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Erschienen in: Journal of Community Health 6/2014

01.12.2014 | Original Paper

Utilization of a Free Fitness Center-Based Exercise Referral Program Among Women with Chronic Disease Risk Factors

verfasst von: Megan R. Waterman, John M. Wiecha, Jennifer Manne, Stephen M. Tringale, Elizabeth Costa, Jean L. Wiecha

Erschienen in: Journal of Community Health | Ausgabe 6/2014

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Abstract

Physical activity (PA) reduces the risk for a number of chronic diseases including heart disease, hypertension, hyperlipidemia, and diabetes mellitus type 2. However, most Americans do not meet expert recommendations for exercise, and minorities and low-income persons are the most inactive. Community-based approaches to promoting PA include primary care exercise referral programs. This study examines patient characteristics associated with utilization of a community health center-based exercise referral program. Adult female patients of a community health center with an affiliated fitness center, in Boston, MA, were included in the study if they received a referral to the fitness center from their primary care provider. Demographic and medical information was abstracted from the medical chart, and fitness records were abstracted to measure activation of a fitness center membership (creation of an account denoting at least an initial visit) and utilization over time. Overall, 503 (40 %) of the 1,254 referred women in the study sample activated their membership. Black women were almost 60 % more likely to activate their membership (adjusted OR 1.6, 95 % CI 1.2–2.2), and women with higher co-morbidity counts were almost 45 % more likely to activate (adjusted OR 1.4, 95 % CI 1.0–2.0). Once activated, a minority of women participated at levels likely to improve cardiometabolic fitness. Of the 503 activations, 96 (19 %) had no participation, 359 (71 %) had low participation, and only 48 (10 %) had high participation. No independent predictors of participation were identified. These findings suggest that program design may benefit from developing activation, initial participation, and retention strategies that address population-specific barriers.
Literatur
1.
Zurück zum Zitat Lee, I., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., & Katzmarzyk, P. T. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. The Lancet, 380(9838), 219–229.CrossRef Lee, I., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., & Katzmarzyk, P. T. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. The Lancet, 380(9838), 219–229.CrossRef
2.
Zurück zum Zitat Britton, K. A., Lee, I. M., Wang, L., Gaziano, J. M., Manson, J. E., Buring, J. E., et al. (2012). Physical activity and the risk of becoming overweight or obese in middle-aged and older women. Obesity (Silver Spring), 20(5), 1096–1103.CrossRef Britton, K. A., Lee, I. M., Wang, L., Gaziano, J. M., Manson, J. E., Buring, J. E., et al. (2012). Physical activity and the risk of becoming overweight or obese in middle-aged and older women. Obesity (Silver Spring), 20(5), 1096–1103.CrossRef
3.
Zurück zum Zitat Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., et al. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334–1359.PubMedCrossRef Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., et al. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334–1359.PubMedCrossRef
4.
Zurück zum Zitat Hamer, M., Ingle, L., Carroll, S., & Stamatakis, E. (2012). Physical activity and cardiovascular mortality risk: Possible protective mechanisms? Medicine and Science in Sports and Exercise, 44(1), 84–88.PubMedCrossRef Hamer, M., Ingle, L., Carroll, S., & Stamatakis, E. (2012). Physical activity and cardiovascular mortality risk: Possible protective mechanisms? Medicine and Science in Sports and Exercise, 44(1), 84–88.PubMedCrossRef
5.
Zurück zum Zitat Lee, D. C., Sui, X., Artero, E. G., Lee, I. M., Church, T. S., McAuley, P. A., et al. (2011). Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: The aerobics center longitudinal study. Circulation, 124(23), 2483–2490.PubMedCentralPubMedCrossRef Lee, D. C., Sui, X., Artero, E. G., Lee, I. M., Church, T. S., McAuley, P. A., et al. (2011). Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: The aerobics center longitudinal study. Circulation, 124(23), 2483–2490.PubMedCentralPubMedCrossRef
6.
Zurück zum Zitat Pasiakos, S. M., Karl, J. P., Lutz, L. J., Murphy, N. E., Margolis, L. M., Rood, J. C., et al. (2012). Cardiometabolic risk in US army recruits and the effects of basic combat training. PLoS ONE, 7(2), e31222.PubMedCentralPubMedCrossRef Pasiakos, S. M., Karl, J. P., Lutz, L. J., Murphy, N. E., Margolis, L. M., Rood, J. C., et al. (2012). Cardiometabolic risk in US army recruits and the effects of basic combat training. PLoS ONE, 7(2), e31222.PubMedCentralPubMedCrossRef
7.
Zurück zum Zitat Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., 3rd, Haskell, W., & Lee, I. M. (2011). Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation, 124(7), 789–795.PubMedCentralPubMedCrossRef Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., 3rd, Haskell, W., & Lee, I. M. (2011). Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation, 124(7), 789–795.PubMedCentralPubMedCrossRef
8.
Zurück zum Zitat Shiroma, E. J., & Lee, I. M. (2010). Physical activity and cardiovascular health: Lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation, 122(7), 743–752.PubMedCrossRef Shiroma, E. J., & Lee, I. M. (2010). Physical activity and cardiovascular health: Lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation, 122(7), 743–752.PubMedCrossRef
9.
Zurück zum Zitat National Center for Health Statistics. (2012). Health, United States, 2011: With special feature on socioeconomic status and health. Hyattsville, MD: National Center for Health Statistics. National Center for Health Statistics. (2012). Health, United States, 2011: With special feature on socioeconomic status and health. Hyattsville, MD: National Center for Health Statistics.
10.
Zurück zum Zitat US Department of Health and Human Services. (2008). 2008 Physical activity guidelines for Americans. Washington, DC. ODPHP Publication No. U0036. US Department of Health and Human Services. (2008). 2008 Physical activity guidelines for Americans. Washington, DC. ODPHP Publication No. U0036.
11.
Zurück zum Zitat Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., & Martin, B. W. (2012). Correlates of physical activity: Why are some people physically active and others not? The Lancet, 380(9838), 258–271.CrossRef Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., & Martin, B. W. (2012). Correlates of physical activity: Why are some people physically active and others not? The Lancet, 380(9838), 258–271.CrossRef
12.
Zurück zum Zitat Dogra, S. (2011). Better self-perceived health is associated with lower odds of physical inactivity in older adults with chronic disease. Journal of Aging and Physical Activity, 19(4), 322–335.PubMed Dogra, S. (2011). Better self-perceived health is associated with lower odds of physical inactivity in older adults with chronic disease. Journal of Aging and Physical Activity, 19(4), 322–335.PubMed
13.
Zurück zum Zitat Moore, S. M., Dolansky, M. A., Ruland, C. M., Pashkow, F. J., & Blackburn, G. G. (2003). Predictors of women’s exercise maintenance after cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, 23(1), 40–49.PubMedCrossRef Moore, S. M., Dolansky, M. A., Ruland, C. M., Pashkow, F. J., & Blackburn, G. G. (2003). Predictors of women’s exercise maintenance after cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, 23(1), 40–49.PubMedCrossRef
14.
Zurück zum Zitat King, W. C., Engel, S. G., Elder, K. A., Chapman, W. H., Eid, G. M., Wolfe, B. M., et al. (2012). Walking capacity of bariatric surgery candidates. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 8(1), 48–59.CrossRef King, W. C., Engel, S. G., Elder, K. A., Chapman, W. H., Eid, G. M., Wolfe, B. M., et al. (2012). Walking capacity of bariatric surgery candidates. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 8(1), 48–59.CrossRef
15.
Zurück zum Zitat Shuval, K., DeVahl, J., Tong, L., Gimpel, N., Lee, J. J., & DeHaven, M. J. (2011). Anthropometric measures, presence of metabolic syndrome, and adherence to physical activity guidelines among African American church members, Dallas, Texas, 2008. Preventing Chronic Disease, 8(1). Retrieved on July 20, 2011 available from, http://www.cdc.gov/pcd/issues/2011/jan/09_0229.htm. Shuval, K., DeVahl, J., Tong, L., Gimpel, N., Lee, J. J., & DeHaven, M. J. (2011). Anthropometric measures, presence of metabolic syndrome, and adherence to physical activity guidelines among African American church members, Dallas, Texas, 2008. Preventing Chronic Disease, 8(1). Retrieved on July 20, 2011 available from, http://​www.​cdc.​gov/​pcd/​issues/​2011/​jan/​09_​0229.​htm.
16.
Zurück zum Zitat Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, 60(Supplement), 1–116. Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, 60(Supplement), 1–116.
17.
Zurück zum Zitat Conn, V. S., Hafdahl, A. R., & Mehr, D. R. (2011). Interventions to increase physical activity among healthy adults: Meta-analysis of outcomes. American Journal of Public Health, 101(4), 751–758.PubMedCentralPubMedCrossRef Conn, V. S., Hafdahl, A. R., & Mehr, D. R. (2011). Interventions to increase physical activity among healthy adults: Meta-analysis of outcomes. American Journal of Public Health, 101(4), 751–758.PubMedCentralPubMedCrossRef
18.
Zurück zum Zitat Pavey, T., Taylor, A., Hillsdon, M., Fox, K., Campbell, J., Foster, C., et al. (2012). Levels and predictors of exercise referral scheme uptake and adherence: A systematic review. Journal of Epidemiology and Community Health, 66(8), 737–744.PubMedCrossRef Pavey, T., Taylor, A., Hillsdon, M., Fox, K., Campbell, J., Foster, C., et al. (2012). Levels and predictors of exercise referral scheme uptake and adherence: A systematic review. Journal of Epidemiology and Community Health, 66(8), 737–744.PubMedCrossRef
19.
Zurück zum Zitat Petrella, R. J., Kennedy, E., & Overend, T. J. (2008). Geographic determinants of healthy lifestyle change in a community-based exercise prescription delivered in family practice. Environmental Health Insights, 1, 51–62.PubMedCentralPubMed Petrella, R. J., Kennedy, E., & Overend, T. J. (2008). Geographic determinants of healthy lifestyle change in a community-based exercise prescription delivered in family practice. Environmental Health Insights, 1, 51–62.PubMedCentralPubMed
20.
Zurück zum Zitat Shelton, R. C., McNeill, L. H., Puleo, E., Wolin, K. Y., Emmons, K. M., & Bennett, G. G. (2011). The association between social factors and physical activity among low-income adults living in public housing. American Journal of Public Health, 101(11), 2102–2110.PubMedCentralPubMedCrossRef Shelton, R. C., McNeill, L. H., Puleo, E., Wolin, K. Y., Emmons, K. M., & Bennett, G. G. (2011). The association between social factors and physical activity among low-income adults living in public housing. American Journal of Public Health, 101(11), 2102–2110.PubMedCentralPubMedCrossRef
21.
Zurück zum Zitat Thomas, S., Halbert, J., Mackintosh, S., Quinn, S., & Crotty, M. (2012). Sociodemographic factors associated with self-reported exercise and physical activity behaviors and attitudes of South Australians: Results of a population-based survey. Journal of Aging and Health, 24(2), 287–306.PubMedCrossRef Thomas, S., Halbert, J., Mackintosh, S., Quinn, S., & Crotty, M. (2012). Sociodemographic factors associated with self-reported exercise and physical activity behaviors and attitudes of South Australians: Results of a population-based survey. Journal of Aging and Health, 24(2), 287–306.PubMedCrossRef
22.
Zurück zum Zitat Willey, J. Z., Paik, M. C., Sacco, R., Elkind, M. S., & Boden-Albala, B. (2010). Social determinants of physical inactivity in the Northern Manhattan study (NOMAS). Journal of Community Health, 35(6), 602–608.PubMedCentralPubMedCrossRef Willey, J. Z., Paik, M. C., Sacco, R., Elkind, M. S., & Boden-Albala, B. (2010). Social determinants of physical inactivity in the Northern Manhattan study (NOMAS). Journal of Community Health, 35(6), 602–608.PubMedCentralPubMedCrossRef
23.
Zurück zum Zitat Ajzen, I. (2012). The theory of planned behavior. In P. A. M. Lange, A. W. Kruglanski, & E. T. Higgins (Eds.), Handbook of theories of social psychology (Vol. 1, pp. 438–459). London: Sage.CrossRef Ajzen, I. (2012). The theory of planned behavior. In P. A. M. Lange, A. W. Kruglanski, & E. T. Higgins (Eds.), Handbook of theories of social psychology (Vol. 1, pp. 438–459). London: Sage.CrossRef
24.
Zurück zum Zitat Schmidt, M., Absalah, S., Nierkens, V., & Stronks, K. (2008). Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes? BMC Public Health, 8, 371.PubMedCentralPubMedCrossRef Schmidt, M., Absalah, S., Nierkens, V., & Stronks, K. (2008). Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes? BMC Public Health, 8, 371.PubMedCentralPubMedCrossRef
25.
Zurück zum Zitat Pavey, T. G., Taylor, A. H., Fox, K. R., Hillsdon, M., Anokye, N., Campbell, J. L., et al. (2011). Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis. BMJ, 343. Pavey, T. G., Taylor, A. H., Fox, K. R., Hillsdon, M., Anokye, N., Campbell, J. L., et al. (2011). Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis. BMJ, 343.
26.
Zurück zum Zitat Taylor, A. H., Doust, J., & Webborn, N. (1998). Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors. Journal of Epidemiology and Community Health, 52(9), 595–601.PubMedCentralPubMedCrossRef Taylor, A. H., Doust, J., & Webborn, N. (1998). Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors. Journal of Epidemiology and Community Health, 52(9), 595–601.PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Tobi, P., Estacio, E., Renton, A., Yu, G., & Foster, N. (2012). Who stays, who drops out? Biosocial predictors of longer term adherence in participants attending an exercise referral scheme in the UK. BMC Public Health, 12(1), 347.PubMedCentralPubMedCrossRef Tobi, P., Estacio, E., Renton, A., Yu, G., & Foster, N. (2012). Who stays, who drops out? Biosocial predictors of longer term adherence in participants attending an exercise referral scheme in the UK. BMC Public Health, 12(1), 347.PubMedCentralPubMedCrossRef
28.
Zurück zum Zitat Williams, N. H., Hendry, M., France, B., Lewis, R., & Wilkinson, C. (2007). Effectiveness of exercise-referral schemes to promote physical activity in adults: Systematic review. British Journal of General Practice, 57(545), 979–986.PubMedCentralPubMedCrossRef Williams, N. H., Hendry, M., France, B., Lewis, R., & Wilkinson, C. (2007). Effectiveness of exercise-referral schemes to promote physical activity in adults: Systematic review. British Journal of General Practice, 57(545), 979–986.PubMedCentralPubMedCrossRef
29.
Zurück zum Zitat Grundy, S. M., Brewer, H. B., Jr, Cleeman, J. I., Smith, S. C., Jr, Lenfant, C., American Heart Association, et al. (2004). Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation, 109(3), 433–438.PubMedCrossRef Grundy, S. M., Brewer, H. B., Jr, Cleeman, J. I., Smith, S. C., Jr, Lenfant, C., American Heart Association, et al. (2004). Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation, 109(3), 433–438.PubMedCrossRef
31.
Zurück zum Zitat Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012). Global physical activity levels: Surveillance progress, pitfalls, and prospects. The Lancet, 380(9838), 247–257.CrossRef Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012). Global physical activity levels: Surveillance progress, pitfalls, and prospects. The Lancet, 380(9838), 247–257.CrossRef
32.
Zurück zum Zitat Heath, G. W., Parra, D. C., Sarmiento, O. L., Andersen, L. B., Owen, N., Goenka, S., et al. (2012). Evidence-based intervention in physical activity: Lessons from around the world. The Lancet, 380(9838), 272–281.CrossRef Heath, G. W., Parra, D. C., Sarmiento, O. L., Andersen, L. B., Owen, N., Goenka, S., et al. (2012). Evidence-based intervention in physical activity: Lessons from around the world. The Lancet, 380(9838), 272–281.CrossRef
Metadaten
Titel
Utilization of a Free Fitness Center-Based Exercise Referral Program Among Women with Chronic Disease Risk Factors
verfasst von
Megan R. Waterman
John M. Wiecha
Jennifer Manne
Stephen M. Tringale
Elizabeth Costa
Jean L. Wiecha
Publikationsdatum
01.12.2014
Verlag
Springer US
Erschienen in
Journal of Community Health / Ausgabe 6/2014
Print ISSN: 0094-5145
Elektronische ISSN: 1573-3610
DOI
https://doi.org/10.1007/s10900-014-9874-2

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