Cynthia K. Perry

Sedentary behavior and cardiovascular morbidity and mortality: A science advisory from the American Heart Association

Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiology-based literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes.

Heart-to-Heart: Promoting walking in rural women through motivational interviewing and group support

Background: Walking can significantly increase cardiorespiratory fitness and thereby reduce the incidence of heart disease in women. However, there is a paucity of research aimed at increasing walking in rural women, a high-risk group for heart disease and one for which exercise strategies may pose particular challenges. Purpose: This study tested Heart-to-Heart (HTH), a 12-week walking program, designed to increase fitness through walking in rural women. Heart-to-Heart integrated individual-oriented strategies, including motivational interviewing, and group-based strategies, including team building. Methods: Forty-six rural women were randomized to either HTH or a comparison group. The primary outcome of cardiorespiratory fitness and secondary outcomes of self-efficacy and social support were measured preintervention and postintervention. Group differences were analyzed with repeated-measures analysis of variance. Results: Women in HTH group had a greater improvement in cardiorespiratory fitness (P =.057) and in social support (P =.004) compared with women in the comparison group. Neither group of women experienced a change in exercise self-efficacy (P =.814). Conclusions: HTH was effective in improving cardiorespiratory fitness in a sample of rural women. Further research is needed to refine HTH and determine the optimal approach in rural women to increase their walking.

Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013

Introduction Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity–related policy and environmental strategies for obesity prevention in rural communities. Methods A literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity–related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers. Results Of 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were “enhance infrastructure supporting walking” (n = 11) and “increase opportunities for extracurricular physical activity” (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes. Conclusion Seven of the 12 COCOMO physical activity–related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.

Rural women walking for health.

The purpose of this qualitative study is to describe rural womens barriers and motivators for participation in a walking program. Twenty rural women, ages 22 to 65, participated in a 12-week walking program. Data from field notes and focus groups were analyzed using qualitative content analysis. Data were inductively coded, codes were categorized into themes, and themes were classified as barriers or motivators to adopting a walking program. Three main barriers are identified: balancing family and self, chronic illness gets in the way of routine, and illness or injury breaks routine. Seven motivators are identified: being part of a group, group camaraderie, learning, pacesetter, seeing progress, energizing, and I am a walker. Women report that family responsibilities are a powerful and pervasive barrier. Motivators center on the importance of group interaction. This qualitative study increases our understanding of rural womens barriers and motivators to embarking on and sustaining a regular walking routine.

Heart disease prevention in women: Promoting exercise

Purpose: To reinforce the importance of exercise in reducing heart disease in women and to describe motivational interviewing (MI), an effective and efficient approach to promoting exercise with women in a brief office visit with a nurse practitioner (NP). Data sources: Information was obtained from a literature review. Two brief examples from clinical practice are presented. Conclusions: Although exercise can reduce the risk of heart disease in women, most women do not exercise enough to achieve a risk reduction. Although health promotion is a key goal of the NP, it can be difficult to incorporate in a busy practice. When time is limited, brief MI interactions can be effective in less than 10 min, and the results surpass those of the traditional advice to exercise. Implications for practice: MI is an effective approach to exercise counseling that the NP can quickly learn and successfully conduct within the confines of a brief office visit.

Commitment strength in motivational interviewing and movement in exercise stage of change in women

Purpose: Motivational interviewing (MI) increasingly is used in behavior change counseling. We explored whether commitment verbalized in an initial MI session predicted subsequent physical activity behavior. Data sources: As part of a 12‐week walking program targeted at rural women, an initial MI session was held that was audio‐recorded. We measured commitment strength during this MI session, stage of change (SOC) pre‐ and postintervention, and minutes of physical activity performed during the 12‐week intervention for the 20 women in the intervention. Conclusions: Commitment strength was significantly correlated with SOC, and SOC was significantly correlated with physical activity behavior. However, commitment strength did not predict physical activity. Further research is needed to determine if commitment strength predicts subsequent physical activity. Implications for practice: Understanding the role of the strength of a commitment statement made during an initial MI session could assist the APN in directing follow‐up MI sessions. This information could be useful in improving the cost effectiveness and efficiency of conducting MI.

Feasibility of an Intergenerational Tai Chi Program: A Community-Based Participatory Research Project

Physical activity programs targeted at only older adults or youth have minimal success. The researchers explore intergenerational programming as an approach to promoting physical activity using community-based participatory research. Study goals are to design and assess the feasibility and efficacy for increasing physical activity and social interaction among older adults and youth through an intergenerational physical activity program. Seven older adults and seven youth completed an eight-week tai chi program. There was interaction between the generations and increased physical activity. Further research is warranted to determine the optimal approach to enhance interaction and physical activity between two generations.

Does neighborhood walkability moderate the effects of intrapersonal characteristics on amount of walking in post-menopausal women?

This study identifies factors associated with walking among postmenopausal women and tests whether neighborhood walkability moderates the influence of intrapersonal factors on walking. We used data from the Womens Health Initiative Seattle Center and linear regression models to estimate associations and interactions. Being white and healthy, having a high school education or beyond and greater non-walking exercise were significantly associated with more walking. Neighborhood walkability was not independently associated with greater walking, nor did it moderate influence of intrapersonal factors on walking. Specifying types of walking (e.g., for transportation) can elucidate the relationships among intrapersonal factors, the built environment, and walking.

Active living environment assessments in four rural Latino communities.

Objective Latinos and rural residents are less active and have a greater prevalence of overweight/obesity compared with their non-Latino white and urban counterparts. The objective of this study was to assess the active living environment in four rural, predominantly Latino communities. Methods Assessments were taken using the Rural Active Living Assessment (RALA) in four rural predominantly Latino communities in Central Washington from September–November 2013. Street Segment Assessments of town center, thoroughfare, neighborhood and school zones were assessed for features related to walkability. Physical activity amenities, programs and policies in each town were assessed. Scores were generated for amenities, programs and policies. Data were analyzed with descriptive statistics and logistic regression. Results A total of 103 segments were assessed. Sidewalks in good condition were present in 32% of segments and shoulders in 44% of segments. Half of street segments were rated as walkable. Parks and playgrounds were available; however, half of these were rated in poor condition. All four districts offered after school physical activity programming but only two had a late bus option. Conclusions These four rural towns have some policies, programming and infrastructure in place that support active living. The information from the RALA can be used to inform program and policy development to enhance physical activity in these rural communities.

Places where children are active: A longitudinal examination of children's physical activity

Using two-year longitudinal data, we examined locations where children spent time and were active, whether location patterns were stable, and relationships between spending time in their home neighborhood and moderate to vigorous physical activity (MVPA). At two time points (2007-2009 and 2009-2011), children living in the metropolitans areas of either San Diego, CA or Seattle, WA wore an accelerometer, and parents recorded their childs locations for seven days. Across two years, global average proportion of time spent in each location was stable, but total time and proportion of time in each location spent in MVPA decreased significantly across all locations. Children spent the largest proportion of time in MVPA in their home neighborhood at both time points, although they spent little time in their home neighborhood.