Recipient of the Outstanding Scientific Contributions in Health Psychology Award from the American Psychological Association, Dr. King's research focuses on the development, evaluation, and translation of public health interventions to reduce chronic disease. Her current research focuses on expanding the reach and generalizability of evidence-based interventions through use of state-of-the-art communication technologies; community-based participatory research perspectives to address health disparities among disadvantaged populations; and policy-level approaches to health promotion. She has served on a number of government taskforces in the U.S. and abroad, including membership on the U.S. Department of Health and Human Services? Scientific Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, and the Science Board of the U.S. President?s Council on Fitness, Sports and Nutrition. An elected member of the Academy of Behavioral Medicine Research and Past President of the Society of Behavioral Medicine, in 2014 she received honors from the Association of American Medical Colleges (AAMC) for outstanding research targeting health inequities. Her research on Citizen Science engagement to promote healthful living environments for All was honored in 2015 with an international excellence award. She has received the Society of Behavioral Medicine?s Distinguished Research Mentor Award, and has twice received the Stanford Prevention Research Center?s Outstanding Contributions to Teaching Award.

Administrative Appointments

  • Member,, School of Medicine Population Health Sciences Leadership Committee (2014 - Present)
  • Member, University Committee on Research (2013 - 2016)
  • Acting Director, Division Chief, Stanford Prevention Research Center/Medicine (2009 - 2010)
  • Advisory Committee member, Sustainable Built Environment initiative, Stanford Woods Institute for the Environment (2007 - 2010)
  • Member, faculty steering committee-Mobility initiative, Stanford Center on Longevity (2007 - 2008)
  • Member, Appointments & Promotions committee, Stanford Medical School (2006 - 2008)
  • Co-Director, NHLBI Postdoctoral Training Grant, Stanford Prevention Research Center/Medicine (1992 - Present)

Honors & Awards

  • International Excellence Award for innovation (for the Stanford Healthy Neighborhood Discovery Tool), Center for Active Design, NYC (2015)
  • Recipient, Outstanding work in Support of Health Equity recognition, Association of American Medical Colleges (AAMC) (2014)
  • Recipient, Distinguished Service Award, Society of Behavioral Medicine (2013)
  • President, Society of Behavioral Medicine (2011 - 2012)
  • Member, Executive Committee and Board of Directors, Society of Behavioral Medicine (2010-2013)
  • Member, US Secretary of DHHS Sci Advis Committee, National Health Promot-Dis Prev 2020 Objectives (2007 - 2011)
  • Recipient, Teaching Award for Outstanding Contributions to Divisional Teaching Activities, Stanford Prevention Research Center, Dept. of Medicine (2011)
  • Recipient, Distinguished Research Mentor Award, Society of Behavioral Medicine (2003)
  • Recipient, Teaching Award for Outstanding Contributions to Divisional Teaching Activities, Stanford Prevention Research Center, Dept. of Medicine (2001)
  • Elected Member, Academy of Behavioral Science Research (1999)
  • Contributing Author, US Surgeon General's Report on Physical Activity and Health (1995-1996)
  • Award for Outstanding Scientific Contributions in Health Psychology, American Psychological Association (1994)
  • Shannon Award for meritorious research on health and aging, National Institutes of Health (1994)
  • Citation Research Honors, Society of Behavioral Medicine (85-86,93,98,00,04-06, 10-11)
  • Co-Author, Outstanding Academic Book of the Year, Choice publication (1989)

Boards, Advisory Committees, Professional Organizations

  • Member, Data & Safety Monitoring Board, NIA/PCORI-funded national Fall Injuries Prevention Partnership Trial (2014 - Present)
  • Member, Science Board, US President's Council on Fitness, Sports, & Nutrition (2014 - Present)
  • Member, Wisdom Council, Society of Behavioral Medicine (2012 - Present)
  • Member, Board of Directors, Society of Behavioral Medicine (2011 - 2013)
  • Member, Scientific Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, U.S. Secretary of the Department of Health and Human Services (2007 - 2011)

Professional Education

  • PhD, VA Poly Inst & State Univers, Clinical Psychology (1983)

Community and International Work

  • Promoting population-wide programs to prevent chronic disease in low-income countries, Paraguay


    Health promotion/disease prevention in Paraguay

    Partnering Organization(s)

    Ministry of Health of Paraguay, National University of Paraguay

    Populations Served

    country of Paraguay



    Ongoing Project


    Opportunities for Student Involvement


  • Neighborhood Eating & Activity Advocacy Projects, International


    Evaluating a citizen-science data collection & advocacy model for promoting healthy neighborhoods

    Partnering Organization(s)

    Health departments, community organizations, universities in US and internationally

    Populations Served

    Underserved residents living in challenging neighborhoods



    Ongoing Project


    Opportunities for Student Involvement


  • Qassim University College of Medicine Educational Partnership, Saudi Arabia


    Collaborating with faculty at Qassim University to develop a preventive medicine curriculum

    Partnering Organization(s)

    Qassim University

    Populations Served

    Medical students & faculty



    Ongoing Project


    Opportunities for Student Involvement


  • Groningen Active Living Model Research, Netherlands


    Community-based evaluation of physical activity program for older adults in the Netherlands

    Partnering Organization(s)

    University of Groningen

    Populations Served

    Older adults in the Netherlands



    Ongoing Project


    Opportunities for Student Involvement


  • The online health literacy of older adults, SF peninsula region and Baltimore, MD


    Web literacy related to seeking health information

    Partnering Organization(s)

    Johns Hopkins School of Public Health

    Populations Served



    Bay Area

    Ongoing Project


    Opportunities for Student Involvement


  • Computer-based physical activity advice for ethnic minority aging adults, San Jose


    Application of interactive technology to physical activity promotion

    Partnering Organization(s)

    Northeastern University, Boston, MA

    Populations Served

    Latino older adults in the South San Francisco Bay area


    Bay Area

    Ongoing Project


    Opportunities for Student Involvement


  • Creating more sustainable decisions and behaviors through new processes and focused interventions


    Environmental sustainability

    Partnering Organization(s)

    Woods Institute for the Environment

    Populations Served

    US consumers



    Ongoing Project


    Opportunities for Student Involvement


  • Multi-scale modeling of health behaviors: Water, sanitation, and child survival in Africa


    water-relevant behaviors

    Partnering Organization(s)

    Stanford School of Engineering and the Woods Institute for the Environment

    Populations Served

    Women and children in Tanzania



    Ongoing Project


    Opportunities for Student Involvement


  • Preventing obesity among socioeconomically disadvantaged women and children, Melbourne, Victoria, Australia


    Obesity prevention

    Partnering Organization(s)

    Deakin University, Australia

    Populations Served

    Socioeconomically disadvantaged women and children



    Ongoing Project


    Opportunities for Student Involvement


  • Get Mobile, New South Wales and Queensland, Australia


    Community-based physical activity promotion via telephone and mail

    Partnering Organization(s)

    Deakin University, University of Queensland

    Populations Served

    Mid-life and older adults



    Ongoing Project


    Opportunities for Student Involvement


  • Environmental Approaches to Increased Walking in Rural Communities, Bootheel region of Missouri


    Impact of built environment on health behaviors

    Partnering Organization(s)

    St. Louis University, CDC

    Populations Served

    Rural adults in Missouri



    Ongoing Project


    Opportunities for Student Involvement


  • Active For Life, Chicago, Memphis, S.F. Bay area, S. California


    Translation/dissemination of physical activity programs for older adults

    Partnering Organization(s)

    Robert Wood Johnson Foundation, Texas A & M University

    Populations Served

    Older adults living in 4 US regions



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

My interests include the applications of behavioral theory and social ecological approaches to achieve large scale change in chronic disease prevention and health promotion areas of relevance, in particular, to mid-life and older adults as well as underserved communities; studying influences of the built and social environments on health behaviors and outcomes; expanding the reach and translation of evidence-based interventions through the use of state-of-the-art communication technologies; applying community-based participatory research perspectives to address health disparities among disadvantaged populations; and evaluating policy-level approaches to health promotion/disease prevention in the US and internationally.

In the physical activity and aging field, I am interested in the study of physical activity as a link to other health-promoting behaviors; and the relationship of physical activity and other health-related behaviors to day-to-day functioning, stress and coping, and sleep quality, particularly in chronically stressed populations.

In pursuing the development of behavioral interventions for chronic disease prevention with broad applicability to the population at large, I have investigated channels of delivery (e.g., mediated approaches and interactive technologies) that do not require ongoing face-to-face contact. We have found that mediated interventions can provide a useful alternative to more intensive face-to-face approaches to health behavior change and, in some cases, such as in the physical activity field, may actually produce better long term (i.e., up to two years) adherence than class- or group-based approaches.

Finally, we are applying "citizen science" perspectives in harnessing the power of residents to change their local environments to improve their health. The goal of this applied community-based research is to provide all residents, regardless of language, culture, or sociodemographic circumstances, with a means of identifying and working with other residents, community organizations, governments, and other decision makers to improve their local environments to promote health and wellbeing.

Clinical Trials

  • Promoting Healthy Lifestyles Using Mobile Phones Not Recruiting

    The purpose of this research is to test programs to increase physical activity and reduce sedentary behavior using motivational messages over a cell phone.

    Stanford is currently not accepting patients for this trial. For more information, please contact Sandra J Winter, PhD, (650) 723 - 4656.

    View full details

  • Virtual Advisors for Physical Activity Promotion in Underserved Communities Recruiting

    This research study will evaluate the effectiveness of a computer-based 'virtual lay advisor' compared to a proven human lay advisor/promotora to promote regular walking among inactive midlife and older Latino adults.

    View full details

  • Computer-Based Physical Activity Advice for Ethnic Minority Aging Adults Not Recruiting

    Despite the recognized health benefits of a physically active lifestyle, mid-life and older low-income and ethnic minority adults, including Hispanic Americans, are among the least active and understudied groups in the U.S. This research aims to develop and evaluate a bi-lingual physical activity promotion program, applying easy to use state-of-the-art computer technology, which is tailored to the preferences and needs of mid-life and older Latino adults. Such computer-based programs represent a potentially low-cost means for reaching the large proportion of low-income and ethnic minority Americans who are under-active.

    Stanford is currently not accepting patients for this trial. For more information, please contact Leslie Pruitt, (650) 725 - 5318.

    View full details

  • The LIFE Study - Lifestyle Interventions and Independence for Elders Not Recruiting

    Based upon promising results from a pilot study among 424 sedentary older adults who were randomized to a physical activity intervention or a successful aging health education intervention, a Phase 3 multi-center randomized controlled trial is being conducted to compare a moderate-intensity physical activity program to a successful aging health education program in 1,600 sedentary older adults who are followed for an average of 2.7 years. The primary aim is to assess the long-term effects of the proposed interventions on the primary outcome of major mobility disability, defined as inability to walk 400 m.

    Stanford is currently not accepting patients for this trial. For more information, please contact Cynthia Castro, (650) 498 - 7281.

    View full details


  • Global "Citizen Science" Neighborhood Eating & Activity Advocacy Projects, Stanford Prevention Research Center, Community organizations, health depts., universities and organizations in US and internationally

    The NEAAT initiative encompasses a variety of research, environmental and policy-oriented projects aimed at empowering residents as "citizen scientists" to gather relevant information about their environments, build consensus around key issues impacting healthy lifestyles, and advocate effectively for change with local decision makers. Projects have been or are being conducted in northern California, Arizona, upstate New York, Mexico, Israel, Colombia, Chile, and Brasil.


    Mexico, Israel, Colombia, Chile, Brazil, Australia, New Zealand, South Africa, EU, Paraguay, Asia, San Francisco Bay area

  • Promoting population-wide programs to prevent chronic disease in low-income countries, Ministry of Health of Paraguay, National University of Paraguay

    : Collaborate with health officials, scientists, community organizations, and residents of Paraguay to initiate a culturally-tailored set of programs and strategies aimed at reducing noncommunicable diseases in Paraguay. This program is part of the Stanford Healthy Aging & Technology Solutions (HARTS) laboratory's "borderless health promotion" initiative.



  • Computer-based physical activity advice for ethnic minority aging adults, Northeastern University, Boston, MA

    Application of interactive technology to physical activity promotion in Latino older adults in the South San Francisco Bay area


    San Jose, CA

  • Preventing obesity among socioeconomically disadvantaged women and children, Deakin University, Australia

    Obesity prevention in socioeconomically disadvantaged women and children



  • The online health literacy of older adults, ): Johns Hopkins School of Public Health

    Web literacy related to seeking health information


    United States

  • Creating more sustainable decisions and behaviors through new processes and focused interventions, Woods Institute for the Environment

    Environmental sustainability


    United States

  • Environmental Approaches to Increased Walking in Rural and Urban Communities, St. Louis University, CDC

    Impact of built environment on health behaviors in rural adults in Missouri


    Missouri, USA

  • Active For Life, Robert Wood Johnson Foundation, Texas A & M University

    Translation/dissemination of physical activity programs for older adults in older adults living in 4 US regions (Chicago, Memphis, SF Bay Area, Southern California)


    United States


2014-15 Courses


All Publications

  • Technologies to Measure and Modify Physical Activity and Eating Environments AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Glanz, K., Patrick, K. 2015; 48 (5): 630-638


    The explosion of technologic advances in information capture and delivery offers unparalleled opportunities to assess and modify built and social environments in ways that can positively impact health behaviors. This paper highlights some potentially transformative current and emerging trends in the technology arena applicable to environmental context-based assessment and intervention relevant to physical activity and dietary behaviors.A team of experts convened in 2013 to discuss the main issues related to technology use in assessing and changing built environments for health behaviors particularly relevant to obesity prevention. Each expert was assigned a specific domain to describe, commensurate with their research and expertise in the field, along with examples of specific applications. This activity was accompanied by selective examination of published literature to cover the main issues and elucidate relevant applications of technologic tools and innovations in this field.Decisions concerning which technology examples to highlight were reached through discussion and consensus-building among the team of experts. Two levels of impact are highlighted: the "me" domain, which primarily targets measurement and intervention activities aimed at individual-level behaviors and their surrounding environments; and the "we" domain, which generally focuses on aggregated data aimed at groups and larger population segments and locales.The paper ends with a set of challenges and opportunities for significantly advancing the field. Key areas for progress include data collection and expansion, managing technologic considerations, and working across sectors to maximize the population potential of behavioral health technologies.

    View details for DOI 10.1016/j.amepre.2014.10.005

    View details for Web of Science ID 000353069300021

    View details for PubMedID 25891063

  • A qualitative study of shopper experiences at an urban farmers' market using the Stanford Healthy Neighborhood Discovery Tool. Public health nutrition Buman, M. P., Bertmann, F., Hekler, E. B., Winter, S. J., Sheats, J. L., King, A. C., Wharton, C. M. 2015; 18 (6): 994-1000


    To understand factors which enhance or detract from farmers' market shopper experiences to inform targeted interventions to increase farmers' market utilization, community-building and social marketing strategies.A consumer-intercept study using the Stanford Healthy Neighborhood Discovery Tool to capture real-time perceptions via photographs and audio narratives.An urban farmers' market in a large metropolitan US city. Participants Thirty-eight farmers' market shoppers, who recorded 748 unique coded elements through community-based participatory research methods.Shoppers were primarily women (65 %), 18-35 years of age (54 %), non-Hispanic (81 %) and white (73 %). Shoppers captured 291 photographs (7·9 (sd 6·3) per shopper), 171 audio narratives (5·3 (sd 4·7) per shopper), and ninety-one linked photograph + audio narrative pairs (3·8 (sd 2·8) per shopper). A systematic content analysis of the photographs and audio narratives was conducted by eight independent coders. In total, nine common elements emerged from the data that enhanced the farmers' market experience (61·8 %), detracted from the experience (5·7 %) or were neutral (32·4 %). The most frequently noted elements were freshness/abundance of produce (23·3 %), product presentation (12·8 %), social interactions (12·4 %) and farmers' market attractions (e.g. live entertainment, dining offerings; 10·3 %).While produce quality (i.e. freshness/abundance) was of primary importance, other contextual factors also appeared important to the shoppers' experiences. These results may inform social marketing strategies to increase farmers' market utilization and community-building efforts that target market venues.

    View details for DOI 10.1017/S136898001400127X

    View details for PubMedID 24956064

  • "It's Got to Be on This Page": Age and Cognitive Style in a Study of Online Health Information Seeking JOURNAL OF MEDICAL INTERNET RESEARCH Agree, E. M., King, A. C., Castro, C. M., Wiley, A., Borzekowski, D. L. 2015; 17 (3)


    The extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy.This study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy.The Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing.Cognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved.The increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Greater support for those who are in the oldest cohorts and for design of interfaces that support users with different cognitive styles may be required in an age of shared medical decision making.

    View details for DOI 10.2196/jmir.3352

    View details for Web of Science ID 000356780900019

    View details for PubMedID 25831483

  • Fostering Multiple Healthy Lifestyle Behaviors for Primary Prevention of Cancer AMERICAN PSYCHOLOGIST Spring, B., King, A. C., Pagoto, S. L., Van Horn, L., Fisher, J. D. 2015; 70 (2): 75-90


    The odds of developing cancer are increased by specific lifestyle behaviors (tobacco use, excess energy and alcohol intakes, low fruit and vegetable intake, physical inactivity, risky sexual behaviors, and inadequate sun protection) that are established risk factors for developing cancer. These behaviors are largely absent in childhood, emerge and tend to cluster over the life span, and show an increased prevalence among those disadvantaged by low education, low income, or minority status. Even though these risk behaviors are modifiable, few are diminishing in the population over time. We review the prevalence and population distribution of these behaviors and apply an ecological model to describe effective or promising healthy lifestyle interventions targeted to the individual, the sociocultural context, or environmental and policy influences. We suggest that implementing multiple health behavior change interventions across these levels could substantially reduce the prevalence of cancer and the burden it places on the public and the health care system. We note important still-unresolved questions about which behaviors can be intervened upon simultaneously in order to maximize positive behavioral synergies, minimize negative ones, and effectively engage underserved populations. We conclude that interprofessional collaboration is needed to appropriately determine and convey the value of primary prevention of cancer and other chronic diseases.

    View details for DOI 10.1037/a0038806

    View details for Web of Science ID 000350556800002

    View details for PubMedID 25730716

  • Validation of Physical Activity Tracking via Android Smartphones Compared to ActiGraph Accelerometer: Laboratory-Based and Free-Living Validation Studies. JMIR mHealth and uHealth Hekler, E. B., Buman, M. P., Grieco, L., Rosenberger, M., Winter, S. J., Haskell, W., King, A. C. 2015; 3 (2)


    There is increasing interest in using smartphones as stand-alone physical activity monitors via their built-in accelerometers, but there is presently limited data on the validity of this approach.The purpose of this work was to determine the validity and reliability of 3 Android smartphones for measuring physical activity among midlife and older adults.A laboratory (study 1) and a free-living (study 2) protocol were conducted. In study 1, individuals engaged in prescribed activities including sedentary (eg, sitting), light (sweeping), moderate (eg, walking 3 mph on a treadmill), and vigorous (eg, jogging 5 mph on a treadmill) activity over a 2-hour period wearing both an ActiGraph and 3 Android smartphones (ie, HTC MyTouch, Google Nexus One, and Motorola Cliq). In the free-living study, individuals engaged in usual daily activities over 7 days while wearing an Android smartphone (Google Nexus One) and an ActiGraph.Study 1 included 15 participants (age: mean 55.5, SD 6.6 years; women: 56%, 8/15). Correlations between the ActiGraph and the 3 phones were strong to very strong (?=.77-.82). Further, after excluding bicycling and standing, cut-point derived classifications of activities yielded a high percentage of activities classified correctly according to intensity level (eg, 78%-91% by phone) that were similar to the ActiGraph's percent correctly classified (ie, 91%). Study 2 included 23 participants (age: mean 57.0, SD 6.4 years; women: 74%, 17/23). Within the free-living context, results suggested a moderate correlation (ie, ?=.59, P<.001) between the raw ActiGraph counts/minute and the phone's raw counts/minute and a strong correlation on minutes of moderate-to-vigorous physical activity (MVPA; ie, ?=.67, P<.001). Results from Bland-Altman plots suggested close mean absolute estimates of sedentary (mean difference=-26 min/day of sedentary behavior) and MVPA (mean difference=-1.3 min/day of MVPA) although there was large variation.Overall, results suggest that an Android smartphone can provide comparable estimates of physical activity to an ActiGraph in both a laboratory-based and free-living context for estimating sedentary and MVPA and that different Android smartphones may reliably confer similar estimates.

    View details for DOI 10.2196/mhealth.3505

    View details for PubMedID 25881662

  • Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults The LIFE Study Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Pahor, M., Guralnik, J. M., Ambrosius, W. T., Blair, S., Bonds, D. E., Church, T. S., Espeland, M. A., Fielding, R. A., Gill, T. M., Groessl, E. J., King, A. C., Kritchevsky, S. B., Manini, T. M., McDermott, M. M., Miller, M. E., Newman, A. B., Rejeski, W. J., Sink, K. M., Williamson, J. D. 2014; 311 (23): 2387-2396
  • Harnessing the potential of older adults to measure and modify their environments: long-term successes of the Neighborhood Eating and Activity Advocacy Team (NEAAT) Study. Translational behavioral medicine Winter, S. J., Buman, M. P., Sheats, J. L., Hekler, E. B., Otten, J. J., Baker, C., Cohen, D., Butler, B. A., King, A. C. 2014; 4 (2): 226-227

    View details for DOI 10.1007/s13142-014-0264-1

    View details for PubMedID 24904707

  • Exercise Advice by Humans Versus Computers: Maintenance Effects at 18 Months HEALTH PSYCHOLOGY King, A. C., Hekler, E. B., Castro, C. M., Buman, M. P., Marcus, B. H., Friedman, R. H., Napolitano, M. A. 2014; 33 (2): 192-196


    Objective: An automated telehealth counseling system, aimed at inactive midlife and older adults, was shown previously to achieve 12-month physical activity levels similar to those attained by human advisors. This investigation evaluated the sustained 18-month impacts of the automated advisor compared with human advisors. Methods: Following the end of the 12-month randomized, controlled trial, participants who had been randomized to either the human advisor (n = 73) or automated advisor (n = 75) arms were followed for an additional 6 months. During that period, human or automated advisor-initiated telephone contacts ceased and participants were encouraged to initiate contact with their advisor as deemed relevant. The primary outcome was moderate-to-vigorous physical activity (MVPA), measured using the Stanford Physical Activity Recall and validated during the major trial via accelerometry. Results: The two arms did not differ significantly in 18-month MVPA or the percentage of participants meeting national physical activity guidelines (ps >.50). No significant within-arm MVPA differences emerged between 12 and 18 months. Evaluation of the trajectory of physical activity change across the 18-month study period indicated that, for both arms, the greatest physical activity increases occurred during the first 6 months of intervention, followed by a relatively steady amount of physical activity across the remaining months. Conclusions: The results provide evidence that an automated telehealth advice system can maintain physical activity increases at a level similar to that achieved by human advisors through 18 months. Given the accelerated use of mobile phones in developing countries, as well as industrialized nations, automated telehealth systems merit further evaluation. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

    View details for DOI 10.1037/a0030646

    View details for Web of Science ID 000330843700011

  • Behavioral Medicine in the 21st Century: Transforming "the Road Less Traveled" into the "American Way of Life" ANNALS OF BEHAVIORAL MEDICINE King, A. C. 2014; 47 (1): 71-78


    A key objective of this paper is to describe some major challenges and opportunities facing the behavioral medicine field in the current decade. Amidst current US statistics that present a sobering image of the nation's health, there have been a number of notable achievements in the behavioral medicine field that span the scientific/health continuum. However, many of these achievements have received little notice by the public and decision makers.A case is presented for the potential of scientific narrative for presenting behavioral medicine evidence in ways that engage attention and compel action. Additional areas for behavioral medicine engagement include expanding interdisciplinary connections into new arenas, continuing the growth of activities involving emerging technologies, building international connections, and engaging with policy.Finally, the fundamental importance of an integrated behavioral medicine field that plays an active role in supporting and advancing its members and the field as a whole is discussed.

    View details for DOI 10.1007/s12160-013-9530-6

    View details for Web of Science ID 000331646100008

    View details for PubMedID 24096957

  • Impact of San Francisco's toy ordinance on restaurants and children's food purchases, 2011-2012. Preventing chronic disease Otten, J. J., Saelens, B. E., Kapphahn, K. I., Hekler, E. B., Buman, M. P., Goldstein, B. A., Krukowski, R. A., O'Donohue, L. S., Gardner, C. D., King, A. C. 2014; 11: E122-?


    In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children's meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children's menus), and the energy and nutrient content of all orders and children's-meal-only orders purchased for children aged 0 through 12 years.Restaurant responses were examined from January 2010 through March 2012. Parent-caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.Both restaurant chains responded to the ordinance by selling toys separately from children's meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children's meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children's side dishes and beverages at Chain A.Although the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes.

    View details for DOI 10.5888/pcd11.140026

    View details for PubMedID 25032837

  • Employing Virtual Advisors in Preventive Care for Underserved Communities: Results From the COMPASS Study JOURNAL OF HEALTH COMMUNICATION King, A. C., Bickmore, T. W., Campero, M. I., Pruitt, L. A., Yin, J. L. 2013; 18 (12): 1449-1464


    Electronically delivered health promotion programs that are aimed primarily at educated, health-literate individuals have proliferated, raising concerns that such trends could exacerbate health disparities in the United States and elsewhere. The efficacy of a culturally and linguistically adapted virtual advisor that provides tailored physical activity advice and support was tested in low-income older adults. Forty inactive adults (92.5% Latino) 55 years of age and older were randomized to a 4-month virtual advisor walking intervention or a waitlist control. Four-month increases in reported minutes of walking/week were greater in the virtual advisor arm (mean increase = 253.5 ± 248.7 minutes/week) relative to the control (mean increase = 26.8 ± 67.0 minutes/week; p = .0008). Walking increases in the virtual advisor arm were substantiated via objectively measured daily steps (slope analysis p = .002). All but one intervention participant continued some interaction with the virtual advisor in the 20-week poststudy period (mean number of poststudy sessions = 14.0 ± 20.5). The results indicate that a virtual advisor delivering culturally and linguistically adapted physical activity advice led to meaningful 4-month increases in walking relative to control among underserved older adults. This interactive technology, which requires minimal language and computer literacy, may help reduce health disparities by ensuring that all groups benefit from e-health opportunities.

    View details for DOI 10.1080/10810730.2013.798374

    View details for Web of Science ID 000328192800005

    View details for PubMedID 23941610

  • Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial ANNALS OF BEHAVIORAL MEDICINE King, A. C., Castro, C. M., Buman, M. P., Hekler, E. B., Urizar, G. G., Ahn, D. K. 2013; 46 (2): 157-168


    BACKGROUND: Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence. PURPOSE: We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes. METHODS: Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms. RESULTS: Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms. CONCLUSIONS: We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.

    View details for DOI 10.1007/s12160-013-9501-y

    View details for Web of Science ID 000324493900007

  • Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults PLOS ONE King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 2013; 8 (4)
  • The stanford healthy neighborhood discovery tool: a computerized tool to assess active living environments. American journal of preventive medicine Buman, M. P., Winter, S. J., Sheats, J. L., Hekler, E. B., Otten, J. J., Grieco, L. A., King, A. C. 2013; 44 (4): e41-7


    The built environment can influence physical activity, particularly among older populations with impaired mobility. Existing tools to assess environmental features associated with walkability are often cumbersome, require extensive training, and are not readily available for use by community residents.This project aimed to develop and evaluate the utility of a computerized, tablet-based participatory tool designed to engage older residents in identifying neighborhood elements that affect active living opportunities.Following formative testing, the tool was used by older adults (aged ?65 years, in 2011) to record common walking routes (tracked using built-in GPS) and geocoded audio narratives and photographs of the local neighborhood environment. Residents (N=27; 73% women; 77% with some college education; 42% used assistive devices) from three low-income communal senior housing sites used the tool while navigating their usual walking route in their neighborhood. Data were analyzed in 2012.Elements (from 464 audio narratives and photographs) identified as affecting active living were commensurate with the existing literature (e.g., sidewalk features, aesthetics, parks/playgrounds, crosswalks). However, within each housing site, the profile of environmental elements identified was distinct, reflecting the importance of granular-level information collected by the tool. Additionally, consensus among residents was reached regarding which elements affected active living opportunities.This tool serves to complement other assessments and assist decision makers in consensus-building processes for environmental change.

    View details for DOI 10.1016/j.amepre.2012.11.028

    View details for PubMedID 23498112

  • Harnessing different motivational frames via mobile phones to promote daily physical activity and reduce sedentary behavior in aging adults. PloS one King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 2013; 8 (4)


    Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors. Despite an explosion of mobile phone applications aimed at physical activity and other health behaviors, few have been based on theoretically derived constructs and empirical evidence. Eighty adults ages 45 years and older who were insufficiently physically active, engaged in prolonged daily sitting, and were new to smartphone technology, participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence. An "analytically" framed custom application focused on personalized goal setting, self-monitoring, and active problem solving around barriers to behavior change. A "socially" framed custom application focused on social comparisons, norms, and support. An "affectively" framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar, whose movements and behaviors reflected the physical activity and sedentary levels of the user. To explore the applications' initial efficacy in changing regular physical activity and leisure-time sitting, behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity questionnaire and the Australian sedentary behavior questionnaire. User acceptability of and satisfaction with the applications was explored via a post-intervention user survey. The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period. Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology. Preliminary data exploring sustained use of the applications across a longer time period yielded promising results. The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors.

    View details for DOI 10.1371/journal.pone.0062613

    View details for PubMedID 23638127

  • Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial. international journal of behavioral nutrition and physical activity Hekler, E. B., Buman, M. P., Otten, J., Castro, C. M., Grieco, L., Marcus, B., Friedman, R. H., Napolitano, M. A., King, A. C. 2013; 10: 109-?


    Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions.Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12).Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

    View details for DOI 10.1186/1479-5868-10-109

    View details for PubMedID 24053756

  • Neighborhood Eating and Activity Advocacy Teams (NEAAT): engaging older adults in policy activities to improve food and physical environments. Translational behavioral medicine Buman, M. P., Winter, S. J., Baker, C., Hekler, E. B., Otten, J. J., King, A. C. 2012; 2 (2): 249-253


    Local food and physical activity environments are known to impact health, and older adults are generally more vulnerable to health-related environmental impacts due to poorer physical function and mobility impairments. There is a need to develop cost-conscious, community-focused strategies that impact local food and physical activity environment policies. Engaging older adult community residents in assessment and advocacy activities is one avenue to address this need. We describe the Neighborhood Eating and Activity Advocacy Team project, a community-based participatory project in low-income communal housing settings in San Mateo County, CA, as one method for engaging older adults in food and physical activity environment and policy change. Methods and strategies used by the "community action teams" to generate relevant neighborhood environmental data, build coalitions, prioritize complex issues, and advocate for change are presented. Advocacy groups are feasible among older adults to improve food and physical activity environments.

    View details for DOI 10.1007/s13142-011-0100-9

    View details for PubMedID 24073118

  • Food Marketing to Children Through Toys Response of Restaurants to the First U.S. Toy Ordinance AMERICAN JOURNAL OF PREVENTIVE MEDICINE Otten, J. J., Hekler, E. B., Krukowski, R. A., Buman, M. P., Saelens, B. E., Gardner, C. D., King, A. C. 2012; 42 (1): 56-60


    On August 9, 2010, Santa Clara County CA became the first U.S. jurisdiction to implement an ordinance that prohibits the distribution of toys and other incentives to children in conjunction with meals, foods, or beverages that do not meet minimal nutritional criteria. Restaurants had many different options for complying with this ordinance, such as introducing more healthful menu options, reformulating current menu items, or changing marketing or toy distribution practices.To assess how ordinance-affected restaurants changed their child menus, marketing, and toy distribution practices relative to non-affected restaurants.Children's menu items and child-directed marketing and toy distribution practices were examined before and at two time points after ordinance implementation (from July through November 2010) at ordinance-affected fast-food restaurants compared with demographically matched unaffected same-chain restaurants using the Children's Menu Assessment tool.Affected restaurants showed a 2.8- to 3.4-fold improvement in Children's Menu Assessment scores from pre- to post-ordinance with minimal changes at unaffected restaurants. Response to the ordinance varied by restaurant. Improvements were seen in on-site nutritional guidance; promotion of healthy meals, beverages, and side items; and toy marketing and distribution activities.The ordinance appears to have positively influenced marketing of healthful menu items and toys as well as toy distribution practices at ordinance-affected restaurants, but did not affect the number of healthful food items offered.

    View details for DOI 10.1016/j.amepre.2011.08.020

    View details for Web of Science ID 000298294000011

    View details for PubMedID 22176847

  • Aging in neighborhoods differing in walkability and income: Associations with physical activity and obesity in older adults SOCIAL SCIENCE & MEDICINE King, A. C., Sallis, J. F., Frank, L. D., Saelens, B. E., Cain, K., Conway, T. L., Chapman, J. E., Ahn, D. K., Kerr, J. 2011; 73 (10): 1525-1533


    While there is a growing literature on the relations between neighborhood design and health factors such as physical activity and obesity, less focus has been placed on older adults, who may be particularly vulnerable to environmental influences. This study evaluates the relations among objectively measured neighborhood design, mobility impairment, and physical activity and body weight in two U.S. regional samples of community dwelling older adults living in neighborhoods differing in walkability and income levels. An observational design involving two time points six months apart was employed between 2005 and 2008. U.S. Census block groups in Seattle-King County, Washington and Baltimore, Maryland-Washington DC regions were selected via geographic information systems to maximize variability in walkability and income. Participants were 719 adults ages 66 years and older who were able to complete surveys in English and walk at least 10 feet continuously. Measurements included reported walking or bicycling for errands (i.e., transport activity) and other outdoor aerobic activities measured via the CHAMPS questionnaire: accelerometry-based moderate-to-vigorous physical activity; reported body mass index; and reported lower extremity mobility impairment measured via the Late-Life Function and Disability Instrument. Across regions, time, and neighborhood income, older adults living in more walkable neighborhoods had more transport activity and moderate-to- vigorous physical activity and lower body mass index relative to those living in less walkable neighborhoods. The most mobility-impaired adults living in more walkable neighborhoods reported transport activity levels that were similar to less mobility-impaired adults living in less walkable neighborhoods. The results add to the small literature aimed at understanding how neighborhood design may influence physical activity and related aspects of health linked with day-to-day function and independence as people age.

    View details for DOI 10.1016/j.socscimed.2011.08.032

    View details for Web of Science ID 000297906100011

    View details for PubMedID 21975025

  • Physical Activity Program Delivery by Professionals Versus Volunteers: The TEAM Randomized Trial HEALTH PSYCHOLOGY Castro, C. M., Pruitt, L. A., Buman, M. P., King, A. C. 2011; 30 (3): 285-294


    Older adults have low rates of physical activity participation, but respond positively to telephone-mediated support programs. Programs are often limited by reliance on professional staff. This study tested telephone-based physical activity advice delivered by professional staff versus trained volunteer peer mentors.A 12-month, randomized, controlled clinical trial was executed from 2003-2008. Twelve volunteer peer mentors and 181 initially inactive adults ages 50 years and older were recruited from the San Francisco Bay Area. Participants were randomized to: (1) telephone-based physical activity advice delivered by professional staff, (2) telephone-based physical activity advice delivered by trained volunteer peers, or (3) an attention-control arm of staff-delivered telephone support for nutrition.Moderate-intensity or more vigorous physical activity (MVPA) was assessed at baseline, 6, and 12 months with the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire, with accelerometry validation (Actigraph) in a randomly selected subsample. Treatment fidelity was examined through analysis of quantity and quality of intervention delivery.At 6 and 12 months, both physical activity arms significantly increased MVPA relative to the control arm. Both physical activity arms were comparable in quantity of intervention delivery, but peers demonstrated more versatility and comprehensiveness in quality of intervention content.This study demonstrates that trained peer volunteers can effectively promote physical activity increases through telephone-based advice. The results support a program delivery model with good dissemination potential for a variety of community settings.

    View details for DOI 10.1037/a0021980

    View details for Web of Science ID 000290695300006

    View details for PubMedID 21553972

  • Maximizing the Potential of an Aging Population JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION King, A. C., Guralnik, J. M. 2010; 304 (17): 1944-1945

    View details for Web of Science ID 000283725900025

    View details for PubMedID 21045101

  • Identifying Subgroups of US Adults at Risk for Prolonged Television Viewing to Inform Program Development AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Goldberg, J. H., Salmon, J., Owen, N., Dunstan, D., Weber, D., Doyle, C., Robinson, T. N. 2010; 38 (1): 17-26


    Although adverse health effects of prolonged TV viewing have been increasingly recognized, little population-wide information is available concerning subgroups at greatest risk for this behavior.This study sought to identify, in a U.S. population-derived sample, combinations of variables that defined subgroups with higher versus lower levels of usual TV-viewing time.A total of 5556 adults from a national consumer panel participated in the mail survey in 2001 (55% women, 71% white, 13% black, and 11% Hispanic). Nonparametric risk classification analyses were conducted in 2008.Subgroups with the highest proportions of people watching >14 hours/week of TV were identified and described using a combination of demographic (i.e., lower household incomes, divorced/separated); health and mental health (i.e., poorer rated overall health, higher BMI, more depression); and behavioral (i.e., eating dinner in front of the TV, smoking, less physical activity) variables. The subgroup with the highest rates of TV viewing routinely ate dinner while watching TV and had lower income and poorer health. Prolonged TV viewing also was associated with perceived aspects of the neighborhood environment (i.e., heavy traffic and crime, lack of neighborhood lighting, and poor scenery).The results can help inform intervention development in this increasingly important behavioral health area.

    View details for DOI 10.1016/j.amepre.2009.08.032

    View details for Web of Science ID 000273413800003

    View details for PubMedID 20117553

  • Why and how to improve physical activity promotion: Lessons from behavioral science and related fields PREVENTIVE MEDICINE King, A. C., Sallis, J. F. 2009; 49 (4): 286-288


    This commentary highlights the importance of regular physical activity to the nation's health and discusses some of the major challenges and opportunities currently facing the field.

    View details for DOI 10.1016/j.ypmed.2009.07.007

    View details for Web of Science ID 000271451700004

    View details for PubMedID 19631233

  • Effects of Moderate-Intensity Exercise on Polysomnographic and Subjective Sleep Quality in Older Adults With Mild to Moderate Sleep Complaints JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Pruitt, L. A., Woo, S., Castro, C. M., Ahn, D. K., Vitiello, M. V., Woodward, S. H., Bliwise, D. L. 2008; 63 (9): 997-1004


    This study sought to determine the 12-month effects of exercise increases on objective and subjective sleep quality in initially inactive older persons with mild to moderate sleep complaints.A nonclinical sample of underactive adults 55 years old or older (n=66) with mild to moderate chronic sleep complaints were randomly assigned to a 12-month program of primarily moderate-intensity endurance exercise (n=36) or a health education control program (n=30). The main outcome measure was polysomnographic sleep recordings, with additional measures of subjective sleep quality, physical activity, and physical fitness. Directional hypotheses were tested.Using intent-to-treat methods, at 12 months exercisers, relative to controls, spent significantly less time in polysomnographically measured Stage 1 sleep (between-arm difference=2.3, 95% confidence interval [CI], 0.7-4.0; p=003), spent more time in Stage 2 sleep (between-arm difference=3.2, 95% CI, 0.6-5.7; p=.04), and had fewer awakenings during the first third of the sleep period (between-arm difference=1.0, 95% CI, 0.39-1.55; p=.03). Exercisers also reported greater 12-month improvements relative to controls in Pittsburgh Sleep Quality Index (PSQI) sleep disturbance subscale score (p=.009), sleep diary-based minutes to fall asleep (p=.01), and feeling more rested in the morning (p=.02).Compared with general health education, a 12-month moderate-intensity exercise program that met current physical activity recommendations for older adults improved some objective and subjective dimensions of sleep to a modest degree. The results suggest additional areas for investigation in this understudied area.

    View details for Web of Science ID 000260074800015

    View details for PubMedID 18840807

  • Exploring refinements in targeted behavioral medicine intervention to advance public health ANNALS OF BEHAVIORAL MEDICINE King, A. C., Ahn, D. F., Atienza, A. A., Kraemer, H. C. 2008; 35 (3): 251-260


    Similar to other fields, a targeted behavioral medicine perspective can aid decision-making related to participant-intervention matching.To present one potentially useful definition of intervention targeting activity; describe potential targeting domains of particular relevance to behavioral medicine; discuss different statistical approaches to aid the targeted intervention development process; and discuss the challenges and opportunities accompanying the incorporation of targeted intervention development methods into behavioral randomized clinical trial (RCT) research.Drawing from recent conceptual work by the MacArthur group and other scientists in the field, methods and approaches to undertaking moderator analysis are discussed.Examples of moderator analyses are provided which reflect the different statistical methods and variable domains that may serve as moderators of intervention success.The recommended exploratory work can help to make the most efficient use of RCTs to identify the best paths for subsequent RCT development in a resource-constrained era.

    View details for DOI 10.1007/s12160-008-9032-0

    View details for Web of Science ID 000258554500001

    View details for PubMedID 18568380

  • Promoting physical activity through hand-held computer technology AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Ahn, D. K., Oliveira, B. M., Atienza, A. A., Castro, C. M., Gardner, C. D. 2008; 34 (2): 138-142


    Efforts to achieve population-wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies. Yet few systematic efforts to evaluate the efficacy of hand-held computers and similar devices for enhancing physical activity levels have occurred. The purpose of this first-generation study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing moderate intensity or more vigorous (MOD+) physical activity levels over 8 weeks in mid-life and older adults relative to a standard information control arm.Randomized, controlled 8-week experiment. Data were collected in 2005 and analyzed in 2006-2007.Community-based study of 37 healthy, initially underactive adults aged 50 years and older who were randomized and completed the 8-week study (intervention=19, control=18).Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback, goal setting, and support. Controls received standard, age-appropriate written physical activity educational materials.Physical activity was assessed via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and 8 weeks.Relative to controls, intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity (p<0.04). Satisfaction with the PDA was reasonably high in this largely PDA-naive sample.Results from this first-generation study indicate that hand-held computers may be effective tools for increasing initial physical activity levels among underactive adults.

    View details for DOI 10.1016/j.amepre.2007.09.025

    View details for Web of Science ID 000252758300008

    View details for PubMedID 18201644

  • Ongoing physical activity advice by humans versus computers: The community health advice by telephone (CHAT) trial HEALTH PSYCHOLOGY King, A. C., Friedman, R., Marcus, B., Castro, C., Napolitano, M., Alm, D., Baker, L. 2007; 26 (6): 718-727


    Given the prevalence of physical inactivity among American adults, convenient, low-cost interventions are strongly indicated. This study determined the 6- and 12-month effectiveness of telephone interventions delivered by health educators or by an automated computer system in promoting physical activity.Initially inactive men and women age 55 years and older (N = 218) in stable health participated. Participants were randomly assigned to human advice, automated advice, or health education control.The validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. Physical activity differences by experimental arm were verified on a random subsample via accelerometry.Using intention-to-treat analysis, at 6 months, participants in both interventions, although not differing from one another, showed significant improvements in weekly physical activity compared with controls. These differences were generally maintained at 12 months, with both intervention arms remaining above the target of 150 min per week of moderate to vigorous physical activity on average.Automated telephone-linked delivery systems represent an effective alternative for delivering physical activity advice to inactive older adults.

    View details for DOI 10.1037/0278-6133.26.6.718

    View details for Web of Science ID 000250861700011

    View details for PubMedID 18020844

  • Effects of a physical activity intervention on measures of physical performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Pahor, M., Blair, S. N., Espeland, M., Fielding, R., Gill, T. M., Guralnik, J. M., Hadley, E. C., King, A. C., Kritchevsky, S. B., Maraldi, C., Miller, M. E., Newman, A. B., Rejeski, W. J., Romashkan, S., Studenski, S., Blair, S. N., Church, T., Ashmore, J. A., Dubreuil, J., Frierson, G., Jordan, A. N., Morss, G., Rodarte, R. Q., Wallace, J. M., Guralnik, J. M., Hadley, E. C., Romashkan, S., King, A. C., Haskell, W. L., Pruitt, L. A., Abbott-Pilolla, K., Fortmann, S., Prosak, C., Wallace, K., Bolen, K., Fielding, R., Nelson, M., Kaplan, R. M., Groessl, E. J., Pahor, M., Perri, M., Caudle, C., Crump, L., Hayden, S., Holmes, L., Maraldi, C., Quirin, C., Newman, A. B., Studenski, S., Goodpaster, B. H., Aiken, E. K., Anthony, S., Glynn, N. W., Kadosh, J., Kost, P., Newman, M., Taylor, C. A., Vincent, P., Kritchevsky, S. B., Brubaker, P., Demons, J., Furberg, C., Katula, J. A., Marsh, A., Nicklas, B. J., Williamson, J. D., Fries, R., Kennedy, K., Murphy, K., Nagaria, S., Wickley-Krupel, K., Miller, M. E., Espeland, M., Hsu, F., Rejeski, W. J., Babcock, D. P., Costanza, L., Harvin, L. N., Kaltenbach, L., Roberson, W. A., Rushing, J., Rushing, S., Walkup, M. P., Lang, W., Gill, T. M. 2006; 61 (11): 1157-1165


    The Short Physical Performance Battery (SPPB), which includes walking, balance, and chair stands tests, independently predicts mobility disability and activities of daily living disability. To date, however, there is no definitive evidence from randomized controlled trials that SPPB scores can be improved. Our objective was to assess the effect of a comprehensive physical activity (PA) intervention on the SPPB and other physical performance measures.A total of 424 sedentary persons at risk for disability (ages 70-89 years) were randomized to a moderate-intensity PA intervention or a successful aging (SA) health education intervention and were followed for an average of 1.2 years.The mean baseline SPPB score on a scale of 0-12, with 12 corresponding to highest performance, was 7.5. At 6 and 12 months, the PA versus SA group adjusted SPPB (+/- standard error) scores were 8.7 +/- 0.1 versus 8.0 +/- 0.1, and 8.5 +/- 0.1 versus 7.9 +/- 0.2, respectively (p < .001). The 400-meter walking speed was also significantly improved in the PA group. The PA group had a lower incidence of major mobility disability defined as incapacity to complete a 400-meter walk (hazard ratio = 0.71, 95% confidence interval = 0.44-1.20).A structured PA intervention improved the SPPB score and other measures of physical performance. An intervention that improves the SPPB performance may also offer benefit on more distal health outcomes, such as mobility disability.

    View details for Web of Science ID 000243118800007

    View details for PubMedID 17167156

  • Identifying subgroups that succeed or fail with three levels of physical activity intervention: The activity counseling trial HEALTH PSYCHOLOGY King, A. C., Marcus, B., Ahn, D., Dunn, A. L., Rejeski, W. J., Sallis, J. F., Coday, M. 2006; 25 (3): 336-347


    The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.

    View details for DOI 10.1037/0278-6133.25.3.336

    View details for Web of Science ID 000237761300010

    View details for PubMedID 16719605

  • Theoretical approaches to the promotion of physical activity - Forging a transdisciplinary paradigm AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Stokols, D., Talen, E., Brassington, G. S., Killingsworth, R. 2002; 23 (2): 15-25


    Research in the physical activity promotion arena has focused on the application of theoretical perspectives aimed primarily at personal levels of understanding and analysis. The investigation of such theories has provided some insights related to potentially useful mediators of physical activity behavior. However, to continue to expand this field, new perspectives on personal-level theories, in addition to the exploration of more macro-level conceptual perspectives, are required.The purpose of this article is to: (1) briefly review the current strengths and limitations of the personal-level, physical activity-theory literature; and (2) introduce concepts and perspectives from other fields, including the social-ecology and urban-planning fields, of potential relevance to the physical activity arena.We provide an overview of potentially relevant theoretical perspectives aimed at different levels of understanding and analysis, from the personal level through the broader-scale meso- and macro-environmental perspectives. In addition, we suggest initial steps to take in developing a transdisciplinary paradigm encompassing all such levels of analysis and investigation.Given the scope of the physical inactivity epidemic facing the U.S. population currently and in the future, methods and approaches that integrate theory and concepts across a broader group of disciplines will be increasingly necessary.

    View details for Web of Science ID 000177181500005

    View details for PubMedID 12133734

  • Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: A randomized controlled trial JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Baumann, K., O'Sullivan, P., Wilcox, S., Castro, C. 2002; 57 (1): M26-M36


    The study objective was to determine the health and quality-of-life effects of moderate-intensity exercise among older women family caregivers.This 12-month randomized controlled trial involved a volunteer sample of 100 women aged 49 to 82 years who were sedentary, free of cardiovascular disease, and caring for a relative with dementia. Participants were randomized to 12 months of home-based, telephone-supervised, moderate-intensity exercise training or to an attention-control (nutrition education) program. Exercise consisted of four 30- to 40-minute endurance exercise sessions (brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate. Main outcomes were stress-induced cardiovascular reactivity levels, rated sleep quality, and reported psychological distress.Compared with nutrition participants (NU), exercise participants (EX) showed significant improvements in the following: total energy expenditure (baseline and post-test means [SD] for EX = 1.4 [1.9] and 2.2 [2.2] kcal/kg/day; for NU = 1.2 [1.7] and 1.2 [1.6] kcal/kg/day; p <.02); stress-induced blood pressure reactivity (baseline and post-test systolic blood pressure reactivity values for EX = 21.6 [12.3] and 12.4 [11.2] mm Hg; for NU = 17.9 [10.2] and 17.7 [13.8] mm Hg; p <.024); and sleep quality (p <.05). NU showed significant improvements in percentages of total calories from fats and saturated fats relative to EX (p values <.01). Both groups reported improvements in psychological distress. Conclusions. Family caregivers can benefit from initiating a regular moderate-intensity exercise program in terms of reductions in stress-induced cardiovascular reactivity and improvements in rated sleep quality.

    View details for Web of Science ID 000173163800010

    View details for PubMedID 11773209

  • Interventions to promote physical activity by older adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C. 2001; 56: 36-46


    Physical inactivity has been established to be an independent risk factor for a range of chronic diseases and conditions that threaten the health of the nation. However, only a minority of the population is currently meeting the recommended levels of regular physical activity, which have been linked with important health and quality-of-life benefits. Older adults are at particular risk for leading sedentary lifestyles. This article provides an overview of factors associated with physical activity for older adults and also describes potentially promising interventions for promoting regular physical activity in this growing population segment. Examples of interventions undertaken at personal and interpersonal as well as broader levels of analysis (e.g., environmental) are provided. Major issues currently facing the field are discussed, including the ongoing challenge of developing assessment tools that are sensitive to the more moderate-intensity physical activities favored by older adults and the formidable task of combining clinical approaches with environmental and policy strategies aimed at combating this public health problem.

    View details for Web of Science ID 000171992700005

    View details for PubMedID 11730236

  • Effects of physical activity counseling in primary care - The activity counseling trial: A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Simons-Morton, D. G., Blair, S. N., King, A. C., Morgan, T. M., Applegate, W. B., O'Toole, M., Haskell, W. L., Albright, C. L., Cohen, S. J., Ribisl, P. M., Shih, J. H. 2001; 286 (6): 677-687


    Physical activity is important for health, yet few studies have examined the effectiveness of physical activity patient counseling in primary care.To compare the effects of 2 physical activity counseling interventions with current recommended care and with each other in a primary care setting.The Activity Counseling Trial, a randomized controlled trial with recruitment in 1995-1997, with 24 months of follow-up.Eleven primary care facilities affiliated with 3 US clinical research centers.Volunteer sample of 395 female and 479 male inactive primary care patients aged 35 to 75 years without clinical cardiovascular disease.Participants were randomly assigned to 1 of 3 groups: advice (n = 292), which included physician advice and written educational materials (recommended care); assistance (n = 293), which included all the components received by the advice group plus interactive mail and behavioral counseling at physician visits; or counseling (n = 289), which included the assistance and advice group components plus regular telephone counseling and behavioral classes.Cardiorespiratory fitness, measured by maximal oxygen uptake (VO(2)max), and self-reported total physical activity, measured by a 7-day Physical Activity Recall, compared among the 3 groups and analyzed separately for men and women at 24 months.At 24 months, 91.4% of the sample had completed physical activity and 77.6% had completed cardiorespiratory fitness measurements. For women at 24 months, VO(2)max was significantly higher in the assistance group than in the advice group (mean difference, 80.7 mL/min; 99.2% confidence interval [CI], 8.1-153.2 mL/min) and in the counseling group than in the advice group (mean difference, 73.9 mL/min; 99.2% CI, 0.9-147.0 mL/min), with no difference between the counseling and assistance groups and no significant differences in reported total physical activity. For men, there were no significant between-group differences in cardiorespiratory fitness or total physical activity.Two patient counseling interventions differing in type and number of contacts were equally effective in women in improving cardiorespiratory fitness over 2 years compared with recommended care. In men, neither of the 2 counseling interventions was more effective than recommended care.

    View details for Web of Science ID 000170271500023

    View details for PubMedID 11495617

  • Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of US middle-aged and older-aged women HEALTH PSYCHOLOGY King, A. C., Castro, C., Wilcox, S., Eyler, A. A., Sallis, J. F., Brownson, R. C. 2000; 19 (4): 354-364


    Personal, program-based, and environmental barriers to physical activity were explored among a U.S. population-derived sample of 2,912 women 40 years of age and older. Factors significantly associated with inactivity included American Indian ethnicity, older age, less education, lack of energy, lack of hills in one's neighborhood, absence of enjoyable scenery, and infrequent observation of others exercising in one's neighborhood. For all ethnic subgroups, caregiving duties and lacking energy to exercise ranked among the top 4 most frequently reported barriers. Approximately 62% of respondents rated exercise on one's own with instruction as more appealing than undertaking exercise in an instructor-led group, regardless of ethnicity or current physical activity levels. The results underscore the importance of a multifaceted approach to understanding physical activity determinants in this understudied, high-risk population segment.

    View details for DOI 10.1037//0278-6133.19.4.354

    View details for Web of Science ID 000088061600006

    View details for PubMedID 10907654

  • Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Pruitt, L. A., Phillips, W., Oka, R., Rodenburg, A., Haskell, W. L. 2000; 55 (2): M74-M83


    Although inactivity is an important contributor to impaired functioning and disability with age, little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken.One hundred three adults age 65 years and older, recruited via population-based methods, were randomized to 12 months of community-based, moderate-intensity endurance and strengthening exercises (Fit & Firm) or stretching and flexibility exercises (Stretch & Flex). A combination of class- and home-based exercise formats was used. Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention.Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects. Stretch & Flex subjects reported greater improvements in bodily pain, and Stretch & Flex men evidenced greater improvements in flexibility relative to Fit & Firm subjects. Although overall exercise adherence was high in both exercise conditions (approximately 80%), subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions.Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes. This represents one of the first studies to report significant improvements in an important quality of life outcome-bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults.

    View details for Web of Science ID 000088044200014

    View details for PubMedID 10737689

  • Physical activity interventions targeting older adults - A critical review and recommendations AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Rejeski, W. J., Buchner, D. M. 1998; 15 (4): 316-333


    Although many of the chronic conditions plaguing older populations are preventable through appropriate lifestyle interventions such as regular physical activity, persons in this age group represent the most sedentary segment of the adult population. The purpose of the current paper was to provide a critical selected review of the scientific literature focusing on interventions to promote physical activity among older adults.Comprehensive computerized searches of the recent English language literature aimed at physical activity intervention in adults aged 50 years and older, supplemented with visual scans of several journal on aging, were undertaken. Articles were considered to be relevant for the current review if they were community-based, employed a randomized design or a quasi-experimental design with an appropriate comparison group, and included information on intervention participation rates, pre- and post-intervention physical activity levels, and/or pre/post changes in relevant physical performance measures.Twenty-nine studies were identified that fit the stated criteria. Among the strengths of the studies reviewed were reasonable physical activity participation rates and relatively long study durations. Among the weaknesses of the literature reviewed were the relative lack of specific behavioral or program-based strategies aimed at promoting physical activity participation, as well as the dearth of studies aimed at replication, generalizability of interventions to important subgroups, implementation, and cost-effectiveness evaluation.Recommendations for future scientific endeavors targeting older adults are discussed.

    View details for Web of Science ID 000076982900005

    View details for PubMedID 9838975

  • Overview of the Activity Counseling Trial (ACT) intervention for promoting physical activity in primary health care settings MEDICINE AND SCIENCE IN SPORTS AND EXERCISE King, A. C., Sallis, J. F., Dunn, A. L., Simons-Morton, D. G., Albright, C. A., Cohen, S., Rejeski, W. J., Marcus, B. H., Coday, M. C. 1998; 30 (7): 1086-1096


    Counseling by health care providers has the potential to increase physical activity in sedentary patients, yet few studies have tested interventions for physical activity counseling delivered in health care settings. The Activity Counseling Trial (ACT) is a 5-yr randomized clinical trial to evaluate the efficacy of two primary care, practice-based physical activity behavioral interventions relative to a standard care control condition. A total of 874 sedentary men and women, 35-75 yr of age, have been recruited from primary care physician offices at three clinical centers for 2 yr of participation. They were randomly assigned to one of three experimental conditions that vary, in a hierarchical fashion, by level of counseling intensity and resource requirements. The interventions, which are based on social cognitive theory and the transtheoretical model, are designed to alter empirically based psychosocial mediators that are known to be associated with physical activity. The present paper describes the theoretical background of the intervention, the intervention methods, and intervention training and quality control procedures.

    View details for Web of Science ID 000074599300011

    View details for PubMedID 9662678

  • Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making HEALTH PSYCHOLOGY King, A. C., Kiernan, M., Oman, R. F., Kraemer, H. C., Hull, M., Ahn, D. 1997; 16 (4): 380-389


    Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.

    View details for Web of Science ID A1997XJ90600011

    View details for PubMedID 9237091

  • Moderate-intensity exercise and self-rated quality of sleep in older adults - A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION King, A. C., Oman, R. F., Brassington, G. S., Bliwise, D. L., Haskell, W. L. 1997; 277 (1): 32-37


    To determine the effects of moderate-intensity exercise training on self-rated (subjective) sleep quality among healthy, sedentary older adults reporting moderate sleep complaints.Randomized controlled trial of 16 weeks' duration.General community.Volunteer sample of 29 women and 14 men (of 67 eligible subjects) aged 50 to 76 years who were sedentary, free of cardiovascular disease, and reported moderate sleep complaints. No participant was withdrawn for adverse effects.Randomized to 16 weeks of community-based, moderate-intensity exercise training or to a wait-listed control condition. Exercise consisted primarily of four 30- to 40-minute endurance training sessions (low-impact aerobics; brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate.Pittsburgh Sleep Quality Index (PSQI).Compared with controls (C), subjects in the exercise training condition (E) showed significant improvement in the PSQI global sleep score at 16 weeks (baseline and posttest values in mean [SD] for C=8.93 [3.1] and 8.8 [2.6]; baseline and posttest values for E=8.7 [3.0] and 5.4 [2.8]; mean posttest difference between conditions=3.4; P<.001; 95% confidence interval, 1.9-5.4), as well as in the sleep parameters of rated sleep quality, sleep-onset latency (baseline and posttest values for C=26.1 [20.0] and 23.8 [15.3]; for E=28.4 [20.2] and 14.6 [13.0]; net improvement=11.5 minutes), and sleep duration baseline and posttest scores for C=5.8 [1.1] and 6.0 [1.0]; for E=6.0 [1.1] and 6.8 [1.2]; net improvement=42 minutes) assessed via PSQI and sleep diaries (P=.05).Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program.

    View details for Web of Science ID A1997VZ76700026

    View details for PubMedID 8980207



    Although exercise parameters such as intensity and format have been shown to influence exercise participation rates and physiological outcomes in the short term, few data are available evaluating their longer-term effects. The study objective was to determine the 2-year effects of differing intensities and formats of endurance exercise on exercise participation rates, fitness, and plasma HDL cholesterol levels among healthy older adults.Higher-intensity, group-based exercise training; higher-intensity, home-based exercise; and lower-intensity, home-based exercise were compared in a 2-year randomized trial. Participants were 149 men and 120 postmenopausal women 50 to 65 years of age who were sedentary and free of cardiovascular disease. Recruitment was achieved through a random digit-dial community telephone survey and media promotion. All exercise occurred in community settings. For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate. Treadmill exercise performance, lipoprotein levels and other heart disease risk factors, and exercise adherence were evaluated at baseline and across the 2-year period. Treadmill exercise test performance improved for all three training conditions during year 1 and was successfully maintained during year 2, particularly for subjects in the higher-intensity, home-based condition. Subjects in that condition also showed the greatest year 2 exercise adherence rates (P < .003). Although no significant increases in HDL cholesterol were observed during year 1, by the end of year 2 subjects in the two home-based training conditions showed small but significant HDL cholesterol increases over baseline (P < .01). The increases were particularly pronounced for subjects in the lower-intensity condition, whose exercise prescription required more frequent exercise sessions per week. For all exercise conditions, increases in HDL cholesterol were associated with decreases in waist-to-hip ratio in both men and women (P < .04).While older adults can benefit from initiating a regular regimen of moderate-intensity exercise in terms of improved fitness levels and small improvements in HDL cholesterol levels, the time frame needed to achieve HDL cholesterol change (2 years) may be longer than that reported previously for younger populations. Frequency of participation may be particularly important for achieving such changes. Supervised home-based exercise regimens represent a safe, attractive alternative for achieving sustained participation.

    View details for Web of Science ID A1995QX58700017

    View details for PubMedID 7743622



    The 12-month effects of exercise training on psychological outcomes in adults ages 50-65 years were evaluated. Ss (N = 357) were randomly assigned to assessment-only control or to higher intensity group, higher intensity home, or lower intensity home exercise training. Exercisers showed reductions in perceived stress and anxiety in relation to controls (p < .04). Reductions in stress were particularly notable in smokers. Regardless of program assignment, greater exercise participation was significantly related to less anxiety and fewer depressive symptoms, independent of changes in fitness or body weight (p < .05). It was concluded that neither a group format nor vigorous activity was essential in attaining psychological benefits from exercise training in healthy adults.

    View details for Web of Science ID A1993NL74100006

    View details for PubMedID 8404803



    --To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults.--Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control.--General community located in northern California.--One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized.--For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate.--Treadmill exercise test performance, exercise participation rates, and heart disease risk factors.--Compared with controls, subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months (P less than .03). Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training. Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition (P less than .0005). There were no significant training-induced changes in lipid levels, weight, or blood pressure.--We conclude that (1) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary, healthy older adults; (2) home-based exercise was as effective as group exercise in producing these changes; (3) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting; and (4) the exercise programs were relatively safe.

    View details for Web of Science ID A1991GE45800034

    View details for PubMedID 1880885

  • Associations Between Ankle-Brachial Index and Cognitive Function: Results From the Lifestyle Interventions and Independence for Elders Trial. Journal of the American Medical Directors Association Espeland, M. A., Newman, A. B., Sink, K., Gill, T. M., King, A. C., Miller, M. E., Guralnik, J., Katula, J., Church, T., Manini, T., Reid, K. F., McDermott, M. M. 2015; 16 (8): 682-689


    The objective of this study was to evaluate cross-sectional and longitudinal associations between ankle-brachial index (ABI) and indicators of cognitive function.Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial).Eight US academic centers.A total of 1601 adults ages 70-89 years, sedentary, without dementia, and with functional limitations.Baseline ABI and interviewer- and computer-administered cognitive function assessments were obtained. These assessments were used to compare a physical activity intervention with a health education control. Cognitive function was reassessed 24 months later (interviewer-administered) and 18 or 30 months later (computer-administered) and central adjudication was used to classify individuals as having mild cognitive impairment, probable dementia, or neither.Lower ABI had a modest independent association with poorer cognitive functioning at baseline (partial r = 0.09; P < .001). Although lower baseline ABI was not associated with overall changes in cognitive function test scores, it was associated with higher odds for 2-year progression to a composite of either mild cognitive impairment or probable dementia (odds ratio 2.60 per unit lower ABI; 95% confidence interval 1.06-6.37). Across 2 years, changes in ABI were not associated with changes in cognitive function.In an older cohort sedentary individuals with dementia and with functional limitations, lower baseline ABI was independently correlated with cognitive function and associated with greater 2-year risk for progression to mild cognitive impairment or probable dementia.

    View details for DOI 10.1016/j.jamda.2015.03.010

    View details for PubMedID 25869993

  • Comparative Effectiveness Research: A Roadmap for Physical Activity and Lifestyle MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Jakicic, J. M., Sox, H., Blair, S. N., Bensink, M., Johnson, W. G., King, A. C., Lee, I., Nahum-Shani, I., Sallis, J. F., Sallis, R. E., Craft, L., Whitehead, J. R., Ainsworth, B. E. 2015; 47 (8): 1747-1754


    Comparative effectiveness research (CER) is designed to support informed decision making at both the individual, population, and policy levels. The American College of Sports Medicine and partners convened a conference with the focus of building an agenda for CER within the context of physical activity and nonpharmacological lifestyle approaches in the prevention and treatment of chronic disease. This report summarizes the conference content and consensus recommendations that culminated in a CER roadmap for physical activity and lifestyle approaches to reducing the risk of chronic disease.This conference focused on presentations and discussion around the following topic areas: 1) defining CER, 2) identifying the current funding climate to support CER, 3) summarizing methods for conducting CER, and 4) identifying CER opportunities for physical activity.This conference resulted in consensus recommendations to adopt a CER roadmap for physical activity and lifestyle approaches to reducing the risk of chronic disease. In general, this roadmap provides a systematic framework by which CER for physical activity can move from a planning phase to a phase of engagement in CER related to lifestyle factors with particular emphasis on physical activity to a societal change phase that results in changes in policy, practice, and health.It is recommended that physical activity researchers and health care providers use the roadmap developed from this conference as a method to systematically engage in and apply CER to the promotion of physical activity as a key lifestyle behavior that can be effective at making an impact on a variety of health-related outcomes.

    View details for DOI 10.1249/MSS.0000000000000590

    View details for Web of Science ID 000357942200024

    View details for PubMedID 25426735

  • Effect of Structured Physical Activity on Sleep-Wake Behaviors in Sedentary Elderly Adults with Mobility Limitations. Journal of the American Geriatrics Society Vaz Fragoso, C. A., Miller, M. E., King, A. C., Kritchevsky, S. B., Liu, C. K., Myers, V. H., Nadkarni, N. K., Pahor, M., Spring, B. J., Gill, T. M. 2015; 63 (7): 1381-1390


    To evaluate the effect of structured physical activity on sleep-wake behaviors in sedentary community-dwelling elderly adults with mobility limitations.Multicenter, randomized trial of moderate-intensity physical activity versus health education, with sleep-wake behaviors prespecified as a tertiary outcome over a planned intervention period ranging from 24 to 30 months.Lifestyle Interventions and Independence for Elders Study.Community-dwelling persons aged 70 to 89 who were initially sedentary and had a Short Physical Performance Battery score less than 10 (N = 1,635).Sleep-wake behaviors were evaluated using the Insomnia Severity Index (ISI) (?8 defined insomnia), Epworth Sleepiness Scale (ESS) (?10 defined daytime drowsiness), and Pittsburgh Sleep Quality Index (PSQI) (>5 defined poor sleep quality) administered at baseline and 6, 18, and 30 months.The randomized groups were similar in terms of baseline demographic variables, including mean age (79) and sex (67% female). Structured physical activity resulted in a significantly lower likelihood of having poor sleep quality (adjusted odds ratios (aOR) for PSQI >5 = 0.80, 95% confidence interval (CI) = 0.68-0.94), including fewer new cases (aOR for PSQI >5 = 0.70, 95% CI = 0.54-0.89), than health education but not in resolution of prevalent cases (aOR for PSQI ?5 = 1.13, 95% CI = 0.90-1.43). No significant intervention effects were observed for the ISI or ESS.Structured physical activity resulted in a lower likelihood of developing poor sleep quality (PSQI >5) over the intervention period than health education but had no effect on prevalent cases of poor sleep quality or on sleep-wake behaviors evaluated using the ISI or ESS. These results suggest that the benefit of physical activity in this sample was preventive and limited to sleep-wake behaviors evaluated using the PSQI.

    View details for DOI 10.1111/jgs.13509

    View details for PubMedID 26115386

  • Interventions to Reduce Sedentary Behavior MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Manini, T. M., Carr, L. J., King, A. C., Marshall, S., Robinson, T. N., Rejeski, W. J. 2015; 47 (6): 1306-1310


    This article reports on the presentations and discussion from the working group on "Influences on Sedentary Behavior and Interventions To Reduce Sedentary Behavior" as part of the Sedentary Behavior: Identifying Research Priorities workshop.Interventions were discussed in the context of targeting sedentary behavior (SB) as a concept distinct from physical activity. It was recommended that interventions targeting SB should consider a life course perspective, a position predicated on the assumption that SB is age and life stage dependent. In addition, targeting environments where individuals have high exposure to SB-such as workplace sitting-could benefit from new technology (e.g., computer-based prompting to stand or move), environmental changes (e.g., active workstations), policies targeting reduced sedentary time (e.g., allowing employees regular desk breaks), or by changing norms surrounding prolonged sitting (e.g., standing meetings).There are limited data about the minimal amount of SB change required to produce meaningful health benefits. In addition to developing relevant scientific and public health definitions of SB, it is important to further delineate the scope of health and quality-of-life outcomes associated with reduced SB across the life course and to clarify what behavioral alternatives to SB can be used to optimize health gains. SB interventions will benefit from having more clarity about the potential physiological and behavioral synergies with current physical activity recommendations, developing multilevel interventions aimed at reducing SB across all life phases and contexts, harnessing relevant and effective strategies to extend the reach of interventions to all sectors of society, as well as applying state-of-the-science adaptive designs and methods to accelerate advances in the science of SB interventions.

    View details for DOI 10.1249/MSS.0000000000000519

    View details for Web of Science ID 000354745500027

    View details for PubMedID 25222818

  • The MAT-sf: Identifying Risk for Major Mobility Disability JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Rejeski, W. J., Rushing, J., Guralnik, J. M., Ip, E. H., King, A. C., Manini, T. M., Marsh, A. P., McDermott, M. M., Fielding, R. A., Newman, A. B., Tudor-Locke, C., Gill, T. M. 2015; 70 (5): 641-646


    The assessment of mobility is essential to both aging research and clinical geriatric practice. A newly developed self-report measure of mobility, the mobility assessment tool-short form (MAT-sf), uses video animations as an innovative method to improve measurement accuracy/precision. The primary aim of the current study was to evaluate whether MAT-sf scores can be used to identify risk for major mobility disability (MMD).This article is based on data collected from the Lifestyle Interventions and Independence for Elders study and involved 1,574 older adults between the ages of 70-89. The MAT-sf was administered at baseline; MMD, operationalized as failure to complete the 400-m walk ? 15 minutes, was evaluated at 6-month intervals across a period of 42 months. The outcome of interest was the first occurrence of MMD or incident MMD.After controlling for age, sex, clinic site, and treatment arm, baseline MAT-sf scores were found to be effective in identifying risk for MMD (p < .0001). Partitioning the MAT-sf into four groups revealed that persons with scores <40, 40-49, 50-59, and 60+ had failure rates across 42 months of follow-up of 66%, 52%, 35%, and 22%, respectively.The MAT-sf is a quick and efficient way of identifying older adults at risk for MMD. It could be used to clinically identify older adults that are in need of intervention for MMD and provides a simple means for monitoring the status of patients' mobility, an important dimension of functional health.

    View details for DOI 10.1093/gerona/glv003

    View details for Web of Science ID 000353899100014

    View details for PubMedID 25680917

  • Light Intensity Physical Activity and Sedentary Behavior in Relation to Body Mass Index and Grip Strength in Older Adults: Cross-Sectional Findings from the Lifestyle Interventions and Independence for Elders (LIFE) Study PLOS ONE Bann, D., Hire, D., Manini, T., Cooper, R., Botoseneanu, A., McDermott, M. M., Pahor, M., Glynn, N. W., Fielding, R., King, A. C., Church, T., Ambrosius, W. T., Gill, T. 2015; 10 (2)


    Identifying modifiable determinants of fat mass and muscle strength in older adults is important given their impact on physical functioning and health. Light intensity physical activity and sedentary behavior are potential determinants, but their relations to these outcomes are poorly understood. We evaluated associations of light intensity physical activity and sedentary time-assessed both objectively and by self-report-with body mass index (BMI) and grip strength in a large sample of older adults.We used cross-sectional baseline data from 1130 participants of the Lifestyle Interventions and Independence for Elders (LIFE) study, a community-dwelling sample of relatively sedentary older adults (70-89 years) at heightened risk of mobility disability. Time spent sedentary and in light intensity activity were assessed using an accelerometer worn for 3-7 days (Actigraph GT3X) and by self-report. Associations between these exposures and measured BMI and grip strength were evaluated using linear regression.Greater time spent in light intensity activity and lower sedentary times were both associated with lower BMI. This was evident using objective measures of lower-light intensity, and both objective and self-reported measures of higher-light intensity activity. Time spent watching television was positively associated with BMI, while reading and computer use were not. Greater time spent in higher but not lower intensities of light activity (assessed objectively) was associated with greater grip strength in men but not women, while neither objectively assessed nor self-reported sedentary time was associated with grip strength.In this cross-sectional study, greater time spent in light intensity activity and lower sedentary times were associated with lower BMI. These results are consistent with the hypothesis that replacing sedentary activities with light intensity activities could lead to lower BMI levels and obesity prevalence among the population of older adults. However, longitudinal and experimental studies are needed to strengthen causal inferences.

    View details for DOI 10.1371/journal.pone.0116058

    View details for Web of Science ID 000348822600018

    View details for PubMedID 25647685

  • Prevalence of Metabolic Syndrome and Its Association with Physical Capacity, Disability, and Self-Rated Health in Lifestyle Interventions and Independence for Elders Study Participants JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Botoseneanu, A., Ambrosius, W. T., Beavers, D. P., De Rekeneire, N., Anton, S., Church, T., Folta, S. C., Goodpaster, B. H., King, A. C., Nicklas, B. J., Spring, B., Wang, X., Gill, T. M. 2015; 63 (2): 222-232


    To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self-rated health in older adults at high risk of mobility disability, including those with and without diabetes mellitus.Cross-sectional analysis.Lifestyle Interventions and Independence for Elders (LIFE) Study.Community-dwelling sedentary adults aged 70 to 89 at high risk of mobility disability (Short Physical Performance Battery (SPPB) score ?9; mean 7.4 ± 1.6) (N = 1,535).Metabolic syndrome was defined according to the 2009 multiagency harmonized criteria; outcomes were physical capacity (400-m walk time, grip strength, SPPB score), disability (composite 19-item score), and self-rated health (5-point scale ranging from excellent to poor).The prevalence of MetS was 49.8% in the overall sample (83.2% of those with diabetes mellitus, 38.1% of those without). MetS was associated with stronger grip strength (mean difference (?) = 1.2 kg, P = .01) in the overall sample and in participants without diabetes mellitus and with poorer self-rated health (? = 0.1 kg, P < .001) in the overall sample only. No significant differences were found in 400-m walk time, SPPB score, or disability score between participants with and without MetS, in the overall sample or diabetes mellitus subgroups.Metabolic dysfunction is highly prevalent in older adults at risk of mobility disability, yet consistent associations were not observed between MetS and walking speed, lower extremity function, or self-reported disability after adjusting for known and potential confounders. Longitudinal studies are needed to investigate whether MetS accelerates declines in functional status in high-risk older adults and to inform clinical and public health interventions aimed at preventing or delaying disability in this group.

    View details for DOI 10.1111/jgs.13205

    View details for Web of Science ID 000349893300002

    View details for PubMedID 25645664

  • Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013-2014. Preventing chronic disease Seguin, R. A., Morgan, E. H., Connor, L. M., Garner, J. A., King, A. C., Sheats, J. L., Winter, S. J., Buman, M. P. 2015; 12: E102-?


    A community's built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement.Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change.Twenty-four adults (mean age, 69.4 y (standard deviation, 13.2 y), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use.An electronic tablet-based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

    View details for DOI 10.5888/pcd12.150147

    View details for PubMedID 26133645

  • Contribution of streetscape audits to explanation of physical activity in four age groups based on the Microscale Audit of Pedestrian Streetscapes (MAPS) SOCIAL SCIENCE & MEDICINE Cain, K. L., Millstein, R. A., Sallis, J. F., Conway, T. L., Gavand, K. A., Frank, L. D., Saelens, B. E., Geremia, C. M., Chapman, J., Adams, M. A., Glanz, K., King, A. C. 2014; 116: 82-92


    Ecological models of physical activity emphasize the effects of environmental influences. "Microscale" streetscape features that may affect pedestrian experience have received less research attention than macroscale walkability (e.g., residential density). The Microscale Audit of Pedestrian Streetscapes (MAPS) measures street design, transit stops, sidewalk qualities, street crossing amenities, and features impacting aesthetics. The present study examined associations of microscale attributes with multiple physical activity (PA) measures across four age groups. Areas in the San Diego, Seattle, and the Baltimore metropolitan areas, USA, were selected that varied on macro-level walkability and neighborhood income. Participants (n = 3677) represented four age groups (children, adolescents, adults, older adults). MAPS audits were conducted along a 0.25 mile route along the street network from participant residences toward the nearest non-residential destination. MAPS data were collected in 2009-2010. Subscale and overall summary scores were created. Walking/biking for transportation and leisure/neighborhood PA were measured with age-appropriate surveys. Objective PA was measured with accelerometers. Mixed linear regression analyses were adjusted for macro-level walkability. Across all age groups 51.2%, 22.1%, and 15.7% of all MAPS scores were significantly associated with walking/biking for transport, leisure/neighborhood PA, and objectively-measured PA, respectively. Supporting the ecological model principle of behavioral specificity, destinations and land use, streetscape, street segment, and intersection variables were more related to transport walking/biking, while aesthetic variables were related to leisure/neighborhood PA. The overall score was related to objective PA in children and older adults. Present findings provide strong evidence that microscale environment attributes are related to PA across the lifespan. Improving microscale features may be a feasible approach to creating activity-friendly environments.

    View details for DOI 10.1016/j.socscimed.2014.06.042

    View details for Web of Science ID 000340695700010

    View details for PubMedID 24983701

  • Sociodemographic Moderators of Relations of Neighborhood Safety to Physical Activity MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Carlson, J. A., Bracy, N. L., Sallis, J. F., Millstein, R. A., Saelens, B. E., Kerr, J., Conway, T. L., Frank, L. D., Cain, K. L., King, A. C. 2014; 46 (8): 1554-1563


    This study aimed to investigate gender, race/ethnicity, education, and income as moderators of relations of perceived neighborhood crime, pedestrian, and traffic safety to physical activity.Participants were from two samples: adults (N = 2199, age = 25-65 yr) and older adults (N = 718, age = 66+ yr) from high- and low-walkable neighborhoods in the Washington, DC, and Seattle, Washington, areas. Neighborhood safety and transportation and leisure walking were assessed via survey, and moderate to vigorous physical activity was assessed using accelerometers. Sociodemographic moderators were investigated using interaction terms and follow-up within-group tests from mixed-effects regression models.Overall direct effects of safety on physical activity were not found, with one exception. Seven interactions were found in each sample. Interactions were found for all physical activity outcomes, although total moderate to vigorous physical activity was involved in more interactions in adults than older adults. Half of the interactions revealed significant positive relations of pedestrian and traffic safety to physical activity in the more affluent/advantaged group (i.e., high education, high income, and non-Hispanic white) and null associations in the less affluent/advantaged group. Race/ethnicity was a moderator only in older adults. One-third of the interactions involved gender; half of these involved crime safety. Interactions involving crime safety showed nonsignificant positive trends in the more affluent/advantaged group and women and nonsignificant negative trends in the less affluent/advantaged group and men.Sociodemographic moderators of neighborhood safety explained some of the variation in adults' and older adults' physical activity. Patterns suggested positive associations between safety and physical activity in participants with more affluent/advantaged sociodemographic characteristics, although some patterns were inconsistent, particularly for gender. More refined conceptualizations and measures of safety are needed to understand if and how these constructs influence physical activity.

    View details for DOI 10.1249/MSS.0000000000000274

    View details for Web of Science ID 000339259700010

    View details for PubMedID 25029166

  • Neighborhood Environment and Physical Activity Among Older Adults: Do the Relationships Differ by Driving Status? JOURNAL OF AGING AND PHYSICAL ACTIVITY Ding, D., Sallis, J. F., Norman, G. J., Frank, L. D., Saelens, B. E., Kerr, J., Conway, T. L., Cain, K., Hovell, M. F., Hofstetter, C. R., King, A. C. 2014; 22 (3): 421-431
  • Sleep-Wake Disturbances in Sedentary Community-Dwelling Elderly Adults with Functional Limitations JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Fragoso, C. A., Miller, M. E., Fielding, R. A., King, A. C., Kritchevsky, S. B., McDermott, M. M., Myers, V., Newman, A. B., Pahor, M., Gill, T. M. 2014; 62 (6): 1064-1072


    To evaluate sleep-wake disturbances in sedentary community-dwelling elderly adults with functional limitations.Cross-sectional.Lifestyle Interventions and Independence in Elder (LIFE) Study.Community-dwelling persons (mean age 78.9) who spent fewer than 20 min/wk in the previous month engaged in regular physical activity and fewer than 125 min/wk of moderate physical activity, and had a Short Physical Performance Battery (SPPB) score of <10 (N = 1,635).Mobility was evaluated according to 400-m walk time (slow gait speed defined as <0.8 m/s) and SPPB score (? 7 defined moderate to severe mobility impairment). Physical inactivity was defined according to sedentary time, as a percentage of accelerometry wear time with activity of <100 counts/min; participants in the top quartile of sedentary time were classified as having a high sedentary time. Sleep-wake disturbances were evaluated using the Insomnia Severity Index (ISI) (range 0-28; ? 8 defined insomnia), Epworth Sleepiness Scale (ESS) (range 0-24; ? 10 defined daytime drowsiness), Pittsburgh Sleep Quality Index (PSQI) (range 0-21; >5 defined poor sleep quality), and Berlin Questionnaire (high risk of sleep apnea).Prevalence rates were 43.5% for slow gait speed and 44.7% for moderate to severe mobility impairment, with 77.0% of accelerometry wear time spent as sedentary time. Prevalence rates were 33.0% for insomnia, 18.1% for daytime drowsiness, 47.8% for poor sleep quality, and 32.9% for high risk of sleep apnea. Participants with insomnia had a mean ISI score of 12.1, those with daytime drowsiness had a mean ESS score of 12.5, and those with poor sleep quality had a mean PSQI score of 9.2. In adjusted models, measures of mobility and physical inactivity were generally not associated with sleep-wake disturbances, using continuous or categorical variables.In a large sample of sedentary community-dwelling elderly adults with functional limitations, sleep-wake disturbances were prevalent but only mildly severe and were generally not associated with mobility impairment or physical inactivity.

    View details for DOI 10.1111/jgs.12845

    View details for Web of Science ID 000337624300008

    View details for PubMedID 24889836

  • Is the relationship between the built environment and physical activity moderated by perceptions of crime and safety? INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Bracy, N. L., Millstein, R. A., Carlson, J. A., Conway, T. L., Sallis, J. F., Saelens, B. E., Kerr, J., Cain, K. L., Frank, L. D., King, A. C. 2014; 11


    Direct relationships between safety concerns and physical activity have been inconsistently patterned in the literature. To tease out these relationships, crime, pedestrian, and traffic safety were examined as moderators of built environment associations with physical activity.Exploratory analyses used two cross-sectional studies of 2068 adults ages 20-65 and 718 seniors ages 66+ with similar designs and measures. The studies were conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington regions during 2001-2005 (adults) and 2005-2008 (seniors). Participants were recruited from areas selected to sample high- and low- income and walkability. Independent variables perceived crime, traffic, and pedestrian safety were measured using scales from validated instruments. A GIS-based walkability index was calculated for a street-network buffer around each participant's home address. Outcomes were total physical activity measured using accelerometers and transportation and leisure walking measured with validated self-reports (IPAQ-long). Mixed effects regression models were conducted separately for each sample.Of 36 interactions evaluated across both studies, only 5 were significant (p

    View details for DOI 10.1186/1479-5868-11-24

    View details for Web of Science ID 000332934900002

    View details for PubMedID 24564971

  • A Dynamical Systems Model of Social Cognitive Theory 2014 AMERICAN CONTROL CONFERENCE (ACC) Martin, C. A., Rivera, D. E., Riley, W. T., Hekler, E. B., Buman, M. P., Adams, M. A., King, A. C. 2014
  • Cohort Profile: The Resilience for Eating and Activity Despite Inequality (READI) study INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Ball, K., Cleland, V., Salmon, J., Timperio, A. F., McNaughton, S., Thornton, L., Campbell, K., Jackson, M., Baur, L. A., Mishra, G., Brug, J., Jeffery, R. W., King, A., Kawachi, I., Crawford, D. A. 2013; 42 (6): 1629-1639


    The Resilience for Eating and Activity Despite Inequality (READI) cohort was established to address the following two key aims: to investigate the pathways (personal, social and structural) by which socio-economic disadvantage influences lifestyle choices associated with obesity risk (physical inactivity, poor dietary choices) and to explore mechanisms underlying 'resilience' to obesity risk in socio-economically disadvantaged women and children. A total of 4349 women aged 18-46 years and 685 children aged 5-12 years were recruited from 80 socio-economically disadvantaged urban and rural neighbourhoods of Victoria, Australia, and provided baseline (T1: 2007-08) measures of adiposity, physical activity, sedentary and dietary behaviours; socio-economic and demographic factors; and psychological, social and perceived environmental factors that might impact on obesity risk. Audits of the 80 neighbourhoods were undertaken at baseline to provide objective neighbourhood environmental data. Three-year follow-up data (2010-11) have recently been collected from 1912 women and 382 children. Investigators welcome enquiries regarding data access and collaboration.

    View details for DOI 10.1093/ije/dys165

    View details for Web of Science ID 000329870400024

    View details for PubMedID 23255533

  • The MAT-sf: Clinical Relevance and Validity JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Rejeski, W. J., Marsh, A. P., Anton, S., Chen, S., Church, T., Gill, T. M., Guralnik, J. M., Glynn, N. W., King, A. C., Rushing, J., Ip, E. H. 2013; 68 (12): 1567-1574


    The measurement of mobility is essential to both aging research and clinical practice. A newly developed self-report measure of mobility, the mobility assessment tool-short form (MAT-sf), uses video animations to improve measurement accuracy/precision. Using a large baseline data set, we recalibrated the items, evaluated the extent to which older patients' self-efficacy (i.e., confidence) for walking was related to MAT-sf scores beyond their actual 400-m walk time, and assessed the relationship of the MAT-sf with body mass index and other clinical variables.The analyses employed baseline data from the Lifestyle Interventions and Independence for Elders Study.Item recalibration demonstrated that the MAT-sf scoring algorithm was robust. In an analysis with 400-m walk time and self-efficacy regressed on the MAT-sf, both variables shared unique variance with the MAT-sf (p < .001). The MAT-sf was inversely related to several comorbidities, most notably hypertension and arthritis (p < .001), and scores were lowest when body mass index ? 35 kg/m(2). Finally, MAT-sf scores were directly related to Short Physical Performance Battery scores, inversely related to difficulty with activities of daily living (p < .001) and higher for men than for women (p < .001).The findings extend the validity and clinical utility of this innovative tool for assessing self-reported mobility in older adults. Longitudinal data on the MAT-sf from the Lifestyle Interventions and Independence for Elders Study will enable us to evaluate the relative contributions of self-report and performance-based measures of mobility on important health outcomes.

    View details for DOI 10.1093/gerona/glt068

    View details for Web of Science ID 000326675000014

    View details for PubMedID 23685766

  • Disability and Chronic Disease Among Older Adults in India: Detecting Vulnerable Populations Through the WHO SAGE Study AMERICAN JOURNAL OF EPIDEMIOLOGY Basu, S., King, A. C. 2013; 178 (11): 1620-1628


    Chronic noncommunicable diseases (NCDs) are now prevalent in many low- and middle-income countries and confer a heightened risk of disability. It is unclear how public health programs can identify the older adults at highest risk of disability related to NCDs within diverse developing country populations. We studied nationally representative survey data from 7,150 Indian adults older than 50 years of age who participated in the World Health Organization Study on Global Aging and Adult Health (2007-2010) to identify population subgroups who are highly disabled. Using machine-learning algorithms, we identified sociodemographic correlates of disability. Although having 2 or more symptomatic NCDs was a key correlate of disability, the prevalence of symptomatic, undiagnosed NCDs was highest among the lowest 2 wealth quintiles of Indian adults, contrary to prior hypotheses of increased NCDs with wealth. Women and persons from rural populations were also disproportionately affected by nondiagnosed NCDs, with high out-of-pocket health care expenditures increasing the probability of remaining symptomatic from NCDs. These findings also indicate that NCD prevalence surveillance studies in low- and middle-income countries should expand beyond self-reported diagnoses to include more extensive symptom- and examination-based surveys, given the likely high rate of surveillance bias due to barriers to diagnosis among vulnerable populations.

    View details for DOI 10.1093/aje/kwt191

    View details for Web of Science ID 000327717600004

    View details for PubMedID 24049156

  • Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Hekler, E. B., Buman, M. P., Otten, J., Castro, C. M., Grieco, L., Marcus, B., Friedman, R. H., Napolitano, M. A., King, A. C. 2013; 10
  • Promoting Healthy Weight With "Stability Skills First": A Randomized Trial JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Kiernan, M., Brown, S. D., Schoffman, D. E., Lee, K., King, A. C., Taylor, C. B., Schleicher, N. C., Perri, M. G. 2013; 81 (2): 336-346


    Although behavioral weight-loss interventions produce short-term weight loss, long-term maintenance remains elusive. This randomized trial examined whether learning a novel set of "stability skills" before losing weight improved long-term weight management. Stability skills were designed to optimize individuals' current satisfaction with lifestyle and self-regulatory habits while requiring the minimum effort and attention necessary.Overweight/obese women (N = 267) were randomly assigned to one of two 6-month interventions and assessed at baseline and at 6, 12, and 18 months. Maintenance First women participated first in an 8-week stability skills maintenance module and then in a standard 20-week behavioral weight-loss program. Weight Loss First women participated first in a standard 20-week behavioral weight-loss program and then in a standard 8-week problem-solving skills maintenance module. There was no intervention staff contact during the 12-month follow-up period (6-18 months).As designed, Maintenance First participants lost the same percentage of initial weight during the 6-month intervention period as Weight Loss First participants (M = -8.6%, SD = 5.7, vs. M = -9.1%, SD = 6.9; t = -0.6, p = .52). However, Maintenance First participants regained significantly less weight during the 12-month follow-up period (6-18 months) than Weight Loss First participants (M = 3.2 lb, SD = 10.4, vs. M = 7.3 lb, SD = 9.9 [M = 1.4 kg, SD = 4.7, vs. M = 3.3 kg, SD = 4.5]; t = 3.3, p = .001, d = 0.4).Learning stability skills before losing weight was successful in helping women to maintain weight loss without intervention staff contact during follow-up. These results can inform the study design of future innovative interventions.

    View details for DOI 10.1037/a0030544

    View details for Web of Science ID 000316908500012

    View details for PubMedID 23106759

  • Physical Activity Increases Gains in and Prevents Loss of Physical Function: Results From the Lifestyle Interventions and Independence for Elders Pilot Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Ip, E. H., Church, T., Marshall, S. A., Zhang, Q., Marsh, A. P., Guralnik, J., King, A. C., Rejeski, W. J. 2013; 68 (4): 426-432


    Physical activity (PA) appears to have a positive effect on physical function, however, studies have not examined multiple indices of physical function jointly nor have they conceptualized physical functioning as a state rather than a trait.About 424 men and women aged 70-89 were randomly assigned to complete a PA or a successful aging (SA) education program. Balance, gait speed, chair stand performance, grip strength, and time to complete the 400-m walk were assessed at baseline and at 6 and 12 months. Using hidden Markov model, empiric states of physical functioning were derived based on these performance measures of balance, strength, and mobility. Rates of gain and loss in physical function were compared between PA and SA.Eight states of disability were identified and condensed into four clinically relevant states. State 1 represented mild disability with physical functioning, states 2 and 3 were considered intermediate states of disability, and state 4 severe disability. About 30.1% of all participants changed states at 6 months, 24.1% at 12 months, and 11.0% at both time points. The PA group was more likely to regain or sustain functioning and less likely to lose functioning when compared with SA. For example, PA participants were 20% more likely than the SA participants to remain in state 1.PA appears to have a favorable effect on the dynamics of physical functioning in older adults.

    View details for DOI 10.1093/gerona/gls186

    View details for Web of Science ID 000316273000012

    View details for PubMedID 22987794

  • Promoting physical activity for elders with compromised function: the Lifestyle Interventions and Independence for Elders (LIFE) Study physical activity intervention CLINICAL INTERVENTIONS IN AGING Rejeski, W. J., Axtell, R., Fielding, R., Katula, J., King, A. C., Manini, T. M., Marsh, A. P., Pahor, M., Rego, A., Tudor-Locke, C., Newman, M., Walkup, M. P., Miller, M. E. 2013; 8: 1119-1131


    The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase III randomized controlled clinical trial ( identifier: NCT01072500) that will provide definitive evidence regarding the effect of physical activity (PA) on major mobility disability in older adults (70-89 years old) who have compromised physical function. This paper describes the methods employed in the delivery of the LIFE Study PA intervention, providing insight into how we promoted adherence and monitored the fidelity of treatment. Data are presented on participants' motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training. Prior to the onset of training, 31.4% of participants noted slight conflict with being able to meet the demands of the program and 6.4% indicated that the degree of conflict would be moderate. Accelerometry data collected during PA training revealed that the average intensity - 1,555 counts/minute for men and 1,237 counts/minute for women - was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults. Also, a sizable subgroup required one or more rest stops. These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function. Moreover, the concept of what constitutes "moderate" exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription.

    View details for DOI 10.2147/CIA.S49737

    View details for Web of Science ID 000324170300001

    View details for PubMedID 24049442

  • Outdoor physical activity and self rated health in older adults living in two regions of the US INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Kerr, J., Sallis, J. F., Saelens, B. E., Cain, K. L., Conway, T. L., Frank, L. D., King, A. C. 2012; 9


    Older adults spend little time outdoors and many are physically inactive. The relationship between outdoor physical activity and self rated health has not been studied in older adults. This paper aimed to assess the relation of location of physical activity to self rated health and physical activity minutes. This was an observational study of ambulatory adults 66 years and older conducted in 2005-2008. Participants (N = 754) completed survey measures of physical activity location and self rated health, and wore an accelerometer to objectively assess physical activity. A mixed model linear regression procedure adjusted for neighborhood clustering effects. Differences in self rated health and physical activity minutes were compared across three physical activity settings (indoor only, outdoor only, both indoor and outdoor).Minutes of moderate to vigorous physical activity were significantly greater in those who were physically active at least once a week outdoors compared with those who were physically active indoors only. Self rated health was significantly related to being physically active but did not vary by location of activity.Older adults who were physically active outdoors accumulated significantly more physical activity, but self-rated health was not significantly greater than those being physically active indoors.

    View details for DOI 10.1186/1479-5868-9-89

    View details for Web of Science ID 000309218500001

    View details for PubMedID 22846594

  • Minority recruitment into clinical trials: Experimental findings and practical implications CONTEMPORARY CLINICAL TRIALS Brown, S. D., Lee, K., Schoffman, D. E., King, A. C., Crawley, L. M., Kiernan, M. 2012; 33 (4): 620-623


    Racial and ethnic minorities in the US suffer disproportionately from obesity and related comorbidities, yet remain underrepresented in health research. To date, research on practical strategies to improve minority reach and recruitment into clinical trials is primarily descriptive rather than experimental. Within a randomized behavioral weight management trial for obese women, this recruitment experiment examined whether two characteristics of direct mail letters, an ethnically-targeted statement and personalization, increased the response rate among minority women. The ethnically-targeted statement noted ethnic-specific information about health risks of obesity. Personalized letters included recipients' names/addresses in the salutation and a handwritten signature on high-quality letterhead. Of women sent direct mail letters (N=30,000), those sent letters with the ethnically-targeted statement were more likely to respond than women sent letters with the generic statement, 0.8% (n=121) vs. 0.6% (n=90) respectively, p=.03, a 34.4% increase. Women sent personalized letters were no more likely to respond than women sent non-personalized letters, p=.53. In the weight management trial itself, of 267 women randomized into the trial, 33.7% (n=90) were minorities. Of minority women randomized into the trial, 68.9% (n=62) were recruited by direct mail letters: 75.8% (n=47) of those were sent a letter and 24.2% (n=15) were referred by friends/family who were sent a letter. The results indicate that a simple modification to a standard recruitment letter can have a meaningful impact on minority reach and recruitment rates. Practical implications include using ethnically-targeted, non-personalized direct mail letters and recruiting through friends/family at no additional cost.

    View details for DOI 10.1016/j.cct.2012.03.003

    View details for Web of Science ID 000305711700010

    View details for PubMedID 22449836

  • Resilience to obesity among socioeconomically disadvantaged women: the READI study INTERNATIONAL JOURNAL OF OBESITY Ball, K., Abbott, G., Cleland, V., Timperio, A., Thornton, L., Mishra, G., Jeffery, R. W., Brug, J., King, A., Crawford, D. 2012; 36 (6): 855-865


    This cross-sectional study aimed to identify sociodemographic and behavioural characteristics of 'overweight-resilient' women, that is, women who were in a healthy body weight range, despite living in socioeconomically disadvantaged neighbourhoods that place them at increased risk of obesity. The study also aimed to test a comprehensive theoretically derived model of the associations between intrapersonal, social and environmental factors and obesity among this target group.A total of 3235 women aged 18-45 years from 80 urban and rural neighbourhoods throughout Victoria, Australia, participated in the Resilience for Eating and Activity Despite Inequality study.Women reported height, weight, sociodemographic characteristics, leisure-time physical activity, dietary behaviours and a range of theoretically derived cognitive, social and neighbourhood environmental characteristics hypothesized to influence obesity risk. A theoretical model predicting body mass index (BMI) was tested using structural equation models.Women classified as 'resilient' to obesity tended to be younger, born overseas, more highly educated, unmarried and to have higher or undisclosed household incomes. They engaged in more leisure-time physical activity and consumed less fast foods and soft drinks than overweight/obese women. Neighbourhood characteristics, social characteristics and cognitive characteristics all contributed to explaining variation in BMI in the hypothesized directions.These results demonstrate several characteristics of women appearing 'resilient' to obesity, despite their increased risk conferred by residing in socioeconomically disadvantaged neighbourhoods. Acknowledging the cross-sectional study design, the results advance theoretical frameworks aimed at investigating obesity risk by providing evidence in support of a comprehensive model of direct and indirect effects on obesity of neighbourhood, as well as social, cognitive and behavioural characteristics.

    View details for DOI 10.1038/ijo.2011.183

    View details for Web of Science ID 000305282400013

    View details for PubMedID 21931326

  • Do User Intentions and Health Feedback Influence Exergame Duration of Use and Measured Exertion? Hekler, E. B., Chen, F. X., King, A. C. LIPPINCOTT WILLIAMS & WILKINS. 2012: 846-847
  • Do the Individual, Social, and Environmental Correlates of Physical Activity Differ Between Urban and Rural Women? ENVIRONMENT AND BEHAVIOR Cleland, V. J., Ball, K., King, A. C., Crawford, D. 2012; 44 (3): 350-373
  • Social Support for Healthy Behaviors: Scale Psychometrics and Prediction of Weight Loss Among Women in a Behavioral Program OBESITY Kiernan, M., Moore, S. D., Schoffman, D. E., Lee, K., King, A. C., Taylor, C. B., Kiernan, N. E., Perri, M. G. 2012; 20 (4): 756-764


    Social support could be a powerful weight-loss treatment moderator or mediator but is rarely assessed. We assessed the psychometric properties, initial levels, and predictive validity of a measure of perceived social support and sabotage from friends and family for healthy eating and physical activity (eight subscales). Overweight/obese women randomized to one of two 6-month, group-based behavioral weight-loss programs (N = 267; mean BMI 32.1 ± 3.5; 66.3% White) completed subscales at baseline, and weight loss was assessed at 6 months. Internal consistency, discriminant validity, and content validity were excellent for support subscales and adequate for sabotage subscales; qualitative responses revealed novel deliberate instances not reflected in current sabotage items. Most women (>75%) "never" or "rarely" experienced support from friends or family. Using nonparametric classification methods, we identified two subscales-support from friends for healthy eating and support from family for physical activity-that predicted three clinically meaningful subgroups who ranged in likelihood of losing ?5% of initial weight at 6 months. Women who "never" experienced family support were least likely to lose weight (45.7% lost weight) whereas women who experienced both frequent friend and family support were more likely to lose weight (71.6% lost weight). Paradoxically, women who "never" experienced friend support were most likely to lose weight (80.0% lost weight), perhaps because the group-based programs provided support lacking from friendships. Psychometrics for support subscales were excellent; initial support was rare; and the differential roles of friend vs. family support could inform future targeted weight-loss interventions to subgroups at risk.

    View details for DOI 10.1038/oby.2011.293

    View details for Web of Science ID 000302143300008

    View details for PubMedID 21996661

  • MOBILE PHONE APPLICATIONS TO PROMOTE PHYSICAL ACTIVITY INCREASES: PRELIMINARY RESULTS King, A. C., Hekler, E., Grieco, L., Winter, S., Buman, M., Banerjee, B., Cirimele, J., Robinson, T. N., Mezias, B., Chen, F. SPRINGER. 2012: S204-S204
  • Reliability and Validity of CHAMPS Self-Reported Sedentary-to-Vigorous Intensity Physical Activity in Older Adults JOURNAL OF PHYSICAL ACTIVITY & HEALTH Hekler, E. B., Buman, M. P., Haskell, W. L., Conway, T. L., Cain, K. L., Sallis, J. F., Saelens, B. E., Frank, L. D., Kerr, J., King, A. C. 2012; 9 (2): 225-236


    Recent research highlights the potential value of differentiating between categories of physical activity intensities as predictors of health and well-being. This study sought to assess reliability and concurrent validity of sedentary (ie, 1 METs), low-light (ie, >1 and ?2 METs; eg, playing cards), high-light (ie, >2 and <3 METs; eg, light walking), moderate-to-vigorous physical activity (MVPA, ?3 METs), and "total activity" (?2 METs) from the CHAMPS survey. Further, this study explored over-reporting and double-reporting.CHAMPS data were gathered from the Seniors Neighborhood Quality of Life Study, an observational study of adults aged 65+ years conducted in 2 US regions.Participants (N = 870) were 75.3 ± 6.8 years old, with 56% women and 71% white. The CHAMPS sedentary, low-light, high-light, total activity, and MVPA variables had acceptable test-retest reliability (ICCs 0.56-0.70). The CHAMPS high-light (? = 0.27), total activity (? = 0.34), and MVPA (? = 0.37) duration scales were moderately associated with accelerometry minutes of corresponding intensity, and the sedentary scale (? = 0.12) had a lower, but significant correlation. Results suggested that several CHAMPS items may be susceptible to over-reporting (eg, walking, housework).CHAMPS items effectively measured high-light, total activity, and MVPA in seniors, but further refinement is needed for sedentary and low-light activity.

    View details for Web of Science ID 000300960800008

    View details for PubMedID 22368222

  • The CHOICE Study: A "taste-test" of Utilitarian vs. Leisure Walking Among Older Adults HEALTH PSYCHOLOGY Hekler, E. B., Castro, C. M., Buman, M. P., King, A. C. 2012; 31 (1): 126-129


    Utilitarian walking (e.g., walking for transport) and leisure walking (e.g., walking for health/recreation) are encouraged to promote health, yet few studies have explored specific preferences for these two forms of physical activity or factors that impact such preferences. A quasi-experimental crossover design was used to evaluate how training underactive midlife and older adults in each type of walking impacted total steps taken and how it was linked to their subsequent choice of walking types.Participants (N = 16) were midlife and older adults (M age = 64 ± 8 years) who were mostly women (81%) and white (75%). To control for order effects, participants were randomized to instruction in either utilitarian or leisure walking for 2 weeks and then the other type for 2 weeks. Participants then entered a 2-week "free choice" phase in which they chose any mixture of the walking types. Outcome variables included walking via OMRON pedometer and the ratio of utilitarian versus leisure walking during the free-choice phase. Participants completed surveys about their neighborhood (NEWS) and daily travel to multiple locations.Instruction in leisure-only, utilitarian-only, and a freely chosen mixture of the two each resulted in significant increases in steps taken relative to baseline (ps < 0.05). Having to go to multiple locations daily and traveling greater distances to locations were associated with engagement in more utilitarian walking. In contrast, good walking paths, neighborhood aesthetics, easy access to exercise facilities, and perceiving easier access to neighborhood services were associated with more leisure walking.Results from this pilot study suggest that midlife and older adults may most easily meet guidelines through either leisure only or a mixture of leisure and utilitarian walking, and tailored suggestions based on the person's neighborhood may be useful.

    View details for DOI 10.1037/a0025567

    View details for Web of Science ID 000299261200018

    View details for PubMedID 21928901

  • Interactions between psychosocial and built environment factors in explaining older adults' physical activity PREVENTIVE MEDICINE Carlson, J. A., Sallis, J. F., Conway, T. L., Saelens, B. E., Frank, L. D., Kerr, J., Cain, K. L., King, A. C. 2012; 54 (1): 68-73


    To evaluate ecological model predictions of cross-level interactions among psychosocial and environmental correlates of physical activity in 719 community-dwelling older adults in the Baltimore, Maryland and Seattle, Washington areas during 2005-2008.Walkability, access to parks and recreation facilities and moderate-to-vigorous physical activity (MVPA) minutes per week (min/week) were measured objectively. Neighborhood aesthetics, walking facilities, social support, self-efficacy, barriers and transportation and leisure walking min/week were self-reported.Walkability interacted with social support in explaining total MVPA (B=13.71) and with social support (B=7.90), self-efficacy (B=7.66) and barriers (B=-8.26) in explaining walking for transportation. Aesthetics interacted with barriers in explaining total MVPA (B=-12.20) and walking facilities interacted with self-efficacy in explaining walking for leisure (B=-10.88; Ps<.05). Summarizing across the interactions, living in a supportive environment (vs. unsupportive) was related to 30-59 more min/week of physical activity for participants with more positive psychosocial attributes, but only 0-28 more min/week for participants with less positive psychosocial attributes.Results supported synergistic interactions between built environment and psychosocial factors in explaining physical activity among older adults. Findings suggest multilevel interventions may be most effective in increasing physical activity.

    View details for DOI 10.1016/j.ypmed.2011.10.004

    View details for Web of Science ID 000299455500016

    View details for PubMedID 22027402

  • Neighborhood Environment Profiles for Physical Activity Among Older Adults AMERICAN JOURNAL OF HEALTH BEHAVIOR Adams, M. A., Sallis, J. F., Conway, T. L., Frank, L. D., Saelens, B. E., Kerr, J., Cain, K. L., King, A. C. 2012; 36 (6): 757-769


    To explore among older adults whether multivariate neighborhood profiles were associated with physical activity (PA) and BMI.Adults (66-97 years) were recruited from Baltimore-Washington, DC (n=360), and Seattle-King County, Washington (n=368), regions. Latent profile analyses were conducted using the Neighborhood Environment Walkability Scale. ANCOVA models tested for criterion validity of profiles by examining relationships to PA and BMI.Neighborhood profiles differed significantly by as much as 10 minutes/day for moderate-to-vigorous PA, 1.1 hours/week for walking for errands, and almost 50 minutes/week for leisure PA.Environmental variables resulted in meaningful neighborhood patterns that explained large differences in seniors' health outcomes.

    View details for DOI 10.5993/AJHB.36.6.4

    View details for Web of Science ID 000309358000004

    View details for PubMedID 23026035

  • Are daily fluctuations in perceived environment associated with walking? PSYCHOLOGY & HEALTH Hekler, E. B., Buman, M. P., Ahn, D., Dunton, G., Atienza, A. A., King, A. C. 2012; 27 (9): 1009-1020


    The physical environment is thought to influence walking; however, daily variations in perceived environment have received little attention. The current study sought to examine if key within-person factors (i.e., implementation intentions, social support, affect and self-efficacy) would be associated with walking and if perceived access to supportive environments (e.g., access to nice walking paths) and perceived environmental barriers (e.g., bad weather and safety issues) were uniquely associated with walking after controlling for other constructs. Participants (N = 14, 50.0% men, 78.6% White, M age = 59.4 ± 6.4) were in the intervention arm of an 8-week controlled trial promoting walking via personal digital assistants. Participants completed electronic surveys twice a day (total entries = 804) in which they reported brisk walking levels and psychosocial and environmental factors. Multilevel modelling was used to examine within-person variations in constructs as determinants of walking. Results suggested that daily variations in implementation intentions, social support and positive affect were positively associated with walking. Further, perceived access to supportive environments, though not perceived environmental barriers, was positively associated with walking after controlling for other constructs (p < 0.05). Future research should explore intervention components that target context-specific information about perceived access to supportive environments as part of a broader perspective on intervention development.

    View details for DOI 10.1080/08870446.2011.645213

    View details for Web of Science ID 000307941100001

    View details for PubMedID 22214492

  • The Lifestyle Interventions and Independence for Elders Study: Design and Methods JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Fielding, R. A., Rejeski, W. J., Blair, S., Church, T., Espeland, M. A., Gill, T. M., Guralnik, J. M., Hsu, F., Katula, J., King, A. C., Kritchevsky, S. B., McDermott, M. M., Miller, M. E., Nayfield, S., Newman, A. B., Williamson, J. D., Bonds, D., Romashkan, S., Hadley, E., Pahor, M. 2011; 66 (11): 1226-1237


    As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap.The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years.LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness.Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

    View details for DOI 10.1093/gerona/glr123

    View details for Web of Science ID 000296102100011

    View details for PubMedID 21825283

  • Moderators and Mediators of Exercise-Induced Objective Sleep Improvements in Mid life and Older Adults With Sleep Complaints HEALTH PSYCHOLOGY Buman, M. P., Hekler, E. B., Bliwise, D. L., King, A. C. 2011; 30 (5): 579-587


    Exercise can improve sleep quality, but for whom and by what means remains unclear. We examined moderators and mediators of objective sleep improvements in a 12-month randomized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints.Participants (N = 66, 67% women, 55-79 years) were randomized to moderate-intensity exercise or health education control. Putative moderators were gender, age, physical function, self-reported global sleep quality, and physical activity levels. Putative mediators were changes in BMI, depressive symptoms, and physical function at 6 months. Objective sleep outcomes measured by in-home polysomnography were percent time in Stage I sleep, percent time in Stage II sleep, and number of awakenings during the first third of sleep at 12 months.Baseline physical function and sleep quality moderated changes in Stage I sleep; individuals with higher initial physical function (p = .01) and poorer sleep quality (p = .03) had greater improvements. Baseline physical activity level moderated changes in Stage II sleep (p = .04) and number of awakenings (p = .01); more sedentary individuals had greater improvements. Decreased depressive symptoms (CI:-1.57 to -0.02) mediated change in Stage I sleep. Decreased depressive symptoms (CI:-0.75 to -0.01), decreased BMI (CI:-1.08 to -0.06), and increased physical function (CI: 0.01 to 0.72) mediated change in number of awakenings.Initially less active individuals with higher initial physical function and poorer sleep quality improved the most. Affective, functional, and metabolic mediators specific to sleep architecture parameters were suggested. These results indicate strategies to more efficiently treat poor sleep through exercise in older adults.

    View details for DOI 10.1037/a0024293

    View details for Web of Science ID 000294876100009

    View details for PubMedID 21688915

  • The Society of Behavioral Medicine (SBM) and public policy advocacy: a call to action. Translational behavioral medicine Estabrooks, P., Pagoto, S., Otten, J., Pbert, L., Stone, A., King, A., Goggin, K., Emmons, K. 2011; 1 (3): 492-496


    In 2010, the Society of Behavioral Medicine heightened its priority to take an even more active role in influencing health-related public policy. Here we discuss the importance of behavioral medicine presence in public policy initiatives, review a brief history of SBM's involvement in public policy, describe steps SBM is now taking to increase its involvement in health-related public policy, and finally, put forth a call to action for SBM members to increase their awareness of and become involved in public policy initiatives.

    View details for DOI 10.1007/s13142-011-0073-8

    View details for PubMedID 24073068

  • The Society of Behavioral Medicine (SBM) and public policy advocacy: a call to action TRANSLATIONAL BEHAVIORAL MEDICINE Estabrooks, P., Pagoto, S., Otten, J., Pbert, L., Stone, A., King, A., Goggin, K., Emmons, K. 2011; 1 (3): 492-496
  • Assessing health-related resources in senior living residences JOURNAL OF AGING STUDIES Kerr, J., Carlson, J. A., Sallis, J. F., Rosenberg, D., Leak, C. R., Saelens, B. E., Chapman, J. E., Frank, L. D., Cain, K. L., Conway, T. L., King, A. C. 2011; 25 (3): 206-214
  • Does Tailoring on Additional Theoretical Constructs Enhance the Efficacy of a Print-Based Physical Activity Promotion Intervention? HEALTH PSYCHOLOGY Williams, D. M., Papandonatos, G. D., Jennings, E. G., Napolitano, M. A., Lewis, B. A., Whiteley, J. A., Bock, B. C., Albrecht, A. E., Dunsiger, S., Parisi, A. F., King, A. C., Marcus, B. H. 2011; 30 (4): 432-441


    To enhance a previously efficacious individually tailored physical activity (PA) promotion intervention by adding theoretical constructs to the tailored feedback.We randomly assigned 248 healthy, underactive (moderate to vigorous physical activity [MVPA] min/week < 90) adults (mean age = 48.8 years, SD = 10.0) to receive either (a) a theoretically tailored (based on 5 constructs from the transtheoretical model and social-cognitive theory [SCT]) print-based PA promotion intervention (print) or (b) the same theoretically tailored print-based PA promotion intervention plus enhanced tailoring addressing 5 additional SCT constructs (enhanced print).The 7-day physical activity recall administered at baseline, Month 6, and Month 12, with outcomes operationalized as percentage achieving 150 min/week of MVPA.When controlling for covariates, there was a nonsignificant trend in favor of the enhanced print condition reflecting 46% and 50% greater odds of achieving 150 min/week of MVPA at Month 6 and Month 12, respectively.Enhanced tailoring based on additional theoretical constructs may result in marginal improvements in physical activity outcomes.

    View details for DOI 10.1037/a0023084

    View details for Web of Science ID 000292809100008

    View details for PubMedID 21574710

  • Promoting culturally targeted chronic disease prevention research through an adapted participatory research approach: The Qassim-Stanford Universities project. Translational behavioral medicine Winter, S. J., King, A. C., Stafford, R. S., Winkleby, M. A., Haskell, W. L., Farquhar, J. W. 2011; 1 (2): 289-298


    The Kingdom of Saudi Arabia (KSA), similar to other countries in the Eastern Mediterranean, has been experiencing a recent rapid increase in the prevalence of chronic diseases and associated risk factors. To begin to take advantage of the chronic disease prevention and health promotion (CDPHP) knowledge available from other nations, researchers at a newly established University in the Qassim Province of the KSA have partnered with Stanford University in the United States of America. To ensure that CDPHP research and interventions are culturally relevant and appropriate, a participatory research approach has been adopted where local researchers are the target "community." Contextual challenges of conducting CDPHP research in the KSA, at the individual, social/cultural, organizational and environmental/policy levels, are identified, as well as examples of CDPHP intervention strategies that may be culturally appropriate at each level.

    View details for DOI 10.1007/s13142-011-0033-3

    View details for PubMedID 24073051

  • Exercise effects on night-to-night fluctuations in self-rated sleep among older adults with sleep complaints JOURNAL OF SLEEP RESEARCH Buman, M. P., Hekler, E. B., Bliwise, D. L., King, A. C. 2011; 20 (1): 28-37


    Sleep interventions have rarely explored reductions in night-to-night fluctuations [i.e. intra-individual variability (IIV)] in sleep, despite the negative impacts of such fluctuations on affective states and cognitive and physical symptoms. In a community-based randomized controlled trial we evaluated whether physical exercise reduced IIV in self-rated sleep outcomes among middle-aged and older adults with sleep complaints. Under-active adults 55 years and older (n = 66, 67% women) with mild to moderate sleep complaints were randomized to 12 months of a moderate-intensity endurance exercise (n = 36) or a health education control group (n = 30). Daily sleep logs, Pittsburgh Sleep Quality Index (PSQI) and in-home polysomnographic sleep recordings (PSG) were collected at baseline, 6 months and 12 months. Sleep log-derived means and IIV were computed for sleep-onset latency (SOL), time in bed, feeling rested in the morning, number of nighttime awakenings, and wake after final awakening (WAFA). Using intent-to-treat methods, at 6 months no differences in IIV were observed by group. At 12 months, SOL-based IIV was reduced in the exercise group compared with the control (difference = 23.11, 95% CI: 3.04-47.18, P = 0.025, Cohen's d = 0.57). This change occurred without mean-level or IIV changes in sleep-wake schedules. For all sleep variables, except SOL and WAFA, IIV changes and mean-level changes in each variable were negatively correlated (r = -0.312 to -0.691, P < 0.05). Sleep log-derived IIV changes were modestly correlated with mean-level PSQI and PSG-based changes at 12 months. Twelve months of moderate-intensity exercise reduced night-to-night fluctuations in self-rated time to fall asleep, and this relationship was independent of mean-level time to fall asleep.

    View details for DOI 10.1111/j.1365-2869.2010.00866.x

    View details for Web of Science ID 000287199200004

    View details for PubMedID 20629937

  • Outcome expectations and realizations as predictors of weight regain among dieters EATING BEHAVIORS Moore, S. D., King, A. C., Kiernan, M., Gardner, C. D. 2011; 12 (1): 60-63


    This prospective study tested whether (a) baseline outcome expectations regarding the benefits of a weight-loss diet, (b) 6-month outcome realizations regarding perceived benefits actually experienced, and/or (c) the interaction between them predicted 6-12-month weight regain among overweight/obese women randomized to one of four popular weight-loss diets (N=311). Positive 6-month realizations regarding improvements in physical shape and appearance predicted less 6-12-month weight regain among Atkins diet participants only (n=70), controlling for baseline expectations, the expectations-realization interaction, and initial weight loss. Atkins participants displayed three distinct patterns of regain based on levels of 6-month realizations and initial weight loss. Experimental research should investigate whether improving realizations leads to reduced weight regain in response to this popular diet.

    View details for DOI 10.1016/j.eatbeh.2010.08.007

    View details for Web of Science ID 000286845700010

    View details for PubMedID 21184975

  • Changes in CVD risk factors in the activity counseling trial. International journal of general medicine Baruth, M., Wilcox, S., Sallis, J. F., King, A. C., Marcus, B. H., Blair, S. N. 2011; 4: 53-62


    Primary care facilities may be a natural setting for delivering interventions that focus on behaviors that improve cardiovascular disease (CVD) risk factors. The purpose of this study was to examine the 24-month effects of the Activity Counseling Trial (ACT) on CVD risk factors, to examine whether changes in CVD risk factors differed according to baseline risk factor status, and to examine whether changes in fitness were associated with changes in CVD risk factors. ACT was a 24-month multicenter randomized controlled trial to increase physical activity. Participants were 874 inactive men and women aged 35-74 years. Participants were randomly assigned to one of three arms that varied by level of counseling, intensity, and resource requirements. Because there were no significant differences in change over time between arms on any of the CVD risk factors examined, all arms were combined, and the effects of time, independent of arm, were examined separately for men and women. Time × Baseline risk factor status interactions examined whether changes in CVD risk factors differed according to baseline risk factor status. Significant improvements in total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, the ratio of total cholesterol to HDL-C, and triglycerides were seen in both men and women who had high (or low for HDL-C) baseline levels of risk factors, whereas significant improvements in diastolic blood pressure were seen only in those men with high baseline levels. There were no improvements in any risk factors among participants with normal baseline levels. Changes in fitness were associated with changes in a number of CVD risk factors. However, most relationships disappeared after controlling for changes in body weight. Improvements in lipids from the ACT interventions could reduce the risk of coronary heart disease in people with already high levels of lipids by 16%-26% in men and 11%-16% in women. Interventions that can be implemented in health care settings nationwide and result in meaningful population-wide changes in CVD risk factors are needed. The ACT physical activity interventions produced substantial improvements among men and women with elevated CVD risk factors.

    View details for DOI 10.2147/IJGM.S15686

    View details for PubMedID 21403793

  • Communicating Health: Harnessing Communication Technologies to Promote Health International Innovation King, A.C. 2011; May
  • Objective Light-Intensity Physical Activity Associations With Rated Health in Older Adults AMERICAN JOURNAL OF EPIDEMIOLOGY Buman, M. P., Hekler, E. B., Haskell, W. L., Pruitt, L., Conway, T. L., Cain, K. L., Sallis, J. F., Saelens, B. E., Frank, L. D., King, A. C. 2010; 172 (10): 1155-1165


    The extent to which light-intensity physical activity contributes to health in older adults is not well known. The authors examined associations between physical activity across the intensity spectrum (sedentary to vigorous) and health and well-being variables in older adults. Two 7-day assessments of accelerometry from 2005 to 2007 were collected 6 months apart in the observational Senior Neighborhood Quality of Life Study of adults aged >65 years in Baltimore, Maryland, and Seattle, Washington. Self-reported health and psychosocial variables (e.g., lower-extremity function, body weight, rated stress) were also collected. Physical activity based on existing accelerometer thresholds for moderate/vigorous, high-light, low-light, and sedentary categories were examined as correlates of physical health and psychosocial well-being in mixed-effects regression models. Participants (N = 862) were 75.4 (standard deviation, 6.8) years of age, 56% female, 71% white, and 58% overweight/obese. After adjustment for study covariates and time spent in moderate/vigorous physical activity and sedentary behavior, low-light and high-light physical activity were positively related to physical health (all P < 0.0001) and well-being (all P < 0.001). Additionally, replacing 30 minutes/day of sedentary time with equal amounts of low-light or high-light physical activity was associated with better physical health (all P < 0.0001). Objectively measured light-intensity physical activity is associated with physical health and well-being variables in older adults.

    View details for DOI 10.1093/aje/kwq249

    View details for Web of Science ID 000283918700008

    View details for PubMedID 20843864

  • Relationship Between Physical Functioning and Physical Activity in the Lifestyle Interventions and Independence for Elders Pilot JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Chale-Rush, A., Guralnik, J. M., Walkup, M. P., Miller, M. E., Rejeski, W. J., Katula, J. A., King, A. C., Glynn, N. W., Manini, T. M., Blair, S. N., Fielding, R. A. 2010; 58 (10): 1918-1924


    To determine whether participation in usual moderate-intensity or more-vigorous physical activity (MVPA) is associated with physical function performance and to identify sociodemographic, psychosocial, and disease-related covariates that may also compromise physical function performance.Cross-sectional analysis of baseline variables of a randomized controlled intervention trial.Four academic research centers.Four hundred twenty-four older adults aged 70 to 89 at risk for mobility disability (scoring <10 on the Short Physical Performance Battery (SPPB)) and able to complete the 400-m walk test within 15 minutes.Minutes of MVPA (dichotomized according to above or below 150 min/wk of MVPA) assessed according to the Community Healthy Activities Model Program for Seniors questionnaire, SPPB score, 400-m walk test, sex, body mass index (BMI), depressive symptoms, age, and number of medications.The SPPB summary score was associated with minutes of MVPA (?=0.16, P=.001). In multiple regression analyses, age, minutes of MVPA, number of medications, and depressive symptoms were associated with performance on the composite SPPB (P<.05). There was an association between 400-m walk time and minutes of MVPA (?=-0.18; P<.001). In multiple regression analyses, age, sex, minutes of MVPA, BMI, and number of medications were associated with performance on the 400-m walk test (P<.05).Minutes of MVPA, sex, BMI, depressive symptoms, age, and number of medications are associated with physical function performance and should all be taken into consideration in the prevention of mobility disability.

    View details for DOI 10.1111/j.1532-5415.2010.03008.x

    View details for Web of Science ID 000282690900012

    View details for PubMedID 20738437

  • Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults JOURNAL OF AGING AND PHYSICAL ACTIVITY Taylor-Piliae, R. E., Newell, K. A., Cherin, R., Lee, M. J., King, A. C., Haskell, W. L. 2010; 18 (3): 261-279


    To compare the effects of Tai Chi (TC, n = 37) and Western exercise (WE, n = 39) with an attention-control group (C, n = 56) on physical and cognitive functioning in healthy adults age 69 +/- 5.8 yr, in a 2-phase randomized trial.TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis.At 6 mo, WE had greater improvements in upper body flexibility (F = 4.67, p = .01) than TC and C. TC had greater improvements in balance (F = 3.36, p = .04) and a cognitive-function measure (F = 7.75, p < .001) than WE and C. The differential cognitive-function improvements observed in TC were maintained through 12 mo.The TC and WE interventions resulted in differential improvements in physical functioning among generally healthy older adults. TC led to improvement in an indicator of cognitive functioning that was maintained through 12 mo.

    View details for Web of Science ID 000279052900002

    View details for PubMedID 20651414

  • Individual, social and environmental correlates of physical activity among women living in socioeconomically disadvantaged neighbourhoods SOCIAL SCIENCE & MEDICINE Cleland, V., Ball, K., Hume, C., Timperio, A., King, A. C., Crawford, D. 2010; 70 (12): 2011-2018


    Women living in socioeconomically disadvantaged neighbourhoods are at heightened risk for physical inactivity, but little is known about the correlates of physical activity among this group. Using a social-ecological framework, this study aimed to determine the individual, social and neighbourhood environmental correlates of physical activity amongst women living in such neighbourhoods. During 2007-2008 women (n = 4108) aged 18-45 years randomly selected from urban and rural neighbourhoods of low socioeconomic status in Victoria, Australia completed the International Physical Activity Questionnaire (long). They reported on individual (self-efficacy, enjoyment, intentions, outcome expectancies, skills), social (childcare, social support from family and friends/colleagues, dog ownership) and neighbourhood environmental (neighbourhood cohesion, aesthetics, personal safety, 'walking environment') factors. Multinomial logistic regression was used to examine the odds of increasing categories of leisure time physical activity (LTPA) and transport-related physical activity (TRPA) for each individual, social and environmental factor. In partially adjusted analyses, all individual, social and environmental variables were positively associated with LTPA, while all individual factors, family and friend support and the walking environment were positively associated with TRPA. In fully adjusted multivariable models, all individual and social factors remained significantly associated with LTPA, while self-efficacy, enjoyment, intentions, social support, and neighbourhood 'walking environment' variables remained significantly associated with TRPA. In conclusion, individual and social factors were most important for LTPA, while individual, social and neighbourhood environmental factors were all associated with TRPA. Acknowledging the cross-sectional design, the findings highlight the importance of different levels of potential influence on physical activity in different domains, which should be considered when developing strategies to promote physical activity amongst women living in socioeconomically disadvantaged neighbourhoods.

    View details for DOI 10.1016/j.socscimed.2010.02.028

    View details for Web of Science ID 000278574300020

    View details for PubMedID 20362380

  • Psychosocial Mediators of Physical Activity and Fitness Changes in the Activity Counseling Trial ANNALS OF BEHAVIORAL MEDICINE Baruth, M., Wilcox, S., Dunn, A. L., King, A. C., Marcus, B. H., Rejeski, W. J., Sallis, J. F., Blair, S. N. 2010; 39 (3): 274-289


    Improved understanding of the mediators of physical activity (PA) interventions could lead to improvements in theory and programs.To examine the 24-month mediating effects of psychosocial variables on PA and cardiorespiratory fitness (CRF) outcomes in 878 initially sedentary adults aged 35-75 participating in the Activity Counseling Trial.Participants were assigned to one of three intervention arms: physician advice, assistance, or counseling. MacKinnon's product of coefficients was used to test for longitudinal and contemporaneous mediation.Changes in behavioral processes of change from baseline to 24 months significantly mediated the relationship between the active intervention arms and improvements in PA and CRF from baseline to 24 months in both men and women. None of the other psychosocial variables tested met criteria for mediation.Results indicate that behavioral interventions should incorporate methods to encourage participants to use these behavioral strategies as they attempt to become more active.

    View details for DOI 10.1007/s12160-010-9178-4

    View details for Web of Science ID 000282082000007

    View details for PubMedID 20431975

  • Healthy Aging and Where You Live: Community Design Relationships With Physical Activity and Body Weight in Older Americans JOURNAL OF PHYSICAL ACTIVITY & HEALTH Frank, L., Kerr, J., Rosenberg, D., King, A. 2010; 7: S82-S90


    Suburban development patterns may impede physical activity (PA) and mobility and affect healthy aging. This paper investigates the relationships between neighborhood design and walking, driving, PA, and obesity in adults over age 65 years.Data from the SMARTRAQ (Atlanta region) survey provided measures of PA, BMI, SES, and travel patterns. Neighborhood design was measured using a walkability index (residential density, street connectivity, retail density, and land use mix). Chi square and regression was used to evaluate relationships.Increased walkability was related with more walking (OR 2.02), less time spent traveling in a car (OR .53), and lower odds of being overweight (OR .68). Those with 1 or no cars were more likely to walk (OR 2.9) and spend less time in cars (OR .53); but also less likely to get recommended levels of PA (OR .55). Visiting a fast food outlet was associated with increased odds of obesity (OR 1.81).Policies are needed to bring older Americans closer to shops and services and healthy food outlets as a means of encouraging regular walking and healthy body weight. Incentives to encourage neighborhood grocery stores and affordable housing in central areas along with regulatory reform through zoning can encourage PA and healthy body weight in the elderly.

    View details for Web of Science ID 000280738300014

    View details for PubMedID 20440017

  • Interruption of Physical Activity Because of Illness in the Lifestyle Interventions and Independence for Elders Pilot Trial JOURNAL OF AGING AND PHYSICAL ACTIVITY Phillips, E. M., Katula, J., Miller, M. E., Walkup, M. P., Brach, J. S., King, A. C., Rejeski, W. J., Church, T., Fielding, R. A. 2010; 18 (1): 61-74


    To examine baseline characteristics and change in gait speed and Short Physical Performance Battery (SPPB) scores in participants medically suspended (MS) from a physical activity intervention (PA).Randomized controlled trial.University and community centers.Sedentary older adults (N = 213) randomized to PA in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P).MS was defined as missing 3 consecutive PA sessions in adoption and transition phases or 2 wk in maintenance phase because of a health event.In all, 122 participants completed PA without MS (NMS subgroup), 48 participants underwent MS and resumed PA (SR subgroup), and 43 participants underwent MS and did not complete PA (SNR subgroup). At baseline, SNR walked slower (p = .03), took more prescribed medications (p = .02), and had lower SPPB scores than NMS and SR (p = .02). Changes from baseline to Month 12 SPPB scores were affected by suspension status, adjusted mean (SE) SPPB change: SNR 0.0957 (0.3184), SR 0.9413 (0.3063), NMS 1.0720 (0.1871); p = .03.MS participants unable to return to complete the PA in a trial of mobility-limited sedentary older adults had slower walking speeds, lower SPPB scores, and a higher number of prescribed medications at baseline. Change in SPPB scores at 12 months was related to suspension status.

    View details for Web of Science ID 000274030100005

    View details for PubMedID 20181994

  • Using Ecological Momentary Assessment to Examine Antecedents and Correlates of Physical Activity Bouts in Adults Age 50+Years: A Pilot Study ANNALS OF BEHAVIORAL MEDICINE Dunton, G. F., Atienza, A. A., Castro, C. M., King, A. C. 2009; 38 (3): 249-255


    National recommendations supporting the promotion of multiple short (10+ minute) physical activity bouts each day to increase overall physical activity levels in middle-aged and older adults underscore the need to identify antecedents and correlates of such daily physical activity episodes.This pilot study used Ecological Momentary Assessment to examine the time-lagged and concurrent effects of empirically supported social, cognitive, affective, and physiological factors on physical activity among adults age 50+ years.Participants (N = 23) responded to diary prompts on a handheld computer four times per day across a 2-week period. Moderate-to-vigorous physical activity (MVPA), self-efficacy, positive and negative affect, control, demand, fatigue, energy, social interactions, and stressful events were assessed during each sequence.Multivariate results showed that greater self-efficacy and control predicted greater MVPA at each subsequent assessment throughout the day (p < 0.05). Also, having a positive social interaction was concurrently related to higher levels of MVPA (p = 0.052).Time-varying multidimensional individual processes predict within daily physical activity levels.

    View details for DOI 10.1007/s12160-009-9141-4

    View details for Web of Science ID 000275425100008

    View details for PubMedID 20052568

  • Evaluation of lifestyle interventions to treat elevated cardiometabolic risk in primary care (E-LITE): a randomized controlled trial BMC FAMILY PRACTICE Ma, J., King, A. C., Wilson, S. R., Xiao, L., Stafford, R. S. 2009; 10


    Efficacy research has shown that intensive individual lifestyle intervention lowers the risk for developing type 2 diabetes mellitus and the metabolic syndrome. Translational research is needed to test real-world models of lifestyle interventions in primary care settings.E-LITE is a three-arm randomized controlled clinical trial aimed at testing the feasibility and potential effectiveness of two lifestyle interventions: information technology-assisted self-management, either alone or in combination with care management by a dietitian and exercise counselor, in comparison to usual care. Overweight or obese adults with pre-diabetes and/or metabolic syndrome (n = 240) recruited from a community-based primary care clinic are randomly assigned to one of three treatment conditions. Treatment will last 15 months and involves a three-month intensive treatment phase followed by a 12-month maintenance phase. Follow-up assessment occurs at three, six, and 15 months. The primary outcome is change in body mass index. The target sample size will provide 80% power for detecting a net difference of half a standard deviation in body mass index at 15 months between either of the self-management or care management interventions and usual care at a two-sided alpha level of 0.05, assuming up to a 20% rate of loss to 15-month follow-up. Secondary outcomes include glycemic control, additional cardiovascular risk factors, and health-related quality of life. Potential mediators (e.g., treatment adherence, caloric intake, physical activity level) and moderators (e.g., age, gender, race/ethnicity, baseline mental status) of the intervention's effect on weight change also will be examined.This study will provide objective evidence on the extent of reductions in body mass index and related cardiometabolic risk factors from two lifestyle intervention programs of varying intensity that could be implemented as part of routine health care.

    View details for DOI 10.1186/1471-2296-10-71

    View details for Web of Science ID 000272354600001

    View details for PubMedID 19909549

  • A Cost Analysis of a Physical Activity Intervention for Older Adults JOURNAL OF PHYSICAL ACTIVITY & HEALTH Groessl, E. J., Kaplan, R. M., Blair, S. N., Rejeski, W. J., Katula, J. A., King, A. C., Fielding, R. A., Glynn, N. W., Pahor, M. 2009; 6 (6): 767-774


    We examined the costs of a physical activity (PA) and an educational comparison intervention. 424 older adults at risk for mobility disability were randomly assigned to either condition. The PA program consisted of center-based exercise sessions 3x weekly for 8 weeks, 2x weekly for weeks 9 to 24 and weekly behavioral counseling for 10 weeks. Optional sessions were offered during maintenance weeks (25-52). The comparison intervention consisted of weekly education meetings for 24 weeks, and then monthly for 6 months. Cost analyses were conducted from the "payer's" perspective, with a 1-year time horizon. Intervention costs were estimated by tracking personnel activities and materials used for each intervention and multiplying by national unit cost averages. The average cost/participant was $1134 and $175 for the PA and the comparison interventions, respectively. A preliminary cost/effectiveness analysis gauged the cost/disability avoided to be $28,206. Costs for this PA program for older adults are comparable to those of other PA interventions. The results are preliminary and a longer study is required to fully assess the costs and health benefits of these interventions.

    View details for Web of Science ID 000282842100012

    View details for PubMedID 20101920

  • What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study) JOURNAL OF NUTRITION HEALTH & AGING Kwon, S., Perera, S., Pahor, M., Katula, J. A., King, A. C., Groessl, E. J., Studenski, S. A. 2009; 13 (6): 538-544


    Performance measures provide important information, but the meaning of change in these measures is not well known. The purpose of this research is to 1) examine the effect of treatment assignment on the relationship between self-report and performance; 2) to estimate the magnitude of meaningful change in 400-meter walk time (400MWT), 4-meter gait speed (4MGS), and Short Physical Performance Battery (SPPB) and 3) to evaluate the effect of direction of change on estimates of magnitude.This is a secondary analysis of data from the LIFE-P study, a single blinded randomized clinical trial. Using change over one year, we applied distribution-based and anchor-based methods for self-reported mobility to estimate minimally important and substantial change in 400MWT, 4MGS and SPPB.Four university-based clinical research sites.Sedentary adults aged 70-89 whose SPPB scores were less than 10 and who were able to complete a 400MW at baseline (n=424).A structured exercise program versus health education.400MWT, 4MGS, SPPB.Relationships between self-report and performance measures were consistent between treatment arms. Minimally significant change estimates were 400MWT: 20-30 seconds, 4MGS: 0.03-0.05m/s and SPPB: 0.3 - 0.8 points. Substantial changes were 400MWT: 50-60 seconds, 4MGS: 0.08m/s, SPPB: 0.4 - 1.5 points. Magnitudes of change for improvement and decline were not significantly different.The magnitude of clinically important change in physical performance measures is reasonably consistent using several analytic techniques and appears to be achievable in clinical trials of exercise. Due to limited power, the effect of direction of change on estimates of magnitude remains uncertain.

    View details for DOI 10.1007/s12603-009-0104-z

    View details for Web of Science ID 000267681900008

    View details for PubMedID 19536422

  • Changes in Cognitive Function in a Randomized Trial of Physical Activity: Results of the Lifestyle Interventions and Independence for Elders Pilot Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Williamson, J. D., Espeland, M., Kritchevsky, S. B., Newman, A. B., King, A. C., Pahor, M., Guralnik, J. M., Pruitt, L. A., Miller, M. E. 2009; 64 (6): 688-694


    Cognitive impairment is an important contributor to disability. Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function (CF). We report results of a pilot study to provide estimates of the relative impact of physical activity (PA) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability.Sedentary persons (102) at increased risk for disability (aged 70-89 years) were randomized to moderate-intensity PA or health education. Participants were administered the Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), modified Stroop test, and Modified Mini-Mental State Examination at baseline and 1 year.Group differences were not significant but improvements in cognitive scores were associated with improvements in physical function. Specifically, the DSST significantly correlated with change in the Short Physical Performance Battery score (r = .38, p = .0002), in chair stand score (r = .26, p = .012), in balance score (r = .21, p = .046), and in 400-m gait speed (r = .15, p = .147). Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair stand and balance, respectively.These results provide further support for the benefits of exercise on CF in older adults. An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to expand the indications for prescribing exercise for prevention of decline in brain function.

    View details for DOI 10.1093/gerona/glp014

    View details for Web of Science ID 000268247100011

    View details for PubMedID 19244157

  • Can Individuals Meet Multiple Physical Activity and Dietary Behavior Goals? AMERICAN JOURNAL OF HEALTH BEHAVIOR Young, D. R., Vollmer, W. M., King, A. C., Brown, A. J., Stevens, V. J., Elmer, P. J., Craddick, S., Sturtevant, D. L., Harsha, D. W., Appel, L. J. 2009; 33 (3): 277-286


    To examine whether participants with the most behavioral goals to achieve were more likely to meet more goals than those given fewer goals.Eight hundred ten participants were randomly assigned to advice-only, established guidelines for blood pressure control (reduced sodium, increased physical activity), or established guidelines plus the DASH diet (increased fruits, vegetables, low-fat dairy, reduced fat).At 6 months, 11.7% of Advice-Only, 19.3% of Established, and 44.6% of Established plus DASH met at least 3 goals (P<0.0001). At 18 months, 33.5% of Established plus DASH met at least 3 goals.Those with the most goals to achieve reached the most goals.

    View details for Web of Science ID 000265657400006

    View details for PubMedID 19063649

  • Feasibility and outcomes of a multilevel place-based walking intervention for seniors: A pilot study HEALTH & PLACE Rosenberg, D., Kerr, J., Sallis, J. F., Patrick, K., Moore, D. J., King, A. 2009; 15 (1): 173-179


    This pilot study tested the feasibility and acceptability of a novel multilevel walking intervention for older adults in a continuing care retirement community (CCRC). The intervention included site-specific walking route maps, pedometers, and individualized goal setting. Pedometers were worn for self-monitoring and for the primary outcome (steps per day). Surveys at pre- and post-intervention assessed daily activities, benefits, barriers, route use, quality of life, and satisfaction. Steps per day were very low at baseline and increased significantly at post-test. The findings indicate that a multilevel site-specific intervention is feasible and acceptable for increasing steps among seniors living in a CCRC.

    View details for DOI 10.1016/j.healthplace.2008.03.010

    View details for Web of Science ID 000261636300020

    View details for PubMedID 18502164

  • Age Differences in the Relation of Perceived Neighborhood Environment to Walking MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Shigematsu, R., Sallis, J. F., Conway, T. L., Saelens, B. E., Frank, L. D., Cain, K. L., Chapman, J. E., King, A. C. 2009; 41 (2): 314-321


    The strength of the relationship of environment to physical activity may differ by age group. Older adults were expected to be more affected by environmental attributes than younger adults. The present study examined age-related differences in associations between perceived neighborhood environment and physical activity.Participants were 1623 adults aged 20 to 97 yr divided into five groups: ages 20-39, 40-49, 50-65, 66-75, and 76+. They were recruited from King County/Seattle, WA, neighborhoods selected to vary in land use and median income. Participants completed questionnaires about neighborhood environment attributes and walking for transportation and for leisure purposes. Neighborhood environment, within a 15- to 20-min walk from home, was measured on nine attributes with the validated Neighborhood Environment Walkability Scale questionnaire: residential density, proximity to nonresidential land uses, ease of access to nonresidential uses, street connectivity, walking/cycling facilities, esthetics, pedestrian traffic safety, crime safety, and proximity to recreation facilities. Participants reported frequency and duration of walking using the validated International Physical Activity Questionnaire and the Community Healthy Activities Model Program for Seniors. Partial correlations were computed, adjusting for demographics.Walking for transportation was significantly related to multiple perceived neighborhood attributes in all age groups, although walking for leisure was not. Walking for transportation was significantly related to almost all neighborhood environment variables in the youngest age group. In contrast, only two environmental attributes, proximity to nonresidential uses (like shops) and recreation facilities, were moderately correlated with walking for transportation in the two oldest groups.Communities need to be designed with many favorable environmental attributes to support walking for transportation among younger adults. Having nonresidential destinations and recreation facilities within walking distance may be among the most important attributes to support older adults' physical activity.

    View details for DOI 10.1249/MSS.0b013e318185496c

    View details for Web of Science ID 000262601200008

    View details for PubMedID 19127195

  • Sleep Patterns and Sleep-Related Factors Between Caregiving and Non-Caregiving Women BEHAVIORAL SLEEP MEDICINE Castro, C. M., Lee, K. A., Bliwise, D. L., Urizar, G. G., Woodward, S. H., King, A. C. 2009; 7 (3): 164-179


    This exploratory study compared objective sleep patterns and sleep-related factors between caregiving and non-caregiving women with sleep impairments, and compared the sleep patterns of the caregivers with their care recipients. Nine women caring for adults with dementia and a comparison sample of 34 non-caregiving women provided three nights of in-home polysomnography (PSG) and self-report questionnaires of sleep quality and physical and emotional well-being. Care recipients' sleep was monitored with actigraphy on the same nights of the caregivers' PSG. Caregivers and non-caregivers' sleep patterns were similar across most PSG-measured parameters. Caregivers perceived more sleep disturbances, but PSG showed minimal differences compared to non-caregivers. Caregivers reported more depressive symptoms, and depression was strongly correlated with longer sleep latency. Caregiver's sleep quantity was highly correlated with the sleep quantity of their care recipient. The results suggest that, in this sample, caregivers' sleep was not significantly different from the non-caregiving women, despite differences in perceptions. Although the sample is small, this exploratory study supports the use of multiple nights of in-home PSG to assess caregiver sleep and provides more data on sleep patterns of female dementia caregivers and their relatives.

    View details for DOI 10.1080/15402000902976713

    View details for Web of Science ID 000274049100003

    View details for PubMedID 19568966

  • Use of Accelerometry to Measure Physical Activity in Older Adults at Risk for Mobility Disability JOURNAL OF AGING AND PHYSICAL ACTIVITY Pruitt, L. A., Glynn, N. W., King, A. C., Guralnik, J. M., Aiken, E. K., Miller, G., Haskell, W. L. 2008; 16 (4): 416-434


    The authors explored using the ActiGraph accelerometer to differentiate activity levels between participants in a physical activity (PA, n = 54) or "successful aging" (SA) program (n = 52). The relationship between a PA questionnaire for older adults (CHAMPS) and accelerometry variables was also determined. Individualized accelerometry-count thresholds (ThreshIND) measured during a 400-m walk were used to identify "meaningful activity." Participants then wore the ActiGraph for 7 days. Results indicated more activity bouts/day > or =10 min above ThreshIND in the PA group than in the SA group (1.1 +/- 2.0 vs 0.5 +/- 0.8, p = .05) and more activity counts/day above ThreshIND for the PA group (28,101 +/- 27,521) than for the SA group (17,234 +/- 15,620, p = .02). Correlations between activity counts/hr and CHAMPS ranged from .27 to .42, p < .01. The ActiGraph and ThreshIND might be useful for differentiating PA levels in older adults at risk for mobility disability.

    View details for Web of Science ID 000260272700005

    View details for PubMedID 19033603

  • Multilevel modeling of walking behavior: Advances in understanding the interactions of people, place, and time MEDICINE AND SCIENCE IN SPORTS AND EXERCISE King, A. C., Satariano, W. A., Marti, J., Zhu, W. 2008; 40 (7): S584-S593


    It has become increasingly clear that the influences on walking as well as other forms of regular physical activity are complex and require an increased understanding of factors across multiple levels of influence. Ecological frameworks have provided the field with a heuristic means of capturing potential impacts on behavior across diverse domains, including personal, behavioral, social or cultural, and environmental. We discuss advances in both understanding and applying this framework through the inclusion of previously ignored dimensions of impact (e.g., time), the application of state-of-the-art statistical methods for understanding interactions among multiple domains (e.g., signal detection), and the development of computer technologies (e.g., agent-based modeling) aimed at simulating the complex relationships between multiple levels of impact and walking behavior. We conclude with suggestions for future research in this emerging field.

    View details for DOI 10.1249/MSS.0b013e31817c66b7

    View details for Web of Science ID 000257192300010

    View details for PubMedID 18562976

  • Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study INTERNATIONAL JOURNAL OF OBESITY Alhassan, S., Kim, S., Bersamin, A., King, A. C., Gardner, C. D. 2008; 32 (6): 985-991


    Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce.We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success.Secondary analysis was performed using data from 181 free-living overweight/obese women (mean+/-s.d. age=43+/-5 years, body mass index=31+/-4 kg m(-2)) participating in a 1-year randomized clinical trial (the A TO Z study) comparing popular weight loss diets (Atkins, Zone and Ornish). Participants' dietary adherence was assessed as the difference between their respective assigned diet's recommended macronutrient goals and their self-reported intake. Association between dietary adherence and 12-month weight change was computed using Spearman's correlations. Differences in baseline characteristics and macronutrient intake between the most and least adherent tertiles for diet groups were compared using t-tests.Within each diet group, adherence score was significantly correlated with 12-month weight change (Atkins, r(s)=0.42, P=0.0003; Zone, r(s)=0.34, P=0.009 and Ornish, r(s)=0.38, P=0.004). Twelve-month weight change in the most vs least adherent tertiles, respectively, was -8.3+/-5.6 vs -1.9+/-5.8 kg, P=0.0006 (Atkins); -3.7+/-6.3 vs -0.4+/-6.8 kg, P=0.12 (Zone) and -6.5+/-6.8 vs -1.7+/-7.9 kg, P=0.06 (Ornish).Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.

    View details for DOI 10.1038/ijo.2008.8

    View details for Web of Science ID 000256788500014

    View details for PubMedID 18268511

  • Exploring physical activity preferences ANNALS OF BEHAVIORAL MEDICINE King, A. C., Wilcox, S. 2008; 35 (1): 123-124

    View details for DOI 10.1007/s12160-007-9012-9

    View details for Web of Science ID 000253573900015

    View details for PubMedID 18347913

  • Metabolic syndrome: do clinical criteria identify similar individuals among overweight premenopausal women? METABOLISM-CLINICAL AND EXPERIMENTAL Alhassan, S., Kiazand, A., Balise, R. R., King, A. C., Reaven, G. M., Gardner, C. D. 2008; 57 (1): 49-56


    The purpose of this analysis was to determine to what extent the clinical criteria for metabolic syndrome (MetSyn) proposed by the World Health Organization (WHO), the European Group for Study of Insulin Resistance (EGIR), the National Cholesterol Education Program Adult Treatment Panel III (ATP III), and the International Diabetes Foundation (IDF); triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio >/=3.0; and enlarged waist circumference (>/=88 cm) and elevated TG (>/=129 mg/dL) (EWET) identified similar or different overweight women and, secondarily, to examine the effect of 7% weight reduction on MetSyn status. Metabolic syndrome was determined among 256 premenopausal women (age = 41 +/- 6 years, body mass index [BMI] = 32 +/- 4 kg/m(2)) participating in a dietary weight loss clinical trial based on the clinical criteria proposed by WHO, EGIR, ATP III, and IDF. The prevalence of TG/HDL-C ratio >/=3.0 and EWET was determined and compared with MetSyn status. Based on the clinical criteria, 16.1% (EGIR), 20.7% (WHO), 31.0% (ATP III), and 31.8% (IDF) of participants met the criteria for MetSyn; 30.3% and 31.8% had TG/HDL-C >/=3.0 and EWET, respectively. Between 77% and 99% of participants were similarly classified across the clinical criteria. The highest and lowest agreements were between ATP III and IDF (kappa = 0.98; 95% confidence interval, 0.96-1.0) and WHO and IDF (kappa = 0.39; 95% confidence interval, 0.26-0.51), respectively. The TG/HDL-C ratio >/=3.0 and EWET moderately agreed with all 4 clinical criteria for MetSyn (kappa range, 0.36-0.59). Among those diagnosed with MetSyn at baseline, 64.0% to 75.0% of the participants who lost >/=7% and 25.8% to 55.6% of participants who lost <7% of their baseline body weight in 6 months no longer met the various clinical criteria for MetSyn, TG/HDL-C >/=3.0, or EWET. Our findings indicate that MetSyn varies substantially between clinical criteria, which raise questions about the clinical utility of these criteria. Regardless of MetSyn clinical criteria, >/=7% reduction in body weight has a beneficial impact on variables used to define MetSyn.

    View details for DOI 10.1016/j.metabol.2007.08.006

    View details for Web of Science ID 000251929400006

    View details for PubMedID 18078858

  • Physical activity in prefrail older adults: Confidence and satisfaction related to physical function JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Rejeski, W. J., King, A. C., Katula, J. A., Kritchevsky, S., Miller, M. E., Walkup, M. P., Glynn, N. W., Pahor, M. 2008; 63 (1): P19-P26


    We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70+ years of age who have deficits in mobility. We randomized a total of 412 adults aged 70-89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months. Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention. Gender, age, and scores on a short physical performance battery did not moderate these effects. Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning. This is an important finding in light of the importance of these process variables in behavior change and quality of life.

    View details for Web of Science ID 000255893500005

    View details for PubMedID 18332190

  • Activity adherence and physical function in older adults with functional limitations MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Fielding, R. A., Katula, J., Miller, M. E., Abbott-Pillola, K., Jordan, A., Glynn, N. W., Goodpaster, B., Walkup, M. P., King, A. C., Rejesk, W. J. 2007; 39 (11): 1997-2004


    Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) was a trial to examine the effects of a physical activity intervention (PA) compared with a health education control (SA) on measures of disability risk in sedentary older adults (N = 424). We examined adherence to the LIFE-P PA intervention for the first 12 months of the trial.The PA intervention consisted of walking, strength, flexibility, and balance training supplemented with behavioral skills training modules, and it used a phased, center-based schedule of adoption (3x wk(-1), weeks 1-8), transition (2x wk(-1), weeks 9-24), and maintenance (1x wk(-1), weeks 25 to end of trial) while transitioning to primarily home-based physical activity. SA consisted of weekly (weeks 1-26) transitioning to monthly health education workshops.Participation in moderate-intensity physical activity increased from baseline to months 6 and 12 in PA compared with SA (P < 0.001). At 12 months, PA participants who reported > or = 150 min x wk(-1) of moderate activity demonstrated a significantly greater improvement in their Short Physical Performance Battery score compared with participants who reported < 150 min.wk of moderate activity (P < 0.017). For the PA arm, center-based attendance was 76.3 +/- 24.5, 65.4 +/- 28.6, and 49.8 +/- 35.8% in the adoption, transition, and maintenance phases, respectively.Adherence to physical activity in LIFE-P was associated with greater improvement in SPPB score and was consistent with adherence in physical activity trials of shorter duration in this subgroup of older adults. Older individuals at risk for disability can adhere to a regular program of physical activity in a long-term randomized trial.

    View details for DOI 10.1249/mss.0b013e318145348d

    View details for Web of Science ID 000250903100015

    View details for PubMedID 17986908

  • Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome HYPERTENSION Lien, L. F., Brown, A. J., Ard, J. D., Loria, C., Erlinger, T. P., Feldstein, A. C., Lin, P., Champagne, C. M., King, A. C., McGuire, H. L., Stevens, V. J., Brantley, P. J., Harsha, D. W., McBurnie, M. A., Appel, L. J., Svetkey, L. P. 2007; 50 (4): 609-616


    Lifestyle modification can reduce blood pressure and lower cardiovascular risk. Established recommendations include weight loss, sodium reduction, and increased physical activity. PREMIER studied the effects of lifestyle interventions based on established recommendations alone and with the addition of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern. This analysis aimed to assess the interventions' impact on cardiometabolic variables in participants with, compared with those without, metabolic syndrome. The primary outcome was 6-month change in systolic blood pressure. Participants with prehypertension or stage-1 hypertension were randomly assigned to an advice only control group, a 6-month intensive behavioral intervention group of established recommendations (EST), or an established recommendations plus DASH group (EST+DASH). Metabolic syndrome was defined per National Cholesterol and Education Program Adult Treatment Panel III. We used general linear models to test intervention effects on change in blood pressure, lipids, and insulin resistance (homeostasis model assessment), in subgroups defined by the presence or absence of metabolic syndrome. Of 796 participants, 399 had metabolic syndrome. Both EST and EST+DASH reduced the primary outcome variable, systolic blood pressure. Within the EST+DASH group, those with and without metabolic syndrome responded similarly (P=0.231). However, within EST, those with metabolic syndrome had a poorer response, with a decrease in systolic blood pressure of 8.4 mm Hg versus 12.0 mm Hg in those without metabolic syndrome (P=0.002). Thus, metabolic syndrome attenuated the systolic blood pressure reduction of EST, but this attenuation was overcome in EST+DASH. Finally, diastolic blood pressure, lipids, and homeostasis model assessment responded similarly to both interventions regardless of metabolic syndrome status. Our data suggest that strategies for lowering BP in individuals with metabolic syndrome may be enhanced by recommendations to adopt the DASH dietary pattern.

    View details for DOI 10.1161/HYPERTENSIONAHA.107.089458

    View details for Web of Science ID 000249586900007

    View details for PubMedID 17698724

  • Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Gardner, C. D., Kiazand, A., Alhassan, S., Kim, S., Stafford, R. S., Balise, R. R., Kraemer, H. C., King, A. C. 2007; 297 (9): 969-977


    Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets [corrected] While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight Identifier: NCT00079573.

    View details for Web of Science ID 000244697900026

    View details for PubMedID 17341711

  • Rural family caregivers and health behaviors - Results from an epidemiologic survey JOURNAL OF AGING AND HEALTH Castro, C. M., King, A. C., Housemann, R., Bacak, S. J., McMullen, K. M., Brownson, R. C. 2007; 19 (1): 87-105


    This study examined health behaviors in a sample of rural family caregivers. In a community telephone survey of rural Missouri, Arkansas, and Tennessee, respondents were asked about their health, physical activity, nutrition, health providers, and family caregiving. Among 1,234 survey respondents, 12% self-identified as family caregivers. Caregivers reported lower fruit intake, more walking for exercise, and more provider advice about stress, fruits, and vegetables than noncaregivers. Groups did not differ in smoking, dietary fat, obesity, or self-rated health. Women caregivers reported more favorable patterns of physical activity, smoking, and provider interactions than men caregivers, and White caregivers had healthier reports of physical activity and body mass index than Black caregivers. These results provide new information about rural caregivers' health habits. Apart from nutritional intake, caregivers were not significantly different in most health behaviors. However, health providers seemed more attentive to caregivers regarding nutrition and stress.

    View details for DOI 10.1177/0898264306296870

    View details for Web of Science ID 000243528700005

    View details for PubMedID 17215203

  • Physical activity and weight management across the lifespan ANNUAL REVIEW OF PUBLIC HEALTH Goldberg, J. H., King, A. C. 2007; 28: 145-170


    This review discusses key findings and recommendations related to the role of physical activity in weight gain prevention, weight loss, and weight-loss maintenance across the lifespan. For weight gain prevention, epidemiological and clinical studies suggest that regular physical activity is critical, with increases above the recommended 30 min daily for health (e.g., to 45 to 60 min daily) potentially desirable for curtailing weight gain. For weight loss, clinical studies suggest that physical activity interventions alone usually produce only modest results. Combining physical activity with dietary interventions increases the chance of success, especially at higher levels of physical activity (e.g., 200 to 300 min or more weekly). For weight-loss maintenance, high levels of physical activity (e.g., 40 to 90 min daily) may be necessary. To manage weight across the lifespan, a comprehensive approach to physical activity is needed supported by public policy interventions that help make physical activity a part of daily life.

    View details for DOI 10.1146/annurev.publhealth.28.021406.144105

    View details for Web of Science ID 000246436700011

    View details for PubMedID 17168638

  • Predictors of adherence to physical activity in the Lifestyle Interventions and Independence for Elders pilot study (LIFE-P) CLINICAL INTERVENTIONS IN AGING Rejeski, W. J., Miller, M. E., King, A. C., Studenski, S. A., Katula, J. A., Fielding, R. A., Glynn, N. W., Walkup, M. P., Ashmore, J. A. 2007; 2 (3): 485-494


    A prospective design was used to examine predictors of adherence to a physical activity intervention in older adults with compromised function.The sample included 213 men (31.1%) and women (68.9%) with an average age of 76.53 years.The predictor variables accounted for 10% of the variance in percent attendance during adoption and transition, respectively. Adding percent attendance during adoption to the prediction of percent attendance during transition increased the explained variance in this phase to 21%. During maintenance, the predictors accounted for 13% of the variance in frequency of physical activity; this estimate increased to 46% when adding in percent attendance from the transition phase.These results are encouraging in that the physical activity intervention appears to have been well tolerated by diverse subgroups of older adults. The role of prior behavior in predicting downstream adherence underscores the importance of developing proactive interventions for treating nonadherence in older adult populations.

    View details for Web of Science ID 000208238500022

    View details for PubMedID 18044198

  • Perceived environments as physical activity correlates and moderators of intervention in five studies AMERICAN JOURNAL OF HEALTH PROMOTION King, A. C., Toobert, D., Ahn, D., Resnicow, K., Coday, M., Riebe, D., Garber, C. E., Hurtz, S., Morton, J., Sallis, J. F. 2006; 21 (1): 24-35


    Few studies have explored how relationships of perceived environment and physical activity vary across different activity domains and populations. This question was explored in five physical activity intervention trials funded by the National Institutes of Health Behavior Change Consortium.Observational.San Francisco peninsula, California (N = 94); Eugene, Oregon (N = 122); Atlanta, Georgia (N = 256); Kingston, Rhode Island (N = 109); Memphis, Tennessee (N = 64).Ethnically diverse community adults ages 18 to 85 years.The Neighborhood Environment Walkability Scale and CHAMPS physical activity questionnaire. Response rate among those invited to complete these measures was 90%.Cross-sectional pooled signal detection analysis indicated that people who reported living in neighborhoods with more attractive scenery and ease of walking were more likely to meet national physical activity recommendations (67%) compared with those without these neighborhood attributes (36%; chi2 = 13.04, p = .0003). Within-site multiple regression identified two additional variables--seeing others when walking and encountering loose dogs that make it difficult to walk--as correlates across multiple sites and activity domains (i.e., minutes of weekly moderate or more vigorous activity, walking for errands, walking leisurely) (incremental R2 = 2.0-7.5; p < .05). Analyses of covariance suggested that traffic safety might be particularly important in facilitating or impeding physical activity in response to a formal intervention (for traffic-arm assignment interactions, F = 3.8-7.0, p < or = .05).Relationships between perceived environments and physical activity may differ depending upon population groups and activity domains and merit investigation by using stronger prospective designs.

    View details for Web of Science ID 000240449100006

    View details for PubMedID 16977910

  • Modifying physical activity in a multiethnic sample of low-income women: One-year results from the IMPACT (increasing motivation for physical activity) project ANNALS OF BEHAVIORAL MEDICINE Albright, C. L., Pruitt, L., Castro, C., Gonzalez, A., Woo, S., King, A. C. 2005; 30 (3): 191-200


    Ethnic minorities or those with low socioeconomic status (SES) are at increased risk of cardiovascular disease, type 2 diabetes, and all-cause mortality, compared to higher SES Whites. National surveys also indicate that low-income, ethnic minority women have the highest rates of inactivity in the United States.This study (the Increasing Motivation for Physical ACTivity or IMPACT study) promoted adoption and maintenance of physical activity (PA) in sedentary, low-income women participating in federally funded job training programs.The study consisted of 2 months of weekly 1-hr classes, then random assignment to 10 months of either home-based telephone counseling for PA plus information and feedback via mailed newsletters (Phone + Mail Counseling condition) or just the mailed newsletters (Mail Support condition). The IMPACT intervention included behavior change strategies for PA as well as discussions related to motivational readiness for PA change. Participants completed surveys and physiological assessments at baseline after the classes ended (i.e., at 10 weeks) and at 6 and 12 months postbaseline. Seventy-three percent of randomized participants (n = 72) were Latina, with a mean age of 32 +/- 10 years. More than half the women had not completed high school, and 73% had an annual income less than 20,000 dollars.After 10 months of a home-based intervention, women in the phone + mail counseling condition had significantly greater increases in estimated total energy expenditure compared to women in the mail support condition (p < .05).Regular PA counseling delivered via the telephone and through the mail appears effective for encouraging regular PA among low-income women transitioning from welfare or job training to the workforce.

    View details for Web of Science ID 000234009600003

    View details for PubMedID 16336070

  • Comparing self-reported versus objectively measured physical activity behavior: A preliminary investigation of older Filipino American women RESEARCH QUARTERLY FOR EXERCISE AND SPORT Atienza, A. A., King, A. C. 2005; 76 (3): 358-362

    View details for Web of Science ID 000232263800013

    View details for PubMedID 16270713

  • Participatory research to promote physical activity at congregate-meal sites JOURNAL OF AGING AND PHYSICAL ACTIVITY Estabrooks, P. A., Fox, E. H., Doerksen, S. E., Bradshaw, M. H., King, A. C. 2005; 13 (2): 121-144


    The purpose of this study was to determine the feasibility and effectiveness of an on-site physical activity (PA) program offered with congregate meals. Study 1 surveyed meal-site users on their likelihood to participate. Study 2 used meal-site-manager interviews and site visits to determine organizational feasibility. Study 3, a controlled pilot study, randomized meal sites to a 12-week group-based social-cognitive (GBSC) intervention or a standard-care control. Studies 1 and 2 indicated that most meal-site users would participate in an on-site PA program, and meal sites had well-suited physical resources and strong organizational support for this type of program. In Study 3, GBSC participants increased their weekly PA over those in the control condition (p < .05, ES = .79). Results indicated that changes in task cohesion might have mediated intervention effectiveness. These studies demonstrate that a PA program offered in this venue is feasible, is effective in promoting PA, and could have a strong public health impact.

    View details for Web of Science ID 000228426300001

    View details for PubMedID 15995260

  • Influence of maternal stress on successful participation in a physical activity intervention: The IMPACT project WOMEN & HEALTH Urizar, G. G., Hurtz, S. Q., Albright, C. L., Ahn, D. K., Atienza, A. A., King, A. C. 2005; 42 (4): 63-82


    Few studies have examined the impact of motherhood on successful participation in physical activity (PA) interventions. The current study focused on mothers in the Increasing Motivation for Physical Activity or IMPACT study, which aimed to promote PA in sedentary, low-income, ethnically diverse women (74% Latina). The aim of this study was to determine whether certain maternal variables (e.g., number of children, number and intensity of maternal stressors) influenced successful participation in an 8-week, class-based, PA intervention. PA consisted of accumulating 30 minutes or more of moderate-intensity activities (e.g., walking) five or more days a week. Sixty-eight mothers (average age = 32 years) were assessed at baseline and 10 weeks. Paired comparison t-tests demonstrated a significant increase in PA-related energy expenditure from baseline to 10 weeks (p < 0.05). Furthermore, this increase in PA was significantly associated with a decrease in the number of maternal stressors reported over this time period (p < 0.01). Simultaneous regression analyses indicated that (1) having a higher number of maternal stressors at baseline was associated with lower class attendance (p

    View details for DOI 10.1300/J013v42n04_04

    View details for Web of Science ID 000241149800004

    View details for PubMedID 16782676

  • Depression and the metabolic syndrome in young adults: Findings from the third national health and nutrition examination survey PSYCHOSOMATIC MEDICINE Kinder, L. S., Carnethon, M. R., Palaniappan, L. P., King, A. C., Fortmann, S. P. 2004; 66 (3): 316-322


    Previous reports have suggested that depression may lead to the development of cardiovascular disease through its association with the metabolic syndrome; however, little is known about the relationship between depression and the metabolic syndrome. The aim of this study was to establish an association between depression and the metabolic syndrome in a nationally representative sample.The Third National Health and Nutrition Examination Survey is a population-based health survey of noninstitutionalized US citizens completed between 1988 and 1994. Three thousand one hundred eighty-six men and 3003 women, age 17 to 39, free of coronary heart disease and diabetes, completed the depression module from the Diagnostic Interview Schedule and a medical examination that provided clinical data needed to establish the presence of the metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults.Women with a history of a major depressive episode were twice as likely to have the metabolic syndrome compared with those with no history of depression. The relationship between depression and metabolic syndrome remained after controlling for age, race, education, smoking, physical inactivity, carbohydrate consumption, and alcohol use. Men with a history of depression were not significantly more likely to have the metabolic syndrome.The prevalence of the metabolic syndrome is elevated among women with a history of depression. It is important to better understand the role depression may play in the effort to reduce the prevalence of the metabolic syndrome and its health consequences.

    View details for DOI 10.1097/01.psy.0000124755.91880.f4

    View details for Web of Science ID 000221548300005

    View details for PubMedID 15184689

  • Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture AMERICAN JOURNAL OF EPIDEMIOLOGY Keegan, T. H., Kelsey, J. L., King, A. C., Quesenberry, C. P., Sidney, S. 2004; 159 (2): 192-203


    This case-control study examined the relation of circumstances of falls and characteristics of fallers with risk of fractures at five sites among persons 45 years of age or older from five Kaiser Permanente Medical Centers in Northern California from 1996 to 2001. Included were distal forearm (n = 1,016), foot (n = 574), proximal humerus (n = 467), pelvis (n = 150), and shaft of the tibia/fibula (n = 141) cases who fell at the time of their fracture, and controls (n = 512) who reported falling in the year before the interview but did not fracture. Interviewers collected information by using a standardized questionnaire. Medium-/high-heeled shoes and shoes with a narrow heel increased the risk of all fractures, and slip-on shoes (adjusted odds ratio = 2.3, 95% confidence interval: 1.4, 4.0) and sandals (adjusted odds ratio = 3.1, 95% confidence interval: 1.5, 6.3) increased the risk of foot fractures. Falling from more than a standing height increased the risk of all fractures by two- to fivefold, while breaking the fall was associated with lower risks of all fractures except the distal forearm. Physical activity and hormone therapy were associated with lower risks of most fractures. These results suggest ways in which risks of fractures in older persons can be reduced.

    View details for DOI 10.1093/aje/kwh026

    View details for Web of Science ID 000188189100013

    View details for PubMedID 14718222

  • The relationship between depressive symptoms and participation in an exercise-based telephone counseling intervention Cassayre, C., Morris, S., Castro, C., Woo, S., King, A. OXFORD UNIV PRESS INC. 2003: 333-333
  • Meaning and knowledge of health among older adult immigrants from Russia: a phenomenological study HEALTH EDUCATION RESEARCH Benisovich, S. V., King, A. C. 2003; 18 (2): 135-144


    This qualitative study examined the meaning and knowledge of health among older adult Russians who have immigrated to the US. Prior studies have shown that this group has a high rate of chronic disease and low compliance with preventative health behaviors. However, little is known about the knowledge and beliefs about health among Russian immigrants that may be driving their low participation in health behaviors. The goal of the present study was to use a phenomenological approach to gain a deeper understanding of the experience of health in this population. Twelve older adults were recruited through English language classes, and interviewed in focus groups about their experience with health and health care. Qualitative analysis using the phenomenological approach revealed a number of important health themes: participants (1) define health as the absence of disease, (2) feel distrust toward media information about health, (3) experience alienation from their current health care system, and (4) experience a sense of stress and helplessness in the US because they do not understand the English language or the US health care system. These themes may underlie the immigrants' lack of participation in health practices and in seeking out information about health. Information about the Russian immigrants' knowledge about health behavior is also reported. This study represents a first step toward better understanding the barriers facing older adult Russian immigrants in learning about and practicing health behaviors. The study also draws attention to the ways in which beliefs about health may impact health behavior.

    View details for Web of Science ID 000182392400001

    View details for PubMedID 12729173

  • Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project HEALTH EDUCATION RESEARCH King, A. C., Friedman, R., Marcus, B., Castro, C., Forsyth, L., Napolitano, M., Pinto, B. 2002; 17 (5): 627-636


    Physical inactivity among middle- and older-aged adults is pervasive, and is linked with numerous chronic conditions that diminish health and functioning. Counselor-directed physical activity programs may enhance extrinsic motivation (reflected in social influence theories, such as self-presentation theory) and, in turn, physical activity adherence, while the counselor is in charge of program delivery. However, external influences can undermine intrinsic motivation, making it more difficult to maintain physical activity once counselor-initiated contact ends. In contrast, programs that diminish the socially evaluative and controlling aspects of the counseling interchange may promote intrinsic motivation (described in cognitive evaluation theory), and, thus, physical activity maintenance, even when counselor-initiated contact ceases. The objective of the Community Health Advice by Telephone (CHAT) project is to compare these two theories by conducting a randomized controlled trial evaluating the effects of a telephone-administered counseling program delivered by a person (social influence enhancement) or computer (cognitive evaluation enhancement) on physical activity adoption and maintenance over 18 months. Healthy, sedentary adults (n = 225) aged 55 years and older are randomized to one of these programs or to a control arm. This study will contribute to advancing motivational theory as well as provide information on the sustained effectiveness of interventions with substantial public health applicability.

    View details for Web of Science ID 000178557500015

    View details for PubMedID 12408207

  • Intervention-related cognitive versus social mediators of exercise adherence in the elderly AMERICAN JOURNAL OF PREVENTIVE MEDICINE Brassington, G. S., Atienza, A. A., Perczck, R. E., DiLorenzo, T. N., King, A. C. 2002; 23 (2): 80-86


    Participation in regular physical activity is recognized as one of the most important health behaviors associated with the prevention of chronic disease and the promotion of health and well-being among the elderly. Although a number of cross-sectional studies have reported predictors of physical activity participation, few studies have assessed changes in intervention-related mediators associated with physical activity adherence in the elderly.The purpose of this study was to compare the relative abilities of cognitive mediating variables (i.e., self-efficacy beliefs and outcome expectancies/realizations) versus a social mediating variable (i.e., exercise-related social support) to examine mediators of a telephone-based, exercise-counseling intervention on exercise adherence during months 7 to 12 of an exercise intervention.Participants were 103 community-dwelling, healthy, sedentary, older adults (67 women and 36 men). Self-efficacy for exercise, outcome expectancies/realizations, and social support for exercise were assessed at baseline, 6 months, and 12 months. Participants received telephone-based exercise counseling to promote exercise adherence during the course of two 12-month exercise programs (i.e., aerobic/strength or flexibility exercises).Changes in cognitive mediators (i.e., self-efficacy and fitness outcome realizations) were associated with 7- to 12-month exercise adherence while exercise-related social support was not.Attention should be given to increasing confidence in the elderly to overcome barriers to exercise and achieve relevant fitness outcomes in exercise programs.

    View details for Web of Science ID 000177181500012

    View details for PubMedID 12133741

  • An exercise program for women who are caring for relatives with dementia PSYCHOSOMATIC MEDICINE Castro, C. M., Wilcox, S., O'Sullivan, P., Baumann, K., King, A. C. 2002; 64 (3): 458-468


    This study describes factors related to retention and adherence to an exercise program for women caregivers.One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization.Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence.This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.

    View details for Web of Science ID 000175791700010

    View details for PubMedID 12021419

  • Telephone-assisted Counseling for physical activity EXERCISE AND SPORT SCIENCES REVIEWS Castro, C. M., King, A. C. 2002; 30 (2): 64-68


    Different methods of intervention have been tested to promote physical activity at the individual level. The telephone is an excellent form of media for delivering exercise counseling and advice. This review highlights important clinical trials that have documented the success of telephone-assisted exercise counseling for promoting physical activity in a variety of populations.

    View details for Web of Science ID 000178735200004

    View details for PubMedID 11991539

  • Community-based health intervention trials: An overview of methodological issues EPIDEMIOLOGIC REVIEWS Atienza, A. A., King, A. C. 2002; 24 (1): 72-79

    View details for Web of Science ID 000176581000009

    View details for PubMedID 12119859

  • Physiological and affective responses to family caregiving in the natural setting in wives versus daughters INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE King, A. C., Atienza, A., Castro, C., Collins, R. 2002; 9 (3): 176-194


    This study examined differences in hemodynamic responses to usual caregiving duties undertaken in the natural setting by caregiving wives versus daughters. Participants were 88 women (36 daughters, 52 wives), 50 years of age or older, caring for a relative with dementia. Participants underwent 2 standard laboratory challenges (1 physical and 1 emotional) and ambulatory monitoring in the natural setting. Although wives and daughters showed similar physiological responses to the laboratory challenges, daughters evidenced greater hemodynamic responses in the natural setting relative to wives when the care recipient was present (p < .02). The increases in hemodynamic responses were accompanied by increased negative interactions with the care recipient as well as other family members (p < .0009). The results add to the small body of research indicating that family caregiving may have negative acute effects on psychosocial and physiological responses in the natural setting, particularly in daughters.

    View details for Web of Science ID 000178126900002

    View details for PubMedID 12360836

  • Men gain additional psychological benefits by adding exercise to a weight-loss program OBESITY RESEARCH Kiernan, M., King, A. C., Stefanick, M. L., Killen, J. D. 2001; 9 (12): 770-777


    Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits. This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment-only control group.This study was part of a larger 1-year randomized weight-loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year.Men and women in either weight-loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program. Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program, despite increases in aerobic capacity.The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint, less disinhibition, and less hunger-is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.

    View details for Web of Science ID 000172892000006

    View details for PubMedID 11743061

  • Telephone versus mail interventions for maintenance of physical activity in older adults HEALTH PSYCHOLOGY Castro, C. M., King, A. C., Brassington, G. S. 2001; 20 (6): 438-444


    Although telephone and mail are often used to promote physical activity adoption, their ability to produce long-term maintenance is unclear. In this study, 140 men and women aged 50-65 years received 1 year of telephone counseling to adopt higher (i.e., more vigorous) versus lower intensity (i.e., moderate) exercise. After 1 year, participants were rerandomized to a 2nd year of contact via (a) telephone and mail or (b) predominantly mail. Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail. Both strategies were similarly effective in promoting maintenance in the lower intensity condition. Results suggest that after successful adoption of physical activity with the help of telephone counseling, less intensive interventions are successful for physical activity maintenance in older adults.

    View details for DOI 10.1037//0278-6133.20.6.438

    View details for Web of Science ID 000172002200006

    View details for PubMedID 11714186

  • Gender differences in cardiovascular response to dementia caregiving GERONTOLOGIST Atienza, A. A., Henderson, P. C., Wilcox, S., King, A. C. 2001; 41 (4): 490-498


    This study examined gender differences in cardiovascular responses to laboratory-based stress, as well as in ambulatory hemodynamic (i.e., blood pressure and heart rate) functioning among caregivers of persons with dementia.Participants were 25 men and 25 women caregivers, matched on age, type of care recipient's dementia, and relationship to the care recipient. After cardiovascular reactivity to a laboratory-based caregiving stressor was assessed, the ambulatory hemodynamic functioning levels of caregivers were measured in caregivers' natural environments.Female caregivers displayed greater systolic and diastolic blood pressure reactivity to a laboratory-based stress task (i.e., discussing caregiving difficulties) compared with male caregivers (p < or =.01). In contrast, no gender differences were found for ambulatory hemodynamic functioning when aggregated overall or when in the presence of the care recipient.Laboratory-based findings suggest that female caregivers experience greater blood pressure reactivity to caregiving-related stress than do male caregivers. However, these laboratory-based gender differences may not generalize to differences in hemodynamic functioning in caregivers' daily lives.

    View details for Web of Science ID 000170248300007

    View details for PubMedID 11490047

  • The mediating effects of situational control on social support and mood following a stressor: A prospective study of dementia caregivers in their natural environments JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Atienza, A. A., Collins, R., King, A. C. 2001; 56 (3): S129-S139


    The present study examined, prospectively and within the context of stress experienced in the natural environment, whether situational control served as a mediator between perceived social support and caregiver's mood.Data came from baseline assessments of individuals participating in health promotion interventions for women caregivers. Participants were 49 female caregivers of dementia patients who monitored their own acute psychological states during the day.Results revealed that although the occurrence of a situational stressor increased negative mood, greater perceived support reduced the detrimental impact of a stressor on negative mood. Moreover, path analyses revealed that changes in situational control partially mediated the relationship between perceived support and stress-induced negative mood changes. However, changes in control did not serve as a mediator in analyses focused on happiness.Results suggest that caregivers with greater perceived support were less emotionally reactive to stress occurring in their natural environments because of, in part, sustained or increased situational control.

    View details for Web of Science ID 000168341400009

    View details for PubMedID 11316838

  • Do logistic regression and signal detection identify different subgroups at risk? Implications for the design of tailored interventions PSYCHOLOGICAL METHODS Kiernan, M., Kraemer, H. C., Winkleby, M. A., King, A. C., Taylor, C. B. 2001; 6 (1): 35-48


    Identifying subgroups of high-risk individuals can lead to the development of tailored interventions for those subgroups. This study compared two multivariate statistical methods (logistic regression and signal detection) and evaluated their ability to identify subgroups at risk. The methods identified similar risk predictors and had similar predictive accuracy in exploratory and validation samples. However, the 2 methods did not classify individuals into the same subgroups. Within subgroups, logistic regression identified individuals that were homogeneous in outcome but heterogeneous in risk predictors. In contrast, signal detection identified individuals that were homogeneous in both outcome and risk predictors. Because of the ability to identify homogeneous subgroups, signal detection may be more useful than logistic regression for designing distinct tailored interventions for subgroups of high-risk individuals.

    View details for DOI 10.1037//1082-989X.6.1.35

    View details for Web of Science ID 000170728000004

    View details for PubMedID 11285811

  • Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years Brassington, G. S., King, A. C., Bliwise, D. L. BLACKWELL PUBLISHING. 2000: 1234-1240


    The purpose of this study was to determine if reported nighttime sleep problems and daytime sleepiness were associated with reported falling during the previous 12 months in a representatively sampled older adult population.Random-digit dial telephone survey.Representatively sampled older adult population living in northern California.Participants were 971 women and 555 men, aged 64 to 99 years.Twenty-minute telephone interview adapted from the National Health Interview Survey.Two hundred and eighty-four participants reported falling during the previous 12 months (19% of the sample). Significantly more women fell than men (20% and 14%, respectively, P < .001). The following variables were significant risk factors for falling in univariate analyses: female gender, being unmarried, living alone, income less than $15,000 per year, difficulty walking, having more than one chronic medical condition, history of cardiovascular disease, hypertension, arthritis, sensory impairment, psychological difficulties, and nighttime sleep problems. All of the nighttime sleep problem variables remained significant risk factors for falling after controlling for other risk factors for falling.The results provide support for an independent association between reported sleep problems and falls in an older population. One of the implications of these data is that behavioral research focusing on the effectiveness of insomnia treatment in old age should not only examine typical sleep-related outcomes (e.g., total time asleep, number of awakenings) but also the occurrence of falls as well.

    View details for Web of Science ID 000089821600008

    View details for PubMedID 11037010

  • Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Wilcox, S., Castro, C., King, A. C., Housemann, R., Brownson, R. C. 2000; 54 (9): 667-672


    Determinants of leisure time physical activity (LTPA) in rural middle aged and older women of diverse racial and ethnic groups are not well understood. This study examined: (1) urban-rural differences in LTPA by sociodemographic factors, (2) urban-rural differences in LTPA determinants, and (3) the pattern of relations between LTPA determinants and LTPA.A modified version of the sampling plan of the Behavioral Risk Factor Surveillance Survey (BRFSS) was used. Zip codes were selected with 20% or more of each of the following race/ethnic groups: African American, American Indian/Alaskan Native (AI/AN), and Hispanic. A comparison group of white women were also surveyed using standard BRFSS techniques.Rural (n=1242) and urban (n=1096) women aged 40 years and older from the US Women's Determinants Study.Rural women, especially Southern and less educated women, were more sedentary than urban women. Rural women reported more personal barriers to LTPA, cited caregiving duties as their top barrier (compared with lack of time for urban women), and had greater body mass indices. Rural women were less likely to report sidewalks, streetlights, high crime, access to facilities, and frequently seeing others exercise in their neighbourhood. Multivariate correlates of sedentary behaviour in rural women were AI/AN and African American race, older age, less education, lack of enjoyable scenery, not frequently seeing others exercise, greater barriers, and less social support (p<0.05); and in urban women, older age, greater barriers, less social support (p<0.05), and less education (p<0.09).Rural and urban women seem to face different barriers and enablers to LTPA, and have a different pattern of determinants, thus providing useful information for designing more targeted interventions.

    View details for Web of Science ID 000088819800010

    View details for PubMedID 10942445

  • Anger expression and natural killer cell activity in family caregivers participating in a physical activity trial. Journal of health psychology Wilcox, S., King, A. C., Vitaliano, P. P., Brassington, G. S. 2000; 5 (4): 431-440


    Associations between psychological functioning and natural killer cell activity (NKA) were examined in 23 older (62.2 ± 7.5 years) family caregivers randomized to a moderate intensity four-month exercise program or to a wait-list control condition. At baseline, although NKA was related to anger-control (r = -.42; trend p < .06) and anger-out (r = .50; p < .03), it was not related to depression, anxiety, perceived stress, or caregiver burden. After controlling for baseline NKA, changes in anger-control explained 14 percent of the variance in NKA four months later. Decreases in anger-control predicted increases in NKA. Group assignment (exercise vs control) was unrelated to changes in NKA over the four-month period; however, the study was not powered to detect this effect. These results are consistent with reported relationships of anger expression with other physiological measures, and extend the importance of anger expression to immune functioning in older family caregivers.

    View details for DOI 10.1177/135910530000500403

    View details for PubMedID 22049187

  • Role of exercise counselling in health promotion BRITISH JOURNAL OF SPORTS MEDICINE King, A. C. 2000; 34 (2): 80-81

    View details for Web of Science ID 000086374400005

    View details for PubMedID 10786859

  • Using direct mail to recruit hispanic adults into a dietary intervention: An experimental study ANNALS OF BEHAVIORAL MEDICINE Kiernan, M., Phillips, K., Fair, J. M., King, A. C. 2000; 22 (1): 89-93


    Identifying strategies for successful recruitment of ethnic minorities into scientific studies is critical. Without effective methods, investigators may fail to recruit the desired sample size, take longer to recruit than planned, and delay progress for research in minority health. Direct mail is an appealing recruitment method because of the potential for reaching large target populations and producing a high volume of inquiries about a study with relatively little staff effort. To determine which of three direct mail strategies yielded higher recruitment, 561 Hispanic employees were randomly assigned to receive either: (a) a flyer about a worksite dietary intervention; (b) the same flyer plus a personalized hand-signed letter containing heart disease risk statistics for the general American population; or (c) the flyer plus a personalized hand-signed letter containing statistics for Hispanics. Two orthogonal chi-square comparisons were examined. The personalized letters plus flyer yielded a significantly higher response rate (7.8%) than the flyer alone (2.1%), X2(1, N = 561) = 7.5, p = .006. However, the personalized letter with Hispanic heart disease risk statistics did not yield a statistically significant higher response rate (9.1%) than the letter with the general population risk statistics (6.5%), X2(1, N = 370) = 0.9, p > .34. These findings suggest that personalized approaches can increase the effectiveness of direct mail efforts for recruiting ethnic minorities into interventions and may be particularly helpful for large-scale interventions.

    View details for Web of Science ID 000088802800011

    View details for PubMedID 10892533

  • Exercise counseling in health promotion The Western journal of medicine King, A. C. 2000; 173 (1): 5-6

    View details for PubMedID 10903270

  • Sleep complaints in older women who are family caregivers JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Wilcox, S., King, A. C. 1999; 54 (3): P189-P198


    Providing care to a family member with dementia has significant psychological and physical consequences. Sleep quality is likely affected by caregiving, yet this domain has received surprisingly little empirical study. In this study, sleep complaints were examined in 90 older women who were family caregivers of adults with dementia. Caregivers reported more sleep complaints than similarly aged healthy adults on all seven components of the Pittsburgh Sleep Quality Index, and a similar level of sleep complaints to those of sleep-impaired women and depressives on 6 and 4 components, respectively. Sleep medication was used by 38% of caregivers in the past month. The most common sleep complaints that occurred at least weekly were waking up in the night or early morning (84%), bathroom needs (83%), and sleep onset difficulties (41%). Sixty percent of the sample reporting nighttime care recipient disruptions stated that these disruptions occurred 3 or more times per week. Caregiver relationship and care recipient diagnosis were unrelated to sleep complaints. Lower levels of education, less internalized anger, care recipient disruptions, and psychological distress were related to poorer overall sleep quality. Sleep complaints are a common yet understudied problem in family caregivers.

    View details for Web of Science ID 000080570300008

    View details for PubMedID 10363041

  • Managing job strain: A randomized, controlled trial of an intervention conducted by mail and telephone JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE Pelletier, K. R., Rodenburg, A., Vinther, A., Chikamoto, Y., King, A. C., Farquhar, J. W. 1999; 41 (4): 216-223


    A randomized, clinical intervention focused on alleviating job strain was conducted over 6 months by mail and/or telephone with a total of 136 employees of Bank of America. Both the mail and mail plus telephone interventions evidenced positive results, with the mail plus telephone intervention being the more effective. Given the relative low cost of such mediated interventions, the results provide a basis for the further development of interventions that may demonstrate both clinical and cost effectiveness.

    View details for Web of Science ID 000079795000003

    View details for PubMedID 10224587

  • Key informant surveys as a tool to implement and evaluate physical activity interventions in the community HEALTH EDUCATION RESEARCH Eyler, A. A., Mayer, J., Rafii, R., Housemann, R., Brownson, R. C., King, A. C. 1999; 14 (2): 289-298


    Key informant surveys are important tools for planning and evaluating community health programs. A survey was conducted to gather views on policies toward physical activity from four sets of key informants: physicians, church leaders, business leaders and civic leaders. Surveys were mailed to 797 key informants who were selected from 12 southeastern Missouri counties. For comparison, data from a telephone survey of 2106 persons in the general population were also analyzed. The majority (> 85%) in all four key informant groups were very supportive of required physical education in schools, but less supportive (< 69%) of government funding for places where community members can exercise. Physicians perceived community members as having somewhat greater access to places to exercise relative to the other key informant groups. Comparisons of the key informant surveys to the population survey indicated similar levels of support for physical activity policy. The information from this survey has been useful in identifying support for physical activity policy and gaining access to potential influences for community change. Since key informant research in the area of physical activity policy and cardiovascular disease prevention is sparse, there is a need for future studies.

    View details for Web of Science ID 000079905200013

    View details for PubMedID 10387507

  • A Modified Exercise-induced Feeling Inventory for Chronic Training and Baseline Profiles of Participants in the Activity Counseling Trial. Journal of health psychology Rejeski, W. J., Reboussin, B. A., Dunn, A. L., King, A. C., Sallis, J. F. 1999; 4 (1): 97-108


    An earlier study reported on the development of a scale to measure feeling states during acute bouts of exercise: the Exercise-induced Feeling Inventory (EFI-A). The present study reports on the psychometric properties of a revised scale to assess responses to habitual or chronic physical activity: the EFI-C. The EFI-C was administered during baseline testing to 830 sedentary men and women patients with a mean age of 51.5 years. Factor analytic procedures revealed that the EFI-C consisted of two factors, one assessing pleasant feeling states and a second that taps the unpleasant experience of physical exhaustion. Both subscales have excellent internal consistency reliability coefficients (0.90) and are reasonably stable over time, having test-retest coefficients in excess of 0.70. The scales correlated in expected directions with related constructs and in preliminary analyses showed an anticipated pattern of sensitivity to physical activity interventions. Mean scores for various demographic groups are reported. Future research should examine whether the EFI-C is a predictor of adherence to physical activity and its potential role in mediating the positive mental health effects of physical activity.

    View details for DOI 10.1177/135910539900400107

    View details for PubMedID 22021437

  • How to promote physical activity in a community: research experiences from the US highlighting different community approaches King, A. C. ELSEVIER IRELAND LTD. 1998: S3-S12


    Much of the research investigating methods for promoting physical activity has occurred on an individual or group level of analysis. Yet, the substantial prevalence of physical inactivity in most developed countries coupled with the public health significance of becoming more regularly active provides a compelling rationale for expanding interventions to higher levels of impact. By targeting the community, the possibility of reaching a greater percentage of the underactive population with potentially lower costs per person becomes more likely. When the target of intervention becomes the community, as opposed to the individual, a shift in the methods by which the physical inactivity problem is both conceptualized and addressed is required. Successful intervention strategies that have occurred at each level of impact (i.e. personal/interpersonal, institutional, environmental, legislative/policy-level) are highlighted. Suggested future directions are summarized.

    View details for Web of Science ID 000073359400003

    View details for PubMedID 10889741

  • The effects of marital transitions on changes in physical activity: Results from a 10-year community study ANNALS OF BEHAVIORAL MEDICINE King, A. C., Kiernan, M., Ahn, D. K., Wilcox, S. 1998; 20 (2): 64-69


    The potential effects of making a marital transition on subsequent physical activity were evaluated across a ten-year period in a population-based sample of 302 women and 256 men ages 25 to 75 years. Subjects completed a structured interview at five timepoints throughout the ten-year period during which they reported on their physical activity level as well as marital status. The transition from a married to a single state did not affect physical activity relative to remaining married when analyses of either slopes or mean values were used. In contrast, the transition from a single to a married state resulted in significant positive changes in physical activity relative to remaining single throughout the study period when physical activity slopes, though not means, were compared. The results suggest that marriage may potentially set the stage for natural changes in physical activity that could be capitalized on through appropriate intervention, but additional research is needed to verify this in light of the inconsistent pattern of findings.

    View details for Web of Science ID 000078467900003

    View details for PubMedID 9989310

  • Managing job strain: A randomized controlled trial of an intervention conducted by mail and telephone AMERICAN JOURNAL OF HEALTH PROMOTION Pelletier, K. R., Rodenburg, A., Chikamoto, Y., Vinther, A., King, A. C., Farquhar, J. W. 1998; 12 (3): 166-169

    View details for Web of Science ID 000075033100004

    View details for PubMedID 10176090

  • Characteristics of successful and unsuccessful dieters: An application of signal detection methodology ANNALS OF BEHAVIORAL MEDICINE Kiernan, M., King, A. C., Kraemer, H. C., Stefanick, M. L., Killen, J. D. 1998; 20 (1): 1-6


    Signal detection methods were used to identify predictors of successful weight loss in 177 mildly to moderately overweight women and men assigned to one of two weight-loss programs. Predictors included initial demographic, physiological, behavioral, and psychosocial characteristics, and program type (e.g. diet-only and diet-plus-exercise). Successful weight loss was defined as a loss of at least two units of body mass index at one year. Four subgroups were identified. Participants in the diet-plus-exercise program who were initially more satisfied with their bodies and did not have a history of repeated weight loss were most likely to succeed (63% succeeded). In contrast, participants assigned to the diet-plus-exercise program who were either extremely dissatisfied with their bodies or who had a history of repeated weight loss were at similar risk for failure as participants in the diet-only program (only 26% to 35% succeeded). The results underscore the potential utility of exploring these subgroups further to inform the development of new treatment strategies to increase the likelihood of success.

    View details for Web of Science ID 000075741800001

    View details for PubMedID 9755345

  • Enhancing physical and psychological functioning in older family caregivers: The role of regular physical activity ANNALS OF BEHAVIORAL MEDICINE King, A. C., Brassington, G. 1997; 19 (2): 91-100


    Although informal caregiving among older adults creates a range of physical and psychological burdens for the caregiver, little research has been directed at evaluating strategies for preserving caregivers physical functioning in addition to their psychological well-being. The purpose of the current research was to examine, through population-based survey sampling procedures, levels of physical activity and related health practices and preferences among a random sample of older family caregivers; evaluate, using an experimental design, the feasibility of initiating a four-month supervised home-based moderate-intensity physical activity regimen among older family caregivers; and explore the potential effects of physical activity on anger expression, caregiver burden, and related psychological outcomes in this population. The results suggest that: (a) physical inactivity is a prevalent risk factor among family caregivers that requires systematic attention; (b) a significant proportion of family caregivers of both sexes are interested in improving their physical activity levels, especially through programs that do not require ongoing attendance at a class or group; and (c) supervised home-based programs that focus on brisk walking and similar moderate-intensity physical activities appear to be both feasible and potentially beneficial in health (e.g. ambulatory blood pressure) as well as mental health (e.g. anger expression) areas.

    View details for Web of Science ID A1997XX31000004

    View details for PubMedID 9603683

  • Intervention strategies and determinants of physical activity and exercise behavior in adult and older adult men and women NUTRITION AND FITNESS: METABOLIC AND BEHAVIORAL ASPECTS IN HEALTH AND DISEASE King, A. C. 1997; 82: 148-158

    View details for Web of Science ID A1997BJ41E00009

    View details for PubMedID 9270318

  • Lifestyle activity - Current recommendations SPORTS MEDICINE Phillips, W. T., Pruitt, L. A., King, A. C. 1996; 22 (1): 1-7


    An accumulation of international scientific evidence indicates that physical inactivity is detrimental to health and that moderate levels of physical activity confer significant health benefits. Unfortunately, in countries where major surveys of physical activity have been conducted, the prevalence of sedentary behaviour has been found to be as high as 40%. In the US, where approximately 30% of adults report little or no physical activity, the Centers for Disease Control and the American College of Sports Medicine recently issued guidelines and recommendations on the amount and frequency of moderate levels of physical activity necessary to elicit health benefits in predominantly sedentary adults. These guidelines utilise a physical activity-health paradigm and, uniquely, recommend the potential effectiveness of activities of daily living or "lifestyle activity' for achieving health benefits. This article briefly reviews the rationale behind these guidelines and, in view of the historical association of the exercise training-fitness model to health, highlights some challenges and potential problems in applying these new guidelines to the general population.

    View details for Web of Science ID A1996UW56700001

    View details for PubMedID 8819236

  • Sleepiness in clinical and nonclinical populations NEUROEPIDEMIOLOGY Bliwise, D. L., King, A. C. 1996; 15 (3): 161-165


    Sleepiness is a commonplace experience for all individuals at some point in their daily lives. Whether such a ubiquitous experience has utility in discriminating a diseased population from the general population has yet to be determined. The purpose of this study was to determine the accuracy of reports of sleepiness across different situations by identifying individuals with sleep apnea. We compared a clinical population of 630 patients aged 50-65 with polysomnographically diagnosed sleep apnea with a randomly sampled population of 1,877 individuals of similar age from a nearby community. Sleepiness while watching television was the most prevalent behavior (about 36% of the reference population and 90% of the apnea patients), but potentially better discrimination occurred with items inquiring about sleepiness in other situations. The data suggest that discrimination between diseased and nondiseased populations may be more successful with sleepiness items involving relatively low, rather than high, rates of endorsement.

    View details for Web of Science ID A1996UJ79600006

    View details for PubMedID 8700308

  • Environmental and policy approaches to cardiovascular disease prevention through physical activity: Issues and opportunities HEALTH EDUCATION QUARTERLY King, A. C., Jeffery, R. W., Fridinger, F., DUSENBURY, L., PROVENCE, S., Hedlund, S. A., SPANGLER, K. 1995; 22 (4): 499-511


    The majority of Americans remain inactive despite evidence of significant health benefits from even moderately intense activity. Previous intervention efforts have generally focused on changing individual behavior. This article discusses the use of policy, legislative and regulatory, and environmental interventions in promoting physical activity to prevent cardiovascular disease (CVD) and other chronic diseases. The authors present evidence on the need, formulation, description, and effectiveness of policy and environmental intervention approaches. Types of approaches addressed to promote physical activity include federal, state, and local legislation and regulation, policy development and implementation, and environmental support. They also describe opportunities for state and local health departments to initiate and participate in environmental and policy approaches.

    View details for Web of Science ID A1995UD81300007

    View details for PubMedID 8550373

  • Sources of social support as predictors of exercise adherence in women and men ages 50 to 65 years. Women's health (Hillsdale, N.J.) Oka, R. K., King, A. C., Young, D. R. 1995; 1 (2): 161-175


    Examines types of social support that best predicts adherence at different time points during a 1-year endurance exercise program in 269 women and men ages 50 to 65 years. Results indicate that social support had similar effects on exercise participation for women and men, and support specific to exercise was a better predictor of exercise adherence than general social support. A preference for receiving a lesser amount of initial support from exercise staff was the strongest social support-related predictor of exercise adherence during the initial 6 months of the program. Support currently received from family and friends and exercise staff at Month 6 was found to be the strongest predictor of adherence during Months 7 to 12. Format of exercise was also a strong predictor of exercise adherence with home-based programs related to greater adherence. Additionally, divorced nonsmokers appear to be at increased risk for poor early exercise adherence and should be targeted in interventions to promote exercise participation.

    View details for PubMedID 9373378



    Although the informal caregiving role is associated with a range of stressors that are both chronic and severe, little is known concerning the acute physical and psychological effects of caregiving in the natural setting. This study evaluated the hemodynamic and psychological responses of five women identified as family caregivers who also worked outside the home and five matched working noncaregivers.Subjects wore an ambulatory blood pressure monitor that recorded blood pressure and heart rate on an hourly basis throughout a one- to two-day period. They also completed hourly logs evaluating psychological, physical, and health-related variables through use of a preprogrammed pocket computer. Within- and between-group responses were compared in clinical, work, and postwork settings.Caregivers and noncaregivers showed comparable ambulatory blood pressure levels in the clinic and work settings. However, in contrast to noncaregivers, who showed the expected decrease in blood pressure level upon leaving the work setting (p values < .03), caregivers demonstrated a significant increase in systolic blood pressure levels following work when they were in the presence of the care recipient (p < .0002). The differences observed in blood pressure responses between the two groups were similarly reflected in the patterns of affective response recorded in the work and postwork settings.The results provide initial evidence of the acute iatrogenic effects of caregiving on physiological as well as psychological response systems.

    View details for Web of Science ID A1994PR34200017

    View details for PubMedID 7963275



    Research in the exercise adherence area over the past several decades has resulted in the identification of a number of promising methods for influencing physical activity on the individual level. The substantial prevalence of underactivity across most sectors of the American population, however, demands that higher-level approaches to physical activity promotion that include environmental, organizational, and policy-level strategies be increasingly brought to bear on this problem. This paper compares individual and community approaches to physical activity intervention and provides examples of how the community/public health approach to physical activity promotion can be implemented to facilitate increases in population-wide physical activity.

    View details for Web of Science ID A1994PQ03300017

    View details for PubMedID 7837963

  • Effect of recruitment strategy on types of subjects entered into a primary prevention clinical trial. Annals of epidemiology King, A. C., Harris, R. B., Haskell, W. L. 1994; 4 (4): 312-320


    Clinical trials typically recruit subjects through referrals or media promotion, with generalizability of the results often uncertain. As part of a primary prevention trial to evaluate strategies for increasing physical activity in sedentary men and women, two recruitment sources, a random-digit-dial telephone survey and a community media campaign, were used to identify subjects. Baseline characteristics of 357 randomized men and women aged 50 to 65 years were compared by recruitment source. Whereas there were few differences between recruitment sources for demographic variables, telephone survey recruitment was particularly successful in recruiting smokers and persons with other cardiovascular risk factors into the trial. Counter to expectations, subsequent exercise adherence rates did not differ by recruitment source. The results suggest that the survey method, while more expensive, may be particularly useful for locating higher-risk subjects who could especially benefit from increases in physical activity but who rarely are recruited through more traditional approaches.

    View details for PubMedID 7921321



    Two questionnaire formats for assessing alcohol consumption in a community sample were compared. Subjects completed the Semi-Quantitative Food Frequency Questionnaire and a questionnaire specifically targeting alcohol use. Across all alcoholic beverages, subjects reported lower consumption on the alcohol questionnaire than on the food frequency questionnaire. The results suggest that food frequency questionnaires may provide a better means for enhancing self-report of alcohol use than questionnaires that target solely alcohol intake.

    View details for Web of Science ID A1994NB62800028

    View details for PubMedID 8296958



    Several studies have suggested that individuals with long or short sleep durations are at greater risk for adverse outcomes relative to individuals sleeping 7-8 hours a night. The mechanisms leading to these results have never been fully explained, but individual differences in how long an individual sleeps are usually considered to reflect lifestyle rather than disease. Alternatively, individuals may sleep a particular amount because of characteristics of their sleep physiology. In this study, we examined population-based data on the associations between sleep duration and several symptoms of sleep-related disease, reported snoring and daytime sleepiness. Results from 1877 independently living individuals between the ages of 50 and 65 years suggested that long, but not short, sleep durations were related to greater reported snoring. Higher levels of reported snoring and daytime sleepiness, but not habitual sleep duration, were related to measures of disease and lower psychosocial function. We suggest that future epidemiologic studies use such additional items as potential indicators of sleep-related disease.

    View details for Web of Science ID A1994MT27800004

    View details for PubMedID 8283193



    To determine predictors of high-density lipoprotein cholesterol (HDL) and triglyceride (TG) concentrations in postmenopausal women.Cross-sectional study.Clinical research facility.One hundred twenty-seven healthy, relatively sedentary, postmenopausal women not on estrogen replacement, mean age 57 years.Alcohol intake, cigarette smoking, aerobic fitness (VO2max), body mass index (BMI), percent body fat, waist-hip ratio, lipids and lipoproteins, fasting plasma glucose (FPG), and insulin (FPI) concentrations.In univariate analyses, HDL was significantly (P < 0.05) inversely related to BMI, waist-hip ratio, smoking, FPG, and FPI, and directly related to VO2max and alcohol intake. Triglycerides were related directly to BMI, waist-hip ratio, percent body fat, FPG, and FPI, and inversely to VO2max. In stepwise multiple regressions, BMI, waist-hip ratio, alcohol, smoking, and FPG were significantly associated with HDL (R2 for the model = 0.43). Addition of TG to these models reduced relations of BMI and waist-hip ratio, but not the other variables, to insignificance. For triglycerides, waist-hip ratio, alcohol, smoking, FPG, and FPI were significant predictors (R2 = 0.33). VO2max and percent body fat did not contribute to any model.Obesity, abdominal obesity, smoking, alcohol intake, and measures of carbohydrate metabolism predict HDL and triglyceride concentrations in postmenopausal women.

    View details for Web of Science ID A1993MK55900001

    View details for PubMedID 8227909

  • DETERMINANTS OF PHYSICAL-ACTIVITY AND INTERVENTIONS IN ADULTS MEDICINE AND SCIENCE IN SPORTS AND EXERCISE King, A. C., Blair, S. N., Bild, D. E., Dishman, R. K., Dubbert, P. M., Marcus, B. H., Oldridge, N. B., Paffenbarger, R. S., Powell, K. E., YEAGER, K. K. 1992; 24 (6): S221-S236

    View details for Web of Science ID A1992HX75400005

    View details for PubMedID 1625548



    The purpose of this study was to determine the effects of a six month aerobic exercise training regimen on cardiovascular responsivity to mental arithmetic in healthy middle-aged men and women. Subjects were randomly assigned to a moderate intensity exercise intervention or to an assessment-only control group. Before and after the intervention subjects' heart rates and blood pressures were measured doing a mental arithmetic task (N = 83). Other physiological and psychosocial measures included the Type A structured interview and a maximal exercise treadmill test. Validated adherence to the exercise regimen exceeded 75% and there were significant increases in aerobic capacity in those subjects receiving exercise training. Exercise did not significantly reduce cardiovascular responsivity to the stress task. Type A behavior did not interact with reactivity across exercisers or controls nor was it significantly correlated with adherence. The results are discussed with respect to factors that have been previously reported to potentially influence the exercise/reactivity relationship.

    View details for Web of Science ID A1992HB79200003

    View details for PubMedID 1538348

  • PREVALENCE OF SELF-REPORTED POOR SLEEP IN A HEALTHY POPULATION AGED 50-65 SOCIAL SCIENCE & MEDICINE Bliwise, D. L., King, A. C., Harris, R. B., Haskell, W. L. 1992; 34 (1): 49-55


    Many population-based surveys have reported that the prevalence of poor sleep increases with age. Despite the uniformity of findings, it remains unclear to what extent age-related declines in overall physical health are related to those results. One approach to this problem has been to adjust for such confounding variables multivariately. Some prior studies using this approach have not shown the expected age-related increases in the prevalence of poor sleep. Another approach has been the study of sleep in carefully screened, healthy populations. The current study reports the prevalence of disturbed sleep in a population, ages 50-65, carefully screened for physical health as part of an ongoing study of exercise and cardiovascular function. The prevalence of self-reported trouble falling asleep every night or almost every night (1.1% M, 2.6% F), trouble awakening and returning back to sleep (4.4% M, 3.3% F), and use of hypnotic medication at least twice a week (1.6% M, 2.6% F) were consistently lower than in nearly all previous population-based studies of individuals of comparable age. This implies that when overall physical health factors are taken into account a decline in sleep quality is not necessarily an inevitable component of aging per se. As has been shown in other studies, there were small but statistically significant relationships between self-reported depression and poor sleep. Despite the low prevalence of poor sleep, about a third of the population reported feeling not well-rested and/or not getting the sleep they required. The individuals in this study also reported obtaining significantly less sleep relative to normative data from 30 years ago.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1992GY69500007

    View details for PubMedID 1738856



    Low plasma high density lipoprotein (HDL) cholesterol concentration is a risk factor for coronary heart disease (CHD) and is frequently associated with high triglyceride concentration. Both of these abnormalities have been related to insulin resistance as estimated by plasma insulin concentrations and to measures of obesity, regional adiposity, and physical fitness. To determine which of these variables (fasting plasma insulin, obesity as measured by body mass index [BMI], or regional adiposity as measured by waist to hip ratio [WHR]) best identifies men with low HDL cholesterol and high triglyceride concentrations, we divided 83 men, aged 50-65 years, who were free of CHD or diabetes, into tertiles based on BMI, WHR, or fasting plasma insulin concentration. Only for plasma insulin tertiles were there statistically significant differences in HDL cholesterol (tertile 1, mean +/- SEM, 1.34 +/- 0.08 mmol/l; 2, 1.16 +/- 0.05 mmol/l; 3, 1.10 +/- 0.06 mmol/l; p less than 0.03) and triglyceride (tertile 1, 1.05 +/- 0.08 mmol/l; 2, 1.48 +/- 0.12 mmol/l; 3, 1.82 +/- 0.17 mmol/l; p less than 0.005) concentrations. In forward stepwise regressions with HDL cholesterol and triglyceride as dependent variables, fasting insulin concentration but not BMI, WHR, or maximal oxygen uptake (VO2max), a measure of physical fitness, predicted HDL cholesterol (R2 = 0.07, p less than 0.02) and triglyceride (R2 = 0.20, p less than 0.001) concentrations. The data suggest that plasma insulin concentration is an important predictor of HDL cholesterol and triglyceride concentrations independent of BMI, WHR, or VO2max.

    View details for Web of Science ID A1991GQ63000002

    View details for PubMedID 1931867



    Obesity is an extremely prevalent condition that is associated with a range of deleterious health effects. While traditionally considered a disorder primarily of energy intake, accumulating evidence underscores the importance of energy expenditure in the development and treatment of obesity. As the most variable component of energy expenditure, physical activity can influence the development of obesity as well as success in achieving both initial and long term weight loss. Among the types of exercise-related physiological and behavioural factors most likely to be involved in the development of obesity are reductions in the amount of physical activity actually performed, differences in the effect of physical activity on diet-induced thermogenesis, and modeling of deleterious dietary and exercise patterns on the part of the family and other facets of the environment. In contrast, there is relatively little evidence supporting the common belief that obese individuals have a significantly greater energy intake than nonobese individuals. With respect to weight reduction in the already obese, while increased physical activity levels often augment caloric restriction programmes in aiding initial weight loss, evidence suggests that physical activity may be particularly important in helping to sustain initial losses through increased total energy output, preservation of lean body mass, and changes in substrate utilisation. The psychological benefits received from regular participation in a physical activity programme may serve as an additional impetus for engaging in such activities over the long run. Developing programmes to aid in long term adherence to physical activity regimens remains the most critical challenge. Recent results suggest the utility of regular, brief contacts in aiding sustained physical activity participation in individuals attempting to control their weight.

    View details for Web of Science ID A1991FK94300004

    View details for PubMedID 2068436



    While worksite exercise programs offer a number of potential advantages with respect to increasing physical activity levels in American adults, typical participation rates remain relatively low. The purpose of this study was to explore employee preferences and needs related to physical activity programming in a major work setting in northern California. Two-thirds (399) of a randomly selected sample of employees responded to a mailed survey. Male and female employees reporting no regular aerobic activity over the past two years more strongly endorsed a number of erroneous beliefs concerning exercise, reported less support for engaging in exercise both at home and at work, and avoided even routine types of activity to a greater extent than more active individuals (p values less than 0.001). Current exercisers reported use of a greater number and variety of motivational strategies as part of their exercise program than past exercisers who were not currently active (p less than 0.001). Respondents, regardless of exercise status and age, reported preferences for moderate-intensity activity occurring away from the workplace which could be performed on one's own rather than in a group or class. Implications of the findings with respect to development of educational and behavioral programs for the current employee population are discussed.

    View details for Web of Science ID A1990DX06600004

    View details for PubMedID 2228630

  • ARE WOMEN USING POSTMENOPAUSAL ESTROGENS - A COMMUNITY SURVEY AMERICAN JOURNAL OF PUBLIC HEALTH Harris, R. B., Laws, A., Reddy, V. M., King, A., Haskell, W. L. 1990; 80 (10): 1266-1268


    Self-reported estrogen and progestin use in a California community was determined in 1986-87 from a telephone survey of postmenopausal women (n = 954) ages 50-65 years. Current use of hormones was reported by 32 percent; 26 percent took estrogens alone while 6 percent used estrogen + progestin. Comparisons pointed to significant social network and medical care utilization differences. Women who used estrogen therapy were younger, thinner, lived in smaller household units, and were less likely to be widowed.

    View details for Web of Science ID A1990EA29100025

    View details for PubMedID 2400044



    Current national data indicate that a greater percentage of women entering their fifth and sixth decades of life are current, as opposed to former, smokers, while for men the opposite pattern is present. A representative sample of 1876 men and women aged 50 to 65 years living in a northern California community were interviewed to examine factors related to gender differences in quit rates in this age group. In this well-educated community, a significantly greater percentage of women (25.6%) continued to smoke relative to men (18.6%), with a greater percentage of men reporting being former smokers. Multivariate analysis revealed educational level and marital status, rather than gender, to be significant, Independent factors associated both with current cigarette use and with successful quitting. Our data indicate that it is not being female per se, but rather the disparities in educational level and marital status that are linked with being an older woman, that are associated with continued smoking in this age group. In light of this, delivery of relevant information and support on the part of physicians and other health professionals may be of particular use to this population segment.

    View details for Web of Science ID A1990DY36400009

    View details for PubMedID 2393315



    The current study explored the relationship between repressive coping and blood pressure responses at rest and during a mental challenge. One hundred and twenty healthy, middle-aged men and women completed anxiety and defensiveness measures. Subjects scoring below the median on anxiety and above the median on defensiveness were categorized as repressors; those below the median on both measures as low-anxious; those above the median on anxiety and below the median on defensiveness as moderately anxious; and those above the median on both measures as defensive moderately-anxious. As predicted, repressors showed greater systolic blood pressure reactivity in response to a mental challenge relative to the other groups (p less than 0.01). Repressors also had greater resting systolic blood pressure levels than the other groups (p less than 0.001). The findings are discussed with respect to the potential influence of this response pattern on blood pressure and other CVD risk factors and behaviors.

    View details for Web of Science ID A1990DN57200012

    View details for PubMedID 2376846



    The effect of a minimal intervention strategy on maintenance of weight lost through either energy restriction alone or exercise alone during the previous year was studied in a sample of middle-aged men. At the end of the initial year of weight loss, dieters (n = 44) and exercisers (n = 46) were randomly assigned to either an intervention condition, comprising monthly mailed informational packets and monthly to quarterly telephone contacts, or an assessment-only condition. The intervention had a significantly greater impact on weight maintenance in exercisers than it did in dieters. In addition, dieters showed a more variable pattern of weight gain and weight loss during the maintenance year than did exercisers. Based on 7-day food records and a 7-day physical activity recall questionnaire, exercisers reported a greater energy intake and a greater amount of time spent in vigorous activity relative to dieters at both the beginning and the end of the maintenance year. We conclude that exercise is easier to maintain in men using minimal contact strategies than dietary approaches to weight control focusing on modification of energy intake, with subsequent benefits in terms of both overall maintenance and stability of weight.

    View details for Web of Science ID A1989CC99300017

    View details for PubMedID 2596943



    Although a variety of psychological benefits have been attributed to regular exercise, few experimentally controlled studies of healthy individuals currently exist. One hundred twenty healthy, sedentary, middle-aged men and women were randomly assigned to either a 6-month home-based aerobic exercise training program or to an assessment-only control condition. Adherence across the 6-month period was found by both self-report and heart rate microprocessor methods to exceed 75% in both sexes. To assess changes in a variety of psychological variables over time, a 14-item Likert rating scale was completed and returned on a biweekly basis throughout the 6-month period. Slope analyses conducted on the 11 items attaining acceptable test-retest reliability coefficients showed significant between-groups differences on the 3 items most closely associated with the actual physical changes that occurred with exercise (all ps less than .004). Implications in relation to repeated measurement of psychological changes in nonclinical populations and the determination of the relevant population-, activity-, and program-specific parameters involved are discussed.

    View details for Web of Science ID A1989AF90200003

    View details for PubMedID 2767021



    Despite increasing interest in worksite exercise programs, little attention has been focused on the blue-collar segment of the workforce. Because of their low participation in traditional exercise classes and programs, blue-collar workers at a university were targeted for an exercise program tailored specifically to their preferences and needs. Thirty-eight sedentary males employed in operations and maintenance shops on the university campus were evaluated with regard to their current exercise behavior, other health habits, and their preferred types of physical activity programs. A pre- and postprogram submaximal exercise test, weight, and blood pressure measurements were also completed on-site. Twenty-two men (23% of the total blue-collar population) subsequently participated in a 16-week exercise program using an on-site parcourse, and incorporating such motivational strategies as public monitoring, intershop competition, and activity-based incentives. Participation rates were substantially higher than those recorded for previous worksite exercise classes. Participants showed increases in fitness levels (P less than 0.0001) and decreases in weight (P less than 0.05) compared with nonparticipants. Suggestions concerning recruitment of such individuals into low-cost exercise programs and subsequent participation maintenance are discussed.

    View details for Web of Science ID A1988P076900010

    View details for PubMedID 3405990



    We examined the immediate and long-term effects of a school-based, behaviorally focused dietary change program for tenth-graders. Our behavioral change objectives included increased consumption of complex carbohydrates and decreased intake of saturated fats, sugar, and salt, particularly in the form of snack foods. We randomly assigned tenth-grade classes in two northern California high schools to either a five-session dietary change program or an assessment-only control group. We collected pre- and postprogram self-report data on 218 students in areas of dietary knowledge, behavior, attitudes, food availability in the home, and intentions and self-efficacy concerning eating in specific ways. We also observed school snack choices both directly and indirectly. Our results indicated significant changes in reported behavior, knowledge, and food availability at home, as well as changes in snack choices at school. We found these changes to be durable at one-year follow-up. Our findings suggest ways in which school-based programs focused on behavioral and environmental changes may be effective in promoting dietary changes at school and at home.

    View details for Web of Science ID A1988N201600002

    View details for PubMedID 3395493



    Two studies were undertaken to compare strategies for the adoption and maintenance of moderate-intensity, home-based exercise training. In the study of adoption, 52 men and women who had served for 6 months as controls for a study of moderate-intensity, home-based exercise training received 30 minutes of baseline instruction. They were then randomized to receive continuing instruction and support through 10 staff-initiated telephone contacts of 5 minutes each every 2 weeks, or to receive no telephone contacts. In subjects receiving telephone contacts, peak oxygen uptake increased significantly after 6 months, whereas no increase was observed in subjects receiving no staff support (p less than 0.05). In the maintenance study, 51 men and women who had significantly increased their peak oxygen uptake by 6 months of moderate-intensity, home-based exercise training were randomized to undergo daily self-monitoring and receive adherence instructions, or undergo weekly self-monitoring only, during a second 6-month period of training. Subjects performing daily self-monitoring reported completing significantly more exercise training sessions during the 6 months of training than subjects performing weekly self-monitoring; functional capacity in both groups remained higher than before training (p less than 0.05). Taken together, these studies suggest that brief baseline instruction followed by continuing telephone contact with staff can be used to help people adopt a moderate-intensity, home-based exercise training program that can be maintained by simple self-monitoring strategies.

    View details for Web of Science ID A1988N611800025

    View details for PubMedID 3344690

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