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Factors Contributing to Access and Adherence to Primary Health Care and Cardiac Rehabilitation for Patients with Obesity: An Overview of a Post Doctoral Program of Research
Abstracts / Can J Diabetes 37 (2013) S217eS289
S279
303 SATURDAY, MAY 4: POSTERS 301 Excess Weight and Abdominal Obesity in Postmenopausal Women ANGELA ANDRÉIA FRANÇA GRAVENA, SHEILA CRISTINA, ROCHA BRISCHILIARI, TIARA CRISTINA, ROMEIRO LOPES, CÁTIA MILLENE DELL’AGNOLO, MARIA DALVA DE BARROS CARVALHO, CAROLINE CYR, FRANCINE DE MONTIGNY, SANDRA MARISA PELLOSO University of Sherbrook, Québec, Canada Objective: The objective was to evaluate the factors associated with the incidence of excess weight and abdominal obesity in postmenopausal women, by means of a population study. Methods: A total of 456 women, from 45 to 69 years of age and residing in the urban area of Maringa, Parana, comprised the sample. Based on systematic sampling with a probability proportional to the size of the census sector, the variables of interest (body mass index- BMI; waist circumference-WC); and behavioral, economic, and sociodemographic data) were collected. Results: The results demonstrated that according to the BMI criterion, 72.6% of the women showed excess weight; and with respect to WC, 81.4% showed abdominal obesity. After a logistical regression analysis, the factors that were most closely associated with excess weight proved to be: having 3 or more children (odds ratio, OR¼1.78; 95% confidence interval, CI 1.06-3.00); and being a non-user of hormone replacement therapy (HRT) (OR¼1.69, 95% CI 1.06-2.63). The incidence of abdominal obesity was positively associated with having a larger number of children (OR¼2.28, 95% CI 1.38-3.78). Conclusions: As observed in this study, the incidences of excess weight and abdominal obesity were higher for women with 3 or more children and for non-users of HRT.
Determinants of Change in Physical Activity Among Obese Older Adults Following a Behavioural Intervention ARIANE BÉLANGER-GRAVEL, GASTON GODIN, ANDREA BILODEAU, PAUL POIRIER Université de Montréal, Montréal, Québec, Canada Introduction: The aim of the study was to investigate the determinants of change in physical activity (PA) following a behavioural intervention. Methods: At baseline, 101 low active obese older adults were randomised to an experimental or a control condition. Objective and self-report PA measures were obtained respectively by pedometers and the Godin leisure-time PA questionnaire at baseline and at six-month follow-up. Theoretical and socio-demographic variables, as well as anthropometric and clinical measures were assessed. Treatment fidelity was self-reported by counsellors by means of a checklist. The attrition rate was 23%. Hierarchical regression analyses were performed controlling for baseline PA and group assignment. Results: For self-reported PA, baseline level of PA (p¼.003), coping planning (p¼.05) and treatment fidelity (p¼.03) were associated with PA at follow-up (R2¼.16). For objective PA, baseline steps count (p<.001) and group assignment (p¼.002) predicted the number of steps/day at follow-up (R2¼.38). Discussion: Higher baseline levels of PA were associated with greater long-term participation in PA. However, a different pattern of predictors emerged for the self-reported and objective measures of PA. For instance, the capacity to cope with unanticipated barriers was associated with PA but not with the number of steps/day, indicating different mechanisms of effect. This also highlights potential measurement issues when evaluating PA interventions.
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Factors Contributing to Access and Adherence to Primary Health Care and Cardiac Rehabilitation for Patients with Obesity: An Overview of a Post Doctoral Program of Research MARY FORHAN, DAVID ALTER, PATTY SOLOMON, CATHY RISDON Toronto Rehabilitation Institute, Burlington, Ontario, Canada
Fear of Fear Influences Physical Exercise Levels in Young Adult Women BRIGITTE SABOURIN, SHERRY STEWART, MARGO WATT Dalhousie University, Halifax, Nova Scotia, Canada
Engagement in primary health care and adherence to cardiac rehabilitation is associated with reduced mortality and morbidity. These benefits are extended to high-risk populations such as those with obesity. However, obesity is associated with avoidance of primary health care and lower rates of adherence to cardiac rehabilitation. A post-doctoral program of research including two separate, yet thematically related studies was completed over two years, one year in a primary health care environment and one year in a cardiac rehabilitation environment for the purpose of identifying factors that contribute to participation in health promoting and secondary prevention behaviours for patients with obesity. The first study used a qualitative methodology and included 11 interviews with patients from a primary health care program. Interviews were coded using thematic analysis to identify key themes related to engagement in primary health care. The second study was a retrospective analysis of a data collected from 12 003 patients enrolled in a cardiac rehabilitation program between 1995-2010. Sequential logistic regression was conducted to examine the extent to which socio-demographic, psychological, anthropometric, fitness and clinical factors account for the higher likelihood of nonadherence to on-site treatment in CR. Results from both studies show that patients with obesity do not believe that their needs are being met in primary health care and are at greater risk of nonadher.
Regular physical activity is an important part of obesity prevention and treatment strategies. Unfortunately, the majority of Canadian women do not meet physical activity guidelines. One reason for not participating in regular physical exercise is lack of energy. The present study sought to determine whether anxiety sensitivity (AS), the fear of anxietyrelated physiological sensations such as increased heart rate, shortness of breath, perspiration (i.e. fear of fear), represents an obstacle to participating in physical exercise, over and above the role of lack of energy. For the present study, 152 high and low AS female undergraduates completed the energy subscale of the SF36 health survey and self-reported total physical exercise levels. High AS participants reported lower levels of physical exercise than low AS participants. A regression analysis was conducted with AS group, energy, and the AS group/ energy interaction, predicting exercise levels. Higher energy levels significantly predicted higher exercise participation (p<.001). This result was qualified by a significant interaction between AS group and energy (p¼.03). Higher energy levels resulted in higher levels of physical exercise for low AS women (p¼.001). On the other hand, higher energy levels did not influence exercise levels in high AS women (p¼.27). These findings highlight the importance of addressing psychological variables (e.g. fear of fear) when attempting to increase exercise in young women.
S279
303 SATURDAY, MAY 4: POSTERS 301 Excess Weight and Abdominal Obesity in Postmenopausal Women ANGELA ANDRÉIA FRANÇA GRAVENA, SHEILA CRISTINA, ROCHA BRISCHILIARI, TIARA CRISTINA, ROMEIRO LOPES, CÁTIA MILLENE DELL’AGNOLO, MARIA DALVA DE BARROS CARVALHO, CAROLINE CYR, FRANCINE DE MONTIGNY, SANDRA MARISA PELLOSO University of Sherbrook, Québec, Canada Objective: The objective was to evaluate the factors associated with the incidence of excess weight and abdominal obesity in postmenopausal women, by means of a population study. Methods: A total of 456 women, from 45 to 69 years of age and residing in the urban area of Maringa, Parana, comprised the sample. Based on systematic sampling with a probability proportional to the size of the census sector, the variables of interest (body mass index- BMI; waist circumference-WC); and behavioral, economic, and sociodemographic data) were collected. Results: The results demonstrated that according to the BMI criterion, 72.6% of the women showed excess weight; and with respect to WC, 81.4% showed abdominal obesity. After a logistical regression analysis, the factors that were most closely associated with excess weight proved to be: having 3 or more children (odds ratio, OR¼1.78; 95% confidence interval, CI 1.06-3.00); and being a non-user of hormone replacement therapy (HRT) (OR¼1.69, 95% CI 1.06-2.63). The incidence of abdominal obesity was positively associated with having a larger number of children (OR¼2.28, 95% CI 1.38-3.78). Conclusions: As observed in this study, the incidences of excess weight and abdominal obesity were higher for women with 3 or more children and for non-users of HRT.
Determinants of Change in Physical Activity Among Obese Older Adults Following a Behavioural Intervention ARIANE BÉLANGER-GRAVEL, GASTON GODIN, ANDREA BILODEAU, PAUL POIRIER Université de Montréal, Montréal, Québec, Canada Introduction: The aim of the study was to investigate the determinants of change in physical activity (PA) following a behavioural intervention. Methods: At baseline, 101 low active obese older adults were randomised to an experimental or a control condition. Objective and self-report PA measures were obtained respectively by pedometers and the Godin leisure-time PA questionnaire at baseline and at six-month follow-up. Theoretical and socio-demographic variables, as well as anthropometric and clinical measures were assessed. Treatment fidelity was self-reported by counsellors by means of a checklist. The attrition rate was 23%. Hierarchical regression analyses were performed controlling for baseline PA and group assignment. Results: For self-reported PA, baseline level of PA (p¼.003), coping planning (p¼.05) and treatment fidelity (p¼.03) were associated with PA at follow-up (R2¼.16). For objective PA, baseline steps count (p<.001) and group assignment (p¼.002) predicted the number of steps/day at follow-up (R2¼.38). Discussion: Higher baseline levels of PA were associated with greater long-term participation in PA. However, a different pattern of predictors emerged for the self-reported and objective measures of PA. For instance, the capacity to cope with unanticipated barriers was associated with PA but not with the number of steps/day, indicating different mechanisms of effect. This also highlights potential measurement issues when evaluating PA interventions.
302
304
Factors Contributing to Access and Adherence to Primary Health Care and Cardiac Rehabilitation for Patients with Obesity: An Overview of a Post Doctoral Program of Research MARY FORHAN, DAVID ALTER, PATTY SOLOMON, CATHY RISDON Toronto Rehabilitation Institute, Burlington, Ontario, Canada
Fear of Fear Influences Physical Exercise Levels in Young Adult Women BRIGITTE SABOURIN, SHERRY STEWART, MARGO WATT Dalhousie University, Halifax, Nova Scotia, Canada
Engagement in primary health care and adherence to cardiac rehabilitation is associated with reduced mortality and morbidity. These benefits are extended to high-risk populations such as those with obesity. However, obesity is associated with avoidance of primary health care and lower rates of adherence to cardiac rehabilitation. A post-doctoral program of research including two separate, yet thematically related studies was completed over two years, one year in a primary health care environment and one year in a cardiac rehabilitation environment for the purpose of identifying factors that contribute to participation in health promoting and secondary prevention behaviours for patients with obesity. The first study used a qualitative methodology and included 11 interviews with patients from a primary health care program. Interviews were coded using thematic analysis to identify key themes related to engagement in primary health care. The second study was a retrospective analysis of a data collected from 12 003 patients enrolled in a cardiac rehabilitation program between 1995-2010. Sequential logistic regression was conducted to examine the extent to which socio-demographic, psychological, anthropometric, fitness and clinical factors account for the higher likelihood of nonadherence to on-site treatment in CR. Results from both studies show that patients with obesity do not believe that their needs are being met in primary health care and are at greater risk of nonadher.
Regular physical activity is an important part of obesity prevention and treatment strategies. Unfortunately, the majority of Canadian women do not meet physical activity guidelines. One reason for not participating in regular physical exercise is lack of energy. The present study sought to determine whether anxiety sensitivity (AS), the fear of anxietyrelated physiological sensations such as increased heart rate, shortness of breath, perspiration (i.e. fear of fear), represents an obstacle to participating in physical exercise, over and above the role of lack of energy. For the present study, 152 high and low AS female undergraduates completed the energy subscale of the SF36 health survey and self-reported total physical exercise levels. High AS participants reported lower levels of physical exercise than low AS participants. A regression analysis was conducted with AS group, energy, and the AS group/ energy interaction, predicting exercise levels. Higher energy levels significantly predicted higher exercise participation (p<.001). This result was qualified by a significant interaction between AS group and energy (p¼.03). Higher energy levels resulted in higher levels of physical exercise for low AS women (p¼.001). On the other hand, higher energy levels did not influence exercise levels in high AS women (p¼.27). These findings highlight the importance of addressing psychological variables (e.g. fear of fear) when attempting to increase exercise in young women.