PURPOSE:To redevelop and improve Transtheoretical Model (TTM) exercise measures for Black and Hispanic/Latinx adults. The redeveloped scales will address barriers to exercise potentially relevant to populations of color in the United States (US). DESIGN:Cross-sectional, split-half measure development. SETTING:Online survey in the US. SUBJECTS:450 Black and/or Hispanic/Latinx adults. MEASURES:Demographics, exercise engagement (IPAQ-SF), stage of change (SOC), decisional balance (DCBL), self-efficacy (SE), and barriers to exercise. ANALYSIS:Split-half exploratory (EFA) and confirmatory factor analyses (CFA) were executed to establish measurement structure and fit, followed by multivariate analyses to assess constructs by SOC. RESULTS:EFA/CFA for DCBL revealed three factors (α = .85, .70, .75) which represented Pros of exercise, Cons of exercise related to time and safety, and Cons of exercise related to physical or emotional discomfort. Model fit was adequate (CFI = .89). For SE, two factors (α = .85, .77) resulted with good model fit (CFI = .91). These factors reflected self-efficacy to exercise when confronted with generally challenging situations, and self-efficacy to exercise when specifically experiencing affective difficulties, such as depression or anxiety. Lastly, a novel Barriers measure resulted in three factors (α = .82, .77, .76), representing barriers encountered due to family responsibilities, work obligations, and health challenges, with good model fit (CFI = .95). Shifts in the core TTM constructs by SOC largely mapped onto the theoretical trends expected under the TTM. CONCLUSION:This study produced systematically developed TTM exercise measures for Black and Hispanic/Latinx adults in the US that address and incorporate important barriers to exercise. This research represents an important step forward in broadening the inclusion of diverse populations to TTM measure development processes and may lead to a better understanding of relevant factors impeding exercise engagement in the US.

Background and aims: Abdominal adiposity indices have stronger associations with cardiometabolic risk factors compared to anthropometric measures but are rarely used in large scale studies due to the cost and efficiency. The aim of this study is to establish sex and race/ ethnicity specific reference equations using anthropometric measures.Methods and results: A secondary data analysis (n Z 6589) of healthy adults was conducted using data from National Health and Nutrition Examination Survey 2011-2018. Variables included in the analyses were anthropometric measures (height; weight; waist circumference, WC) and abdominal adiposity indices (android percent fat; android to gynoid ratio, A/G ratio; visceral adipose tissue area, VATA; visceral to subcutaneous adipose area ratio, VSR). Multivariable prediction models were developed using quantile regression. Bland-Altman was used for external validation of prediction models. Reference equations to estimate android percent fat, A/G ratio, VATA and VSR from anthropometric measurements were developed using a randomly selected subsample of 4613. These reference equations for four abdominal adiposity indices were then cross-validated in the remaining subsample of 1976. The measured and predicted android percent fat, A/G ratio, VATA and VSR were not statistically different (p > 0.05) except for the A/G ratio in Asian males and VSR in White females. The results of Bland-Altman further revealed that >93% of predicted abdominal adiposity indices fell within the limits of agreement (& PLUSMN;1.96 standard deviation).Conclusion: The sex and race/ethnicity specific reference equations for abdominal adiposity indices established using anthropometrics in the present study have strong predictive ability in US healthy adults.& COPY; 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Despite the rising awareness of abdominal adiposity associated health problems and demographic health disparities, research is lacking about abdominal fat trends using a national representative sample of US adults. Our purpose was to examine national demographic specific abdominal fat composition and distribution trends from 2011 to 2018. This trend analysis was using National Health and Nutrition Examination Survey data (n = 13,163). Visceral adipose percent (VAT%), visceral adipose tissue area (VAA) and visceral to subcutaneous adipose area ratio (VSR) were utilized in data analyses. Multiple polynomial linear regression was utilized with adjustment for confounding variables. Our findings revealed that VAT%, VAA and VSR trends were concave among all demographic groups. The VAT%, VAA and/or VSR changes were observed in most demographic groups (p < 0.05) except younger, White and Black respondents. The pattern was consistent with biennial increases up to 2014 or 2016 followed by decreases in 2017–2018. There were demographic disparities, with middle-aged respondents and Hispanics having the most evident VAT%, VSR and/or VAA changes biennially when compared to their counterparts (p < 0.05). In conclusion, abdominal fat composition and distribution increased before 2014 or 2016 but decreased afterwards with variations by age and/or race/ethnicity. Further research is needed to explore the possible causes of abdominal fat changes overtime.

BackgroundEating rate (ER), comprising the amount of food consumed per unit of time, is associated with obesity and energy intake (EI). MethodsThe present study tested whether adding a self-monitoring wearable device to a multifaceted 8-week weight loss intervention increased weight loss. In addition, the device's effect on secondary change outcomes in EI, ER and estimated energy expenditure was explored. Tertiary outcomes included examining eating behaviours measured by the Weight-Related Eating Questionnaire (WREQ). Seventy-two adults who were overweight or obese [mean (SD) age, 37.7 (15.3) years; body mass index, 31.3 (3.2) kg m(-2)] were randomised into two groups: intervention workbook plus device (WD) or intervention workbook only (WO). Three 24-h dietary recalls were obtained before weeks 0 and 8. Participants were weighed, consumed a test meal and completed 7-day Physical Activity Recall and WREQ at weeks 0 and 8. ResultsThere was no significant difference between WD and WO groups with respect to weight change [-0.46 (1.11) vs. 0.26 (0.82) kg, respectively], ER, EI, energy expenditure or WREQ scores, although there were significant changes over time, and within-group changes on all of these variables. At week 8, participants were dichotomised into weight loss or weight stable/gainers groups. A significant time by group change was seen in susceptibility to external cues scores, with significant time effects for susceptibility and restraint. ConclusionsAn intervention focused on reducing ER, energy density and increasing steps was effective for weight loss, although the wearable device provided no additional benefit. Participants with higher susceptibility to external eating may be more responsive to this intervention.

Objective: Our objective was to describe behavioral change trajectories for healthful eating and exercise in a group of community-dwelling older adults. A secondary aim was to determine predictors of maintenance and resilience. Method: Subjects were participants in the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) I study who had achieved postaction stage of change for at least one behavior by its end. They were recruited for SENIOR II, a 48-month study with annual assessments on demographic, anthropometric, cognitive, psychosocial, and behavioral variables. Results: Maintainers generally had higher levels of healthy behaviors and better cognitive function. Resilient older adults were similar to maintainers but were older and had greater functional limitations. Discussion: Findings suggest that both physical health and psychological capital provide important resources upon which to draw as older adults grow even older. The trajectory model can provide useful information for developing resilience interventions for older adults.

A single exercise session evokes blood pressure (BP) reductions that are immediate and persist for ≥24hr, termed postexercise hypotension (PEH). Self-monitoring of PEH may foster positive outcome expectations of exercise, and thus, enhance exercise adherence among adults with hypertension. PURPOSE: To compare the efficacy of self-monitoring of exercise (EXERCISE) versus exercise plus PEH (EXERCISE+PEH) for exercise adherence and BP control among adults with hypertension. METHODS: Adults with high BP were randomized to EXERCISE (n=12) or EXERCISE+PEH (n=12). Subjects underwent supervised, moderate intensity aerobic exercise training for 40-50min/session, 3d/wk for 12wk, and were encouraged to exercise unsupervised at home ≥30min/d, 1-2d/wk. All subjects self-monitored exercise using a calendar recording method. EXERCISE+PEH also self-monitored BP before and after exercise. Adherence was calculated as [(# of exercise sessions performed ÷ # of possible exercise sessions) X 100%]. BP was measured pre- and post-training. RESULTS: Healthy, middle-aged (52.3±10.8y) men (n=11) and women (n=13) with hypertension (136.2±10.7/85.2±8.9mmHg) completed exercise training with 87.9±12.1% adherence. EXERCISE+PEH demonstrated greater adherence to supervised training (94.3±6.6%) than EXERCISE (81.6±13.2%; p=0.007). In addition, EXERCISE+PEH performed 32.6±22.5min/wk more unsupervised home exercise than EXERCISE (p=0.004), resulting in greater overall study exercise adherence (107.3±18.7%) than EXERCISE (82.7±12.2%; p=0.002). Post- versus pre-training, BP was reduced -7.4±11.3/-4.9±9.9mmHg (ps<0.025) with no statistical difference between EXERCISE (-5.2±13.3/-3.6±6.1mmHg) and EXERCISE+PEH (-9.9±11.3/-6.1±6.9mmHg; ps>0.344). CONCLUSIONS: This study is the first to demonstrate that PEH self-monitoring is an efficacious tool to improve exercise adherence among adults with hypertension. Future research among a larger, more diverse sample is needed to confirm these novel findings and determine whether EXERCISE+PEH translates to better BP control relative to EXERCISE self-monitoring alone.

BACKGROUND:A single exercise session evokes immediate blood pressure (BP) reductions that persist for at least 24 h, termed postexercise hypotension (PEH). Self-monitoring of PEH may foster positive outcome expectations of exercise, and thus, enhance exercise adherence among adults with hypertension. PURPOSE:To compare the efficacy of self-monitoring of exercise (EXERCISE) versus exercise and PEH (EXERCISE + PEH) to improve exercise adherence and BP control among adults with hypertension. METHODS:Adults with high BP were randomized to EXERCISE (n = 12) or EXERCISE + PEH (n = 12). Participants underwent supervised, moderate intensity aerobic exercise training for 40-50 min/session, 3 days/week for 12 weeks and encouraged to exercise unsupervised at home at least 30 min/day, 1-2 days/week. EXERCISE + PEH also self-monitored BP before and after exercise. Adherence was calculated as [(no. of exercise sessions performed/no. of possible exercise sessions) × 100%]. BP was measured pre and posttraining. RESULTS:Healthy, middle-aged (52.3 ± 10.8 years) men (n = 11) and women (n = 13) with hypertension (136.2 ± 10.7/85.2 ± 8.9 mmHg) completed exercise training with 87.9 ± 12.1% adherence. EXERCISE + PEH demonstrated greater adherence to supervised training (94.3 ± 6.6%) than EXERCISE (81.6 ± 13.2%; P = 0.007). EXERCISE + PEH performed 32.6 ± 22.5 min/week more unsupervised home exercise than EXERCISE (P = 0.004), resulting in greater exercise adherence (107.3 ± 18.7%) than EXERCISE (82.7 ± 12.2%; P = 0.002). Post versus pretraining BP was reduced -7.4 ± 11.3/-4.9 ± 9.9 mmHg (P < 0.025) with no statistical difference between EXERCISE (-5.2 ± 13.3/-3.6 ± 6.1 mmHg) and EXERCISE + PEH (-9.9 ± 11.3/-6.1 ± 6.9 mmHg; P > 0.344). CONCLUSION:The current study is the first to demonstrate that PEH self-monitoring is an efficacious tool to improve exercise adherence among a small sample of adults with hypertension. Future research among a larger, more diverse sample is needed to confirm these novel findings and determine whether EXERCISE + PEH translates to better BP control relative to EXERCISE self-monitoring alone.

Health-related quality of life (HRQoL) is an important indicator of population health, yet no age-specific trend analyses in HRQoL have been conducted with a nationally representative sample since 2004. Therefore, to address this gap, an age-specific trend analysis of HRQoL was conducted using National Health and Nutrition Examination Surveys (NHANES) data. NHANES 2001–2016 data (8 cycles) were examined to evaluate trends in HRQoL by age group (young adults: 21–39, middle-aged: 40–64, older adults: 65+). HRQoL was assessed by self-reported health (SRH) and number of physically unhealthy, mentally unhealthy, and inactive days to due to physical or mental health in the past 30 days. Multiple linear or logistic regression analyses explored trends in HRQoL by age group, adjusting for demographics over time. Analysis revealed increasing fair/poor SRH over time for the entire sample (β = 0.34, 95% CI 0.08, 0.60, p = 0.011). However, age-specific analysis identified a bi-annual increase in fair/poor SRH only among young adults (β = 0.49, 95% CI 0.22, 0.76, p < 0.001) and a decrease among older adults (β = − 0.60, 95% CI − 1.14, − 0.06, p = 0.03). Closer inspection revealed increasing fair/poor SRH increased among young women (β = 0.52, 95% CI 0.11, 0.93, p = 0.013) and young men (β = 0.46, 95% CI 0.04, 0.88, p = 0.03) but decreased among older women (β = − 0.81, 95% CI − 1.59, − 0.03, p = 0.042) over time. Analyses also determined that there was a trend for a decreasing number of physically unhealthy days among young adults (p < 0.001), although no trends were observed for the other HRQoL items. Although there was a significant trend over time for increasing fair/poor SRH when considering the entire sample, this trend was not consistent between age groups or sexes. Given increasing fair/poor SRH among young adults, there is a need to understand and address factors relating to HRQoL among this age group.

Abstract Vincent, LM, Blissmer, BJ, and Hatfield, DL. National Scouting Combine scores as performance predictors in the National Football League. J Strength Cond Res 33(1): 104–111, 2019—The National Football League (NFL) hosts an annual scouting combine to evaluate the approximately 300 elite college football players who are most likely to be selected in the upcoming NFL draft. Given the public interest, player obligations, coaching staff commitments, and business aspects of the combine, several questions have arose in recent years concerning the applicability of combine scores to eventual draft NFL performance. The primary purpose of this study is to investigate the relationship between specified National Scouting Combine (NSC) scores and measures of performance by player position. A secondary aim was to determine whether correlated variables could predict player performance at the quarterback (QB), running back (RB), wide receiver (WR), defensive end (DE), defensive tackle (DT), and linebacker (LB) positions. Subjects in this study were combine participants between the years 2005–2010 who subsequently played in the NFL. The positional groups investigated were QBs (N = 44), RBs (N = 82), WRs (N = 116), LBs (N = 139), DEs (N = 59), and DTs (N = 72). Combine raw scores for 40-yd dash time, countermovement vertical jump (CMVJ) height, standing long jump (SLJ) distance, and pro-agility time were recorded. Measures of horizontal and vertical power were calculated for the 40-yd dash and CMVJ. Combine scores and on-field positional statistics for the first 4 years for QBs and 3 years of all other players' careers were analyzed to investigate relationships. Significant correlations were shown between at least one combine measure and on-field success at every position. Hierarchal regression showed combine measures could predict between 4% and 62% of the variance for individual on-field variables. Quarterback rushing yards were significantly correlated with 40T, CMVJ, vertical jump power (VJP), vertical jump relative power (VJRP), and horizontal power (HP), and those factors accounted for 62.2% of the total variance. Horizontal power and VJP were predictive of QB rushing attempts (r2 = 0.370). At RB, 40T and SLJ combined were predictive of total rushing yards (r2 = 0.200), rushing attempts (r2 = 0.195), and yards per game (r2 = 0.197). Power variables were predictive of total tackles for DEs' 40HP (r2 = 0.096) and VJP (r2 = 0.018), accounting for a total of 21% of the variance. The current study suggests that combine tests are modest predictors of future performance. Should the NFL change the current NSC testing battery, the addition of horizontal and vertical power measurements, as well as position-specific skill tests are recommended.

Introduction: Although integrated primary care (IPC) is growing, several barriers remain. Better understanding of behavioral health professionals' (BHPs') readiness for and engagement in IPC behaviors could improve IPC research and training. This study developed measures of IPC behaviors and stage of change. Method: The sample included 319 licensed, practicing BHPs with a range of interests and experience with IPC. Sequential measurement development procedures, with split-half cross-validation were conducted. Results: Exploratory principal components analyses (N = 152) and confirmatory factor analyses (N = 167) yielded a 12-item scale with 2 factors: consultation/practice management (CPM) and intervention/knowledge (IK). A higher-order Integrated Primary Care Behavior Scale (IPCBS) model showed good fit to the data, and excellent internal consistencies. The multivariate analysis of variance (MANOVA) on the IPCBS demonstrated significant large-sized differences across stage and behavior groups. Discussion: The IPCBS demonstrated good psychometric properties and external validation, advancing research, education, and training for IPC practice.

This research examined dynamic transtheoretical model (TTM) constructs for adopting sun protection practices. This secondary data analysis pooled four large population-based TTM-tailored intervention studies and examined use of constructs across three groups, organized by longitudinal progress: maintainers, relapsers, and stable non-changers.

Overwhelming evidence supports the health benefits of physical activity and the negative health consequences associated with physical inactivity. Nonetheless, the vast majority of older adults (65+ years of age) are insufficiently active. There is an array of psychosocial factors associated with physical activity among older adults. This chapter provides an overview of several of these key psychosocial factors that may be unique to older adults and are amenable to change through intervention. They should be considered when developing interventions to increase or maintain physical activity participation, regardless of intervention setting. Expanding our understanding of, and addressing psychosocial factors associated with, physical activity among older adults may strengthen programs designed to increase physical activity in this age group, which can lead to both reduced chronic diseases and disabilities and increased quality of life.

This study examined longitudinal differences in use of transtheoretical model (TTM) behavior change constructs in maintainers (who reached and maintained exercise guidelines), relapsers (who reached guidelines, then regressed), and nonchangers (who did not reach guidelines). Data from two population-based TTM-tailored randomized trial intervention groups targeting exercise behavior ( N = 1050) were pooled, and analyses assessed differences in TTM constructs between the three groups at baseline, 12 months, and 24 months. Findings indicated that relapsers tended to use TTM variables similarly to maintainers with the exception of self-efficacy, consciousness raising, and most behavioral processes of change, at 24 months. Nonchangers, however, used all TTM variables less than maintainers at nearly every time point. Findings suggest that relapsers remain more active than nonchangers in terms of use of change processes. Poor response to interventions (nonchangers) may be predicted by low baseline engagement in change processes. Although relapsers reverted to physical inactivity, their overall greater use of TTM constructs suggests that their efforts to change remain better than those of the stable nonchanger group. Future research can focus on treatment engagement strategies to help the stable nonchangers initiate change and to help relapsers to maintain treatment gains.

This research examined dynamic transtheoretical model (TTM) constructs for dietary fat reduction. This secondary data analysis pooled three large population-based TTM-tailored school, worksite, medical, and home-based intervention studies and examined use of constructs across three groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. The criteria for successful change, at the time, were that less than 30% of calories came from fat. A total of 2,718 adults met criteria for an unhealthy diet at baseline. The majority of participants were female, White, married, and middle-aged. Demographics, Stage of Change, Processes of Change, Decisional Balance, and Temptations were measured. Dynatype groups were assessed with reliable and valid scales assessing constructs at baseline and 6, 12, and 24 months. Analyses included a multivariate analysis of variance followed by a series of analyses of variance, with Tukey follow-up tests assessing differences in use of TTM constructs across the three groups at each time point. Relapsers and Maintainers were similar in their use of all TTM Processes of Change at baseline, with the exception of Self-Liberation (η(2) = 0.15, p < .001) and Reinforcement Management (η(2) = 0.01, p < .001). Although Relapsers reverted to an unhealthy diet, their overall greater use of Processes of Change suggests that their behaviors and strategy use remain better than that of the Stable Non-Changer group. Results suggest that specific cognitive and behavioral constructs may contribute differentially to intervention outcomes.

Purpose. Develop and demonstrate preliminary validation of a brief questionnaire aimed at assessing social cognitive determinants of physical activity (PA) in a college population. Design. Quantitative and observational. Setting. A midsized northeastern university. Subjects. Convenience sample of 827 male and female college students age 18 to 24 years. Measures. International Physical Activity Questionnaire and a PA stage-of-change algorithm. Analysis. A sequential process of survey development, including item generation and data reduction analyses by factor analysis, was followed with the goal of creating a parsimonious questionnaire. Structural equation modeling was used for confirmatory factor analysis and construct validation was confirmed against self-reported PA and stage of change. Validation analyses were replicated in a second, independent sample of 1032 college students. Results. Fifteen items reflecting PA self-regulation, outcome expectations, and personal barriers explained 65% of the questionnaire data and explained 28.6% and 39.5% of the variance in total PA and moderate-to-vigorous–intensity PA, respectively. Scale scores were distinguishable across the stages of change. Findings were similar when the Cognitive Behavioral Physical Activity Questionnaire (CBPAQ) was tested in a similar and independent sample of college students (40%; R2 moderate-to-vigorous–intensity PA = .40; p < .001). Conclusion. The CBPAQ successfully explains and predicts PA behavior in a college population, warranting its incorporation into future studies aiming at understanding and improving on PA behavior in college students.