Judith McDevitt

Menopausal status, moderate-intensity walking, and symptoms in midlife women.

The purpose of this randomized clinical trial study was to determine the effectiveness of a 24-week, home-based, moderate-intensity, walking intervention in improving symptoms (vasomotor, uro-genital/sexual, sleep, psychological, cognitive, physical) experienced by midlife women. One hundred and seventy-three Caucasian and African American women aged 45 to 65 who were not on hormone therapy, had no major signs or symptoms of cardiovascular disease, and were sedentary in their leisure activity were randomly assigned to the moderate-intensity walking group or the nonexercise control group. The exercise prescription was walking at a frequency of 4 times a week for a duration of 20 to 30 minutes. The symptom impact inventory included the frequency, intensity, and bothersomeness of 33 symptoms collected at baseline and 24 weeks. Adherence was measured with a heart rate monitor and exercise log. Average adherence to frequency of walking was 71.6% of the expected walks. After 24 weeks, there were no differences between the walking and control group on change in symptoms. However, multiple regression revealed that frequency of adherence to walking along with change in physical symptoms and menopausal status were significant predictors of change in sleep symptoms. While walking did not improve most symptoms experienced by midlife women, frequency of walking may improve sleep.

Midlife Women's Adherence to Home-Based Walking During Maintenance

BackgroundDespite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3–6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. ObjectiveThe purpose of this study was (a) to describe midlife womens maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. MethodsThere were Black and White women participants (N = 90) aged 40–65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. ResultsRetention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. DiscussionThese results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in womens walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

Neighborhood Environment and Adherence to a Walking Intervention in African American Women

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

Outcomes of a Home-Based Walking Program for African-American Women

Purpose. As compared with minimal treatment (MT), to determine the effectiveness of a home-based walking intervention enhanced by behavioral strategies targeted and tailored to African-American women (enhanced treatment [ET]) on adherence, physical activity, fitness, and body composition at 24 and 48 weeks. Design. Using a quasi-experimental design, treatments were randomly assigned to one of two community health centers. Setting. The centers were in predominately African-American communities. Participants. Sedentary women (156 ET, 125 MT) 40 to 65 years were recruited within a 3-mile radius of each center. Intervention. Both treatments had the same orientation. The ET group had four targeted workshops followed by weekly tailored telephone calls over 24 weeks. Methods. Generalized linear mixed models were used to test effects of treatments on adherence, physical activity, aerobic fitness, and body composition. Results. Adherence was significantly higher in the ET than the MT group and was related to the number of workshops attended (r = .58) and tailored calls (r = .25) received. On-treatment analysis showed significant postintervention improvement in waist circumference and fitness in the ET group; however, these improvements were not statistically different between the two groups. Intent to treat analysis showed a significant increase in fitness, decrease in waist circumference, and no change in body mass index in both treatments. Conclusion. Findings suggest the potential impact of workshop group support on adherence in African-American women.

A Walking Program for Outpatients in Psychiatric Rehabilitation: Pilot Study

The purposes of this quasi-experimental pilot study were to determine adherence to a 12-week group-based moderate-intensity walking program for sedentary adult outpatients with serious and persistent mental illness and to examine change from baseline to after the walking program in health status (mental and physical health, mood, and psychosocial functioning) and exercise motivation (exercise outcomes expectancies, exercise decisional balance). The 15 volunteers in this study were aged 21 to 65 years and enrolled in psychosocial rehabilitation; they participated in a 12-week walking program meeting three times per week for 1 hr, supplemented with four health information workshops delivered at the beginning of the study. Participants received individual exercise prescriptions determined by preprogram fitness testing and used heart rate monitors during walking sessions. Thirteen participants (87%) completed the study and attended 76% of the walking sessions. Overall, they walked at lower intensity than prescribed, with pulses within target heart rate ranges 35% of the time during Weeks 1 through 4, 26% of the time during Weeks 5 through 8, and 22% of the time during Weeks 9 through 12. However, mood improved (Profile of Mood States, t = -2.51, two-tailed, df = 12, p = .02), as did psychosocial functioning (Multnomah Community Ability Scale, two-tailed, df = 12, t = 2.49, p = .02). The findings indicate a walking group may be feasible for rehabilitation programs. In addition to the known cardiovascular risk-reduction benefits of regular walking, walking may improve mood and psychosocial functioning in adults with serious and persistent mental illness.

Neighborhood Characteristics, Adherence to Walking, and Depressive Symptoms in Midlife African American Women

BACKGROUND African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women. METHODS Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included. RESULTS Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks. CONCLUSIONS Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.

Women’s Walking Program for African American women: Expectations and recommendations from participants as experts

Effective interventions that increase adherence to physical activity are important for African American women because generally they are less active and more obese compared to white American women. The purpose of the authors in this study was to elicit from women who began a 12-month physical activity program between 2002 and 2005: (1) their recollections of outcome expectations and barriers, (2) feedback on program components, and (3) suggestions for program change. In 2007, the authors conducted qualitative post-intervention focus group interviews with women who had participated in the enhanced treatment group. Thirty-three African American women aged 44–69 years at the time of the study participated in one of four focus groups held at their community intervention site. Focus groups were formed on the basis of low (walked < 50% of expected walks) versus high (walked ≥ 50% of expected walks) adherence and low (0–2) versus high (3–4) attendance at the four workshops held during the 6-month adoption phase. Audio-taped sessions were transcribed, coded independently, and then uploaded into NVivo7 for final coding and data analysis. Suggestions for future program components include a lifestyle physical activity prescription, pedometers for self-monitoring, ongoing group support, and automated telephone support. Focus group participants can serve as experts to assist in content development for improving program effectiveness.

Smoking Cessation and Serious Mental Illness

A focus group methodology was employed to identify personal, social, and environmental factors that affect smoking cessation in persons with serious mental illness. Four focus groups were held: two for those who had attempted to quit smoking and two for those who had never attempted to quit. Smoking is central to daily survival in patients with serious mental illness. Social and environmental reinforcement can both assist and hinder efforts to stop smoking. Smoke-free environments influence decisions to quit smoking if positive social comparisons with nonsmokers occur. Peer modeling and interpersonal connections with nonsmokers can offer links to forming supportive nonsmoking relationships.

Effectiveness, efficiency, duration, and costs of recruiting for an African American women's lifestyle physical activity program

In a 48-week lifestyle physical activity controlled trial in African American women, we analyzed recruitment effectiveness, efficiency, duration, and costs. Social networking was the most effective approach for inviting women to the trial. Of the 609 who responded to invitations, 514 completed telephone screening; of these, 409 (80%) were found eligible. The health assessment screening was completed by 337 women; of these, 297 (88%) were found eligible. The mean number of days from completion of the telephone and health assessment screenings to beginning the intervention was 23.01, and the mean cost was

Center for Integrated Health Care: primary and mental health care for people with severe and persistent mental illnesses.

74.57 per person. Results suggest that provision of health assessment screening by study staff as part of recruitment is effective for minimizing attrition and also might be cost-effective.