Older adults' evaluations of the standard and modified pedometer-based Green Prescription

INTRODUCTION: The Green Prescription is a primary care programme designed to increase physical activity in individuals with low activity levels. Older adults tend to engage in insufficient physical activity to obtain health-related gain. AIM: To examine participants’ ratings of the Healthy Steps intervention and to assess how participants rated the use of a pedometer-based Green Prescription in aiding their physical activity. METHODS: In total, 330 community-dwelling older adults who have low levels of activity were randomised to receive either a standard time-based Green Prescription or a modified pedometer-based Green Prescription. Post-intervention, 259 participants completed the participant evaluation questionnaire via postal survey. Data were analysed using descriptive statistics and Chi-squared analyses. RESULTS: The standard components of the Green Prescription (general practitioner consultations and telephone counselling) received similar and higher ratings across both allocation groups than the use of print materials. A pedometer-based Green Prescription was rated as being helpful in aiding physical activity. DISCUSSION: This study supports the importance of general practitioners’ initial role in prescribing physical activity for older adults and of ongoing telephone support for longer-term adherence. Incorporating a pedometer can be effective in helping low-active older adults initiate and maintain regular physical activity

The incidence of injuries traveling to and from school by travel mode

Objective. To assess the absolute and relative risks of youth school-related travel using the New Zealand's no fault accident liability scheme and Census at School datasets. Methods. Injury risk associated with traveling to and from school was assessed by combining census data from the Accident Compensation Commission database, New Zealand's no fault liability accident scheme database and the Census at School survey. Population injury and cost was assessed for incidents during a 2-year period (1 July 2003 to 30 June 2005) and during normal school travel hours (7.30 a.m.–9.00 a.m., 3.00 p.m.–4.30 p.m., weekdays) for youth 5–17 years of age. Results. Overall, 7573 cases were identified as being school travel-related, representing 1.6% of total, and 11.4% school travel period injuries. Walking (30.7%), cycling (30.3%), and motor vehicles (27.7%) provided the majority of injuries. Risk of injury per million trips was highest for cycling (46.1), walking (10.3), and motor vehicle travel (6.1). Conclusion. These data provide the first comprehensive examination of absolute risk of travel to and from school and by transport mode, showing that school-related travel is a relatively safe activity contributing to a minority of all injuries sustained by youth

Measuring flourishing: The impact of operational definitions on the prevalence of high levels of wellbeing

The epidemiology of flourishing is an important research topic prompting international interest in its psychometric assessment. But the need to measure human feelings and functioning at the population level has resulted in the creation of a multitude of different conceptual frameworks of flourishing: a term now commonly used to describe high levels of subjective wellbeing. Not only do different researchers theorise and conceptualise flourishing in different ways, but also the categorical diagnosis of flourishing is dependent upon the various combinations of components, and researcher-determined thresholds, used in each operationalization. The multiplicity of approaches is potentially limiting the usefulness of the resultant epidemiology. This paper comprises two parts: Part 1 identifies four operationalizations of flourishing in the psychology literature and reviews their psychometric properties and utility; Part 2 investigates the impact of operational definition on the prevalence of flourishing using the Sovereign Wellbeing Index survey, a sample of 10,009 adult New Zealanders, and reports substantial variation in prevalence rates according to the four different operationalizations: Huppert and So (24%), Keyes (39%), Diener et al. (41%) and Seligman et al. (47%). Huppert and So’s model was the only one of the four to require endorsement of one particular variable, making it the most stringent criterion for flourishing, while the other three were more flexible in their categorisation. Cross-tabulation analysis indicated strong agreement between our replications of Keyes and Seligman et al.’s models (81%), and between Diener et al. and Seligman et al.’s models (80%). Agreement between Seligman, and Huppert and So’s, operationalizations was moderate (74%). Taken together, and in line with recent OECD recommendations, our findings reinforce the need for greater international collaboration and conceptualisation consensus when measuring flourishing. In the absence of any published empirical research investigating perceptions of flourishing among laypersons, a prototype analysis investigating alignment between lay and academic conceptualisations of flourishing is recommended

The green prescription and older adults:What do general practitioners see as barriers?

Introduction: Limited research exists that has examined the barriers that older adults (those aged 65 years and older) can encounter when given a Green Prescription (GRx)). This study aimed to identify what general practitioners (GPs) perceived their older-aged patients' barriers were with regard to carrying out a GRx. This study also identified the strategies that GPs used to assist their older-aged patients in overcoming barriers to physical activity engagement. Methods: Fifteen GPs from the Auckland region of New Zealand were interviewed individually. An inductive thematic approach was used to analyse data. Findings: GPs identified chronic health conditions, fear of injury, transportation contraints, set routines and lack of confidence as being barriers that some of their older-aged patients have encountered when considering whether to become more physically active and, also, when engaging in actual physical activity. Conclusion: Physical activity interventions, such as the GRx programme, can have an important role in helping confer health-related gain for low-active older adults. To ensure that such interventions are successful on a long-term basis, practitioners need to be aware of the barriers that their older-aged patients can encounter when given a prescription for physical activity

Social support for youth physical activity: Importance of siblings, parents, friends and school support across a segmented school day

<p>Abstract</p> <p>Background</p> <p>Whilst evidence exists for the influence of encouragement on physical activity participation, the diversity of support sources and the type of physical activity examined previously is limited. This study examined the importance of perceived encouragement from parents, siblings/cousins, friends, and schools on participation levels across three time-specific activity opportunities that are available during a school day (after-school physical activities, lunchtime activity, and active transportation to and from school).</p> <p>Methods</p> <p>A cross-sectional sample of 12–18 year old high school students (n = 3,471) were recruited from low SES schools within South Auckland, New Zealand and categorised as either Junior (Years 9–11) or Senior (Years 12 & 13) students. Participants reported their physical activity levels and quantity of encouragement received from their parent(s), friend(s), sibling(s)/cousin(s), and school to be active. For each physical activity variable participants were dichotomized as being either "active" or "less active". For each social support source, participants were grouped into either receiving "high" or "low" levels of support. Binary logistic regression analyzes were conducted to calculate odd ratios and 95% confidence intervals.</p> <p>Results</p> <p>Low parental support (Juniors, OR: 0.47, 95% CI: 0.38–0.58; Seniors, OR: 0.41, 95% CI: 0.29–0.60) and low peer support (Juniors, OR: 0.61, 95% CI: 0.51–0.74; Seniors, OR: 0.49, 95% CI: 0.35–0.69) were associated with reduced odds of being regularly active after school. For lunchtime activity, low peer support (Juniors, OR: 0.39, 95% CI: 0.32–0.48; Seniors, OR: 0.41, 95% CI: 0.29–0.57) was associated with reduced odds of being categorized as active. While no variables were significantly related to active transportation among senior students, low peer support was associated with reduced odds of actively commuting for Junior students (OR: 0.78, 95% CI: 0.66–0.92). Irrespective of the activity examined, no significant difference was noted for students receiving high support from two parents than students reporting high support from their sole parent in a single parent family.</p> <p>Conclusion</p> <p>The importance of encouragement from parents, siblings, friends, and schools on physical activity is dependant on the time-specific activity examined. It is clear that proximal social networks need to be considered during the development of physical activity promotion strategies.</p

Correlates of pedometer use: Results from a community-based physical activity intervention trial (10,000 Steps Rockhampton)

Background: Pedometers have become common place in physical activity promotion, yet little information exists on who is using them. The multi-strategy, community-based 10,000 Steps Rockhampton physical activity intervention trial provided an opportunity to examine correlates of pedometer use at the population level. Methods: Pedometer use was promoted across all intervention strategies including: local media, pedometer loan schemes through general practice, other health professionals and libraries, direct mail posted to dog owners, walking trail signage, and workplace competitions. Data on pedometer use were collected during the 2-year follow-up telephone interviews from random population samples in Rockhampton, Australia, and a matched comparison community (Mackay). Logistic regression analyses were used to determine the independent influence of interpersonal characteristics and program exposure variables on pedometer use. Results: Data from 2478 participants indicated that 18.1% of Rockhampton and 5.6% of Mackay participants used a pedometer in the previous 18-months. Rockhampton pedometer users (n = 222) were more likely to be female (OR = 1.59, 95% CI: 1.11, 2.23), aged 45 or older (OR = 1.69, 95% CI: 1.16, 2.46) and to have higher levels of education (university degree OR = 4.23, 95% CI: 1.86, 9.6). Respondents with a BMI > 30 were more likely to report using a pedometer (OR = 1.68, 95% CI: 1.11, 2.54) than those in the healthy weight range. Compared with those in full-time paid work, respondents in 'home duties' were significantly less likely to report pedometer use (OR = 0.18, 95% CI: 0.06, 0.53). Exposure to individual program components, in particular seeing 10,000 Steps street signage and walking trails or visiting the website, was also significantly associated with greater pedometer use. Conclusion: Pedometer use varies between population subgroups, and alternate strategies need to be investigated to engage men, people with lower levels of education and those in full-time 'home duties', when using pedometers in community-based physical activity promotion initiatives

Hyperinsulinemia: Best management practice

Chronic hyperinsulinemia associated with insulin resistance is directly and indirectly associated with many metabolic disorders that contribute to significant morbidity and mortality. Because hyperinsulinemia is not widely recognised as an independent health risk, there are few studies that assess management strategies. Medication management may not address the multiple issues associated with hyperinsulinemia. Lifestyle management includes physical activity, especially high intensity interval training, and dietary management. Reducing carbohydrate quantity and increasing nutrient density are discussed with carbohydrate-restricted and Mediterranean diets conferring additional benefits to a low-fat diet. Physical activity and dietary management provide the foundation for hyperinsulinemia management and may work synergistically. Of these principles, a combination of resistance and high intensity interval training, and carbohydrate restriction provide the two most effective frontline management strategies for managing hyperinsulinemia

Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: A randomised clinical trial

Background Low-carbohydrate, high-fat (LCHF) diets are useful for treating a range of health conditions, but there is little research evaluating the degree of carbohydrate restriction on outcome measures. This study compares anthropometric and cardiometabolic outcomes between differing carbohydrate-restricted diets. Objective Our hypothesis was that moderate carbohydrate restriction is easier to maintain and more effective for improving cardiometabolic health markers than greater restriction. Design A total of 77 healthy participants were randomised to a very low-carbohydrate ketogenic diet (VLCKD), low-carbohydrate diet (LCD), or moderate-low carbohydrate diet (MCD), containing 5%, 15% and 25% total energy from carbohydrate, respectively, for 12-weeks. Anthropometric and metabolic health measures were taken at baseline and at 12 weeks. Using ANOVA, both within and between-group outcomes were analysed. Results Of 77 participants, 39 (51%) completed the study. In these completers overall, significant reductions in weight and body mass index occurred ((mean change) 3.7 kg/m2; 95% confidence limits (CL): 3.8, 1.8), along with increases in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, (0.49 mmol/L; 95% CL; 0.06, 0.92; p = 0.03), and total cholesterol concentrations (0.11 mmol/L; 95% CL; 0.00, 0.23; p = 0.05). Triglyceride (TG) levels were reduced by 0.12 mmol/L (95% CL; −0.20, 0.02; p = 0.02). No significant changes occurred between groups. The largest improvements in high density lipoprotein cholesterol (HDL-c) and TG and anthropometric changes occurred for the VLCKD group. Conclusions Low-carbohydrate, high-fat diets have a positive effect on markers of health. Adherence to the allocation of carbohydrate was more easily achieved in MCD, and LCD groups compared to VLCKD and there were comparable improvements in weight loss and waist circumference and greater improvements in HDL-c and TG with greater carbohydrate restriction

How many steps/day are enough? for adults

Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions or translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognize that "some physical activity is better than none" while maintaining a focus on time spent in moderate-to-vigorous physical activity (MVPA). Thus, the purpose of this review was to update our existing knowledge of "How many steps/day are enough?", and to inform step-based recommendations consistent with current physical activity guidelines. Normative data indicate that healthy adults typically take between 4,000 and 18,000 steps/day, and that 10,000 steps/day is reasonable for this population, although there are notable "low active populations." Interventions demonstrate incremental increases on the order of 2,000-2,500 steps/day. The results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity. Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking. Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA. Computed steps/day translations of time in MVPA that also include estimates of habitual activity levels equate to 7,100 to 11,000 steps/day. A direct estimate of minimal amounts of MVPA accumulated in the course of objectively monitored free-living behaviour is 7,000-8,000 steps/day. A scale that spans a wide range of incremental increases in steps/day and is congruent with public health recognition that "some physical activity is better than none," yet still incorporates step-based translations of recommended amounts of time in MVPA may be useful in research and practice. The full range of users (researchers to practitioners to the general public) of objective monitoring instruments that provide step-based outputs require good reference data and evidence-based recommendations to be able to design effective health messages congruent with public health physical activity guidelines, guide behaviour change, and ultimately measure, track, and interpret steps/day