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The incidence of severe physical child abuse in Wales.

OBJECTIVES: The purposes of this study were: (1) to ascertain the incidence and nature of severe physical child abuse in Wales; (2) to ascertain the incidence of all physical abuse in babies under 1 year of age; and (3) to determine whether child protection registers (CPR) accurately reflect the numbers of children who are physically abused. METHODS: This is a population-based incidence study based in Wales, UK, for 2 years from April 1996 through March 1998. Children studied were under the age of 14 with severe physical abuse consistent with the criminal law level of Grievous Bodily Harm. This included seven categories of injury (death; head injury including subdural hemorrhage; internal abdominal injury; physical injury in Munchausen Syndrome by Proxy including suffocation; fracture; burn or scald; adult bite). Cases were ascertained by a pediatrician surveillance reporting system (WPSU). A criterion for inclusion was multidisciplinary agreement that physical abuse had occurred (at case conference, strategy meeting, or Part 8 Review). The incidence of all babies under 1 year of age with physical abuse was also studied. Ascertainment of babies under the age of 1 year was undertaken from CPR as well as the WPSU. RESULTS: Severe abuse is six times more common in babies [54/100,000/year (95% CI +/- 17.2)] than in children from 1 year to 4 years of age [9.2/100,000 (95% CI +/- 3.6)]. It is 120 times more common than in 5- to 13-year-olds [0.47/100,000 (95% CI +/- 0.47)]. This is mainly because two types of serious abuse (brain injury including subdural hemorrhage and fractures) are more common in babies under the age of 1 year than older children. Using data from two sources (the WPSU and CPRs), the incidence of physical abuse in babies is 114/100,000 (CI 114 +/- 11.8) per year. This equates to 1 baby in 880 being abused in the first year of life. The largely rural Health Authority area in Wales had incidence figures for abuse in babies that were 50% of the three other predominantly urban Health Authority areas. Boys throughout the series were more at risk of being severely abused than girls (p < .025). Only 29% of the babies under 1 year of age on the CPR had actually been injured. Thirty percent of abused babies under the age of 1 year and 73% of severely abused children over the age of 1 year had caused previous concern to health professionals regarding abuse or neglect. CONCLUSIONS: Physical abuse is a significant problem in babies under the age of 1 year. Very young babies (under 6 months old) have the highest risk of suffering damage or death as a result of physical abuse. Severe abuse, in particular subdural hematoma and fracture, is much more common in babies than in older children. There is evidence of failure of secondary prevention of child abuse by health professionals, with a greater need to act on concerns regarding abuse and neglect. Interagency child protection work in partnership with parents should focus more on protecting babies under age 1 year from further abuse than on maintenance of the infant within an abusive home. The CPR is not intended as an accurate measure of children suffering abuse. It is a record of children requiring a child protection plan and must not be used as a measure of numbers of abused children.

Abdominal Injuries↗

Negative affect and parental aggression in child physical abuse.

OBJECTIVE: Parental negative affect is a risk factor for child physical abuse. As negative affect contributes to aggression, and because physical abuse involves an aggressive act directed at the child, we examined the relationship between negative affect and parent-to-child aggression (PTCA) in parents reported to Child Protective Services for physical abuse. METHOD: Baseline assessment data were retrospectively examined on 49 participants in a treatment study for child physical abuse. The negative affects studied were depression, anxiety, and hostility on the Beck Depression Inventory and the Brief Symptom Inventory. PTCA was assessed using the physical aggression subscales (Minor and Severe Physical Violence) of the Conflict Tactics Scale. The contribution of these negative affects to PTCA was examined after controlling individually for the effects of parental attributions and contextual variables widely regarded as etiological factors in child physical abuse. RESULTS: Contributions of negative affect to PTCA after individually controlling for other predictors were found for Minor Physical Violence but not Severe Physical Violence. Findings were strongest with depression on the Beck Depression Inventory and to a lesser extent with hostility on the Brief Symptom Inventory. CONCLUSIONS: Finding that negative affect contributed to PTCA in this sample suggests that it may be important to study the effects of emotion-focused treatments in physically abusive parents. These findings also suggest that PTCA may have qualities of impulsive aggression, a form of aggression that is conceptualized as driven by negative affect, occurs in response to aversive events, and is not planned.

Adult↗

Changes in depression and physical decline in older adults: a longitudinal perspective.

BACKGROUND: The impact of chronicity and changes in depression on physical decline over time in older persons has not been elucidated. METHODS: This prospective cohort study of 2121 community-dwelling persons aged 55-85 years uses two measurement occasions of depression (CES-D scale) over 3 years to distinguish persons with chronic, remitted, or emerging depression and persons who were never depressed. Physical function is assessed by self-reported physical ability as well as by observed performance on a short battery of tests. RESULTS: After adjustment for baseline physical function, health status and sociodemographic factors, chronic depression was associated with significantly greater decline in self-reported physical ability over 3 years when compared to never depressed persons (odds ratio (OR)=2.83, 95% confidence interval (CI)=1.86-4. 30). In the oldest old, but not in the youngest old, chronic depression was also significantly predictive of greater decline in observed physical performance over 3 years (OR=2.22, 95% CI=1.43-3. 79). Comparable effects were found for older persons with emerging depression. Persons with remitted depression did not have greater decline in reported physical ability or observed performance than persons who were never depressed. CONCLUSIONS: Our findings among community-dwelling older persons show that chronicity of depression has a large impact on physical decline over time. Since persons with remitted depression did not have greater physical decline than never depressed persons, these findings suggest that early recognition and treatment of depression in older persons could be protective for subsequent physical decline.

Aged↗

[Habitual physical activity in a population residing in the city of Barcelona].

OBJECTIVES: To describe the sociodemographic distribution of habitual physical activity and to analyse its relationship with self-perceived health status and occupational status, among the population older that 16 years of age in the city of Barcelona, Spain. METHODS: A sample of 1,885 adult men and 2,196 women answered the Health Interview Survey of Barcelona in 1992. Those whose habitual activity required high physical exertion or walking were considered as active. Bivariate and multivariate analyses adjusting logistic regression models were used to study the relationship between habitual physical activity and the rest of variables, for each occupational situation. RESULTS: Fifty six percent of adults reported being physically active. Physical activity was lower among workers than non workers, although workers reported more physical exertion (14.5% in men and 8.0% in women). Physical activity was associated with occupation and educational level among male workers, but only with occupation among female workers. In the non working population, physical activity was lower among those who perceived their health status as fair or poor, compared with those that described it as good or very good, (ORa in men was 0.2, 95% confidence interval = 0.1-0.5; ORa in women was 0.5, 95% confidence interval = 0.3-0.8). CONCLUSIONS: More than half of the Barcelona population were physically active in an habitual manner. Among workers, this activity was mainly determined by the occupation. Non-workers with a poor self-perceived health status did less physical activity.

Adolescent↗

Correlates of physical activity in urban Midwestern Latinas.

BACKGROUND: Latinas (Latino women) are at higher risk than non-Latina white women of cardiovascular disease and stroke, primarily because of higher rates of obesity and type-2 diabetes mellitus. Increases in physical activity help control these cardiovascular risk factors, but a higher percentage of Latinas than white women are inactive. The study goals were to identify personal, social environmental, and physical environmental correlates of physical activity of urban-dwelling, Midwestern Latinas and to obtain their recommendations for increasing exercise in their communities. METHODS: A face-to-face interview (Women and Physical Activity Survey) that covered personal, social environmental, and physical environmental correlates of physical activity was performed with 300 volunteer Latinas (242 in Spanish, 58 in English), aged 20 to 50 years, living in Chicago. Physical activity was measured with questions on lifestyle and planned leisure activity (exercise) from the Behavioral Risk Factor Surveillance System survey. RESULTS: The sample consisted of urban-dwelling Latinas who were primarily from Mexico and who spoke predominantly Spanish. The breakdown was as follows: 36% met current recommendations for moderate or vigorous physical activity, 52.3% were insufficiently active, and 11.7% were inactive. Physical activity was higher among younger women, married women, and women with the following characteristics: had some confidence about becoming more active, saw people exercising in the neighborhood, attended religious services, or lived in areas with heavy traffic. CONCLUSIONS: Interventions need to focus on encouraging Latinas, especially those who are older, to reach the level of physical activity recommended to benefit health. The church may be a suitable community setting for initiating programs that provide women with the knowledge, skills, and motivation to become more active so that they can bring back to the larger Latina community.

Adult↗

Does late-life physical activity or exercise prevent or minimize disablement? A critical review of the scientific evidence.

Physical activity and exercise are widely purported to enhance health and minimize or prevent functional loss and disability. Yet, do the benefits of late-life physical activity or exercise extend beyond disease and impairment-level factors? Does late-life physical activity minimize or prevent functional limitations and disability? To address these questions, a best-evidence framework was used to examine the effects of late-life physical activity on disablement outcomes. This review shows that exercise-particularly walking-increases muscle strength and aerobic capacity and reduces functional limitations. It is less clear, however, whether physical activity or exercise prevents or minimizes physical disability. Furthermore, this review shows a discrepancy between prospective and experimental studies: several well-conducted prospective studies show a beneficial effect of physical activity on minimizing disability, whereas the majority of experimental studies that have examined disability as an outcome do not show improvements in disability. Three research priorities are identified that would advance the science in this field: (1). development of a clear conceptual and theoretical framework of late-life physical activity and assessment; (2). use of a disablement outcomes framework to examine the outcomes of late-life physical activity; and (3). development of a mechanism of action explaining the relationship between physical activity and exercise and disablement outcomes.

Activities of Daily Living↗

Physical activity and cancer etiology: associations and mechanisms.

OBJECTIVES: This paper reviews the epidemiologic data of associations between physical activity and cancer risk, describes potential mechanisms for a physical activity cancer link, and proposes future directions for research. METHODS: We reviewed English-language published papers on physical activity and cancer through Medline searches for epidemiologic studies, and through references on individual reports. We reviewed general texts on effects of exercise on human biology and applied the concepts to the biology of cancer in humans to describe potential mechanisms for a physical activity-cancer association. RESULTS: Considerable epidemiologic evidence has accrued linking increased physical activity with reduced occurrence of cancers of the breast and colon. The association between physical activity and cancers of other sites is unclear. Potential mechanisms for the association between physical activity and reduced risk for breast and colon cancer are varied: they range from bias due to physical activity's strong correlations with other health factors (e.g., diet, smoking, alcohol use, use of medications) to the metabolic effects resulting from increased physical activity and fitness, such as reduced obesity, hormonal and reproductive effects, mechanical effects, and enhancement of the immune system. CONCLUSIONS: The elucidation of biologic mechanisms for an association between physical activity and cancer may provide biological support for the association. It will contribute information to determine the type, frequency, and duration of exercise needed to maximize protection. This information will be needed before large-scale community interventions are begun, in order to choose the correct interventions for the desired effect of reduced incidence of the most common cancers.

Adult↗

Leisure time physical activity and health-related quality of life: cross-sectional and longitudinal associations.

Studies that relate change in physical activity to change in health-related quality of life in the general population are needed to confirm associations suggested by cross-sectional studies. In the present study, cross-sectional as well as longitudinal associations between leisure time physical activity and health-related quality of life were studied in an apparently healthy population. The present study showed cross-sectional associations between at least moderately intense leisure time physical activity and general health perceptions, vitality, physical functioning and role limitations due to physical health problems. No associations were present for total leisure time physical activity. Change in leisure time physical activity was associated with change in social functioning in men as well as in women, irrespective of the intensity of physical activity. Only in men, change in total leisure time physical activity was associated with change in vitality and general mental health. In our study, cross-sectional associations were not confirmed by longitudinal analyses. Cross-sectional associations were mainly found for physical components of health-related quality of life, whereas longitudinal associations were predominantly observed for mental components of health-related quality of life. Confirmation of our results by those of other studies is needed in order to quantify health promotion messages.

Adult↗

Longitudinal study of the long-term relation between physical activity and obesity in adults.

BACKGROUND: Earlier observational studies of the relation between physical activity and obesity are inconsistent and ambiguous, showing a clear cross-sectional inverse relation, and a prospective association only when physical activity at the time of follow-up is included. OBJECTIVE: To examine the long-term effect of leisure time physical activity (LTPA) on subsequent development of obesity and the effect of body weight on later physical inactivity in a population-based longitudinal setting taking into account the effects of historical changes on future changes as well as pertinent confounders. DESIGN: The study included 3653 women and 2626 men aged 20-78 y selected at random within sex-age strata from the general population of Copenhagen. At two surveys, 5 y apart, LTPA, body mass index (BMI) (weight/height2, kg/m2), several possible confounders and modifying factors were assessed. Obesity (defined as BMI > or =30 kg/m2) and LTPA was assessed at the 3rd survey 10 y later. Odds ratios (with 95% confidence limits) for developing obesity between the last two surveys were estimated by logistic regression analysis, taking into account baseline and preceding changes in BMI and LTPA. A similar analysis of odds ratios for physical inactivity as outcome at the 3rd survey was conducted. RESULTS: Compared to physical inactivity, the odds ratios of development of obesity among women with medium and high level of activity were 0.81 (0.53, 1.25) and 1.16 (0.73, 1.84), respectively, and among men, the odds ratios were 1.28 (0.71, 2.33) and 1.65 (0.91, 2.99), respectively. Compared to median BMI, the odds ratio of later physical inactivity among women with high BMI was 1.91 (1.39, 2.61), and among men the odds ratio was 1.50 (1.01, 2.22). The associations were not confounded or modified by age, pre-existing diseases, smoking, alcohol intake, educational level, occupational physical activity or by familial predisposition to obesity. CONCLUSION: This study did not support that physical inactivity as reported in the freely living adult population in the long term is associated with the development of obesity, but the study indicates that obesity may lead to physical inactivity.

Adult↗

The importance of physical activity in the prevention of overweight and obesity in childhood: a review and an opinion.

The prevalence of childhood obesity is increasing and there are a number of theoretical reasons as to why intervention may be more effective in childhood. There are certain risk times for the development of obesity in childhood, which provide a basis for targeted intervention. In addition, tracking data supports the persistence of obesity, at least in later childhood, as well as cardiovascular risk factors. Physical activity is the discretionary component of energy expenditure and there is evidence that falling levels of physical activity are contributing to the obesity epidemic. Physical activity in children is related to developmental stage, is reduced with increasing age and is influenced by parental physical activity. While there is debate about the immediate health benefits of physical activity to children, there are data to support that lower physical activity levels and sedentary behaviours are associated with a higher prevalence of obesity in children. Physical activity is an accepted strategy in the treatment of established obesity (tertiary prevention). The role of physical activity in the prevention of obesity (primary and secondary prevention) is less clear. However a number of recent school-based interventions directed at either increasing physical activity and/or decreasing sedentary behaviours, have shown encouraging results. On balance, increasing physical activity in children is an attractive and non-restrictive approach to obesity prevention. To adopt this approach requires the support and involvement of many community sectors other than health.

Adolescent↗

Changes in lean body mass and total body weight are weakly associated with physical functioning in patients with HIV infection.

CONTEXT: For clinicians managing weight loss in patients with HIV, it would be useful to understand how changes in lean body mass (LBM) effect physical functioning, and whether LBM is more strongly related to physical functioning than total body weight (TBW). OBJECTIVE: To determine the relationship of changes in LBM and changes in total body weight (TBW) to changes in self-reported physical functioning in men and women with HIV infection. METHODS: Study design was longitudinal analysis of 1474 patient-intervals (each interval was approximately 6 months long) in 486 persons. Patients were participants in Nutrition for Healthy Living, a cohort study of HIV positive persons in Massachusetts and Rhode Island. The main outcome measure was change in self-reported physical functioning. RESULTS: Of the 1,474 intervals, 1,165 were contributed by men and 309 by women. The mean CD4 count for the 1,474 intervals was 383 cells/ micro L. In men, 5 kg changes in LBM and TBW were associated with 2.2 (95% confidence interval, 0.9, 3.4, P= 0.001) and 2.6 (95% confidence interval, 1.3, 3.9, P= 0.0002) point changes in physical functioning (on a 100-point scale), respectively, after adjusting for covariates. The relationships of changes in LBM and TBW to changes in physical functioning were linear. In women, there were no significant relationships between changes in LBM or TBW to changes in physical functioning. CONCLUSIONS: In this longitudinal analysis of relatively healthy persons with HIV infection, changes in LBM and TBW were significantly related to changes in physical functioning in men, but the magnitude of the relationship was small. In women, changes in LBM and TBW were not related to changes in physical functioning. Our data suggest that it is not necessary to measure body composition (lean and fat compartments) to understand the impact of changes in weight on physical functioning - it is sufficient to follow total body weight.

Adult↗

Tracking and explanation of physical activity in young adults over a 7-year period.

Tracking and explaining physical activity in young adults was investigated in a 7-year longitudinal design. From a representative sample of 980 respondents at baseline (M age = 21 years), 172 respondents, comprising 18% of the original sample, completed psychosocial questionnaires and were interviewed at home to assess their level of physical activity at follow-up. Psychosocial variables were grouped into four groups: social variables, self-efficacy, perceived benefits, and perceived barriers. Drop-out analyses showed no major differences between the baseline and follow-up samples. The aims of the present study were: (a) to investigate tracking in physical activity and psychosocial determinants over a 7-year period, and (b) to examine baseline determinants and change in determinants in predicting physical activity change in men and women. No significant tracking of physical activity level was found for men. For women, moderate tracking scores were found for total energy expenditure and moderate-intensity energy expenditure (r = .34 and .41, respectively). There was higher tracking in psychosocial determinants than in physical activity. Relatively high tracking scores for perceived benefits and barriers suggest that cognitions related to physical activity are more stable than the behavior itself. Although baseline psychosocial variables were poor predictors of physical activity change, determinants'change scores accounted for 16-19% of the variance in physical activity in men and 7-24% in women. Significant predictors were different for men and women. Present results can inform the design of physical activity interventions for these populations.

Adaptation, Psychological↗

Work, retirement and physical activity: cross-sectional analyses from the Whitehall II study.

BACKGROUND: To explore the relationship between work, retirement and physical activity. METHODS: Cross-sectional analyses of data from self-completed questionnaires by 6224 civil servants aged 45-69 years participating in phase 5 of the Whitehall II longitudinal study. RESULTS: There appeared to be a dose-response relationship between hours worked and the prevalence of physical activity, with a lower prevalence of recommended physical activity amongst participants working full time (> or =30 h/week), higher prevalence rates amongst those working part time (<30 h/week), and the highest rates amongst participants who were not working at all. Physical activity rates did not increase greatly amongst study participants who had retired from the Civil Service but had gone on to do further full-time work, however, the higher physical activity rates of participants working part time, or not at all, were further enhanced amongst those who had also retired. CONCLUSIONS: These findings suggest that full-time work is associated with lower rates of recommended physical activity levels in this cohort of middle-aged white-collar office workers. Lower grade occupations are also less likely to meet the recommended physical activity levels. While retirement is associated with higher rates of recommended physical activity levels, this benefit is evident amongst those who work part time, or not at all, during their retirement, for whom the benefits of retirement and lower working hours on rates of physical activity appear additive. The frequency of different types of physical activity is associated with different occupational grades, with more sport and gardening being done by the higher occupational grades.

Aged↗

On the consistency of a physical mapping method to reconstruct a chromosome in vitro.

During recent years considerable effort has been invested in creating physical maps for a variety of organisms as part of the Human Genome Project and in creating various methods for physical mapping. The statistical consistency of a physical mapping method to reconstruct a chromosome, however, has not been investigated. In this paper, we first establish that a model of physical mapping by binary fingerprinting of DNA fragments is identifiable using the key assumption-for a large randomly generated recombinant DNA library, there exists a staircase of DNA fragments across the chromosomal region of interest. Then we briefly introduce epi-convergence theory of variational analysis and transform the physical mapping problem into a constrained stochastic optimization problem. By doing so, we prove epi-convergence of the physical mapping model and epi-convergence of the physical mapping method. Combining the identifiability of our physical mapping model and the epi-convergence of a physical mapping method, finally we establish strong consistency of a physical mapping method.

Aspergillus nidulans↗

Physical activity participation by presence and type of functional deficits in older women: The Women's Health and Aging Studies.

BACKGROUND: Physical activity is important for maintaining functional independence of older persons, especially for those with existing functional deficits. Since such deficits may pose barriers to activity, it would be instructive to examine activity patterns in relation to specific types of deficits to determine the amount and type of physical activity older women pursue. This study sought to identify categories of functional deficits associated with activity levels and evaluated the potential for older women to increase their physical activity levels. METHODS: Community-dwelling women, aged 70-79 years, from the Women's Health and Aging Studies I and II (N = 710), were assessed for self-reported physical activity, functional deficits and chronic conditions, along with objective measures of muscle strength. Both type (household chores, exercise, and recreational activity) and amount of physical activity (min/wk) were examined. Meeting physical activity recommendations was defined as > or =150 minutes per week of moderate intensity physical activity, and inactivity was defined as no weekly moderate intensity physical activity. Hierarchical categories of functional deficits were based on self-reported difficulty in four functional domains (i.e., mobility/exercise tolerance, upper extremity, higher functioning, and self-care), and self-reports ranged from no difficulty to difficulty in all four domains. RESULTS: The prevalence of inactivity and meeting activity recommendations were 14.4% and 12.7%, respectively. Severity of functional deficits was associated with increased risk of inactivity (adjusted odds ratios [ORs(adj)] = 3.14-17.61) and reduced likelihood of meeting activity recommendations (ORs(adj) =.11-.40). Even among those with higher functioning or self-care difficulties, 30% reported walking for exercise. CONCLUSION: There was evidence that older women with functional deficits can remain physically active. However, for some of these women, meeting the recommended levels of activity may be unrealistic. Efforts to increase physical activity levels among older adults should include treatment or management of functional deficits, chronic conditions, and poor strength.

Activities of Daily Living↗

Physical activity and its correlates among urban primary care patients aged 55 years or older.

OBJECTIVES: Physical inactivity is a leading cause of death and disability, but very little is known about physical activity and its determinants among socially disadvantaged and medically vulnerable adults. The purpose of this study was to assess physical activity and its correlates, including measures of physical activity knowledge, perceived barriers, and self-efficacy, among socioeconomically disadvantaged older adults. METHODS: A stratified random sample of 1,088 patients aged 55 years or older was selected from an urban primary care center serving a predominantly low-income population. Of the 1,088 patients sampled, 771 (71%) completed an interviewer-administered questionnaire. RESULTS: A physical activity instrument, developed specifically for the population being studied, showed an average of 65 minutes of physical activity per week. Scores on a true-false knowledge quiz were no better than expected by chance, and over two thirds reported symptom and perceived environmental barriers to physical activity. Lower self-efficacy and greater symptom and motivational barriers were found to be associated with less physical activity. DISCUSSION: Given the prevalence of inactivity, knowledge deficits, and perceived barriers to physical activity, population-specific interventions may be required to improve rates of physical activity among socially disadvantaged and medically vulnerable adults.

Aged↗

The importance of policy orientation and environment on physical activity participation--a comparative analysis between Eastern Germany, Western Germany and Finland.

Environmental and policy interventions are seen as boosting physical activity because they are designed to influence large groups. However, they have not been much researched and the evidence on their role is still quite limited. The purpose of this study was to investigate differences in and relationships between policy orientation, the objective and perceived physical environment, and physical activity between Finland, Eastern Germany and Western Germany. The data are taken from a public telephone survey carried out as part of the international MAREPS project (Methodology for the Analysis of Rationality and Effectiveness of Prevention and Health Promotion Strategies; Eastern Germany, n = 913; Western Germany, n = 489; Finland, n = 400), statistics of sports facilities and policy documents. Results from the survey showed that Finns are more active than Germans and that they differ in their way of practising physical activity from Germans. Finns were more satisfied with their opportunities for physical activity and were better informed about physical programmes and measures. Finland also has the best opportunities in indoor sports facilities and outdoor sports grounds per number of inhabitants (excluding indoor swimming pools). Analysis of policy orientations showed that Finland had the most extensive 'Sport for All' policy, although West Germany's policy orientation did not differ that much from Finland's. East Germany's policy orientation was characterized by competitive sports. A policy orientation that places emphasis on the physical activity of the whole population seems to be related to better opportunities and a better infrastructure for sports and physical activity. This study suggests that there is a relationship between policy orientation, physical environment and physical activity participation.

Attitude to Health↗

Health Opportunities with Physical Exercise (HOPE): social contextual interventions to reduce sedentary behavior in urban settings.

Physical activity interventions targeting social and physical environments of the urban poor hold promise in improving health outcomes in underserved communities. This study randomly assigned overweight, sedentary, economically disadvantaged adults to one of three intervention conditions at The Hope and Healing Center, a large inner-city health facility providing numerous options for exercise. Within the tenets of Social Action Theory, the Health Opportunities with Physical Exercise (HOPE) trial will test the efficacy of two behavior change models, social support and patient-provider interaction, to increase physical activity. In addition to a standard care condition, in which patients have open access to Hope and Healing physical activity programming, patients were assigned to one of two behavior change interventions. Those assigned to patient-peer receive face-to-face, systematic and scheduled encouragement from study-trained 'peer' interventionists at the facility. Patients assigned to patient-provider receive face-to-face, systematic and scheduled encouragement provided by study-trained 'provider' interventionists also at the facility. The primary outcomes of change in exercise behavior will be documented by self-reported physical activity and confirmed by fitness testing at baseline, 6, 12 and 24 months during the 1 year of active intervention and 1 year of relapse prevention follow-up. Intervention conditions will be compared on psychosocial mediators including motivational appraisals, ratings of social support, rapport, problem solving and self-efficacy for overcoming barriers to increased physical activity. Novel aspects of this intervention include: (1) delivery of socially based physical activity interventions to an economically disadvantaged urban population, (2) reduction of environmental barriers to be physically active and (3) emphasis on social interactions influencing health habit change. Results of this study have the potential to identify mechanisms of behavior change that could be adopted by physical activity interventions aimed at reducing sedentary behavior and health disparities in high-risk, underserved populations.

Exercise↗