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Engagement in regular physical activity is one of the best strategies for older adults to remain healthy. Unfortunately, only 35% of older adults meet guidelines for muscle strengthening activities. Eliciting participant preferences is one possible way to improve physical activity engagement. However, other sources of participant input to improve uptake and maintenance remain uninvestigated. This study compared preferences to self-efficacy ratings for two strength training programs. We conducted a national cross-sectional survey of 611 US adults over age 65. We compared two participant evaluations (the preferred program and the program for which they had higher barrier self-efficacy) of two hypothetical strength training programs (45 minutes performed three times per week (traditional) and 5 minutes performed daily (brief)). Most participants (68%) preferred the brief strength training program. The difference in self-efficacy ratings was an average of 1.2 (SD = 0.92). One in five participants preferred a strength training program for which they had less self-efficacy; nearly all of these participants (92%) preferred the traditional strength training program but had more self-efficacy for the brief strength training program. Older adults reported preferring and having more self-efficacy for a brief compared to a traditional strength training program. Differences in self-efficacy ratings between the two strength training programs were large. Preferences were often not congruent with ratings of self-efficacy. Preferences for strength training programming may not always reflect the program most likely to be maintained. Future investigations should evaluate differences in behavioral uptake, maintenance, and outcomes from two comparative strength training interventions using preferences and self-efficacy.

Resistance training (RT) improves strength and physical function; however, only 35% of older adults meet national guidelines for muscle strengthening activities. Though time is often noted as a barrier to physical activity participation, little is known about the interest of older adults in brief RT programs. This study compared preferences for brief, more frequent vs longer, less frequent RT programs. A nationwide survey was conducted among 611 US adults aged 65 and over. Preference for either (1) a traditional (45 minutes per session, three days per week) RT program or (2) a short (5 minutes per session, daily) RT program was compared. Overall, 2.2 times as many older adults preferred the daily 5-minute RT program versus the traditional RT program (68.4% v. 31.6%). Preference for the brief, daily RT program was 5.3 times higher among adults with difficulty walking (84.2% v. 15.8%) than for the traditional RT program. Preference for a daily 5-minute RT program is significantly higher than for traditional 45-minute, three times weekly programs. This difference is larger in older adults who have serious difficulty walking or climbing stairs. Brief daily RT options may help engage older adults in RT at a population level, particularly those with poorer health and mobility disability. Future investigations should evaluate differences in uptake, adherence, and outcomes from two RT programs of varying durations and frequencies.

Asthma is one of the most burdensome chronic illnesses in the US. Despite widespread dissemination of evidence-based guidelines, more than half of the adults with asthma have uncontrolled symptoms. To examine the efficacy of an online tool designed to improve asthma control. 12-month single blind randomized controlled trial of the online tool (Intervention condition, IC) versus an active control tool (CC). Patients enrolled in an insurance plan. Participants were 408 adults (21-60 years of age) with persistent asthma. At least once each month and before provider visits, participants in the IC answered questions online about their asthma symptoms, asthma medications and asthma care received from providers, such as an asthma management plan. The tool then provided tailored feedback to remind patients 1) to ask health care providers specific questions that may improve asthma control (e.g., additional controller medications) and 2) to consistently perform specific self-care behaviors (e.g., proper inhaler technique). Participants in the CC received similar questions and feedback, yet focused instead on preventive services unrelated to asthma control (e.g., cancer screening). The main outcome measure was asthma control, as assessed by the 5-question Asthma Control Test (ACT). Secondary outcomes included quality of life, medication use and healthcare utilization (e.g., emergency department visits). After 12 months, 323 participants completed follow-up measures (79.2%). Participants in the IC reported a greater mean improvement in the ACT score than participants in the CC (2.3 vs. 1.2; p = 0.02) and 9 of 11 individual asthma control survey items showed non-significant improvements favoring the IC. No differences were observed in medication adherence, number of asthma controller medications or health care utilization. Simple and brief online patient reminders improved asthma control among insured patients. Although future studies are needed to understand the mechanism of the improvement, the magnitude of the effect on asthma control was similar to the addition of an additional controller medication. Given the widespread use of the Internet, simple tools such as this may be useful for improving the control of other chronic diseases as well. This study is registered at clinicaltrials.gov, NCT00921401, \"Improving the Quality of Asthma Care Using the Internet\".

Global life satisfaction has been linked with long-term health advantages, yet how life satisfaction impacts the trajectory of long-term health is unclear. This paper examines one such possible mechanism—that greater life satisfaction confers momentary benefits in daily life that accumulate over time. A community sample of working adults ( n  = 115) completed a measure of life satisfaction and then three subsequent days of ecological momentary assessment surveys (6 times/day) measuring affect (i.e., emotional valence, arousal), and perceived stress, and also provided salivary cortisol samples. Multilevel models indicated that people with higher (vs. lower) levels of life satisfaction reported better momentary affect, less stress, marginally lower momentary levels and significantly altered diurnal slopes of cortisol. Findings suggest individuals with high global life satisfaction have advantageous daily experiences, providing initial evidence for potential mechanisms through which global life satisfaction may help explain long-term health benefits.

Introduction/Objectives: One in four older adults in the United States (US) reports being socially isolated or lonely, leading to increases in the odds of having heart disease, a stroke, and dementia. Physical activity (PA) has many benefits in this population, both physical and psychological. One such type of PA growing in popularity is pickleball. Our objective was to understand the relationship of pickleball participation with perceived loneliness and social isolation among older adults in the US. Methods: We conducted a national cross-sectional survey of 825 US adults over age 50 years. We compared the effect of 3 levels of pickleball play history (never played (NP); played previously, not currently (PP); and currently play (CP)) on loneliness and social isolation. Results: Most participants (65%) who had ever played pickleball were still currently playing. Over half of the sample (57%) reported being lonely. The adjusted odds of being lonely were greater for NP (adjusted odds ratio 95% CI = 1.53, 1.04-2.23), and PP (1.95, 1.24-3.05) groups. Compared to NP, PP, and CP groups were found to be associated with having made more social connections and reporting a greater number of social engagements, thus appearing to experience less social isolation. Conclusion: Older adults who participate in pickleball had an associated decreased perceived loneliness and reduced risk of social isolation. Further research is needed to determine if recommendations for those able to physically participate in pickleball might result in similar changes to loneliness and social isolation.

The COVID-19 pandemic has disrupted physical activity, particularly among women. Limited research has explored how social network support may explain gender-based variations in physical activity during COVID-19. The purpose of this study was to examine the mediating role of social networks in the association between gender and physical activity during a pandemic. This cross-sectional survey assessed whether social network characteristics (i.e., in-person social network size, frequency of in-person social network interactions, and online friend network size) mediate the relationship between gender and either past-week or past-year physical activity. Multiple mediation analyses were conducted to determine the indirect effect of gender on physical activity through social networks. Among 205 participants, women (n = 129) were significantly less physically active (β = −73.82; p = 0.02) than men (n = 76) and reported significantly more Facebook friends (β = 0.30; p < 0.001) than men, which was inversely associated with past-week physical activity (β = −64.49; p = 0.03). Additionally, the indirect effect of gender on past-week physical activity through Facebook friends was significant (β = −19.13; 95% CI [−40.45, −2.09]). Findings suggest that social media sites such as Facebook could be used to encourage physical activity among women during a pandemic.

Background: Guidelines recommend that physicians screen all adults for obesity and offer an intensive counseling and behavioral interventions for weight loss for obese adults. Current trends of weight-related counseling are unknown in the setting of the US obesity epidemic. Objectives: To describe primary care physician (PCP) weight-related counseling, comparing counseling rates in 1995-1996 and 2007-2008. Research Design: Data analysis of outpatient PCP visits in 1995-1996 and 2007-2008, as reported in the National Ambulatory Medical Care Survey. Subjects: A total of 32,519 adult primary care visits with PCPs. Measures: Rates of counseling for weight, diet, exercise, and a composite variable, weight-related counseling (defined as counseling for weight, diet, or exercise) between survey years. Adjusted analyses controlled for patient and visit characteristics. Results: Weight counseling declined from 7.8% of visits in 1995-1996 to 6.2% of visits in 2007-2008 [adjusted odds ratios, 0.64; 95% confidence intervals, 0.53, 0.79]. Rates of receipt of diet, exercise, and weight-related counseling similarly declined. Greater declines in odds of weight-counseling receipt were observed among those with hypertension (47%), diabetes (59%), and obesity (41%), patients who stand the most to gain from losing weight. Conclusions: Rates of weight counseling in primary care have significantly declined despite increased rates of overweight and obesity in the United States. Further, these declines are even more marked in patients with obesity and weight-related comorbidities, despite expectations to provide such care by both patients and policymakers. These findings have implications for determining deliverable, novel ways to engage PCPs in addressing the obesity epidemic.

Abstract Background Social networks can influence physical activity, but little is known about how best to engineer online and in-person social networks to increase activity. Purpose The purpose of this study was to conduct a randomized trial based on the Social Networks for Activity Promotion model to assess the incremental contributions of different procedures for building social networks on objectively measured outcomes. Methods Physically inactive adults (n = 308, age, 50.3 (SD = 8.3) years, 38.3 % male, 83.4 % overweight/obese) were randomized to one of three groups. The Promotion group evaluated the effects of weekly emailed tips emphasizing social network interactions for walking (e.g., encouragement, informational support); the Activity group evaluated the incremental effect of adding an evidence-based online fitness walking intervention to the weekly tips; and the Social Networks group evaluated the additional incremental effect of providing access to an online networking site for walking as well as prompting walking/activity across diverse settings. The primary outcome was mean change in accelerometer-measured moderate-to-vigorous physical activity (MVPA), assessed at 3 and 9 months from baseline. Results Participants increased their MVPA by 21.0 min/week, 95 % CI [5.9, 36.1], p = .005, at 3 months, and this change was sustained at 9 months, with no between-group differences. Conclusions Although the structure of procedures for targeting social networks varied across intervention groups, the functional effect of these procedures on physical activity was similar. Future research should evaluate if more powerful reinforcers improve the effects of social network interventions. Trial Registration Number The trial was registered with the ClinicalTrials.gov (NCT01142804).

Although stress is a common experience in everyday life, a clear understanding of how often an individual experiences and reports stress is lacking. Notably, there is little information regarding factors that may influence how frequently stress is reported, including which stress dimension is measured (i.e., stressors—did an event happen, subjective stress—how stressed do you feel, conditional stress—how stressful a stressor was) and the temporal features of that assessment (i.e., time of day, day of study, weekday vs. weekend day). The purpose of the present study was to conduct a coordinated analysis of five independent ecological momentary assessment studies utilizing varied stress reporting dimensions and temporal features. Results indicated that, within days, stress was reported at different frequencies depending on the stress dimension. Stressors were reported on 15–32% of momentary reports made within a day; across days, the frequency ranged from 42 to 76% of days. Depending on the cutoff, subjective stress was reported more frequently ranging about 8–56% of all moments within days, and 40–90% of days. Likewise, conditional stress ranged from just 3% of moments to 22%, and 11–69% of days. For the temporal features, stress was reported more frequently on weekdays (compared to weekend days) and on days earlier in the study (relative to days later in the study); time of day was inconsistently related to stress reports. In sum, stress report frequency depends in part on how stress is assessed. As such, researchers may wish to measure stress in multiple ways and, in the case of subjective and conditional stress with multiple operational definitions, to thoroughly characterize the frequency of stress reporting.

ObjectivesTo evaluate sex differences in demographic and clinical characteristics, treatments and outcomes for patients with diagnosed obstructive hypertrophic cardiomyopathy (oHCM) in the USA.SettingRetrospective observational study of administrative claims data from MarketScan Commercial Claims and Encounters Database from IBM Watson Health.ParticipantsOf the 28 million covered employees and family members in MarketScan, 9306 patients with oHCM were included in this analysis.Main outcome measuresoHCM-related outcomes included heart failure, atrial fibrillation, ventricular tachycardia/ fibrillation, sudden cardiac death, septal myectomy, alcohol septal ablation (ASA) and heart transplant.ResultsAmong 9306 patients with oHCM, the majority were male (60.5%, p<0.001) and women were of comparable age to men (50±15 vs 49±15 years, p<0.001). Women were less likely to be prescribed beta blockers (42.7% vs 45.2%, p=0.017) and undergo an implantable cardioverter-defibrillator (1.7% vs 2.6%, p=0.005). Septal reduction therapy was performed slightly more frequently in women (ASA: 0.08% vs 0.05%, p=0.600; SM: 0.35% vs 0.18%, p=0.096), although not statistically significant. Women were less likely to have atrial fibrillation (6.7% vs 9.9%, p<0.001).ConclusionWomen were less likely to be prescribed beta blockers, ACE inhibitors, anticoagulants, undergo implantable cardioverter-defibrillator and have ventricular tachycardia/fibrillation. Men were more likely to have atrial fibrillation. Future research using large, clinical real-world data are warranted to understand the root cause of these potential treatment disparities in women with oHCM.