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Bess H Marcus

Publications and source records attributed to Bess H Marcus.

At least 19 recordsLinked to original sources
PubMed2006

Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research.

In this review, our first purpose is to provide an overview of existing physical activity intervention research, focusing on subpopulations and intervention modalities. Our reviews within each area are not exhaustive or quantitative, as each area has been reviewed in more depth in numerous other reports. Instead, our goal is to provide a single document that provides a qualitative overview of intervention research that emphasizes selected topics of particular importance for improving the population-wide impact of interventions. Therefore, in synthesizing this vast literature, we begin with existing reviews of physical activity research in each area and incorporate in our discussions recent reports of well-designed individual physical activity intervention studies that expand the existing research base and/or target new areas of research. Our second purpose is to offer new ideas and recommendations to improve the state of the science within each area and, where possible, to propose ideas to help bridge the gaps between these existing categories of research.

Adolescent↗
PubMed2006

Outcomes from the women's wellness project: a community-focused physical activity trial for women.

BACKGROUND: Given the low rates of physical activity participation, innovative intervention approaches are needed to make a public health impact. METHODS: The study was conducted at the Miriam Hospital/Brown Medical School in Providence, RI, and in communities of Southeastern Massachusetts from 2002 to 2005. Previously sedentary women (n = 280; mean age = 47.1; 94.6% Caucasian) were randomly assigned to one of three conditions: (1) Choose to Move, a self-help printed booklet (n = 93), (2) Jumpstart, a motivationally tailored, print based intervention (n = 95); or (3) Wellness, women's health materials (n = 92). Face-to-face contact at months 3 (M3) and 12 (M12) occurred within participants' communities in local libraries. RESULTS: At M3, participants in the Jumpstart condition reported significantly more minutes of physical activity per week (M = 140.4, SE = 14.82) than participants in the Wellness condition (M = 98.1, SE = 15.09), (t(275) = 2.00, p < 0.05). The Jumpstart arm showed a trend towards significance (t(275) = 1.93, p = 0.054) when compared with the CTM arm (M = 99.5, SE = 15.11); there was no significant difference between the CTM and Wellness arms (t(275) = 0.07, p = NS). At M12, there were no significant differences (F(2,275) = 0.147, p = NS) between any of the treatment arms. CONCLUSIONS: Results suggest that print-based programs for physical activity may be efficacious short-term, but more research is needed to find approaches that are effective long-term. It is possible to deliver print-based programs through existing community infrastructures, however these approaches need further evaluation to examine maintenance effects apart from the demand characteristics of a research study.

Adult↗
PubMed2006

Examination of print and telephone channels for physical activity promotion: Rationale, design, and baseline data from Project STRIDE.

BACKGROUND: Project STRIDE is a 4-year randomized controlled trial comparing two computer-based expert system guided intervention delivery channels (phone vs. print) for physical activity adoption and short-term maintenance among previously sedentary adults. METHODS: Sedentary adults (n=239) were randomized to one of the following (1) telephone-based, individualized motivationally-tailored feedback; (2) print-based, individualized motivationally-tailored feedback; (3) contact-control delayed treatment group (received intervention after 12 months as control). This paper: (1) outlines the study design, rationale, and participant sample; and (2) describes relationships between baseline variables to better understand their influence on the efficacy of the intervention. RESULTS: Participants averaged 19.8+/-25.0 min of physical activity/week that was at least of moderate intensity, with no group differences. The average estimated VO(2) at 85% of maximum heart rate was 25.6 ml/kg/min. Body fat was 34.1% for women and 23.2% for men and the BMI of the sample averaged 28.5 kg/m(2). CONCLUSIONS: Project STRIDE examines non face-to-face approaches for promoting physical activity behavior. It has unique features including a direct comparison of an expert system guided intervention delivered via phone or print. Future analyses will examine the cost-effectiveness of the interventions and this will likely yield important information for policy-makers.

Adult↗
PubMed2006

Worksite and communications-based promotion of a local walking path.

Current research has shown relationships between the environment (eg, parks and trails) and levels of physical activity participation. This study was designed to implement and evaluate a communications based worksite campaign to promote awareness of an existing local walking path and to increase walking. Promotional materials were distributed for 1 month via flyers, email, website postings, and during bi-weekly information booths. Evaluations were conducted at baseline, during, and following the promotional campaign. Borderline statistically significant increases in walking activity from baseline were observed midway through the campaign (p = 0.069) and following the campaign (p = 0.075). Counts observed during the intervention were almost triple those at baseline and increased in the post-campaign phase to approximately three and a half times those at baseline. Sign recognition surveys revealed at baseline, 51% of the participants correctly identified the walking path signs, which increased to 65% during the campaign (p = .0674). Familiarity with physical activity messages around the workplace increased from 64.6% at baseline to 75.5% during the campaign (p = .097). This study shows initial promise of a theoretically based communications intervention to increase knowledge of physical activity and to promote walking.

Adult↗
PubMed2006

Psychosocial factors related to physical activity and weight loss in overweight women.

PURPOSE: This study examined whether psychosocial factors related to physical activity in overweight, previously sedentary women were affected by a 6-month behavioral weight loss program. In addition, these psychosocial factors were examined across levels of weight loss and self-reported physical activity in response to a weight loss intervention. METHODS: Data from 165 overweight (body mass index (BMI) = 32.7 +/- 4.2 kg.m(-2)) women (age = 37.6 +/- 5.5 yr) who participated in a comprehensive behavioral weight loss program that included behavioral education, moderate caloric restriction, and progressive home-based exercise were examined. Body weight was assessed at 0 and 6 months. Perceived benefits and barriers, physical activity self-efficacy, and physical activity processes of change were assessed at 0 and 6 months. Physical activity (minutes per week of at least moderate-intensity activity) was assessed using the 7-Day Physical Activity Recall at 0 and 6 months. RESULTS: The intervention resulted in increases in physical activity self-efficacy, behavioral processes of change, and several cognitive processes of change(P < 0.05). There was a reduction in expected barriers for physical activity (P < 0.05). Individuals with > or = 10% weight loss reported higher levels of physical activity self-efficacy, greater use of behavioral strategies to elicit social support, and fewer barriers to physical activity than those with lower levels of physical activity and less weight loss (P < 0.05). Individuals reporting higher levels of exercise also reported higher levels of physical activity self-efficacy, greater use of behavioral strategies, and fewer barriers to physical activity than those individuals with lower levels of physical activity (P < 0.05). CONCLUSION: Targeting self-efficacy, behavioral strategies, and barriers in weight management programs may improve physical activity, which may result in improved weight loss in overweight adults.

Adult↗
PubMed2005

Home-based physical activity intervention for breast cancer patients.

PURPOSE: The efficacy of a home-based physical activity (PA) intervention for early-stage breast cancer patients was evaluated in a randomized controlled trial. PATIENTS AND METHODS: Eighty-six sedentary women (mean age, 53.14 years; standard deviation, 9.70 years) who had completed treatment for stage 0 to II breast cancer were randomly assigned to a PA or contact control group. Participants in the PA group received 12 weeks of PA counseling (based on the Transtheoretical Model) delivered via telephone, as well as weekly exercise tip sheets. Assessments were conducted at baseline, after treatment (12 weeks), and 6 and 9 month after baseline follow-ups. The post-treatment outcomes are reported here. RESULTS: Analyses showed that, after treatment, the PA group reported significantly more total minutes of PA, more minutes of moderate-intensity PA, and higher energy expenditure per week than controls. The PA group also out-performed controls on a field test of fitness. Changes in PA were not reflected in objective activity monitoring. The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines. No significant group differences were found in body mass index and percent body fat. Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group. There was a positive trend in intervention effects on overall mood and body esteem. CONCLUSION: The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients. The success of a home-based PA intervention has important implications for promoting recovery in this population.

Adult↗
PubMed2005

Effects of using a computer in a doctor's office on patient attitudes toward using computerized prompts in routine care.

BACKGROUND: We undertook this investigation to understand the effect of using a computer in a primary care setting on attitudes toward using computers to improve health services delivery. METHODS: In this analysis, we compared the acceptability data from the group of primary care patients from 10 community-based practices who did not use a computer program, and answered the questions hypothetically, with data from a group of patients who actually used a program such as one proposed in the survey taken by the first group of patients. Attitudes toward three uses of the program, screening, counseling and changing treatments were measured, as well as attitudes toward specific aspects of the program, such as security. RESULTS: The great majority of patients who used the program believed that the program was not too long (80.1%), was easy to use (82.3%) and that the questions were not hard to answer (75.7%). Also, on average only 20% of patients had concerns about the privacy and confidentiality of using the program. Patients who had used the computer program were significantly less likely to favor its use for screening [odds ratio (OR)=0.09, 95% confidence interval (CI)=0.04-0.19], counseling [OR=0.13 (95% CI=0.05-0.31)] and changing treatments for chronic conditions, such as hypertension [OR=0.12 (95% CI=0.07-0.23)]. Patients who felt that the computer took too long to use were less likely to favor its use for each of the three uses. CONCLUSIONS: Despite acceptability ratings that were high and consistent with ratings observed in other studies, exposure to the program significantly diminished support for using it in routine care. These findings highlight the need for measuring overall program acceptability in the context of a realistic use scenario and for correlating overall acceptability with acceptability of individual program components and attitudes, as a means for identifying opportunities for program improvement.

Adult↗
PubMed2005

Prevalence and predictors of multiple behavioral risk factors for colon cancer.

OBJECTIVES: This paper examines the prevalence of behavioral risk factors for colorectal cancer (CRC) (e.g., red meat consumption, fruit and vegetable intake, multivitamin intake, alcohol, smoking, and physical inactivity), co-occurrence among these behaviors, and motivation for change among patients at increased risk. METHODS: The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone. RESULTS: Sixty-six percent of participants had not been diagnosed with polyps before. Fifty-eight percent of the sample had red meat as a risk factor, 63% had fruit and vegetable consumption as a risk factor, 54% did not take a daily multivitamin, and 44% had physical activity as a risk factor. In contrast, only 9% of the sample had alcohol consumption as a risk factor and only 14% were current smokers. The prevalence of the six individual risk factors was combined into an overall multiple risk factor score (MRF). The average number of risk factors was 2.43. Men, those with a high school education or below, those reporting fair or poor health status, and those with less self-efficacy about risk factor change had more risk factors. CONCLUSIONS: There is a need for multiple risk factor interventions that capitalize on natural intersections among intra- and interpersonal factors that maintain them.

Adult↗
PubMed2005

The efficacy of moderate-intensity exercise as an aid for smoking cessation in women: a randomized controlled trial.

Evidence suggests that vigorous-intensity exercise interventions may be effective for smoking cessation among women; however, few studies have examined the efficacy of a moderate-intensity exercise program. The present study examined the efficacy of moderate-intensity exercise for smoking cessation among female smokers. Healthy, sedentary female smokers (N = 217) were randomly assigned to an 8-week cognitive-behavioral smoking cessation program plus moderate-intensity exercise (CBT+EX) or to the same cessation program plus equal contact (CBT). A subsample received nicotine replacement therapy. Results indicated that the CBT+EX and CBT groups were equally likely to attain smoking cessation at the end of treatment, as measured by cotinine-verified 7-day point-prevalence abstinence (20.2% for CBT+EX vs. 18.5% for CBT). The CBT+EX group was more likely to report smoking cessation, as measured by 7-day point prevalence at the 3-month follow-up (11.9% vs. 4.6%, p<.05), compared with the CBT group. No group differences were found at 12 months by either 7-day point prevalence (7.3% for CBT+EX vs. 8.3% for CBT) or continuous abstinence (0.9% for CBT+EX vs. 0.9% for CBT). Additionally, among participants in the CBT+EX group, those with higher adherence to the exercise prescription were significantly more likely to achieve smoking cessation at the end of treatment than were participants reporting lower adherence to exercise. Our findings indicate that the empirical support for moderate-intensity exercise as an adjunctive treatment to CBT for smoking cessation may be limited. Perhaps future studies could compare moderate- vs. vigorous-intensity physical activity to test their relative efficacy.

Adult↗
PubMed2005

Project PREVENT: a randomized trial to reduce multiple behavioral risk factors for colon cancer.

BACKGROUND: This report examines the outcome data for Project PREVENT, a two-site randomized control trial designed to reduce behavioral risk factors for colorectal cancer among individuals who have been diagnosed with adenomatous colon polyps. METHODS: The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone, and were randomized to either Usual Care (UC) or the PREVENT intervention, which was designed to target multiple risk factors. The intervention consisted of a telephone-delivered intervention plus tailored materials, and focused on the six primary behavioral risk factors for colorectal cancer, including red meat consumption, fruit and vegetable intake, multivitamin intake, alcohol, smoking, and physical inactivity. RESULTS: Participation in the PREVENT intervention was associated with a significantly greater reduction in prevalence of multiple risk factors for colorectal cancer compared with UC. Only about one third of UC participants dropped any risk factors during the study period, compared with almost half of the PREVENT participants. PREVENT participants were also significantly more likely to change more than one behavior than UC participants. CONCLUSIONS: The PREVENT intervention was effective in helping patients change multiple risk factors. These results provide further support that more comprehensive interventions that move beyond emphasis on a single risk factor are acceptable to patient populations, can result in improvements, and are cost effective.

Adenomatous Polyposis Coli↗
PubMed2004

Visit satisfaction and tailored health behavior communications in primary care.

BACKGROUND: Although studies suggest that computer-tailored health communications can help patients improve health behaviors, their effect on patient satisfaction, when used in healthcare settings, has yet to be examined. METHODS: A stand-alone computer application was developed to provide tailored, printed feedback for patients and physicians about two of the most common adverse health behaviors seen in primary care: smoking and physical inactivity. Ten primary care providers and 150 of their patients were recruited to use the program in the office before their visit. After the visit, patients completed a self-report survey that addressed demographics, computer use history, satisfaction with the visit, and the extent to which the physician addressed the reports during the visit. All data presented were collected between October 2001 and February 2002. RESULTS: Most patients were female (67.6%), approximately half (46.0%) were seen for a routine exam, most (63.3%) had at least one chronic illness, and fewer than one third (31.3%) had ever used the Internet or e-mail. Most (81.1%) patients reported that the program was easy to use, but fewer than half of the doctors looked at the report in front of the patient (49.2%) or discussed the report with the patient (44.3%). Multivariate modeling showed that visit satisfaction was significantly greater among those whose doctor examined the report. This effect of the doctor examining the report on satisfaction was even greater for those who reported a chronic illness. CONCLUSIONS: Physicians who incorporate computer tailored messaging programs into the primary care setting, but who do not address the feedback reports that they create may contribute to patients being less satisfied with their care.

Adult↗
PubMed2004

Accuracy of recall of exercise counseling among primary care patients.

BACKGROUND: In evaluating the efficacy of health care provider counseling to encourage patients to modify health behaviors such as physical activity, it is important to be able to accurately measure the extent of health care provider counseling. METHODS: The Physical Activity Exit Interview (PAEI) is a brief measure of a patient's perception of the content of physical activity promotion counseling received during a visit with his or her physician. Forty-three primary care patients, and their physicians, completed a PAEI following a visit, which was compared to an audiotape of the visit that was coded to identify the physical activity counseling steps taken. RESULTS: Participants were 67% female, 81.7% white, and had a mean age of 47.1 years. Overall, there was good concordance in the overall number of counseling activities reported between patients and audiotapes (r = 0.47, P < 0.01), patients and physicians (r = 0.51, P < 0.01), and between physicians and audiotapes (r = 0.57, P < 0.01). Significant differences between the three measurement methods (patient exit interview, physician exit interview, audiotape) existed for only 4 of 12 items. CONCLUSIONS: The PAPEI was overall accurate in measuring the content of physical activity counseling, though accuracy differed between items. When discrepancy occurred, it was typically due to patient overreporting of counseling steps.

Adult↗
PubMed2004

Feasibility of incorporating computer-tailored health behaviour communications in primary care settings.

BACKGROUND: We set out to investigate the feasibility of incorporating a computer-tailored health behaviour program into routine care in a group of primary care practices in Rhode Island. METHODS: Two existing computer programs (physical activity, smoking) that tailored text and graphical feedback to survey responses were combined and adapted for use in primary care directly by patients. Ten primary care practices were recruited and worked closely with project staff to develop a practice-specific plan for incorporating the program into the workflow and office routine. Feasibility was measured by the percentage of patients who used the program during the day of their visit. RESULTS: Only one of the ten offices was able to successfully incorporate the program into their office workflow and delivery of routine care. The main categories of barriers to incorporating the computer program into routine care included: the program was viewed overall as inconsistent with practice workflow, the staff was inexperienced with the program, technical problems with the computer and/or printer, the program placed an additional time burden on staff who already felt overworked. Suggestions for improving the program or the way that it was incorporated into routine care included: shortening the program, modifying the program's orientation to a target population (such as patients with hypertension) and incorporating decision-support feedback to help physicians manage the target condition, modifying the program to include other programs pertinent to primary care (for example, depression screening), selecting patients to use the program, rather than asking all patients to use it. CONCLUSIONS: After working closely with ten highly motivated primary care offices, we were unable to fully implement a point-of-care health behaviour computer system for patients and providers. Suggestions for disseminating computer-tailored health behaviour communications in primary care settings are discussed.

Feasibility Studies↗
PubMed2003

Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial.

CONTEXT: A higher duration and intensity of exercise may improve long-term weight loss. OBJECTIVE: To compare the effects of different durations and intensities of exercise on 12-month weight loss and cardiorespiratory fitness. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial conducted from January 2000 through December 2001 involving 201 sedentary women (mean [SD] age, 37.0 [5.7] years; mean [SD] body mass index, 32.6 [4.2]) in a university-based weight control program. INTERVENTION: Participants were randomly assigned to 1 of 4 exercise groups (vigorous intensity/high duration; moderate intensity/high duration; moderate intensity/moderate duration; or vigorous intensity/moderate duration) based on estimated energy expenditure (1000 kcal/wk vs 2000 kcal/wk) and exercise intensity (moderate vs vigorous). All women were instructed to reduce intake of energy to between 1200 and 1500 kcal/d and dietary fat to between 20% and 30% of total energy intake. MAIN OUTCOME MEASURES: Body weight, cardiorespiratory fitness, and exercise participation. RESULTS: After exclusions, 184 of 196 randomized participants completed 12 months of treatment (94%). In intention-to-treat analysis, mean (SD) weight loss following 12 months of treatment was statistically significant (P <.001) in all exercise groups (vigorous intensity/high duration = 8.9 [7.3] kg; moderate intensity/high duration = 8.2 [7.6] kg; moderate intensity/moderate duration = 6.3 [5.6] kg; vigorous intensity/moderate duration = 7.0 [6.4] kg), with no significant difference between groups. Mean (SD) cardiorespiratory fitness levels also increased significantly (P =.04) in all groups (vigorous intensity/high duration = 22.0% [19.9%]; moderate intensity/high duration = 14.9% [18.6%]; moderate intensity/moderate duration = 13.5% [16.9%]; vigorous intensity/moderate duration = 18.9% [16.9%]), with no difference between groups. Post hoc analysis revealed that percentage weight loss at 12 months was associated with the level of physical activity performed at 6 and 12 months. Women reporting less than 150 min/wk had a mean (SD) weight loss of 4.7% [6.0%]; inconsistent (other) pattern of physical activity, 7.0% [6.9%]; 150 min/wk or more, 9.5% [7.9%]; and 200 min/wk or more of exercise, 13.6% [7.8%]. CONCLUSIONS: Significant weight loss and improved cardiorespiratory fitness were achieved through the combination of exercise and diet during 12 months, although no differences were found based on different exercise durations and intensities in this group of sedentary, overweight women.

Adult↗
PubMed2003

Rationale, design, and baseline data for Commit to Quit II: an evaluation of the efficacy of moderate-intensity physical activity as an aid to smoking cessation in women.

BACKGROUND: Commit to Quit II is a 4-year randomized controlled trial comparing the efficacy of a cognitive-behavioral smoking cessation treatment plus moderate-intensity physical activity with the same cessation treatment plus contact control. METHODS: Sedentary women smokers (n = 217) were randomized to receive 8 weeks of treatment followed by 12 months of follow-up. This article outlines the study design, presents baseline data about the sample, and compares the sample to national samples and to our previous study examining vigorous-intensity exercise as an aid to smoking cessation. RESULTS: Married and white participants reported significantly higher levels of nicotine dependence than unmarried and minority participants. Higher levels of nicotine dependence were also significantly related to lower smoking cessation self-efficacy and higher levels of self-reported depression, anxiety, and perceived stress. Additionally, participants smoked significantly more cigarettes (mean 20.6) than a national sample of female smokers (mean 16.1). On average, participants were significantly older, weighed significantly more, and scored significantly higher on a measure of anxiety than participants in our previous trial. CONCLUSIONS: Our sample consisted of women who were heavier smokers than national samples seeking treatment. It remains to be determined how this will impact their ability to attain cessation in the present study.

Administration, Cutaneous↗
PubMed2003

Print versus website physical activity programs: a randomized trial.

BACKGROUND: Mediated physical activity interventions can reach large numbers of people at low cost. Programs delivered through the mail that target the stage of motivational readiness have been shown to increase activity. Communication technology (websites and e-mail) might provide a means for delivering similar programs. METHODS: Randomized trial conducted between August and October 2001. Participants included staff at an Australian university (n=655; mean age=43, standard deviation, 10 years). Participants were randomized to either an 8-week, stage-targeted print program (Print) or 8-week, stage-targeted website (Web) program. The main outcome was change in self-reported physical activity. RESULTS: There was no significant increase in total reported physical activity within or between groups when analyzed by intention to treat (F [1,653]=0.41, p=0.52). There was a significant increase in total physical activity reported by the Print participants who were inactive at baseline (t [1,173]=-2.21, p=0.04), and a significant decrease in the average time spent sitting on a weekday in the Web group (t [1,326]=2.2, p=0.03). CONCLUSIONS: There were no differences between the Print and Web program effects on reported physical activity. The Print group demonstrated slightly larger effects and a higher level of recognition of program materials.

Adult↗
PubMed2003

Population-based randomized controlled trial of a stage-targeted physical activity intervention.

BACKGROUND: Intervention trials with self-selected participants have shown that mailed stage-targeted print materials can increase participation in physical activity in the short term. We examined the effects of a mailed stage-targeted print intervention designed to promote physical activity, in a random sample of adults living in a regional city. METHOD: Participants (n = 462, 40-60 years of age) were randomly allocated to an intervention (n = 227) or control group (n = 235). Measures included validated 2-week physical activity recall and stage of motivational readiness for physical activity. The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets (specific to precontemplation, contemplation, preparation, and action/maintenance) 1 week postbaseline. Follow-up interviews were conducted at 2 and 6 months postbaseline. RESULTS: After 2 months, participants in the intervention group were significantly more likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group (adjusted odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.44-3.99). After 6 months, intervention participants who reported receiving and reading the intervention materials were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group (adjusted OR = 2.03; 95% CI = 1.16-3.56). CONCLUSIONS: The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the materials. This low-cost, generalizable intervention has demonstrated potential as a practical population-based physical activity promotion strategy. Further research is required before widespread dissemination would be justified, as additional strategies may be required to ensure sustained change.

Adult↗