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PubMed1992

Parental and peer influences on leisure-time physical activity in young adolescents.

Influence from parents and friends on adolescents' self-reported level of leisure-time physical activity was examined through measures of (a) perceived leisure-time physical activity of parents and best friend, (b) perceived direct support for physical activity from parents and friends, (c) direct help from parents in exercising vigorously, and (d) perceived value of physical activity of parents and friends. The present analysis included 904 students in western Norway (M age 13.3 years, SD 0.3) who took part in a health behavior survey, which included questions regarding physical activity. Students completed a confidential questionnaire at school. All four measures of influence were positively related to students' activity levels. None of the examined measures was clearly stronger than the other. Parental and peer physical activity level and parental and peer support for physical activity seem to influence the reported physical activity level of the respondents. The findings indicate that, by serving as models and supporters, significant others have an important impact in promoting physical activity in young adolescents.

Adolescent↗
PubMedDate not supplied

The importance of considering biological maturity when assessing physical fitness measures in girls and boys aged 10 to 16 years.

It is widely considered that biological maturity influences physical fitness test performance, children can be advantaged/disadvantaged in physical fitness tests by being more or less mature than counterparts of the same chronological age. The current study sought to investigate the effect sexual maturity had upon performance in physical fitness tests. A cross-sectional study involving 161 girls and 152 boys was carried out. Each subject was assessed for stature, mass, self-assessment of sexual maturity, vertical jump, hand grip strength and the 20 m shuttle run test, all procedures were standardized. Spearman's rank correlation coefficients were developed to assess the relationship between maturity and physical fitness measures. ANCOVA inferential statistics were performed to investigate if performance in physical fitness tests differed between children of different sexual maturity stages irrespective of mass and stature. Significance was set at p < 0.05. Stage of sexual maturity was significantly correlated with all physical fitness measures (boys: r=0.56 to 0.73; girls: r=0.24 to 0.46). ANCOVA revealed that when stature and mass were taken into account significant differences were evident between sexual maturity stages in boys but not girls. This suggests that increases in mass and stature are primarily responsible for variation in girls' physical performance throughout maturation, whereas in boys there are some qualitative differences in performance due to other factors. It was concluded that sexual maturity has a large influence on physical fitness measures in boys but less effect in girls. Rating of physical fitness, particularly for boys should take into account biological maturity.

Adolescent↗
PubMed1998

Measuring physical activity in midlife, older, and minority women: issues from an expert panel.

This article summarizes the findings of an exploratory meeting of 53 experts brought together under the aegis of the Women's Health Initiative to identify important issues related to measuring physical activity in minority women, women in midlife (aged 40-75), and older women (aged > 75). The findings address five areas, three dealing with measurement and two concerning the design of surveys: (1) population characteristics to consider when measuring the physical activity of women and minority populations, (2) activity dimensions relevant to physical activity surveys, (3) measuring moderate and intermittent activities, (4) designing and administering physical activity surveys for older and minority women, and (5) establishing the reliability and validity of such physical activity surveys. Although the focus of the expert panel meeting was on identifying issues related to the measurement of physical activity in women, many issues summarized here can be generalized to children and men. The panel's findings concerning measuring physical activity are timely, as they directly bear on the challenges associated with the physical activity guidelines jointly issued by the Centers for Disease Control and Prevention and the American College of Sports Medicine and the recommendations made in the Surgeon General's 1996 report, Physical Activity and Health.

Adult↗
PubMed2004

Inflammatory markers and physical performance in older persons: the InCHIANTI study.

BACKGROUND: Some studies have proposed chronic inflammation as an underlying biological mechanism responsible for physical function decline in elderly people. The aim of this study is to evaluate the relationship between several inflammatory markers and physical performance in an older population. METHODS: This study is part of the "Invecchiare in Chianti" (InCHIANTI) study, a prospective population-based study of older people, aimed at identifying risk factors for late-life disability. The study sample consisted of 1020 participants aged 65 years and older living in the Chianti area of Italy. Physical performance was assessed using walking speed, the chair-stand test, and the standing balance test. Hand-grip strength was assessed using a hand-held dynamometer. Serum levels of C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), IL-10, IL-1beta, IL-6sR, and IL-1RA were determined. Linear regression analyses were used to assess the multivariate relationship of inflammatory marker levels with physical performance, scored as a continuous variable from 0 to 3, and hand-grip strength after adjustment for demographics, chronic conditions, medication use, and other biological variables. RESULTS: CRP, IL-6, and IL1RA were significantly correlated with physical performance (r=-0.162, r=-0.251, and r=-0.127, respectively). Significant correlations with hand-grip strength were found for CRP and IL-6 (r=-0.081 and r=-0.089, respectively). After adjustment for covariates, high levels of IL-6 and IL-1RA continued to be strongly associated with worse physical performance (p<.001 and p=0.004, respectively). High levels of CRP (p<.001) and IL-6 (p<.001) were associated with low hand-grip strength. Mean adjusted physical performance scores ranged from 2.21 in the CRP<0.59 mg/dl group to 2.07 in the CRP>0.60 mg/dl group (p for trend=.004), and from 2.25 in the lowest IL-6 quartile to 2.08 in the highest IL-6 quartile (p for trend<.001). This trend was also reflected in mean adjusted hand-grip strength, with a range from 28.8 kg for the CRP<0.59 mg/dl group to 26.0 kg for the CRP>0.60 mg/dl group (p for trend=.001), and from 27.4 kg for the lowest IL-6 quartile to 25.1 kg for the highest IL-6 quartile (p for trend=.001). CONCLUSIONS: Inflammation, measured as high levels of IL-6, CRP, and IL-1RA, is significantly associated with poor physical performance and muscle strength in older persons. These data also support the biological face validity of physical performance measures. The assessment of inflammatory markers may represent a useful screening test and perhaps a potential target of intervention.

Aged↗
PubMed1989

The association between physical fitness and cardiovascular disease risk factors in children in a five-year follow-up study.

The relation between physical fitness and cardiovascular disease (CVD) risk factors was studied in 633 children selected from all fourth grades in 37 elementary schools in New York. They were participating in the control group of an intervention study to reduce CVD risk factors in children. Blood pressure, total and high-density lipoprotein (HDL) cholesterol and physical fitness were measured at baseline and at four subsequent examinations during five years of follow-up. Systolic blood pressure (SBP) at baseline was highest in children with poor physical fitness. The five-year change in physical fitness was inversely associated with the change in SBP, ie, children with the strongest decline in physical fitness showed the largest rise in SBP. HDL cholesterol at baseline was lowest in boys with poor physical fitness. The five-year change in physical fitness was positively related to the change in HDL cholesterol levels in boys; ie, boys with the largest decline in physical fitness had the largest decrease in HDL cholesterol level. These observations indicate that unfavourable long-term changes in physical condition in childhood may be related to unfavourable changes in blood pressure and serum lipids.

Blood Pressure↗
PubMed1998

Assess workers' needs and preferences first before planning a physical fitness programme: findings from a polytechnic institute in Singapore.

Workplace physical fitness programmes are usually poorly attended because the activities do not meet workers' needs. We investigated leisure-time physical activity and its relation to sociodemographic characteristics and cardiovascular risk factors in a polytechnic institute in Singapore before planning a physical fitness programme. Low leisure-time physical activity (defined as no activity or engaging in physical activity less than once per week) was more prevalent among older women, married workers, smokers and men with unhealthy dietary habits. The type of physical activity varied with age and gender, with a preference for walking by women and older men and jogging by younger men. Low physical activity was significantly associated with sickness absence and self-reported stress in women and higher values of triglycerides and low density lipoprotein cholesterol in men. This survey helps to identify target groups for physical fitness programmes and determine leisure-time physical activities specific to workers' preferences by age and gender.

Absenteeism↗
PubMed2004

How sedentary are people in "sedentary" occupations? The physical activity of teachers in urban South India.

AIMS: The aim of this study was to assess the total and occupational physical activity status of school and college teachers in Bangalore, South India and to evaluate the use of "job description" as an indicator of occupational physical activity. METHOD: A self-administered questionnaire was given to a convenience sample of 198 (25 males and 173 females) school and college teachers. RESULTS: Despite the categorization of "teacher" in India as "sedentary", our data indicate that the overall physical activity status of teachers varies considerably and is dependent on non-occupational physical activity, such as household chores and discretionary exercise. Thus, only 12% of teachers were truly sedentary, based on computations of the contributions of all measured physical activity domains, while 10% were heavily active. The contribution of other physical activity domains to the overall physical activity status in our data set was dependent on gender; in women, the energy expenditure related to household chores was 4-fold higher than in men (P < 0.01), while in men, energy expenditure related to discretionary exercise was 3-fold higher than in women (P < 0.01). CONCLUSIONS: This study highlights the problems associated with extrapolating occupational activity using job descriptors to overall physical activity status. The findings have implications in epidemiological studies which use occupational activity as a surrogate for overall physical activity status. However, the impact of potential misclassifications will need to be assessed within a socio-cultural context.

Adult↗
PubMed1996

Physical activity and cardiovascular risk factors among elderly men in Finland, Italy, and the Netherlands.

Physical activity pattern and its relation with cardiovascular risk factors was investigated in 1,402 men aged 69-90 years who participated in the 30-year follow-up survey of the Finnish (Eastern and Western Finland), Italian (Montegiorgio and Crevalcore), and Dutch (Zutphen) cohorts of the Seven Countries Study. Physical activity was assessed with a validated self-administered questionnaire designed for retired men. Total physical activity varied largely within cohorts. Median total reported physical activity ranged from 50 minutes/day in Montegiorgio to 89 minutes/day in Crevalcore. Walking, gardening, and bicycling together contributed more than 70% of total physical activity in all cohorts. Depending on the definition of physical inactivity, the estimated prevalence of inactivity varied between 5% and 33% in Zutphen and between 18% and 68% in Montegiorgio. Total physical activity was inversely associated with resting heart rate (r= -0.11, p < 0.001) and was positively associated with high density lipoprotein (HDL) cholesterol (r = 0.08, p < 0.01) in pooled data. These associations remained statistically significant after adjustment for age, cohort, smoking, body mass index, and alcohol intake. Total activity was not associated with total cholesterol, non-HDL cholesterol, blood pressure, or body mass index. The authors conclude that physical activity may have a beneficial effect on HDL cholesterol levels in elderly men. Walking, gardening, and bicycling contribute substantially to their physical activity pattern.

Aged↗
PubMed1999

Baseline and previous physical activity in relation to mortality in elderly men: the Zutphen Elderly Study.

Understanding the effect of changes in physical activity on mortality risk may help researchers clarify intervention strategies. This study investigated associations of physical activity at baseline and 5 years previously with all-cause mortality risk in a cohort of 472 elderly Dutch men. Relative risks were estimated for relations between mortality in 1990-1995 and physical activity levels in 1990 and 1985. Adjustments were made for baseline age, chronic diseases, functional status, and lifestyle factors. In contrast to previous levels of physical activity (adjusted p-trend = 0.39), baseline total time spent in physical activity was inversely associated with mortality risk (p-trend = 0.004; for the most active tertile vs. the least active, relative risk = 0.44; 95% confidence interval: 0.25, 0.80). No consistent associations were observed after fractionating total physical activity into activities of differing intensity or into four different types of activity. Relative to maintaining a physically active lifestyle (i.e., walking or bicycling for 20 minutes at least three times per week) in both survey years, a gradient of increasing risk was observed from adopting an active lifestyle to becoming sedentary to remaining sedentary (p-trend = 0.004). Recent levels of physical activity were more important for mortality risk among elderly men than activity 5 years previously. Becoming or remaining sedentary was significantly associated with increased mortality risk in comparison with remaining physically active.

Activities of Daily Living↗
PubMed1988

Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study.

The relation between self-reported physical activity and depressive symptoms was analyzed for 1,900 healthy subjects aged 25-77 years in the Epidemiologic Follow-up Study (1982-1984) to the first National Health and Nutrition Examination Survey (NHANES I). Depressive symptomatology as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) was examined by sex and race in relation to recreational physical activity and physical activity apart from recreation, controlling for age, education, income, employment status, and chronic conditions. Little or no recreational physical activity and little or no physical activity apart from recreation were cross-sectionally associated with depressive symptoms in whites and in blacks. After exclusion of those with depressive symptoms at baseline, recreational physical activity was an independent predictor of depressive symptoms an average of eight years later in white women. The adjusted odds of depressive symptoms at follow-up were approximately 2 for women with little or no recreational physical activity compared with women with much or moderate recreational physical activity (95% confidence interval 1.1-3.2). These findings are the first indication from a prospective study of a large community sample that physical inactivity may be a risk factor for depressive symptoms.

Adult↗
PubMed1989

Salary, education, and managerial-level differences of physical therapists in Maryland.

The purpose of this study was to determine whether differences existed between a random sample of male and female physical therapists on selected factors. These factors included salary, managerial level, number of courses taken in management or administration, years of work experience in physical therapy, and years of seniority in an organization. A self-reported questionnaire was sent to 400 licensed physical therapists in Maryland who were also American Physical Therapy Association members. Data were analyzed on the 244 respondents using chi-square tests, t tests, and critical ratios. Results showed that female physical therapists, when employed full time in Maryland as department managers, on average, earned significantly less than their male counterparts. A significant difference existed between male and female department managers for full-time work experience in physical therapy. Neither the number of management courses taken nor seniority in an organization were significantly different for male and female physical therapists, regardless of managerial level. Conclusions were that differences existed on several factors between male and female physical therapy department managers and that schools preparing physical therapists for entry into the profession should assess the need for management preparation.

Administrative Personnel↗
PubMed1989

Outpatient views on direct access to physical therapy in Indiana.

The purpose of this study was to determine the opinions of outpatients receiving physical therapy in Indiana about physical therapy evaluation and treatment without referral (direct access). Subjects were 361 individuals being treated at one of 25 privately owned clinics. Each subject completed a 15-item questionnaire. Results showed that 82.8% of the respondents supported direct access to physical therapy. A majority indicated they would seek physical therapy services without referral if they were available. Physical therapists were cited as frequently as all other health care professionals combined as the practitioners providing the most thorough evaluation. Physical therapists were cited far more often than other health care professionals combined as the practitioners providing the best information about the control of symptoms. Subjects who had received more treatments than others were significantly more likely to support direct access (p less than .05). Conclusions were that individuals who have received physical therapy at private outpatient physical therapy clinics in Indiana are supportive of direct access to physical therapy services.

Adolescent↗
PubMed1991

A comparison of hospital-based and private outpatient physical therapy practices.

A paucity of data exists about the delivery of contemporary adult outpatient physical therapy services in the United States. Although many debates about this issue have taken place within the physical therapy profession, assumptions about practice patterns have generally not been studied. This article reports some of the first-year findings from a 3-year survey research effort begun in September 1988 by Mathematica Policy Research Inc for the American Physical Therapy Association. Analyses are based on survey data from national probability samples of physical therapy facilities and discharged patients from 155 hospital-based and 166 private outpatient practices. The primary goal was to compare outpatient physical therapy practice patterns in the hospital-based and private practice settings. Findings reveal considerable homogeneity in private and hospital-based outpatient physical therapy practices. Hospital-based and private practices serve predominantly young, white adults who have private health insurance and a prevalence of orthopedic impairments. In both settings, direct access to outpatient physical therapy services was the exception and not the rule. Even in states in which direct access without a physician's referral was permitted by law, the majority of outpatient physical therapy was provided with a physician's referral. Most respondents in direct-access states indicated that reimbursement requirements were the major reason for needing a physician's referral to provide outpatient physical therapy.

Adult↗
PubMed1992

The impact of physical therapy on nursing home patient outcomes.

The objective of this retrospective study was to assess the intensity and outcome of individual components of interdisciplinary care, including physical therapy, in a teaching nursing home. Two independent reviewers abstracted records from 90 consecutive patients admitted to the nursing home. They rated intensity and outcome of each program component using a structured, standardized data-abstraction form. Program components were physical therapy, speech therapy, psychosocial therapy, medication adjustment, and other medical and nursing care. Physical therapy and medication adjustment were the most frequently received therapies. Eighty-eight percent of the patients receiving high-intensity physical therapy and 33% of the patients receiving moderate-intensity physical therapy improved. For medication adjustment, 93% and 72% of the high- and moderate-intensity groups, respectively, improved. In univariate analyses, physical therapy intensity and age were associated with improvement. Baseline function in activities of daily living and cognitive function were not associated with physical therapy outcome. A stepwise multiple logistic regression analysis revealed that only therapy intensity was associated with improved outcome. We conclude that physical therapy was efficacious for patients receiving high-intensity treatment. Advanced age, activities-of-daily-living status, and cognitive impairment were not associated with poor physical therapy outcome.

Aged↗
PubMed1995

Interrater reliability of auscultation of breath sounds among physical therapists.

BACKGROUND AND PURPOSE: Although auscultation is routinely used in the assessment of respiratory status, the ability of the rater to accurately and consistently identify lung sounds has been questioned. The literature on this issue is sparse and has focused on reliability of auscultation of tape-recorded rather than in vivo lung sounds. The purposes of this study were to determine the interrater reliability of physical therapists in the direct auscultation of lung sounds based on their clinical experience in chest physical therapy and to determine whether the adoption of standardized nomenclature and education on proper technique and interpretation affects reliability. SUBJECTS AND METHODS: A group of 57 registered physical therapists were stratified by clinical experience into four groups. Sixteen therapists (ie, 4 in each stratum) were randomly chosen using a random number table. The following criteria were developed to delineate clinical experience. Group 1 subjects were senior chest physical therapists with at least 5 years of experience in this area of practice. Group 2 subjects were experienced therapists who had a minimum of 2 years of experience in chest physical therapy and were currently practicing in this area. Group 3 subjects were experienced physical therapists in other areas who were also practicing in chest physical therapy on occasional weekend service. Group 4 subjects were new graduates. Ten patients were evaluated by each group of 4 physical therapists using a teaching stethoscope with one diaphragm/bell and four pairs of earpieces. The education session consisted of discussion of the adoption of standardized nomenclature and education on proper technique and interpretation of auscultation. Interrater reliability was assessed before and after the education session using kappa (kappa) values. Comparisons were made between kappa values before and after the education session to determine the effect of education and between groups to determine the effect of clinical experience. RESULTS: The kappa values before the education session were low, indicating poor reliability in detecting specific abnormal sounds (kappa = -.02-.59). Group 1 (seniors in respiratory therapy) and group 4 (new graduates) demonstrated the greatest reliability levels. The lowest kappa values were observed for detecting and categorizing the quality of breath sounds (normal, absent, bronchial, or decreased) (kappa = -.02-.25). Following the education session, there was a general improvement in reliability (kappa = -.30-.77), especially for group 3 (specialists in other areas). The most improvement was noted for the detection of the quality of breath sounds (kappa = .08-.50). CONCLUSION AND DISCUSSION: Reliability of auscultation was poor to fair, in general, before the education session. There was a definite improvement in reliability after the education session. There was no clear effect of clinical experience on reliability, and the agreement among observers appeared to depend on the abnormal lung sound present. Limitations of this study and recommendations for future research are discussed. [Brooks D, Thomas J. Interrater reliability of auscultation of breath sounds among physical therapists.

Auscultation↗
PubMed1996

Physical activity in the prevention of cardiovascular disease.

Research during the past several decades confirms the health benefits of regular physical activity, including improved cardiovascular function and quality of life, with reduced risks of morbidity and mortality from cardiovascular heart disease (CHD). Health care professionals, including physical therapists, can assist the public by promoting physical activity and describing the type, quantity, and quality of activity that confers health benefits. Participation in vigorous physical activity for at least 30 minutes a day is recommended for cardiorespiratory fitness, but recent studies suggest that physical activity below this level can have benefits in reducing the risk for CHD. This article addresses the relationship between physical inactivity and the financial burdens on health care, the relationship between physical inactivity and the risks of developing CHD in different age groups, the health benefits associated with moderate levels of physical activity, and the amounts and types of physical activities that are needed to reduce the risk of CHD.

Adolescent↗
PubMed1994

Development, implementation, and evaluation of an advanced physical diagnosis course for senior medical students.

PURPOSE: To develop, implement, and evaluate a new course curriculum designed to increase senior medical students' knowledge, psychomotor skills, interpretative abilities, and clinical utility regarding physical examination techniques. METHOD: From February 1991 through February 1993, 53 fourth-year students at the Medical College of Wisconsin participated in a one-month elective, Advanced Physical Diagnosis (APD), which was taught by faculty members of the Division of General Internal Medicine. The APD course included the following modules: (1) organ-specific didactic and interactive practice sessions; (2) physical-examination-based case conferences; and (3) professorial rounds, consisting of rounds on inpatient medical services and the use of professional patients, i.e., outpatients with specific, incontrovertible physical findings. An objective structured clinical examination (OSCE) was developed to evaluate the examination skills of the APD students. A pre- and post-course OSCE format was used with both the APD students and a control group of students rotating on the general medicine ward service. In addition, the APD students evaluated their own skills in physical examination and evaluated the course and each of its components by anonymously completing an extensive end-of-course survey. RESULTS: The pre-course OSCE detection rate of incontrovertible physical findings was similar between the control and APD students (Mantel-Haenszel chi 2 = 2.4, p > .1); the post-course OSCE showed significant improvement in the detection rates for the APD students compared with the control students (Mantel-Haenszel chi 2 = 45.8, p < .0001). The APD students felt strongly that the course had improved their physical examination skills and highly recommended the elective to their colleagues. CONCLUSION: Both the OSCE results and the students' self-assessments indicate that the pilot curriculum for the APD course improved the students' physical examination skills. The curriculum can be expanded and also exported to other institutions. Such a course may help promote and refine the use of physical diagnosis in the delivery of quality, timely, and cost-efficient health care.

Clinical Competence↗
PubMed1996

Physical and sedentary activity in school children grades 5-8: the Bogalusa Heart Study.

Physical and sedentary activity in children and adolescents has immediate health benefits and can also set a pattern that carries over into adulthood, resulting in long-term health benefits. Activity levels in a free-living biracial sample of children and adolescents, ages 9-15 yr (N = 995), were examined using a 24-h recall instrument, the Self-Administered Physical Activity Checklist. Selected sedentary activities (television watching and video-/computergame playing) were also assessed. Overall, boys were more physically active than girls and engaged in more heavy physical activity, while girls reported a larger percentage of time spent in light and moderate physical activities. Gender and, to a lesser extent, ethnic differences were seen in the types of activities reported. Although most physical activity occurred after school, children who reported no physical education class during school had less physical activity overall. There was a decrease in moderate physical activity with increasing grade levels in school and an increase in sedentary behavior. Black children reported more sedentary activity than white children, and girls reported more than boys. Although this 24-h recall method has limitations, it allows characterization of the activity of groups of children and provides useful data for policy recommendations.

Activities of Daily Living↗