., Dubbert, P. M., Marcus, B. H., Oldridge, N. B., Paffenbarger, R. S., Powell, K. E., YEAGER, K. K. 1992; 24 (6): S221-S236

  View details for Web of Science ID A1992HX75400005

  View details for PubMedID 1625548

• EFFECT OF A 6-MONTH AEROBIC EXERCISE TRAINING-PROGRAM ON CARDIOVASCULAR RESPONSIVITY IN HEALTHY MIDDLE-AGED ADULTS JOURNAL OF PSYCHOSOMATIC RESEARCH Albright, C. L., King, A. C., Taylor, C. B., Haskell, W. L. 1992; 36 (1): 25-36

  Abstract

  The purpose of this study was to determine the effects of a six month aerobic exercise training regimen on cardiovascular responsivity to mental arithmetic in healthy middle-aged men and women. Subjects were randomly assigned to a moderate intensity exercise intervention or to an assessment-only control group. Before and after the intervention subjects' heart rates and blood pressures were measured doing a mental arithmetic task (N = 83). Other physiological and psychosocial measures included the Type A structured interview and a maximal exercise treadmill test. Validated adherence to the exercise regimen exceeded 75% and there were significant increases in aerobic capacity in those subjects receiving exercise training. Exercise did not significantly reduce cardiovascular responsivity to the stress task. Type A behavior did not interact with reactivity across exercisers or controls nor was it significantly correlated with adherence. The results are discussed with respect to factors that have been previously reported to potentially influence the exercise/reactivity relationship.

  View details for Web of Science ID A1992HB79200003

  View details for PubMedID 1538348

• PREVALENCE OF SELF-REPORTED POOR SLEEP IN A HEALTHY POPULATION AGED 50-65 SOCIAL SCIENCE & MEDICINE Bliwise, D. L., King, A. C., Harris, R. B., Haskell, W. L. 1992; 34 (1): 49-55

  Abstract

  Many population-based surveys have reported that the prevalence of poor sleep increases with age. Despite the uniformity of findings, it remains unclear to what extent age-related declines in overall physical health are related to those results. One approach to this problem has been to adjust for such confounding variables multivariately. Some prior studies using this approach have not shown the expected age-related increases in the prevalence of poor sleep. Another approach has been the study of sleep in carefully screened, healthy populations. The current study reports the prevalence of disturbed sleep in a population, ages 50-65, carefully screened for physical health as part of an ongoing study of exercise and cardiovascular function. The prevalence of self-reported trouble falling asleep every night or almost every night (1.1% M, 2.6% F), trouble awakening and returning back to sleep (4.4% M, 3.3% F), and use of hypnotic medication at least twice a week (1.6% M, 2.6% F) were consistently lower than in nearly all previous population-based studies of individuals of comparable age. This implies that when overall physical health factors are taken into account a decline in sleep quality is not necessarily an inevitable component of aging per se. As has been shown in other studies, there were small but statistically significant relationships between self-reported depression and poor sleep. Despite the low prevalence of poor sleep, about a third of the population reported feeling not well-rested and/or not getting the sleep they required. The individuals in this study also reported obtaining significantly less sleep relative to normative data from 30 years ago.(ABSTRACT TRUNCATED AT 250 WORDS)

  View details for Web of Science ID A1992GY69500007

  View details for PubMedID 1738856

• RELATION OF FASTING PLASMA-INSULIN CONCENTRATION TO HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL AND TRIGLYCERIDE CONCENTRATIONS IN MEN ARTERIOSCLEROSIS AND THROMBOSIS Laws, A., King, A. C., Haskell, W. L., Reaven, G. M. 1991; 11 (6): 1636-1642

  Abstract

  Low plasma high density lipoprotein (HDL) cholesterol concentration is a risk factor for coronary heart disease (CHD) and is frequently associated with high triglyceride concentration. Both of these abnormalities have been related to insulin resistance as estimated by plasma insulin concentrations and to measures of obesity, regional adiposity, and physical fitness. To determine which of these variables (fasting plasma insulin, obesity as measured by body mass index [BMI], or regional adiposity as measured by waist to hip ratio [WHR]) best identifies men with low HDL cholesterol and high triglyceride concentrations, we divided 83 men, aged 50-65 years, who were free of CHD or diabetes, into tertiles based on BMI, WHR, or fasting plasma insulin concentration. Only for plasma insulin tertiles were there statistically significant differences in HDL cholesterol (tertile 1, mean +/- SEM, 1.34 +/- 0.08 mmol/l; 2, 1.16 +/- 0.05 mmol/l; 3, 1.10 +/- 0.06 mmol/l; p less than 0.03) and triglyceride (tertile 1, 1.05 +/- 0.08 mmol/l; 2, 1.48 +/- 0.12 mmol/l; 3, 1.82 +/- 0.17 mmol/l; p less than 0.005) concentrations. In forward stepwise regressions with HDL cholesterol and triglyceride as dependent variables, fasting insulin concentration but not BMI, WHR, or maximal oxygen uptake (VO2max), a measure of physical fitness, predicted HDL cholesterol (R2 = 0.07, p less than 0.02) and triglyceride (R2 = 0.20, p less than 0.001) concentrations. The data suggest that plasma insulin concentration is an important predictor of HDL cholesterol and triglyceride concentrations independent of BMI, WHR, or VO2max.

  View details for Web of Science ID A1991GQ63000002

  View details for PubMedID 1931867

• THE ROLE OF EXERCISE IN WEIGHT REGULATION IN NONATHLETES SPORTS MEDICINE King, A. C., Tribble, D. L. 1991; 11 (5): 331-349

  Abstract

  Obesity is an extremely prevalent condition that is associated with a range of deleterious health effects. While traditionally considered a disorder primarily of energy intake, accumulating evidence underscores the importance of energy expenditure in the development and treatment of obesity. As the most variable component of energy expenditure, physical activity can influence the development of obesity as well as success in achieving both initial and long term weight loss. Among the types of exercise-related physiological and behavioural factors most likely to be involved in the development of obesity are reductions in the amount of physical activity actually performed, differences in the effect of physical activity on diet-induced thermogenesis, and modeling of deleterious dietary and exercise patterns on the part of the family and other facets of the environment. In contrast, there is relatively little evidence supporting the common belief that obese individuals have a significantly greater energy intake than nonobese individuals. With respect to weight reduction in the already obese, while increased physical activity levels often augment caloric restriction programmes in aiding initial weight loss, evidence suggests that physical activity may be particularly important in helping to sustain initial losses through increased total energy output, preservation of lean body mass, and changes in substrate utilisation. The psychological benefits received from regular participation in a physical activity programme may serve as an additional impetus for engaging in such activities over the long run. Developing programmes to aid in long term adherence to physical activity regimens remains the most critical challenge. Recent results suggest the utility of regular, brief contacts in aiding sustained physical activity participation in individuals attempting to control their weight.

  View details for Web of Science ID A1991FK94300004

  View details for PubMedID 2068436

• IDENTIFYING STRATEGIES FOR INCREASING EMPLOYEE PHYSICAL-ACTIVITY LEVELS - FINDINGS FROM THE STANFORD LOCKHEED EXERCISE SURVEY HEALTH EDUCATION QUARTERLY King, A. C., Taylor, C. B., Haskell, W. L., DeBusk, R. F. 1990; 17 (3): 269-285

  Abstract

  While worksite exercise programs offer a number of potential advantages with respect to increasing physical activity levels in American adults, typical participation rates remain relatively low. The purpose of this study was to explore employee preferences and needs related to physical activity programming in a major work setting in northern California. Two-thirds (399) of a randomly selected sample of employees responded to a mailed survey. Male and female employees reporting no regular aerobic activity over the past two years more strongly endorsed a number of erroneous beliefs concerning exercise, reported less support for engaging in exercise both at home and at work, and avoided even routine types of activity to a greater extent than more active individuals (p values less than 0.001). Current exercisers reported use of a greater number and variety of motivational strategies as part of their exercise program than past exercisers who were not currently active (p less than 0.001). Respondents, regardless of exercise status and age, reported preferences for moderate-intensity activity occurring away from the workplace which could be performed on one's own rather than in a group or class. Implications of the findings with respect to development of educational and behavioral programs for the current employee population are discussed.

  View details for Web of Science ID A1990DX06600004

  View details for PubMedID 2228630

• ARE WOMEN USING POSTMENOPAUSAL ESTROGENS - A COMMUNITY SURVEY AMERICAN JOURNAL OF PUBLIC HEALTH Harris, R. B., Laws, A., Reddy, V. M., King, A., Haskell, W. L. 1990; 80 (10): 1266-1268

  Abstract

  Self-reported estrogen and progestin use in a California community was determined in 1986-87 from a telephone survey of postmenopausal women (n = 954) ages 50-65 years. Current use of hormones was reported by 32 percent; 26 percent took estrogens alone while 6 percent used estrogen + progestin. Comparisons pointed to significant social network and medical care utilization differences. Women who used estrogen therapy were younger, thinner, lived in smaller household units, and were less likely to be widowed.

  View details for Web of Science ID A1990EA29100025

  View details for PubMedID 2400044

• SMOKING IN OLDER WOMEN - IS BEING FEMALE A RISK FACTOR FOR CONTINUED CIGARETTE USE ARCHIVES OF INTERNAL MEDICINE King, A. C., Taylor, C. B., Haskell, W. L. 1990; 150 (9): 1841-1846

  Abstract

  Current national data indicate that a greater percentage of women entering their fifth and sixth decades of life are current, as opposed to former, smokers, while for men the opposite pattern is present. A representative sample of 1876 men and women aged 50 to 65 years living in a northern California community were interviewed to examine factors related to gender differences in quit rates in this age group. In this well-educated community, a significantly greater percentage of women (25.6%) continued to smoke relative to men (18.6%), with a greater percentage of men reporting being former smokers. Multivariate analysis revealed educational level and marital status, rather than gender, to be significant, Independent factors associated both with current cigarette use and with successful quitting. Our data indicate that it is not being female per se, but rather the disparities in educational level and marital status that are linked with being an older woman, that are associated with continued smoking in this age group. In light of this, delivery of relevant information and support on the part of physicians and other health professionals may be of particular use to this population segment.

  View details for Web of Science ID A1990DY36400009

  View details for PubMedID 2393315

• THE RELATIONSHIP BETWEEN REPRESSIVE AND DEFENSIVE COPING STYLES AND BLOOD-PRESSURE RESPONSES IN HEALTHY, MIDDLE-AGED MEN AND WOMEN JOURNAL OF PSYCHOSOMATIC RESEARCH King, A. C., Taylor, C. B., Albright, C. A., Haskell, W. L. 1990; 34 (4): 461-471

  Abstract

  The current study explored the relationship between repressive coping and blood pressure responses at rest and during a mental challenge. One hundred and twenty healthy, middle-aged men and women completed anxiety and defensiveness measures. Subjects scoring below the median on anxiety and above the median on defensiveness were categorized as repressors; those below the median on both measures as low-anxious; those above the median on anxiety and below the median on defensiveness as moderately anxious; and those above the median on both measures as defensive moderately-anxious. As predicted, repressors showed greater systolic blood pressure reactivity in response to a mental challenge relative to the other groups (p less than 0.01). Repressors also had greater resting systolic blood pressure levels than the other groups (p less than 0.001). The findings are discussed with respect to the potential influence of this response pattern on blood pressure and other CVD risk factors and behaviors.

  View details for Web of Science ID A1990DN57200012

  View details for PubMedID 2376846

• DIET VS EXERCISE IN WEIGHT MAINTENANCE - THE EFFECTS OF MINIMAL INTERVENTION STRATEGIES ON LONG-TERM OUTCOMES IN MEN ARCHIVES OF INTERNAL MEDICINE King, A. C., FREYHEWITT, B., Dreon, D. M., Wood, P. D. 1989; 149 (12): 2741-2746

  Abstract

  The effect of a minimal intervention strategy on maintenance of weight lost through either energy restriction alone or exercise alone during the previous year was studied in a sample of middle-aged men. At the end of the initial year of weight loss, dieters (n = 44) and exercisers (n = 46) were randomly assigned to either an intervention condition, comprising monthly mailed informational packets and monthly to quarterly telephone contacts, or an assessment-only condition. The intervention had a significantly greater impact on weight maintenance in exercisers than it did in dieters. In addition, dieters showed a more variable pattern of weight gain and weight loss during the maintenance year than did exercisers. Based on 7-day food records and a 7-day physical activity recall questionnaire, exercisers reported a greater energy intake and a greater amount of time spent in vigorous activity relative to dieters at both the beginning and the end of the maintenance year. We conclude that exercise is easier to maintain in men using minimal contact strategies than dietary approaches to weight control focusing on modification of energy intake, with subsequent benefits in terms of both overall maintenance and stability of weight.

  View details for Web of Science ID A1989CC99300017

  View details for PubMedID 2596943

• INFLUENCE OF REGULAR AEROBIC EXERCISE ON PSYCHOLOGICAL HEALTH - A RANDOMIZED, CONTROLLED TRIAL OF HEALTHY MIDDLE-AGED ADULTS HEALTH PSYCHOLOGY King, A. C., Taylor, C. B., Haskell, W. L., DeBusk, R. F. 1989; 8 (3): 305-324

  Abstract

  Although a variety of psychological benefits have been attributed to regular exercise, few experimentally controlled studies of healthy individuals currently exist. One hundred twenty healthy, sedentary, middle-aged men and women were randomly assigned to either a 6-month home-based aerobic exercise training program or to an assessment-only control condition. Adherence across the 6-month period was found by both self-report and heart rate microprocessor methods to exceed 75% in both sexes. To assess changes in a variety of psychological variables over time, a 14-item Likert rating scale was completed and returned on a biweekly basis throughout the 6-month period. Slope analyses conducted on the 11 items attaining acceptable test-retest reliability coefficients showed significant between-groups differences on the 3 items most closely associated with the actual physical changes that occurred with exercise (all ps less than .004). Implications in relation to repeated measurement of psychological changes in nonclinical populations and the determination of the relevant population-, activity-, and program-specific parameters involved are discussed.

  View details for Web of Science ID A1989AF90200003

  View details for PubMedID 2767021

• INCREASING EXERCISE AMONG BLUE-COLLAR EMPLOYEES - THE TAILORING OF WORKSITE PROGRAMS TO MEET SPECIFIC NEEDS PREVENTIVE MEDICINE King, A. C., Carl, F., BIRKEL, L., Haskell, W. L. 1988; 17 (3): 357-365

  Abstract

  Despite increasing interest in worksite exercise programs, little attention has been focused on the blue-collar segment of the workforce. Because of their low participation in traditional exercise classes and programs, blue-collar workers at a university were targeted for an exercise program tailored specifically to their preferences and needs. Thirty-eight sedentary males employed in operations and maintenance shops on the university campus were evaluated with regard to their current exercise behavior, other health habits, and their preferred types of physical activity programs. A pre- and postprogram submaximal exercise test, weight, and blood pressure measurements were also completed on-site. Twenty-two men (23% of the total blue-collar population) subsequently participated in a 16-week exercise program using an on-site parcourse, and incorporating such motivational strategies as public monitoring, intershop competition, and activity-based incentives. Participation rates were substantially higher than those recorded for previous worksite exercise classes. Participants showed increases in fitness levels (P less than 0.0001) and decreases in weight (P less than 0.05) compared with nonparticipants. Suggestions concerning recruitment of such individuals into low-cost exercise programs and subsequent participation maintenance are discussed.

  View details for Web of Science ID A1988P076900010

  View details for PubMedID 3405990

• PROMOTING DIETARY CHANGE IN ADOLESCENTS - A SCHOOL-BASED APPROACH FOR MODIFYING AND MAINTAINING HEALTHFUL BEHAVIOR AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Saylor, K. E., Foster, S., Killen, J. D., Telch, M. J., Farquhar, J. W., Flora, J. A. 1988; 4 (2): 68-74

  Abstract

  We examined the immediate and long-term effects of a school-based, behaviorally focused dietary change program for tenth-graders. Our behavioral change objectives included increased consumption of complex carbohydrates and decreased intake of saturated fats, sugar, and salt, particularly in the form of snack foods. We randomly assigned tenth-grade classes in two northern California high schools to either a five-session dietary change program or an assessment-only control group. We collected pre- and postprogram self-report data on 218 students in areas of dietary knowledge, behavior, attitudes, food availability in the home, and intentions and self-efficacy concerning eating in specific ways. We also observed school snack choices both directly and indirectly. Our results indicated significant changes in reported behavior, knowledge, and food availability at home, as well as changes in snack choices at school. We found these changes to be durable at one-year follow-up. Our findings suggest ways in which school-based programs focused on behavioral and environmental changes may be effective in promoting dietary changes at school and at home.

  View details for Web of Science ID A1988N201600002

  View details for PubMedID 3395493

• STRATEGIES FOR INCREASING EARLY ADHERENCE TO AND LONG-TERM MAINTENANCE OF HOME-BASED EXERCISE TRAINING IN HEALTHY MIDDLE-AGED MEN AND WOMEN AMERICAN JOURNAL OF CARDIOLOGY King, A. C., Taylor, C. B., Haskell, W. L., DeBusk, R. F. 1988; 61 (8): 628-632

  Abstract

  Two studies were undertaken to compare strategies for the adoption and maintenance of moderate-intensity, home-based exercise training. In the study of adoption, 52 men and women who had served for 6 months as controls for a study of moderate-intensity, home-based exercise training received 30 minutes of baseline instruction. They were then randomized to receive continuing instruction and support through 10 staff-initiated telephone contacts of 5 minutes each every 2 weeks, or to receive no telephone contacts. In subjects receiving telephone contacts, peak oxygen uptake increased significantly after 6 months, whereas no increase was observed in subjects receiving no staff support (p less than 0.05). In the maintenance study, 51 men and women who had significantly increased their peak oxygen uptake by 6 months of moderate-intensity, home-based exercise training were randomized to undergo daily self-monitoring and receive adherence instructions, or undergo weekly self-monitoring only, during a second 6-month period of training. Subjects performing daily self-monitoring reported completing significantly more exercise training sessions during the 6 months of training than subjects performing weekly self-monitoring; functional capacity in both groups remained higher than before training (p less than 0.05). Taken together, these studies suggest that brief baseline instruction followed by continuing telephone contact with staff can be used to help people adopt a moderate-intensity, home-based exercise training program that can be maintained by simple self-monitoring strategies.

  View details for Web of Science ID A1988N611800025

  View details for PubMedID 3344690