Purpose: To compare exercise capacity and cardiovascular response to exercise in elderly individuals with coronary artery disease (CAD) who attend ongoing community-based maintenance cardiac rehabilitation (CR) versus age- and gender-matched healthy "very active" (HVA; >= 2000 kcal/week) and healthy "less active" (HLA; <2000 kcal/week) individuals. Method: Sixty-three participants (age: 72.3 +/- 5.1 years; 62% men; n = 21 per group) completed the following assessments: (1) symptom-limited graded exercise test with expired gas analysis and bioimpedance assessment of cardiovascular function during exercise; (2) walking tests; (3) physical function; (4) anthropometry and (5) 12-month physical activity recall. Results: The CR group achieved 98% (range: 73-154%) of age- and gender-predicted peak oxygen consumption for healthy individuals. Peak oxygen consumption was lower in CR compared to HVA but not HLA group (VO2peak: CR: 19.0 +/- 4.5, HVA: 23.7 +/- 2.9, HLA: 20.7 +/- 4.7 ml center dot kg(-1)cmin(-1), p = 0.001 versus HVA; p = 0.390 versus HLA). Peak heart rate was lower in CR compared to both HVA and HLA. Walking test results and cardiovascular and physical function were not different between the groups. Conclusions: Elderly individuals with CAD participating in maintenance CR have similar exercise capacity and cardiorespiratory response to exercise compared to their age- and gender-matched less active healthy peers. The findings support referral of elderly patients to community-based CR.Implications for RehabilitationFitness benefits of long-term maintenance cardiac rehabilitation (CR) programs remain unknown.Elderly individuals with coronary artery disease participating in maintenance CR have exercise capacity and cardiorespiratory response to exercise similar to their less active healthy peers.Maintenance CR may play an important role prolonging independent living in elderly individuals.

Background: Self-efficacy has been associated with adolescent exercise. Previous studies have revealed that self-efficacy is relatively resistant to change. Effective strategies to build self-efficacy among adolescents are needed. Purpose: To describe the changes in self-efficacy and leisure time exercise produced by the Planning to be Active Curriculum (PBA). These changes will be studied among insufficiently active and active adolescents. Methods: A treatment/control group design was implemented in 3 rural Appalachian high schools. PBA curriculum was received by the treatment group, and the control group received a sport-based curriculum. Measurements were collected at pretest, mid-intervention, and 2 weeks postintervention. Results: A significant decrease in self-efficacy was produced by PBA for the insufficiently active at intervention midpoint. These scores significantly increased by intervention posttest. This group also reported an increase from 1 to 3 days of moderate-intensity exercise per week. Discussion: Behaviorally based health education programs could produce initial declines in self-efficacy. Skill building assignments over 8 weeks can build self-efficacy for exercise. Translation to Health Education Practice: Health education programs should target behavioral skills over a period of 8 to 10 weeks to overcome short-term declines and build self-efficacy.

Objectives: With increasingly sedentary lifestyles, opportunities for physical activity such as active transport to school need to be promoted in adolescents. This study examines personal, social and environmental correlates of active transport to school among adolescents including sociodemographics, behavioural patterns, motivational factors, perceived barriers, peer support, family resources, school characteristics, urban/rural setting, distance to school and neighbourhood safety perceptions.Design: Cross-sectional study.Methods: In 2009 and 2011, 2018 secondary school students (age: 14.8 +/- 1.3 years; 73% urban; 53% boys) from 22 out of 24 schools from Otago, New Zealand completed the Otago School Students Lifestyle Survey. Multivariate binary logistic regression models were used to compare active transport to school correlates in students using active transport to school versus bus and car users (motorised transport).Results: Overall, 37% of students used active transport to school, 24% bus, and 39% car. Compared to motorised transport users, active transport to school users were more likely to live closer to school (1.4 +/- 1.4 active transport to school vs. 8.3 +/- 8.4 km motorised transport; p < 0.001). In a multivariate analysis, shorter distance to school (OR (95%CI) (0.03 (0.01-0.05)), younger age (0.85 (0.78-0.92)), fewer vehicles (0.66 (0.49-0.89)) and fewer screens (0.53 (035-0.82)) per household, meeting screen time guidelines (1.74 (1.22-2.50)), opportunity to chat with friends (2.26 (1.58-3.23)), nice scenery (1.69 (1.14-2.50)), and parental perceptions of active transport to school safety (2.32 (1.25-4.30)) were positively associated with active transport to school, while perceived time constraints (0.46 (0.29-0.72)) and attending girls-only school (0.51 (0.35-0.75)) had a negative association with active transport to school.Conclusions: Future active transport to school interventions in adolescents should focus on encouraging active transport to school, reiterating its social benefits, and addressing parental safety concerns around active transport to school. (C) 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Purpose: Compared with symptom-limited cardiopulmonary exercise test (CPET), timed walking tests are cheaper, well-tolerated and simpler alternative for assessing exercise capacity in coronary artery disease (CAD) patients. We developed multivariate models for predicting peak oxygen consumption (VO2peak) from 6-minute walk test (6MWT) distance and peak shuttle walk speed for elderly stable CAD patients. Methods: Fifty-eight CAD patients (72 SD 6 years, 66% men) completed: (1) CPET with expired gas analysis on a cycle ergometer, (2) incremental 10-meter shuttle walk test, (3) two 6MWTs, (4) anthropometric assessment and (5) 30-second chair stands. Linear regression models were developed for estimating VO2peak from 6MWT distance and peak shuttle walk speed as well as demographic, anthropometric and functional variables. Results: Measured VO2peak was significantly related to 6MWT distance (r = 0.719, p<0.001) and peak shuttle walk speed (r = 0.717, p<0.001). The addition of demographic (age, gender), anthropometric (height, weight, body mass index, body composition) and functional characteristics (30-second chair stands) increased the accuracy of predicting VO2peak from both 6MWT distance and peak shuttle walk speed (from 51% to 73% of VO2peak variance explained). Conclusions: Addition of demographic, anthropometric and functional characteristics improves the accuracy of VO2peak estimate based on walking tests in elderly individuals with stable CAD.

Objective. To examine long-term changes in physical function and body composition in coronary artery disease (CAD) patients participating in ongoing community-based cardiac rehabilitation (CR). Design. Thirty-four individuals (69.7±8.2 years; 79% men) participated in this longitudinal observational study. Baseline and follow-up assessments included incremental shuttle walk, short physical performance battery, handgrip strength, chair stands, body composition, last year physical activity, and CR attendance. Results. Participants attended 38.5±30.3% sessions during 1.6±0.2 year followup. A significant increase in 30-second chair stands (17.0±4.7 to 19.6±6.4, P<0.001), body weight (75.8±11.1 to 77.2±12.1 kg, P=0.001), and body fat (27.0±9.5 to 29.1±9.6%, P<0.001) and a decline in handgrip strength (36.4±9.4 to 33.0±10.6 kg·f, P<0.001) and muscle mass (40.8±5.6 to 39.3±5.8%, P<0.001) were observed during followup. There was no significant change in shuttle walk duration. CR attendance was not correlated to observed changes. Conclusions. Elderly CAD patients participating in a maintenance CR program improve lower-body muscle strength but experience a decline in handgrip strength and unfavourable changes in body composition, irrespective of CR attendance.

Background: Despite significant benefits, cardiac rehabilitation remains an underutilised intervention and long-term effects of such programs remain unknown. This study compared exercise capacity and cardiovascular function in elderly individuals with coronary artery disease (CAD) attending ongoing community-based cardiac rehabilitation (CR) versus age- and gender-matched healthy active (HA) and sedentary (HS) individuals.

Background Active transport (AT) is an effective way for increasing physical activity in adolescents. While individual, family, social, and safety factors influence transport choices to school, less is known about factors influencing means of transport within the urban setting. Aims This study compares individual, household, and social factors associated with AT (walking and cycling) versus MT (motorised transport) to parks and playgrounds, city centre, and sport and recreational facilities among urban adolescents in Dunedin, New Zealand. Methods In 2009, 1182 secondary school students (age: 14.2±1.2 years; 53.6% boys) from 10 urban schools completed the online Otago School Students Lifestyle Survey. Data collected included sociodemographic and behavioural information, parental perceptions of safety, social support for AT, and usual mode of transport to parks and playgrounds, city centre, and sport and recreational facilities. Results Most students used AT to parks and playgrounds (70.5%), but less to city centre (20.5%) and sport and recreational facilities (19.8%). Overall, 46.5% of students met physical activity guidelines and 37.4% met screen time guidelines. Parental concern for safety was the greatest barrier for AT to parks and playgrounds (AT:4.0% vs MT:12.1%), p<0.001). Bus was perceived as a more convenient transport option to city centre (AT:61.5% vs MT:78.8%, p=0.001) and safer transport option to sport and recreational facilities (AT:53.1% vs MT:67.6%, p=0.001). Contribution to the Field Adolescents are most likely to use AT to visit parks and playgrounds, while MT is perceived as safer and more convenient for accessing city centre and sport and recreational facilities.

Background: Short duration of outpatient cardiac rehabilitation (CR) programs, poor attendance and high drop-out rates present a challenge in examining long-term effects of CR in coronary artery disease (CAD) patients. This study examined changes in physical function and body composition over a 1.5-year follow-up in CAD patients participating in ongoing community-based CR programs.

Background With increasing prevalence of sedentary lifestyle and less time dedicated to physical education and free play in youth, there is a greater need to promote other opportunities for physical activity, such as active transport (AT). Aims This study examines individual and school-related factors associated with AT—walking and cycling—to school among adolescents in Otago, New Zealand. Methods In 2009, a total of 1726 secondary school students (age: 15.1±1.1 years; 68.5% urban; 51.6% boys) from 19 of 23 schools in the Otago Region completed the online Otago School Students Lifestyle Survey. Data collected included usual mode of transport to school, sociodemographic and behavioural information, social support for AT, and personal and family perceptions of safety when using AT. Results Overall, 36.6% of secondary students used AT and 63.4% used motorised transport (MT) to school. Boys were more likely than girls to use AT to get to school (39.3% boys vs 33.8% girls, p=0.024). Regional status was also a predictor of AT to school (46.1% rural vs 32.2% urban students, p<0.001). Overall, 63.7% of students believed taking a bus was safer than walking or cycling (61.0% AT vs 64.6% MT, p=0.244). Other factors influencing transport choices to school were parental perceptions of safety (91.5% AT vs 84.3% MT, p<0.001) and encouragement from friends (47.9 AT vs 21.3% MT, p<0.001). Significance Boys and rural students are more likely to use AT to school. The greatest barriers to AT were safety concerns and lack of peer support.

BACKGROUND:Reduced time dedicated to physical education and free play in recent decades emphasizes the need to promote opportunities for sport participation in adolescents in order to increase physical activity levels. The purpose of this study was to examine the association of sociodemographic and biological characteristics, behavioural patterns, and school-related and sport-specific variables with time spent participating in sport.METHODS:A total of 1837 secondary school students (age: 14.6 ± 1.2 years; 50.9 % boys) from 19 of 23 schools in the Otago Region (New Zealand) completed an online sport survey and Youth Physical Activity Questionnaire in 2009. Using multilevel modeling, we examined the association of individual-, school- and sport-related variables on sport participation and the amount of time spent in sports.RESULTS:Higher rates of sport participation were associated with lower neighbourhood deprivation scores (OR (95%CI): 0.75 (0.49-1.14), 0.57 (0.38-0.86), 0.48 (0.28-0.81)), higher quintiles of physical activity (2.89 (2.10-3.96), 2.81 (1.68-4.70), 3.54 (2.24-5.57), 3.97 (1.99-7.95)), highest quintiles of screen time (1.58 (0.94-2.65), 1.99 (1.42-2.80), 2.17 (1.43-3.30), 1.88 (1.37-2.57)) and boys only school status (2.21 (1.57-3.10)). Greater amount of time spent in sports was associated with male gender (0.56 (0.43-0.74), lower neighbourhood deprivation scores (0.72 (0.59-0.93), 0.78 (0.58-1.04), 0.62 (0.39-1.00)), higher quintiles of physical activity (3.18 (2.29-4.41), 4.25 (2.91-6.20), 8.33 (5.58-12.44), 6.58 (4.07-10.64)), highest quintile of screen time (1.83 (1.31-2.56), greater availability of sports outside school (1.68 (1.22-2.32)), better sport management (2.57 (1.63-4.07)) and provision of sport courts at school (0.57 (0.40-0.81)). Conversely, obesity was associated with less time spent participating in sport (0.50 (0.31-0.80)).CONCLUSION:Results support the use of sport participation as an effective strategy to increase physical activity levels and identify target groups and areas for interventions, program design and policy development. Interventions should focus on improving accessibility to sport programs for all adolescents, providing adequate sport grounds at school, and promoting good sport management practices. Programs and policies encouraging sport participation should address in particular the needs of adolescents living in deprived neighborhoods, those attending coeducational and girls-only schools, and those who are obese.

A novel approach to health promotion intervention evaluation is examining the ability of an intervention to produce changes in the theoretical constructs under which it was designed. PURPOSE: The primary purpose was to examine the ability of the Plan for Exercise, Plan for Health intervention to produce changes in four targeted SCT constructs. The secondary purpose was to determine whether the efficacy of the intervention differed when implemented by an exercise behavior specialist or trained high school teachers. METHODS: The physical education, health, and/or life skills teachers within three high schools were trained to deliver a 9-week, 9-lesson exercise promotion curriculum as an integrated component of their courses. Students (n = 262) receiving the intervention delivered by trained high school teachers were compared to students (n = 124) receiving a typical physical education curriculum and students (n = 143) receiving a similar intervention delivered by a trained exercise specialist. Students in all groups were given questionnaires to assess the four targeted SCT constructs at pretest and at post-test, using previously validated instruments. ANCOVA analysis, using the pretest score as a covariate, was used to answer the research questions. RESULTS: Each of the ANCOVA models was statistically significant. On average, the students in the trained teacher intervention group scored higher on self-efficacy (p<0.01), self-regulation (p<0.01), social support (p<0.01), and outcome expectancyvalues (p<0.01) than the students in the comparison group at post-test. No differences were found between the intervention groups on social support, self-efficacy, or outcome expectancy-values. Self-regulation scores were higher at post-test for the exercise specialist group compared to the trained teacher group. CONCLUSIONS: The intervention was able to produce significant differences between the intervention and comparison schools on each of the post-test SCT scores. The largest programmatic effect on any of the educational constructs was for self-regulation. This study suggests that teachers can be trained to deliver the exercise promotion curriculum. The impact of the intervention on the underlying theoretical constructs using trained teachers was similar to when a specialist delivered the curriculum.

PURPOSE:The purpose of this study was to describe the physical activity behavior of high school students living in the Appalachian region of Ohio.METHODS:A cross-sectional sample of 1,024 subjects from 11 schools in Appalachian Ohio was drawn. Previously validated instruments were used to measure physical activity behavior over 7 days.FINDINGS:Appalachian adolescents fell short of recommended levels of activity. They reported high rates of sedentary behavior by 9th grade. Appalachian adolescents may be acquiring sedentary behaviors earlier than adolescents living in other regions. Low rates of activity make this population particularly at risk for the health consequences associated with inactivity.

Assessment of physical activity needs to improve in order to gain a more comprehensive understanding of the relationship between characteristics of the environment and physical activity. Our study evaluated a method [Block Walk Method (BWM)] for observing physical activity along residential sidewalks and streets. The BWM was utilized in 12 U.S. Census block groups over a three-month period. Examination transportation routes (ETRs), 1,524 m in length, were constructed and examined in each block group. On 6 days, ETRs were traversed by a trained observer for 50 min. Physical activities, street names, and geographical locations (e.g., addresses) were recorded. We found encouraging results for the BWM. The level of agreement between independent observers was >98% for activity type. The number of individuals seen walking, running, or biking did not differ significantly between the days of the week or observation times. The number of individuals observed was correlated with block group characteristics (e.g., percent walking/biking to work) and weather (e.g., temperature). The BWM is an easy to use, economically viable observational approach to obtaining reliable information concerning physical activities performed on residential streets and sidewalks. Its use could help advance our understanding about the environment–physical activity relationship.

Background:Methods are needed to assess the impact of walk-to-school programs on behavior. This study developed an observation method for counting the number of children and adults walking/biking to school.Methods:Two elementary schools located in different urban, US census tracts were chosen for this study. Six walking/biking routes to each school were observed for 30 min before and after school. Strict guidelines were followed for determining whether a child/adult was counted.Results:Levels of agreement between observers were over 97% for children and adults. Reliability coefficients (R) for two days of observations exceeded 0.90 for children and adults walking. No differences were seen between days of the week or before and after school observation periods (P > 0.05). The number seen walking did depend on the route observed (P < 0.01).Conclusion:This study presents a reliable observation method for determining the number of children and adults walking and biking to/from school.

Establishing accurate accounts of physical activity rates in the population is essential for the tracking of behavior and potential disease risk. Several national samples currently track or account for the physical activity levels of the population. The National College Health Risk Behavior Survey (NCHRBS) has published physical activity statistics for the college population with regard to their engagement in vigorous and moderate physical activity over the past seven days. Their data suggest more than one third (37.6%) of college student's nationwide meet recommendations for vigorous physical activity and (19.5%) meet the guidelines for moderate physical activity. The Behavioral Risk Factor Surveillance System (BRFSS) is used to produce national data demonstrating the prevalence of those adults who meet physical activity recommendations over the past month. The prevalence of those who engaged in recommended levels of activity was 25.4%, the prevalence of those reporting insufficient activity was 45.9%, and those reporting no physical activity was 28.7%. The BRFSS also points out that these rates of recommended activity have remained relatively stable for many years. PURPOSE The purpose of this study was to track individual levels of physical activity using a seven-day recall instrument for one month and classify them based upon the two systems used in the BRFSS and the NCHRBS to see how closely the data reflect the national data. METHODS This study tracked the physical activity behavior of 645 college aged adult volunteers for four weeks. Each survey participant filled out a seven-day physical activity recall for four consecutive weeks. RESULTS In contrast to those national data sources the results of this study indicated rates of meeting recommendations for vigorous activity ranged from 25% to 32% and moderate activity rates that ranged from 28% to 31% over the four weeks surveyed. Another difference was found in the comparison to the BRFSS data where over the month surveyed only 11.7% meet recommended moderate guidelines for the month and 8.4 % were sedentary for the entire four weeks. This data suggests that roughly 80% of persons in the sample were insufficiently active for the four weeks. The activity level for most of the sample demonstrate wide fluctuations in activity from week to week as demonstrated in bivariate correlations that were relatively low for moderate and vigorous activity from week to week. CONCLUSIONS The findings from this study differ from the national data that suggest stability in physical activity behavior over time. These results may suggest that physical activity behavior is not stable from week to week.

Researchers assume that how an environmental feature is perceived is related to the degree of influence the feature has on physical activity. This assumption has never been examined. PURPOSE This investigation studied the relationship between perceptions of environmental features and physical activity and the relationship between self-rated influence level of environmental features and physical activity. METHODS A random sample of 324 women and 232 women between 18 and 82 years of age were interviewed at their place of residence. The interview format was used to administer a questionnaire (with visuals) asking about participant demographics, physical activity behavior (7-day recall), perceptions about nine neighborhood features (1 -poor condition, e.g., high crime and 10-good condition, e.g., low crime), and if the neighborhood feature influenced their physical activity in their neighborhood (1 - low influence; 10-high influence). Chi square analyses were used to examine the relationships between perceptions, influence and three different physical activities (walking for exercise, jogging, and biking). RESULTS While women were more likely to walk for exercise than men, they were less likely to jog and bike (p < 0.05). For each of the nine environmental features examined, women were more likely than men to view the feature as influential (p < 0.05). Few significant relationships were found between perceptions of the environmental features and walking, jogging, or biking. Self-rated influence levels of several neighborhood environmental features were associated with greater odds of being physically active in the neighborhood. Walking for exercise in the neighborhood was influenced by more environmental features than jogging and biking in the neighborhood. CONCLUSIONS The results of this study show that the relationship between environmental features and physical activity is complex. Individual characteristics (gender), aspects of physical activity (mode), and how environmental features are explored (perception vs. influence) require attention in future studies.