Lesley D. Lutes

How many steps/day are enough? For older adults and special populations

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

Extended-Care Programs for Weight Management in Rural Communities: The Treatment of Obesity in Underserved Rural Settings (TOURS) Randomized Trial

BACKGROUND Rural counties in the United States have higher rates of obesity, sedentary lifestyle, and associated chronic diseases than nonrural areas, yet the management of obesity in rural communities has received little attention from researchers. METHODS Obese women from rural communities who completed an initial 6-month weight-loss program at Cooperative Extension Service offices in 6 medically underserved rural counties (n = 234) were randomized to extended care or to an education control group. The extended-care programs entailed problem-solving counseling delivered in 26 biweekly sessions via telephone or face to face. Control group participants received 26 biweekly newsletters containing weight-control advice. RESULTS Mean weight at study entry was 96.4 kg. Mean weight loss during the initial 6-month intervention was 10.0 kg. One year after randomization, participants in the telephone and face-to-face extended-care programs regained less weight (mean [SE], 1.2 [0.7] and 1.2 [0.6] kg, respectively) than those in the education control group (3.7 [0.7] kg; P = .03 and .02, respectively). The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight-management strategies, and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention. CONCLUSIONS Extended care delivered either by telephone or in face-to-face sessions improved the 1-year maintenance of lost weight compared with education alone. Telephone counseling constitutes an effective and cost-efficient option for long-term weight management. Delivering lifestyle interventions via the existing infrastructure of the Cooperative Extension Service represents a viable means of adapting research for rural communities with limited access to preventive health services. Trial Registration clinicaltrials.gov Identifier: NCT00201006.

Why do pedometers work?: a reflection upon the factors related to successfully increasing physical activity.

The results of two recent independent meta-analyses focused on pedometerbased programmes conclude that they work; that is, they are effective. Specifically, physical activity increases while blood pressure and weight decrease as a result of participating in a pedometer-based intervention. An improved understanding of the unique measurement and motivational properties of pedometers as behaviour-change tools will assist researchers and practitioners to maximize benefits. In an effort to begin to outline why pedometers work, for whom, and under what conditions, the purpose of this current opinion article is to explore the published literature (drawing heavily from those studies previously identified in published meta-analyses and our own work in this area) to identify factors related to using pedometers to increase physical activity. In particular it is important to: (i) gain a better understanding of the activitypromoting characteristics of pedometers; (ii) determine effective elements of pedometer-based programming; and (iii) identify participants who engage in, and benefit most from, such programming. Pedometers are most sensitive to walking behaviours, which is consistent with public health and clinical approaches to increasing physical activity. Specifically, they offer an affordable and accessible technology that is simplistic in output, low-literacy friendly, and immediately understandable to end-users. Support materials are becoming readily available for researchers and practitioners in terms of expected (normative or benchmark) values, patterns of change, indices to aid screening and interpretation, and measurement protocols. Pedometer-based programme theory is now being articulated and tested, and the critical elements necessary to shape a successful programme are becoming more clearly defined. More research is needed, however, to compare the effectiveness of self-selected individualized goals with tailored goals (based on a specified baseline characteristic, for example), standardized goals (e.g. percentage-based increments) and pre-set uniformly administered goals (i.e. a volume total of 10 000 steps/ day or an incremental total of 2000 extra steps/day for everyone). Since most studies of pedometer-based programmes have been of relatively short duration, it is unknown to what extent observed changes are sustainable or whether it is possible to continue to accrue benefits over long-term adherence. Peer delivery of treatment has the potential for enabling wider and less costly dissemination, although this has not been directly evaluated. In addition, the majority of pedometer-based programme participants to date have been women, suggesting that more research is needed onmen and how they react to this form of physical activity intervention. Increases in steps/day have been negatively correlated with baseline values, indicating that those with lower baseline steps/day stand to make the greatest relative incremental increases in physical activity behaviour. A clearly articulated programme theory is lacking in most interventions. A clearer understanding is needed of what programme features, including the nature of goal-setting, are necessary for optimal participant success. Additionally, we need a better profile of the participant who benefits most, and/or requires additional or alternative strategies to succeed in their personal behaviour-change attempts. Continued efforts to refine answers regarding what works well for whom under what conditions will foster evidencebased applications of pedometer-based programmes.

Comparison of Parent-Only vs Family-Based Interventions for Overweight Children in Underserved Rural Settings: Outcomes From Project STORY

OBJECTIVE To assess the effectiveness of parent-only vs family-based interventions for pediatric weight management in underserved rural settings. DESIGN A 3-arm randomized controlled clinical trial. SETTING All sessions were conducted at Cooperative Extension Service offices in underserved rural counties. PARTICIPANTS Ninety-three overweight or obese children (8-14 years old) and their parent(s). INTERVENTION Families were randomized to (1) a behavioral family-based intervention, (2) a behavioral parent-only intervention, or (3) a wait-list control group. OUTCOME MEASURE The primary outcome measure was change in childrens standardized body mass index (BMI). RESULTS Seventy-one children completed posttreatment (month 4) and follow-up (month 10) assessments. At the month 4 assessment, children in the parent-only intervention demonstrated a greater decrease in BMI z score (mean difference [MD], 0.127; 95% confidence interval [CI], 0.027 to 0.226) than children in the control condition. No significant difference was found between the family-based intervention and the control condition (MD, 0.065; 95% CI, -0.027 to 0.158). At month 10 follow-up, children in the parent-only and family-based intervention groups demonstrated greater decreases in BMI z score from before treatment compared with those in the control group (MD, 0.115; 95% CI, 0.003 to 0.220; and MD, 0.136; 95% CI, 0.018 to 0.254, respectively). No difference was found in weight status change between the parent-only and family-based interventions at either assessment. CONCLUSIONS A parent-only intervention may be a viable and effective alternative to family-based treatment of childhood overweight. Cooperative Extension Service offices have the potential to serve as effective venues for the dissemination of obesity-related health promotion programs.

Comparison of program costs for parent-only and family-based interventions for pediatric obesity in medically underserved rural settings.

PURPOSE To compare the costs of parent-only and family-based group interventions for childhood obesity delivered through Cooperative Extension Services in rural communities. METHODS Ninety-three overweight or obese children (aged 8 to 14 years) and their parent(s) participated in this randomized controlled trial, which included a 4-month intervention and 6-month follow-up. Families were randomized to either a behavioral family-based intervention (n = 33), a behavioral parent-only intervention (n = 34), or a waitlist control condition (n = 26). Only program costs data for the parent-only and family-based programs are reported here (n = 67). Assessments were completed at baseline, post-treatment (month 4) and follow-up (month 10). The primary outcome measures were total program costs and cost per child for the parent-only and family interventions. FINDINGS Twenty-six families in the parent-only intervention and 24 families in the family intervention completed all 3 assessments. As reported previously, both intervention programs led to significantly greater decreases in weight status relative to the control condition at month 10 follow-up. There was no significant difference in weight status change between the parent-only and family interventions. Total program costs for the parent-only and family interventions were 13,546 US dollars and 20,928, US dollars respectively. Total cost per child for the parent-only and family interventions were 521 US dollars and 872 US dollars, respectively. CONCLUSIONS Parent-only interventions may be a cost-effective alternative treatment for pediatric obesity, especially for families in medically underserved settings.

A small-change approach delivered via telephone promotes weight loss in veterans: Results from the ASPIRE-VA pilot study

OBJECTIVE High rates of overweight and obesity (70%) among US veterans pose a significant threat of obesity-related chronic disease and disability. The purpose of this pilot study was to demonstrate feasibility and impact of a phone-based small-change weight loss intervention (ASPIRE-VA) with veterans. METHODS Participants received a pedometer, food log book, and treatment manual outlining the small change program. Participants then scheduled weekly phone calls with a lifestyle coach, during which they reviewed the prior weeks goals and developed new goals for the following week. Primary outcome was weight loss measured at 12 weeks, compared to baseline. RESULTS Fourteen sedentary (4471+/-2315 steps per day), obese (37.0+/-4.2 BMI), middle aged (53.8+/-12.5) male (64%) and female (36%) participants were enrolled. At 12 weeks participants exhibited significant weight loss (-3.8+/-3.6 kg; p=.002) and increased intake of fruits and vegetables (+2.2+/-3.1 daily servings; p=.03); though no change in walking (+786+/-2288 daily steps; p=.24). CONCLUSION Results suggest that a phone-based small change program is feasible and beneficial for promoting weight loss in overweight/obese veterans. PRACTICE IMPLICATIONS This telephone-based program has the potential to reduce rates of overweight and obesity among veterans and thus prevent and improve prognosis of associated chronic conditions.

Findings all psychologists should know from the new science on subjective well-being.

Recent decades have seen rapid growth in the science of subjective well-being (SWB), with 14,000 publications a year now broaching the topic. The insights of this growing scholarly literature can be helpful to psychologists working both in research and applied areas. The authors describe 5 sets of recent findings on SWB: (a) the multidimensionality of SWB; (b) circumstances that influence long-term SWB; (c) cultural differences in SWB; (d) the beneficial effects of SWB on health and social relationships; and (e) interventions to increase SWB. In addition, they outline the implications of these findings for the helping professions, organizational psychology, and for researchers. Finally, they describe current developments in national accounts of well-being, which capture the quality of life in societies beyond economic indicators and point toward policies that can enhance societal well-being. Nous avons assisté lors des dernières décennies à une forte croissance de la science du bien-être subjectif, les publications se chiffrant actuellement à environ 14 000 par année. Les constats dont cette littérature savante grandissante font état peuvent être utiles aux psychologues œuvrant dans les domaines de la psychologie appliquée et de la recherche. Les auteurs y décrivent cinq ensembles de récents constats au sujet du bien-être subjectif : (a) la multidimensionnalité du bien-être subjectif; (b) les circonstances qui influencent le bien-être subjectif; (c) l’impact des différences culturelles sur le bien-être subjectif; (d) les effets bénéfiques du bien-être subjectif sur la santé et les relations sociales; et (e) les interventions visant à augmenter le bien-être subjectif. On y précise également les implications de ces constats pour les professions d’aide, la psychologie organisationnelle et les chercheurs. Finalement, les auteurs y décrivent les développements actuels des témoignages de bien-être, lesquels rendent compte de la qualité de vie dans les sociétés, au-delà des indicateurs économiques, et nous guident vers des politiques visant à augmenter le bien-être de la société.

Theoretical models for pedometer use in physical activity interventions

Abstract Background: Research shows that pedometers help to increase daily physical activity. However, much less is known about why pedometers work, specifically as it relates to the theoretical grounding of pedometer-based interventions. Objectives: To complete a full review of the literature regarding the use of theory and specific skills/tools used in pedometer-based interventions as it relates to changes in behaviour across time. Methods: Thirty-one original theoretically-based intervention studies were identified to inform this review of theoretical constructs, intervention strategies, and pedometer contributions that influence walking behaviour. Results: Studies suggest that Social Cognitive Theory (SCT), specifically the behaviours of self-monitoring, feedback, and goal-setting are critical elements for an intervention. While the Theory of Planned Behaviour (TBP) successfully increases motivation, there is less evidence that changing motivation alone translates into behaviour change. However, adding the Implementation Intention (II) Theory appears to hold promise. Using behavioural techniques guided by the Transtheoretical Model (TTM) appear to provide benefit when considering population, the environment, and overcoming environmental barriers. Other and new integrated models are also emerging in this area, such as the small changes model (SCM). Conclusions: While the field of pedometer-based interventions holds significant potential to address the physical inactivity crisis, interventionists should use theory to guide intervention, consistent description of the theory, skills and tools used in an intervention, and reported step counts to compare interventions in order to advance the impact of this important area of research.

High‐frequency binge eating predicts weight gain among veterans receiving behavioral weight loss treatments

To assess for the frequency of binge eating behavior and its association with weight loss in an overweight/obese sample of veterans.

Small-Changes Obesity Treatment Among Veterans: 12-Month Outcomes

BACKGROUND Weight-loss trials tend to recruit highly selective, non-representative samples. Effective weight-loss approaches are needed for real-world challenging populations. PURPOSE To test whether a small-changes intervention, delivered in groups or via telephone, promotes greater weight loss than standard obesity treatment in a predominantly male, high-risk Veteran population. Data were collected in 2010-2012 and analyzed in 2013. DESIGN A three-arm, 12-month randomized pragmatic effectiveness trial. SETTING/PARTICIPANTS Four-hundred eighty-one overweight/obese participants from two Midwestern Veterans Affairs (VA) Medical Centers were randomly assigned to one of three programs: the 12-month Aspiring to Lifelong Health (ASPIRE) weight-loss program delivered (1) individually over the phone (ASPIRE-Phone) or (2) in-person group sessions (ASPIRE-Group); compared to (3) VAs standard weight-loss program (MOVE!). INTERVENTION Twenty-eight sessions with a non-clinician coach via telephone or in-person groups using a small-changes obesity treatment approach compared to a 15-30-session standard VA program. MAIN OUTCOME MEASURES Twelve-month change in weight (kilograms). RESULTS Participants in all three arms lost significant (p<0.01) weight at 12 months. Participants in the ASPIRE-Group arm lost significantly more weight at 12 months than those in the other two treatment arms (-2.8 kg, 95% CI=-3.8, -1.9, in ASPIRE-Group vs -1.4 kg, 95% CI=-2.4, -0.5, in ASPIRE-Phone and -1.4 kg, 95% CI=-2.3, -0.4) in MOVE!(®). ASPIRE-Group resulted in greater improvements in all other anthropometric measures compared to MOVE! at 12 months (p<0.05) and for all (p<0.05) but waist circumference (p=0.23) compared to ASPIRE-Phone. CONCLUSIONS Group-based delivery of the ASPIRE weight management program is more effective than MOVE! and the phone-based version of ASPIRE at promoting sustained weight loss in a predominantly male population with multiple comorbidities. The incremental benefits of group-based ASPIRE over the current MOVE! program could yield significant population-level benefits if implemented on a large scale.