Determinants of physical activity and interventions in adults.
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Biomedical subjects
B H Marcus
Publications and source records attributed to B H Marcus.
Restrictive workplace smoking policies: impact on nonsmokers' tobacco exposure.
The health consequences of exposure to environmental tobacco smoke (ETS) are well documented. Although nonsmokers are generally aware of the health risks of ETS exposure, the majority of nonsmokers are regularly exposed. The most common source of exposure is the workplace. Restrictive workplace smoking policies are being used as a primary means of reducing ETS exposure. However, few studies have focused on the relation between workplace policy and ETS exposure. We performed two studies which examined the relationship between smoking policy, self-reported ETS exposure, and salivary cotinine concentrations. Study I, a pilot study, focused on a workplace-based sample of 106 volunteers; Study 2 examined exposure among 881 nonsmokers in workplace settings. In both studies, more restrictive workplace smoking policies were associated with a lower proportion of nonsmoking volunteers with detectable salivary cotinine. In Study 2, the larger study, the only other variable found to be significantly related to cotinine detection was the presence of smokers in the home. These results suggest that restrictive workplace smoking policies may reduce employees' overall ETS exposure.
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Usefulness of physical exercise for maintaining smoking cessation in women.
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Cognitive-behavioral mediators of changing multiple behaviors: smoking and a sedentary lifestyle.
BACKGROUND: A significant percentage of the U.S. population has multiple poor health behaviors. Understanding the relationship among these behavioral risk factors is important for designing effective multiple risk factor interventions. While there is some evidence suggesting that participation in physical exercise may have a positive impact on smoking cessation, there is much to be learned about the relationships between cognitive-behavioral (self-efficacy, decisional-balance) and motivational mechanisms (stage of change) which have been shown to mediate changes in both exercise and smoking behavior. METHODS: The sample comprised 332 smokers employed at two workplaces-a government agency and a medical center-recruited as part of a larger worksite health promotion project and who completed questionnaires on their smoking and exercise behaviors. RESULTS: The results revealed significant relationships between smoking variables and exercise variables. Smokers who rated as important the positive benefits of smoking also rated as important the costs associated with increased physical activity. Similarly, the negative consequences of smoking were significantly associated with the positive benefits of physical activity. Self-efficacy for one behavior was significantly associated with self-efficacy for the other. Significant differences by exercise and smoking stage of change were found on the cross-behavior sets of variables (self-efficacy, pros, cons). Smokers who were contemplating a more active lifestyle reported the negative consequences of smoking to be significantly more important to them than smokers who were not considering adoption of a more active lifestyle. Smokers who were exercising regularly reported significantly more confidence in their ability to refrain from smoking than smokers not exercising regularly. Finally, smokers preparing for quitting reported less confidence in their ability to exercise than smokers who had already taken action to change their smoking behavior. CONCLUSIONS: The cognitive mechanisms associated with changes in smoking behavior are related to the cognitive variables which have been shown to predict changes in exercise behavior. Significant relationships in mediating mechanisms including decisional balance and self-efficacy between smoking and exercise provide preliminary information on how change in one risk behavior may relate to change in another. These associations have implications for future intervention research and for methods research on multiple risk factors interactions.
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Training physicians to conduct physical activity counseling.
BACKGROUND: In accordance with the U.S. Preventive Services Task Force recommendations, the current pilot study tests the feasibility and efficacy of a physician-delivered physical activity counseling intervention. METHODS: A sequential comparison group design was used to examine change in self-reported physical activity between experimental (counseling and self-help materials) and control (usual care) patients at base-line and 6 weeks after the initial office visit. Patients in both groups were contacted by telephone 2 weeks after their office visit and asked about the physical activity counseling at their most recent physician visit. Experimental patients also received a follow-up appointment to discuss physical activity with their physician 4 weeks after their initial visit. RESULTS: Counseling was feasible for physicians to do and produced short-term increases in physical activity levels. Both groups increased their physical activity, but the increase in physical activity was greater for patients who reported receiving a greater number of counseling messages. CONCLUSIONS: Physician-delivered physical activity interventions may be an effective way to achieve wide-spread improvements in the physical activity of middle-aged and older adults.
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Rationale, design, and baseline data for Commit to Quit: an exercise efficacy trial for smoking cessation among women.
BACKGROUND: The Commit to Quit trial was designed to address the methodological problems of prior studies that have examined the contribution of exercise to smoking cessation. METHODS: This paper provides an overview of the study design and describes the sample of women who participated in this trial (N = 281). Interrelationships among eating, exercise, and smoking behavior are examined. RESULTS: Subjects randomized into the study compared with the sample of women who completed the initial assessment but were not randomized were more likely to be white, to have at least a high school education, and to smoke fewer cigarettes per day. Overall, the most frequent ineligibility criteria were health-related issues and scheduling conflicts. On average, participants in this study smoked more cigarettes per day than national samples of women smokers. Significant interrelationships include the positive association of motivational readiness for quitting smoking and enhanced levels of dietary restraint and the positive association of motivational readiness for exercise adoption and high levels of weight concern. CONCLUSIONS: This study represents the first adequately powered randomized controlled clinical trial comparing the relative efficacy of a cognitive-behavioral smoking cessation treatment plus vigorous exercise with the same treatment plus contact control.
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Reduction in cardiovascular disease risk factors: 6-month results from Project Active.
BACKGROUND: Project Active is a randomized clinical trial that compares a lifestyle physical activity intervention with a traditional structured exercise intervention. The purpose of this paper is to report 6-month results of these interventions on cardiovascular disease (CVD) risk factors among healthy, sedentary, middle-aged men and women, and to examine the psychological strategies used in each group (Lifestyle and Structured) to reach the level of physical activity recommended by the Centers for Disease Control and Prevention (CDC) and American College of Sports Medicine (ACSM) and to achieve changes in these CVD risk factors. METHODS: A total of 116 initially sedentary men (mean +/- SD self-reported physical activity, 33.2 +/- 1.4 kcal.kg-1.day-1) and 119 women (32.9 +/- 1.0 kcal.kg-1.day-1), ages 35-60 years (46.0 +/- 6.7 years) were randomly assigned to a 6-month lifestyle physical activity counseling intervention or a 6-month gymnasium-based structured program. At baseline and 6 months, changes in lipid and lipoprotein-cholesterol concentrations, blood pressure, and body composition and cognitive and behavioral measures of change were assessed. One-way analyses of variance with covariate adjustment were used to test for between-group differences in CVD risk factors. Associations between achieving the CDC/ACSM criterion and changes in cognitive and behavioral measures were assessed with multiple logistic regression models. RESULTS: After 6 months of intervention, 78% of Lifestyle participants and 85% of Structured participants were meeting or exceeding the CDC/ACSM recommendation of accumulating 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week. This was verified by a significant increase in cardiorespiratory fitness in both groups. The adjusted mean increase in maximal METs (VO2peak divided by 3.5 ml.kg-1.min-1) between treadmill tests was 0.4 kcal.kg-1.hr-1 (P < 0.001) for Lifestyle and 1.1 kcal.kg-1.hr-1 (P < 0.001) for Structured. There was a significant difference between intervention groups for this outcome. Both groups had significant reductions in total cholesterol, total cholesterol/HDL-C ratio, diastolic blood pressure, and percentage of body fat. There were no significant between-group differences in changes in these outcomes. Adjusted mean changes in total cholesterol, systolic blood pressure, and percentage of body fat in Lifestyle [in Structured] participants were -0.2 [-0.3] mmol.L-1, -3.2[-1.8] mm Hg, and -1.4 [-1.7] %, respectively. There were significant associations between achieving the CDC/ACSM physical activity criterion and greater use of the cognitive and behavioral strategies of change. Both groups changed self-efficacy and many of the behavioral measures, but there were no significant differences between intervention groups. CONCLUSIONS: These results demonstrate that lifestyle physical activity counseling is as effective as structured exercise programs in increasing physical activity and improving CVD risk factors after 6 months among initially sedentary men and women. Furthermore, specific cognitive and behavioral counseling strategies were increased significantly as a result of the intervention. These strategies are effective and could be used in a wide variety of settings.
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Activity counseling by primary care physicians.
Modifying patients' sedentary lifestyle, a risk factor for many chronic diseases, is a challenge to health professionals. Although physicians can play a vital role in promoting physical activity among sedentary patients, the prevalence of physician-based exercise counseling is low. This paper presents a review of studies that have targeted physicians as agents of behavior change. Changing sedentary behavior is more likely to be effective when the intervention is grounded in theory. This paper outlines an integration of two theoretical models that have potential for enhancing behavior change, and it describes specific techniques for physicians interested in promoting a more active lifestyle among their patients.
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Exercise enhances the maintenance of smoking cessation in women.
We examined the effects of physical exercise on smoking relapse. Twenty previously sedentary female smokers were randomly assigned to smoking cessation plus exercise or smoking cessation with frequency contact control. The smoking cessation program included 12 professionally led sessions over 12 weeks. Exercise treatment included three supervised exercise sessions per week for 15 weeks. Contact control included three women's health/wellness lectures per week for 15 weeks. Smoking abstinence was validated by carbon monoxide and saliva cotinine. Mean exercise attendance for exercise subjects was 88% with an increase in estimated VO2 of 25%. The percentage of subjects who quit for 24 hours was 80% for the exercise and 90% for the contact group. One subject in the contact group remained abstinent at the end of the 12-week treatment and at 1-, 3-, and 12-month follow-ups, whereas three subjects in the exercise group were abstinent at these time points. These results suggest that exercise training improves short-term quit rates and may prove a useful strategy for long-term maintenance of smoking cessation.
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Weight control smoking among sedentary women.
This study examined characteristics associated with weight control smoking among 281 sedentary women enrolled in a smoking cessation trial. A series of regression models were developed to identify predictors of weight control smoking as measured by the Smoking Situations Questionnaire. Predictor variables included demographic variables, dietary intake, weight gain following previous quit attempts, dietary restraint, self-efficacy for weight management, smoking behavior, exercise behavior, negative affect and psychological constructs relevant to smoking cessation, and exercise adoption. In the final predictor model, anticipation of weight gain in the current quit attempt, higher dietary restraint, younger age, greater Fagerstrom scores, greater number of pounds gained in previous quit attempts, and lower levels of self-efficacy to manage weight in negative affect situations were associated with smoking for weight control. Treatment implications for women who smoke for weight control reasons are discussed.
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Exercise effects on withdrawal and mood among women attempting smoking cessation.
This study investigated both acute and longer term ("chronic") effects of vigorous exercise training on affect, nicotine withdrawal, and cigarette craving among women enrolled in a smoking cessation research study. All subjects participated in a 12-week cognitive behavioral smoking cessation program and were randomly assigned to attend three sessions per week of either a vigorous exercise program or contact control. Measures of positive and negative affect, cigarette craving, and nicotine withdrawal were administered immediately before, and again immediately after the final exercise or contact session each week of the program. Study I enrolled 24 women who had been assigned to the exercise condition. Significant reductions in negative affect, nicotine withdrawal and cigarette craving were observed following exercise most weeks of the program. No significant changes in positive affect were observed. In Study II this protocol was repeated among 62 women (44 exercise, 18 contact control) in two consecutive cohorts of the larger study. Significant reduction were observed in negative affect, nicotine withdrawal and cigarette craving during most weeks of the program among exercise subjects but not contact condition subjects. No chronic (baseline to posttreatment) changes in positive or negative affect, cigarette craving or withdrawal symptoms were observed in either study. Vigorous exercise appears to produce acute improvements in withdrawal symptoms, cigarette craving, and negative affect among sedentary women attempting to quit smoking.
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Body image evaluations in women smokers.
While body image has been found to be an important predictor for several health behaviors (abnormal dieting. weight regain, exercise), only one study to date has examined body image attitudes in women smokers (Australian sample) with results suggesting that women smokers feel less attractive than nonsmokers. The purpose of the present study was to compare body image in women smokers to normative samples of women. Subjects were 136 women (89.0% White, M age = 39.85, 74% employed. 52% married, body mass index [BMI] = 25.54) entering a randomized clinical smoking cessation trial. Subjects completed the Appearance Evaluation and Fitness Orientation subscales of the Multidimensional Body-Self Relations Questionnaire and the Silhouette Choosing Task. Pooled t-tests showed that subjects scored significantly lower on Appearance Evaluation (t = -6.58, p < .01) and Fitness Orientation (t = -5.55, p < .01) than the normative sample. For the silhouette choosing task, the present sample reported a significantly higher current silhouette (t = 2.29, p < .05) and dissatisfaction score (t = 4.04, p < .01) than the comparative sample. There were no significant differences on the ideal or attraction scores. Results suggest that women smokers may be more dissatisfied with their bodies than women in general. Possible implications include that smoking may adversely affect body image and/or body image concerns may negatively impact cessation attempts.
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History of depression and subsyndromal depression in women smokers.
While Major Depressive Disorder (MDD) is associated with difficulty quitting smoking, few studies have examined the role of subsyndromal depression (SubD). We examined pretreatment differences in smoking, weight concerns, and negative affect among three groups of women (N = 281) enrolling in a smoking cessation program who responded to a self-report questionnaire about the lifetime presence of MDD symptoms: self-report positive for MDD, self-report positive for SubD, and self-report negative for depression (fulfilling either DSM-III-R symptom or duration criteria, but not both). Compared to MDD Subjects (Ss), SubD Ss were more likely to report eating disordered behaviors. Compared to Non-Depressed (Non-Dep) Ss, SubD Ss initiated smoking earlier, and reported greater previous withdrawal symptoms, more eating disordered behaviors, and higher anxiety, depression, and stress. Compared to Non-Dep Ss, MDD Ss reported a greater smoking rate during their heaviest usage period, greater previous withdrawal symptoms, lower self-efficacy to manage food intake (especially during negative affect situations), and greater depression and anxiety. Many of these significant differences disappeared when SubD Ss were combined with Non-Dep Ss and compared with MDD Ss as is done traditionally. SubD does not appear to be on a continuum with Non-Dep and MDD groups, but rather warrants further investigation as a discrete subset of smokers. The implications for assessment and treatment are discussed.
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Tailoring interventions to promote physically active lifestyles in women.
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Use of a 24-hour recall diary to assess exposure to environmental tobacco smoke.
Methods to assess exposure to environmental tobacco smoke need to be valid and relatively easy to use. We therefore explored the use of a 24-h environmental tobacco smoke exposure-recall diary by comparing data from the 24-h diary with questionnaire responses and levels of salivary cotinine--a biochemical marker of environmental tobacco smoke exposure. A total of 875 nonsmokers at five Rhode Island worksites participated in the study. Twenty-five percent of the participants lived with smokers, and 96% had regular exposure to environmental tobacco smoke at work. Individuals who lived with smokers reported more exposures in the 24-h diary, both outside of work and during work hours, compared with those who had no smokers in their household. The correlation between saliva cotinine concentrations and the exposures recorded in the diary was weak (r = .10). Brief instruments for assessment of environmental tobacco smoke should be viewed cautiously, and use of this 24-h recall diary is not recommended.
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Longitudinal shifts in employees' stages and processes of exercise behavior change.
PURPOSE: This study examines the usefulness of using the stages and processes of change model to explore exercise adoption and maintenance over time. DESIGN: Data for this study were collected as part of the baseline and follow-up survey of participants in a worksite health promotion project. SUBJECTS: Three hundred fourteen employees completed exercise questionnaires. The average age was 41 years, mean body mass index was 26, average years of education were 13, and 66% were women. SETTING: The study was conducted in two worksites, a retail outlet and a manufacturing company. MEASURES: Previously validated questionnaires to determine stages and processes of exercise adoption were administered at baseline and 6-month follow-up, along with questions about demographic variables. RESULTS: Four patterns of stage change emerged: subjects who became more active (adopters, 26%), those who became less active (relapsers, 15%), and those who did not change over time (stable sedentary, 32%; stable active, 27%). Adopters displayed increases in use of the processes of change, whereas relapsers displayed decreases in process use. Stable profiles were associated with no change in process use. CONCLUSIONS: These findings have important implications for research on exercise adoption and maintenance. Interventions tailored specifically to subjects' stage of readiness to be active and using specific processes to help in the change process are warranted at this time.
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What makes a good staging algorithm: examples from regular exercise.
PURPOSE: This study retrospectively compared subjects from three unrelated studies using eight algorithms to stage exercise behavior. SUBJECTS AND SETTINGS: Study One included 936 employees involved in a smoking cessation study at four worksites--a medical center, retail store, manufacturing firm, and a government agency. Study Two included 19,212 members of a New England HMO; and Study Three included a convenience sample of 327 adult New Englanders. MEASURES: The eight algorithms used different descriptions of stages based on the transtheoretical model, as well as different definitions of exercise and response formats. RESULTS: Algorithms using longer, more precise definitions of exercise resulted in larger numbers of subjects being staged in precontemplation and contemplation in comparison to algorithms using shorter definitions, which tended to stage subjects in preparation and action. Maintenance was the most and preparation the least consistently described stage across algorithms. CONCLUSIONS: Alteration of the descriptions of stage and the definition of exercise has consequences for the staging of subjects. Definitions need to be explicit, stating all parameters needed to meet criterion, and subjects must be able to assess themselves. Either a 5-Choice or a true/false response format is effective in assessing stage.
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Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace.
PURPOSE: This study compares the efficacy of a self-help intervention tailored to the individual's stage of motivational readiness for exercise adoption with a standard self-help exercise promotion intervention. DESIGN: Interventions were delivered at baseline and 1 month; assessments were collected at baseline and 3 months. SETTING: Eleven worksites participating in the Working Healthy Research Trial. SUBJECTS: Participants (n = 1559) were a subsample of employees at participating worksites, individually randomized to one of two treatment conditions. INTERVENTION: Printed self-help exercise promotion materials either (1) matched to the individual's stage of motivational readiness for exercise adoption (motivationally tailored), or (2) standard materials (standard). MEASURES: Measures of stage of motivational readiness for exercise and items from the 7-Day Physical Activity Recall. RESULTS: Among intervention completers (n = 903), chi-square analyses showed that, compared to the standard intervention, those receiving the motivationally tailored intervention were significantly more likely to show increases (37% vs. 27%) and less likely to show either no change (52% vs. 58%) or regression (11% vs. 15%) in stage of motivational readiness. Multivariate analyses of variance showed that changes in stage of motivational readiness were significantly associated with changes in self-reported time spent in exercise. CONCLUSIONS: This is the first prospective, randomized, controlled trial demonstrating the efficacy of a brief motivationally tailored intervention compared to a standard self-help intervention for exercise adoption. These findings appear to support treatment approaches that tailor interventions to the individual's stage of motivational readiness for exercise adoption.
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