Carol Rheaume

Active for Life : Final Results from the Translation of Two Physical Activity Programs

BACKGROUND Most evidence-based programs are never translated into community settings and thus never make a public health impact. DESIGN 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. SETTING/PARTICIPANTS 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). INTERVENTION 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. MAIN OUTCOME MEASURE Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure. RESULTS 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. CONCLUSIONS 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 adults health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

Results of the First Year of Active for Life: Translation of 2 Evidence-Based Physical Activity Programs for Older Adults Into Community Settings

OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

African American Men's Perspectives on Promoting Physical Activity: “We're Not That Difficult to Figure Out!”

African American men report poorer health than do White men and have significantly greater odds for developing chronic diseases partly because of limited physical activity. Understanding how to encourage healthy behaviors among African American men will be critical in the development of effective physical activity messages and programs. Guided by principles of cultural sensitivity and social marketing, this research examined middle-aged and older African American mens recommended strategies for promoting physical activity to African American men of their age. The authors report results from 49 interviews conducted with middle-aged (45–64 years) and older (65–84 years) African American men in South Carolina. Four groups of African American men were recruited: middle-aged active men (n = 17), middle-aged inactive men (n = 12), older active men (n = 10), older inactive men (n = 10). Themes related to marketing and recruitment strategies, message content, and spokesperson characteristics emerged and differed by age and physical activity level. Recommended marketing strategies included word of mouth; use of mass media; partnering with churches, businesses, and fraternities; strategic placement of messages; culturally appropriate message framing; and careful attention to selection of program spokespersons. Findings will help in the marketing, design, implementation, and evaluation of culturally appropriate interventions to encourage physical activity among middle-aged and older African American men in the South.

Exploring the feasibility of a physical activity intervention for midlife African American men

BACKGROUND This study tested the initial efficacy of implementing a physical activity (PA) behavior change intervention for midlife African American (AA) men. METHODS Intervention components were based on information gathered during formative research preceding the intervention. Eligible participants were underactive AA men ages 45-66 years. In a quasi-experimental pre-post design, participants attended 90-min program sessions twice weekly for 8 weeks. Session topics specific to PA included overcoming barriers, gaining social support, setting goals, tracking progress and integrating into ones lifestyle. Participants were assigned to teams to facilitate group discussion, problem solving, accountability and camaraderie. RESULTS 25 AA men (mean age = 54.7 ± 4.8 years) completed the intervention. After 8 weeks, significant (P < 0.05) positive changes were observed for moderate to vigorous-intensity PA (+7.3 hour week(-1)) and overall PA (+9.4 hour week(-1)), self-efficacy for PA (+12%), social support for PA from family (+28%) and friends (+53%), self-regulation for planning (+33%) and goal setting (+48%) and each fitness component (+9 to +144%). Based on a post-intervention satisfaction survey, participants rated the program very positively. CONCLUSION These positive results attest to the feasibility of successfully engaging midlife AA men in a tailored PA behavior change program.

Sustainability of evidence-based community-based physical activity programs for older adults: lessons from Active for Life

Program sustainability in community and healthcare settings is critical to realizing the translation of research into practice. The purpose of this study is to describe the implementation and assessment of an intervention to increase organizational maintenance of evidence-based physical activity programs and the factors that impede or facilitate sustainability. All organizations implemented a sustainability action plan that included identifying factors related to sustainability, examining resources available, identifying program modifications to enhance sustainability, and long-term action planning. A mixed methods approach was used. Organizational (n = 12 sites) ability to demonstrate program effectiveness, align priorities with the organizational mission, and integrate the program within the existing infrastructure were strengths related to sustainability. Sites were more optimistic about program sustainability when they had less reliance on internal financial, but more reliance on internal human resources to run the program post-funding. The study resulted in a number of tools that can help community organizations plan for sustainability of physical activity programs.

Evolution of murine alpha 1-proteinase inhibitors: gene amplification and reactive center divergence.

The organization and sequence of genes encoding the α1-proteinase inhibitor (α1PI), a major serine proteinase inhibitor of the mammalian bloodstream, have been compared in several species, including murine rodents (genus Mus). Analysis of gene copy number indicates that amplification of α1PI genes occurred at some time during evolution of the Mus genus, leading to fixation of a family of about three to five genes in several existing species (e.g., M. domesticus and M. saxicola), and only a single gene in others (e.g., M. caroli). A phylogeny for the various mammalian α1PI mRNAs was constructed based upon synonymous substitutions within coding regions. The mRNAs in different murine species diverged from a common ancestor before the formation of the first species lineages of the Mus genus, i.e., about 10–13 million years ago. Thus, α1PI gene amplification must have occurred prior to Mus speciation; gene families were retained in some, but not all, murine species. The reactive center region of the α1PI polypeptide, which determines target protease specificity, has diverged rapidly during evolution of the Mus species, but not during evolution of other mammalian species included in the analysis. It is likely that this accelerated evolution of the reactive center, which has been noted previously for serine proteinase inhibitors, was driven by some sort of a positive Darwinian selection that was exerted in a taxon-specific manner. We suggest that evolution of α1PI genes of murine rodents has been characterized by both modification of gene copy number and rapid reactive center divergence. These processes may have resulted in a broadened repertoire of proteinase inhibitors that was evolutionarily advantageous during Mus speciation.

Understanding the Challenges Encountered and Adaptations Made by Community Organizations in Translation of Evidence-Based Behavior Change Physical Activity Interventions: A Qualitative Study

Purpose. Designing programs for mid-life to older adults whose sedentary behaviors are associated with increased health risks is crucial. The U.S. Task Force on Community Preventive Services strongly recommends individually adapted behavior change programs as one approach to increasing physical activity in communities. The purpose of this study is to report challenges organizations faced when translating two evidence-based programs in real-world settings, adaptations made, and whether or not fidelity was negatively impacted by these adaptations. Design: A grounded theory approach to qualitative research was used. Setting and Participants: Nine community organizations across the country participated. Two organizations had more than one site participating, for a total of 12 sites from nine organizations. Within those organizations, 2796 participants were part of the program during the first 2 years. Participants were underactive (i.e., not meeting Centers for Disease Control and Prevention and American College of Sports Medicine recommendations) mid- to older-aged adults. Methods: Community organizations participated in monthly conference calls, and program information was entered into an electronic database regularly. Data obtained from the calls and database were used for analyses. Results: Challenges and adaptations emerged in three categories: (1) program logistics, (2) program theory, and (3) program philosophy. Conclusion: Challenges were present for community organizations; however, with some level of adaptation, the community organizations were able to effectively deliver and maintain fidelity in two evidence-based physical activity programs to a large and diverse group of mid- to older-aged adults.

Molecular genetics of androgen-inducible RP2 gene transcription in the mouse kidney.

Androgen control of the RP2 gene in the mouse kidney has been modified during evolution. In inbred mice (Mus domesticus), the concentrations of mRNAs encoded by RP2 undergo a 10- to 12-fold induction in response to testosterone; in other Mus species (e.g., Mus hortulanus and Mus caroli), induction ranges from none to about two- to fourfold. In this communication, we show that androgens induced RP2 transcription in M. domesticus, although this induction may not have fully accounted for the increase in mRNA levels. Reduced mRNA inducibility in M. hortulanus and in several other species was associated with an absence of transcriptional induction. Analysis of an interspecies backcross population indicated that the difference in RP2 inducibility between M. domesticus and M. hortulanus was due to a single Mendelian locus tightly linked (0 of 47 recombinants) to RP2. The RP2 gene was found to contain at least two promoters, only one of which was highly sensitive to testosterone. These results indicate that induction of the RP2 mRNAs, as well as interspecies variations in RP2 inducibility, are primarily a consequence of effects on this promoter.