Barth B. Riley

Exercise training in a predominantly African-American group of stroke survivors.

PURPOSE The purpose of this study was to determine the effects of a 12-wk exercise training program in a predominantly African-American group of stroke survivors with multiple comorbidities. METHODS A lag-control group design was employed to provide training to all participants (N = 35). Two 12-wk training iterations were arranged. Participants trained 3 d x wk(-1) for 60 min x d(-1) (cardiovascular, 30 min; strength, 20 min; flexibility, 10 min). Outcome measures included peak VO2 (mL x min(-1), mL x kg(-1) x min(-1), maximal workload (MW), time to exhaustion (TTE), 10 RM on two LifeFitness strength machines, grip strength (GS), body weight (BW), total skinfolds (TS), waist to hip ratio (WHR), hamstring/low back flexibility (HLBF), and shoulder flexibility (SF). RESULTS Compared with controls, the exercise group showed significant gains in peak VO2 (P < 0.01), strength (P < 0.01), HLBF (P < 0.01), and body composition (BW and BMI, P < 0.05; TS, P < 0.01). There was no significant difference between exercise and controls on WHR, SF, and GS. DISCUSSION A supervised exercise training program for stroke survivors with multiple comorbidities was highly effective in improving overall fitness, potentially reducing the risk of further disease and disability. Greater effort must be made on the part of the public health community to increase access to community-based physical activity programs for persons with stroke.

A New Measure for Assessing the Physical Activity Behaviors of Persons With Disabilities and Chronic Health Conditions: The Physical Activity and Disability Survey

Purpose. Assess the psychometric properties of the Physical Activity and Disability Survey (PADS), a new physical activity measure for persons with disabilities and chronic health conditions. Design. Cross-sectional and pre-post designs were employed. Setting. A Midwestern university fitness center. Subjects. Participants were 103 individuals with disabilities and/or chronic health conditions. Measures. The Physical Activity and Disability Survey (PADS), peak oxygen uptake (peak VO2), maximum workload (MW), and time to exhaustion (TE) during exercise. Results. Factor analysis revealed a four-factor model that generally corresponded to PADS subscales. Cronbach alpha coefficients ranged from .67 (Exercise) to .77 (Time Indoors). Test-retest reliability (1-week interval) ranged from .78 (Time Indoors) to .95 (Leisure Time Physical Activity). Interrater reliability ranged from .92 (Household Activities) to .99 (Exercise, Leisure Time Physical Activity, Total Activity). Significant (p < .05) correlations were found between PADS subscales and absolute peak VO2 (Leisure Time Physical Activity, Household Activity, Total Activity), relative peak VO2 (Exercise, Time Indoors), MW (Time Indoors, Household Activity), and TE (Household Activity, Total Activity). Analyses of variance revealed that, unlike controls, health promotion program participants evidenced significant pre-post gains as measured by the Exercise subscale and Total Activity score. Conclusions. The findings lend support for the reliability and validity of the PADS as a measure of physical activity of groups who are sedentary and disabled.

Effects of a short-term health promotion intervention for a predominantly African-American group of stroke survivors.

BACKGROUND The study examined the effects of a 12-week health promotion intervention for a predominantly urban African-American population of stroke survivors. DESIGN A pre-test/post-test lag control group design was employed. PARTICIPANTS/SETTING Participants were 35 stroke survivors (9 male, 26 female) recruited from local area hospitals and clinics. MAIN OUTCOME MEASURES Biomedical, fitness, nutritional, and psychosocial measures were employed to assess program outcomes. RESULTS Treatment group made significant gains over lag controls in the following areas: (1) reduced total cholesterol, (2) reduced weight, (3) increased cardiovascular fitness, (4) increased strength, (5) increased flexibility, (6) increased life satisfaction and ability to manage self-care needs, and (7) decreased social isolation. CONCLUSION A short-term health promotion intervention for predominantly African-American stroke survivors was effective in improving several physiological and psychological health outcomes.

Development and validation of AIMFREE: Accessibility Instruments Measuring Fitness and Recreation Environments

Purpose: The purpose of this study was to develop and validate a series of 16 survey instruments measuring fitness and recreation accessibility, collectively referred to as AIMFREE (Accessibility Instruments Measuring Fitness and Recreation Environments). General domains of assessment included the built environment, equipment, programmes, policies, and training and behaviour. Methods: Fitness and recreation professionals (n = 35) assessed fitness centres/swimming pools (n = 35) in nine regions across the US. Rasch analysis was used to assess the psychometric properties of the instrument. Results: The AIMFREE evidenced adequate to good fit to the Rasch model and adequate to good internal consistency (r = 0.70 – 0.90). Test-retest reliability ranged from 0.70 (entrance areas) to 0.97 (swimming pools). Analysis of differential item functioning indicated that item calibrations generally did not differ significantly between urban and suburban environments. Conclusion: The AIMFREE instruments demonstrated adequate to good fit to the Rasch model with several of the subscales demonstrating well to excellent separation of facility accessibility.

Exercise training for African Americans with disabilities residing in difficult social environments.

OBJECTIVE To examine the feasibility, efficacy, and safety of a structured 12-week exercise training program for a predominantly African-American group of adults with multiple health conditions who reside in difficult social environments. METHODS A total of 37 females and 7 males (mean age, 54.1 years) participated in an exercise training regimen 3 days per week for 60 minutes per day (cardiovascular, 30 minutes; strength, 20 minutes; and flexibility, 10 minutes). Outcome measures included peak VO(2) (mL min(-1), mL kg(-1) min(-1)); upper and lower body strength (strength); hand-grip strength (GS); body weight (BW); total skin folds (TS); waist-to-hip ratio (WHR); hamstring/low-back flexibility (HLBF); and shoulder flexibility (SF). RESULTS Compared to the control group, the exercise group showed significant gains in peak VO(2) (p < 0.01); strength (p < 0.01); and body composition (TS, p < 0.01). There was no significant difference between the exercise and control groups on BW, WHR, HLBF, and GS. Of a total 1116 exercise sessions (31 experimental participants x 36 sessions), 87% of the sessions were attended. CONCLUSIONS A structured exercise-training program can provide substantial improvement in strength and cardiovascular fitness in low-income, sedentary adults with multiple chronic conditions and/or risk factors for chronic conditions. Future research should explore simple home-based and community-based physical activity interventions that provide ongoing support for increasing and maintaining physical activity participation in this cohort.

Validation of the Crime and Violence Scale (CVS) Against the Rasch Measurement Model Including Differences by Gender, Race, and Age

In assessing criminality, researchers have used counts of crimes, arrests, and so on, because interval measures were not available. Additionally, crime seriousness varies depending on demographic factors. This study examined the Crime and Violence Scale (CVS) regarding psychometric quality using item response theory (IRT) and invariance of the crime seriousness hierarchy for gender, age, and racial/ethnic groups on 7,435 respondents. The CVS is a useful measure of criminality, though some items could be improved or dropped. Differential item functioning (DIF) analysis revealed that crime seriousness varies by age and gender. IRT shows promise in assessing and adjusting for demographic variations in crime seriousness.

Curtailment and Stochastic Curtailment to Shorten the CES-D

The Center for Epidemiologic Studies–Depression (CES-D) scale is a well-known self-report instrument that is used to measure depressive symptomatology. Respondents who take the full-length version of the CES-D are administered a total of 20 items. This article investigates the use of curtailment and stochastic curtailment (SC), two sequential analysis methods that have recently been proposed for health questionnaires, to reduce the respondent burden associated with taking the CES-D. A post hoc simulation based on 1,392 adolescents’ responses to the CES-D was used to compare these methods with a previously proposed computerized adaptive testing (CAT) approach. Curtailment lowered average test lengths by as much as 22% while always matching the classification decision of the full-length CES-D. SC and CAT achieved further reductions in average test length, with SC’s classifications exhibiting more concordance with the full-length CES-D than do CAT’s. Advantages and disadvantages of each method are discussed.

Medical assistant coaching to support diabetes self-care among low-income racial/ethnic minority populations: randomized controlled trial.

Innovative, culturally tailored strategies are needed to extend diabetes education and support efforts in lower-resourced primary care practices serving racial/ethnic minority groups. A randomized controlled trial (RCT) examined the effect of a diabetes self-care coaching intervention delivered by medical assistants and the joint effect of intervention and ethnicity over time. The randomized repeated-measures design included 270 low-income African American and Hispanic/Latino patients with type 2 diabetes. The 1-year clinic- and telephone-based medical assistant coaching intervention was culturally tailored and guided by theoretical frameworks. A1C was obtained, and a self-care measure was completed at baseline, 6 months, and 12 months. Data were analyzed using mixed-effects models with and without adjustment for covariates. There was a significant overall improvement in mean self-care scores across time, but no intervention effect. Results revealed differences in self-care patterns across racial/ethnic subgroups. No differences were found for A1C levels across time or group.

Ecological momentary assessment of environmental and personal factors and snack food intake in African American women

This study examined contributions of environmental and personal factors (specifically, food availability and expense, daily hassles, self-efficacy, positive and negative affect) to within-person and between-person variations in snack food intake in 100 African American women. Participants were signaled at random five times daily for seven days to complete a survey on a study-provided smartphone. Women reported consuming snack foods at 35.2% of signals. Easier food availability accounting for ones usual level was associated with higher snack food intake. Being near outlets that predominately sell snacks (e.g., convenience stores), while accounting for ones usual proximity to them, was associated with higher snack food intake. Accounting for ones usual daily hassle level, we found that on days with more frequent daily hassles snack food intake was higher. The positive association between within-person daily hassles frequency and snack food intake was stronger when foods were easily available. Public and private policies to curb ubiquitous food availability and mobile health interventions that take into account time-varying influences on food choices and provide real-time assistance in dealing with easy food availability and coping with stressors may be beneficial in improving African American womens day to day food choices.

Disparities in patients presenting to the emergency department with potential acute coronary syndrome: It matters if you are Black or White

OBJECTIVES To explore disparities between non-Hispanic Blacks and non-Hispanic Whites presenting to the emergency department (ED) with potential acute coronary syndrome (ACS). BACKGROUND Individuals with fewer resources have worse health outcomes and these individuals are disproportionately those of color. METHODS This prospective study enrolled 663 patients in four EDs. Clinical presentation, treatment, and patient-reported outcome variables were measured at baseline, 1, and 6 months. RESULTS Blacks with confirmed ACS were younger; had lower income; less education; more risk factors; more symptoms, and longer prehospital delay at presentation compared to Whites. Blacks experiencing palpitations, unusual fatigue, and chest pain were more than 3 times as likely as Whites to have ACS confirmed. Blacks with ACS had more clinic visits and more symptoms 1 month following discharge. CONCLUSIONS Significant racial disparities remain in clinical presentation and outcomes for Blacks compared to Whites presenting to the ED with symptoms suggestive of ACS.