Professional Documents
Culture Documents
(2014) 48:125129
DOI 10.1007/s12160-013-9578-3
BRIEF REPORT
Abstract
Background Previous findings are inconclusive regarding the
mediators of physical activity behavior change.
Purpose To test self-efficacy and social support as mediators
of Active Choices, a telephone-delivered physical activity
intervention, and Active Living Every Day, a group-based
physical activity intervention, implemented with midlife and
older adults in community settings.
Methods MacKinnon's product of coefficients was used to
examine social support and self-efficacy as mediators of
change in physical activity. The proportion of the total effect
mediated was calculated. Each model controlled for age,
gender, race (white vs. non-white), body mass index (BMI),
and education (high school graduate or less vs. at least some
college).
Results Increases in self-efficacy mediated increases in physical activity among Active Choices (n =709) and Active Living Every Day (n =849) participants. For Active Living Every
Day, increases in social support also mediated increases in
physical activity in single mediator models.
Conclusions Increasing self-efficacy and social support may
help increase physical activity levels in older adults.
K. Becofsky : S. Wilcox (*)
Department of Exercise Science, Arnold School of Public Health,
University of South Carolina, 921 Assembly Street, Columbia,
SC 29208, USA
e-mail: wilcoxs@mailbox.sc.edu
K. Becofsky
e-mail: becofsky@email.sc.edu
M. Baruth
College of Health and Human Services, Saginaw Valley State
University, 7400 Bay Rd University Center,
Columbia, MI 48710, USA
S. Wilcox
Prevention Research Center, University of South Carolina,
Columbia, SC, USA
Introduction
Mediation analyses can help explain how physical activity
interventions achieve their outcomes [1]. Acquiring this information may provide support for current behavior change
theories, or may prompt revision or new theory development.
The ultimate goal of mediation analyses is to understand the
critical components of successful interventions (or the missing
components of unsuccessful ones) to maximize the efficiency
and effectiveness of future programs.
Physical activity self-efficacy and social support have
long been considered key factors for physical activity adoption and maintenance. Physical activity and self-efficacy refers to an individual's confidence in his or her ability to engage
in physical activity, even when encountering barriers, whereas
social support encompasses various types of encouragement
and assistance received for engaging in physical activity.
These constructs are consistent with social cognitive theory
[2] and the transtheoretical model [3], both of which are
commonly used as the theoretical bases for physical activity
interventions.
Although physical activity self-efficacy and social support
are staples of the physical activity behavior change literature,
evidence of their ability to mediate intervention effects is
conflicting [4, 5]. Even less information is known about their
mediating role in interventions targeting older adults. Two
review papers have found limited evidence for the role of
these behavioral constructs in mediating physical activity
interventions, although one excluded studies with adults 65+
[5], and the other included only 1 study with older adults [4].
Cerin et al. suggested that the inconclusive findings regarding
the mediators of physical activity behavior change may be
126
Methods
Active For Life was a 4-year translational initiative that successfully implemented two physical activity programs, Active
Choices (a 6-month telephone-based program) and Active
Living Every Day (a 20-week group-based program), into
community settings with diverse midlife and older adult populations [8]. Both Active Choices [9, 10] and Active Living
Every Day [11, 12] were previously tested in rigorous randomized controlled trials. Both led to significant improvements in physical activity when translated to community
settings (see Wilcox et al. 2008 [8] for methodology details
and other major findings). In the last year of the Active for
Life initiative, the Active Living Every Day program was
shortened from 20 to 12 weeks at the request of the participating organizations; steps were taken to ensure essential
elements were preserved [8]. The current study used a pre
post design, with data collected from 2003 to 2007.
Participants
All Active for Life participants were 50 years of age, not
meeting physical activity recommendations (2 days/week
and <120 min/week), and free of serious medical conditions
or disabilities that required higher levels of supervision [8].
Measures
Self-reported moderate-to-vigorous physical activity was
measured via the 41-item Community Health Activities Model Program for Seniors questionnaire; total hours per week
spent in moderate-to-vigorous physical activity (3 METs)
was determined based on the frequency and duration of all
reported activities [13]. Physical activity self-efficacy was
measured with a 5-item scale which asked participants to rate
their confidence in overcoming common barriers to physical
activity [14]. Social support from friends and family was
measured with a 5-item scale developed for the US Women's
Determinants Study [15] and derived from an original scale
developed by Sallis and colleagues [16]. Participants
K. Becofsky et al.
Results
Table 1 shows the baseline characteristics of all participants
included in analyses. For Active Choices (n =709) and Active
Living Every Day (n =849), respectively, participants were
66.7 (8.9) and 70.4 (9.0)years old, 80 and 84 % female, and
50.6 and 63.8 % white. Table 2 shows the - and coefficients and the asymmetric confidence limits of all single
and multiple mediator regression analyses. For Active
127
pathway
pathway
Dose (# of calls
completed for AC or %
of classes attended for
ALED)
Hrs/Week of moderate to
vigorous physical activity
1 pathway
1 pathway
Dose (# of calls
completed for AC or %
of classes attended for
ALED
Hrs/Week of moderate to
vigorous physical activity
2 pathway
Mediator 2:
2 pathway
Self-Efficacy
b
Percentage of phone calls (Active Choices) and group-based
sessions (Active Living Every
Day) completed
Age, years
BMI, kg/m2
Gender
Male
Female
Education
HS grad or less
At least some college
Race
Non-white
White
Social support
Self-efficacy
Attendance, %b
MVPA, hours/week
Active Choices
Mean (SD) or %
Mean (SD) or %
709
709
66.7 (9.8)
30.5 (7.0)
849
849
70.4 (9.0)
30.0 (6.9)
142
567
20.0
80.0
134
715
15.8
84.2
186
523
26.2
73.8
335
514
39.5
60.5
350
359
709
709
49.4
50.6
13.4 (3.1)
20.9 (6.9)
307
542
849
849
36.2
63.8
13.4 (3.0)
20.0 (7.8)
709
709
78.7 (24.8)
2.9 (3.6)
849
849
75.7 (21.5)
2.7 (3.7)
128
K. Becofsky et al.
Table 2 Mediation effects for physical activity in Active Choices (n =709) and Active Living Every Day (n =849)a
Alpha estimate (SE b)
Proportion mediated
0.051 (0.015)
0.037 (0.006)
0.001
<0.001
0.027, 0.063
0.054, 0.228
4%
37 %
0.040 (0.015)
0.034 (0.006)
0.007
<0.001
0.022, 0.052
0.054, 0.228
3%
35 %
0.036 (0.014)
0.0342 (0.005)
0.009
<0.001
0.001, 0.081
0.007, 0.163
7%
17 %
0.0267 (0.014)
0.033 (0.005)
0.049
<0.001
0.002, 0.066
0.007, 0.158
5%
16 %
Each model controlled for age, gender, race (white vs. non-white), body mass index, and education (high school graduate or less vs. at least some
college)
SE standard error
Discussion
In this study, increases in self-efficacy mediated the relationship between intervention dose and increases in moderate-tovigorous physical activity in older adults in both Active
Choices and Active Living Every Day. Social support also
mediated this relationship in Active Living Every Day, but
only when considered separately from self-efficacy. Significance in all -pathways indicates that changes in self-efficacy
and social support were indeed related to physical activity
adoption in Active for Life. Significance in the self-efficacy
-pathway for Active Choices and both the self-efficacy and
social support -pathways for Active Living Every Day
suggest that the mode of delivery may have determined
each program's psychosocial effects; the one-on-one
feedback provided by the phone-based Active Choices
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