Rodney P. Joseph

Background: Engaging in regular aerobic physical activity (PA) during midlife is associated with reduced risk for Alzheimer disease and related dementias. Yet, most midlife adults fail to meet national PA guidelines. Goal setting is a commonly used behavior change technique to increase PA, but limited empirical evidence exists regarding whether certain types of goal setting are more effective than others. This study served as an initial step toward understanding how different goal-setting strategies may enhance PA and promote adherence to national PA guidelines among insufficiently active midlife adults with obesity. Objective: This study aimed to establish the feasibility and acceptability of a 4-arm mechanistic trial design comparing 3 different PA goal-setting techniques with a non–goal-setting comparison condition. Methods: This study was a 6-month stage IA mechanistic trial (based on National Institute on Aging’s Stage Model) that randomized insufficiently active midlife adults with obesity to 1 of 4 study groups: (1) Static Goal-Setting Group (weekly moderate to vigorous physical activity [MVPA] goal of 150 minutes), (2) Self-Selected Goal-Setting Group (participants self-selected a weekly MVPA goal), (3) Incremental Goal-Setting Group (weekly MVPA goal 20% greater than the previous week), and (4) Non–Goal-Setting Comparison Group (encouraged to increase MVPA without specific reference to a weekly goal). All participants (n=24) received a standardized, Social Cognitive Theory–based PA promotion intervention, which consisted of structured action planning sessions and a Fitbit activity monitor for self-monitoring of MVPA. The only difference across study groups was the goal-setting technique implemented. Primary outcomes included feasibility of study implementation, as assessed by recruitment, retention, and engagement rates; the ability to deliver the intervention as planned and collect outcomes necessary for evaluating the effects of different goal-setting techniques in a subsequent larger-scale trial; and participant acceptability of the intervention, as assessed by participant perceptions of and satisfaction with the intervention. Results: The sample (n=24; mean age 54.1, SD 5.8 years; mean BMI 36.3, SD 5.0 kg/m ² ) was recruited in approximately 4 months, equating to an enrollment rate of 6 participants per month. Retention at 6 months was 87.5% (21/24). Participants completing the intervention attended 85.9% of action planning sessions and wore the Fitbit for >10 hours per day on 87.1% of intervention days. Data collection rates for outcome measures ranged from 96% to 100%. Most participants expressed satisfaction with the intervention, with 86% (18/21) reporting gaining knowledge about PA and 90% (19/21) reporting that they would recommend the study to a friend. Conclusions: The next step in this research is to build on these findings by conducting a larger-scale phase 1B proof-of-concept trial to examine the preliminary effects of the goal-setting techniques for increasing MVPA and promoting adherence to national aerobic PA guidelines.

Problem, Research Strategy, and Findings: Low physical activity (PA) and Type 2 diabetes are associated with cognitive aging and Alzheimer’s disease, but the evidence is inconsistent and particularly limited by ethnicity. The purpose of this study was to examine the relationships of PA and Type 2 diabetes with cognition in Mexican Americans and non-Hispanic Whites. The study was a cross-sectional analysis of the Health and Aging Brain Study-Health Disparities (n = 1,982–2,000 after removing outliers). Predictors included Rapid Assessment of Physical Activity and hemoglobin A1c (HbA1c). Episodic memory was assessed by Weschler Memory Scale–Third Edition Logical Memory and Spanish-English Verbal Learning Test, executive function by Weschler Memory Scale–Third Edition Digit Span and Digit Symbol Substitution Test, verbal fluency by FAS and animal naming, and global cognition by the Mini-Mental State Examination. Results show that aerobic PA and HbA1c were not associated with domain-specific, or global cognition, but strength/flexibility PA was associated with FAS (b = 0.404, 95% CI [0.023, 0.761]). Higher aerobic PA was associated with greater verbal fluency for Mexican Americans (b = 0.294, 95% CI [0.96, 0.497]) only. HbA1c was negatively associated with Mini-Mental State Examination (b = 0.838, 95% CI [0.008, 1.656]). For low HbA1c, the association between aerobic PA and Digit Symbol Substitution Test was significant for non-Hispanic Whites (b = 0.838, 95% CI [0.008, 1.656]) in comparison to Mexican Americans. Takeaway for Practice: The relationships between PA, Type 2 diabetes, and cognition vary by cognitive domains and ethnicity. Increasing aerobic activities may be particularly important for Mexican Americans who have elevated HbA1c to potentially improve fluency or executive function.

The purpose of this review was to synthesize the available literature on breast cancer-screening barriers, facilitators, and interventions among U.S. African immigrants. Following the integrative review framework and PRISMA guidelines for reporting systemic reviews, five electronic databases were searched: PubMed, CINAHL, PsycINFO, Medline, and Google Scholar. Studies were included if they were published in English language journals after 1 January 2000 and reported data on breast cancer-screening barriers, facilitators, or interventions among U.S. African immigrants. Barriers and facilitators reported by studies were descriptively examined and synthesized by two authors and classified as aligning with one of the three levels of influences based on the social–ecological model (intrapersonal, interpersonal, and community). Interventions promoting breast cancer screening were narratively summarized. Search procedures retrieved 1011 articles, with 12 meeting the criteria for inclusion in the review (6 qualitative and 6 quantitative). Intrapersonal barriers included limited awareness, fear of pain, language barriers, health concerns, transportation issues, costs, and negative past experiences. Interpersonal barriers involved modesty, spiritual beliefs, and lack of support, while community-level barriers included provider and healthcare-system challenges. Regarding facilitators, past screening experiences and health insurance were the most commonly reported intrapersonal facilitators. The only interpersonal facilitator identified was observing other women experience a breast cancer diagnosis and undergo treatment. Community-level facilitators included appointment reminders, scheduling assistance, culturally congruent interpreters, transportation to screening facilities, and patient navigators. Three articles reported outcomes of breast cancer-screening interventions. All three were pilot studies and reported increased knowledge and attitudes regarding breast cancer screening following the respective interventions. One study examined the uptake of breast cancer screening following the intervention, with results indicating an increase in screening. Findings provide a comprehensive synthesis of factors influencing breast cancer screening among African immigrants and highlight the need for future research on the topic. This review was registered with Prospero (CRD42024502826) before the initiation of search procedures.

Background: Climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic are large-scale, societal events (ie, forces of change) that affect the timing, settings, and modes of youth physical activity. Despite the impact that forces of change have on youth physical activity and physical activity environments, few studies consider how they affect physical activity promotion. Methods: The authors use 2 established frameworks, the ecological model of physical activity and the youth physical activity timing, how, and setting framework, to highlight changes in physical activity patterns of youth in North America that have resulted from contemporary forces of change. Results: North American countries—Canada, Mexico, and the United States—have faced similar but contextually different challenges for promoting physical activity in response to climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic. Innovative applications of implementation science, digital health technologies, and community-based participatory research methodologies may be practical for increasing and sustaining youth physical activity in response to these forces of change. Conclusions: Thoughtful synthesis of existing physical activity frameworks can help to guide the design and evaluation of new and existing physical activity initiatives. Researchers, practitioners, and policymakers are encouraged to carefully consider the intended and unintended consequences of actions designed to respond to forces of change.

Purpose of Review This narrative review summarizes environmental, sociocultural, behavioral, and biological factors associated with cognitive decline and dementia in Black Americans. Recent Findings Variations in environmental factors (education, toxins) contribute to poor cognition in Blacks. Historical context, early-life educational experiences, and environmental exposures should be considered for addressing late-life cognitive disparities. Sociocultural (stress, discrimination, social networks, social activity, loneliness) and behavioral (depression, coping, health behaviors) factors can have positive and negative implications for cognitive aging. Given these factors are not consistently shown to play a role in maintaining cognition in Blacks, further examination is needed. Cardiometabolic conditions increase the risk of cognitive issues and are more common in Blacks; thus, examination of biological mechanisms (inflammation, vascular changes, etc.) warrants further study. Summary Future studies should explore the impact of education and segregation and identify mechanisms linking stress and discrimination to cognitive outcomes. Further, culturally tailored programs focused on preventative behaviors are needed to enhance health outcomes and reduce disparities.

"Reducing Sedentary Behavior and Increasing Physical Activity Among Low Active, Underserved Adults: A Staircase Approach" published on 06 Jun 2023 by Human Kinetics.

Background Latinas are disproportionately affected by low physical activity (PA) levels and related health conditions (e.g., diabetes, obesity). Few Latinas in the U.S. (17%) meet the National PA Guidelines for both aerobic PA and muscle-strengthening activity (MSA), yet, research to date in this population has focused almost exclusively on aerobic PA. Performing regular MSA is linked with numerous health improvements and reduced mortality; thus, may be key to addressing health disparities in this community. This study examined perspectives on engaging in MSA among Latinas enrolled in two aerobic PA RCTs. Methods Brief quantitative surveys were conducted to assess interest in MSA among Latinas (N = 81), along with 19 follow-up in-depth semi-structured interviews on knowledge, barriers, and facilitators for engaging in regular MSA. Interview transcripts were analyzed by two independent bilingual researchers using a directed content analysis approach. Results Eighty-one Latinas (18–65 years) completed the survey. Most (91%) expressed interest in learning more about MSA and 60% reported not knowing how to do MSA as a substantial MSA barrier. Interview results indicated Latinas were aware of health benefits of MSA and motivated to engage in MSA but reported barriers (e.g., perception that MSA is for men, a taboo topic, and lack of knowledge on how to do MSA). Conclusion This study contributes to a critical gap in PA research among Latinas. Findings will inform future culturally appropriate MSA interventions in this at-risk population. Addressing MSA and aerobic PA together in future interventions will provide a more comprehensive approach to reducing PA-related health disparities in Latinas than aerobic PA alone.