PEDS 409 Group 1PEDS 409 Group 1Nicholas JendzjowskyNicholas JendzjowskyCameron McKnightCameron McKnight

Emily MotykaEmily MotykaKristen RosichukKristen Rosichuk

Physician Advice to the Elderly About Physical Activity

Also called sample surveysAlso called sample surveysUses surveys to directly study the Uses surveys to directly study the

characteristics of populations characteristics of populations Tools used in survey research are:Tools used in survey research are:

InterviewsInterviewsFocus groups (small group of respondents Focus groups (small group of respondents

are interviewed and re-interviewed)are interviewed and re-interviewed)Mail questionnairesMail questionnaires

Alseny Balde- Cecil County Health Alseny Balde- Cecil County Health Department, Elkton, MD.Department, Elkton, MD.

Jaime Figuras- Public health officer, Jaime Figuras- Public health officer, City of Wilmington, DE.City of Wilmington, DE.

Dawn A. Hawking- Health Care Dawn A. Hawking- Health Care Financing Administration, Baltimore, Financing Administration, Baltimore, MD.MD.

John R. Miller- Network to Improve John R. Miller- Network to Improve Community Health, Greenbelt, MDCommunity Health, Greenbelt, MD..

Do Physicians counsel their elderly Do Physicians counsel their elderly patients to exercise?patients to exercise?

Do patients follow their doctors' Do patients follow their doctors' advice?advice?

Does it make a difference in the Does it make a difference in the patient's health status?patient's health status?

Four hundred randomly assigned Four hundred randomly assigned questionnaires were distributed to questionnaires were distributed to low-income senior citizens (65+ low-income senior citizens (65+ years of age) living in public high-rise years of age) living in public high-rise apartment buildings (w/o gym apartment buildings (w/o gym facilities).facilities).

Two Part QuestionnaireTwo Part Questionnaire(Adapted from Cartmel & Moon, 1992; (Adapted from Cartmel & Moon, 1992;

Godin & Shephard, 1985)Godin & Shephard, 1985)11stst: demographic information: demographic information  

22ndnd: height, weight, general health, : height, weight, general health, physician advice about physical activity, physician advice about physical activity, and type of physical activity performed.and type of physical activity performed.

146 Completed (36.5% completion rate)146 Completed (36.5% completion rate)

Characteristics of the elderly who Characteristics of the elderly who were or were not counseled to were or were not counseled to exercise were compared using exercise were compared using univariate analysis.univariate analysis.  

Categorical variables were assessed Categorical variables were assessed using chi-square tests.using chi-square tests.

Continuous variables were assessed Continuous variables were assessed using Students t tests.using Students t tests.

How Health Status was DeterminedHow Health Status was DeterminedHealth risk determined by BMI, and self-Health risk determined by BMI, and self-

reported health status.reported health status.Men with a BMI of 27.8 or more and Men with a BMI of 27.8 or more and

women with a BMI of 27.3, are women with a BMI of 27.3, are considered overweight, and people with considered overweight, and people with a BMI of 30 or more are considered a BMI of 30 or more are considered obese.obese.

46.4% surveyed were overweight, (higher 46.4% surveyed were overweight, (higher incidence for women than men, 51.2% vs. incidence for women than men, 51.2% vs. 28.9%.)28.9%.)

38% of participants with college education were 38% of participants with college education were overweight, 46% with a high school education overweight, 46% with a high school education were overweight, and 45% of those with less than were overweight, and 45% of those with less than a high school education were overweight.a high school education were overweight.

28% of women were obese, compared with 21% 28% of women were obese, compared with 21% of men.of men.

29% of White participants were obese, 19% of 29% of White participants were obese, 19% of racial minority racial groups were obese.racial minority racial groups were obese.

30% of participants self-reported their health 30% of participants self-reported their health status to be poor.status to be poor.

Physician CounselingPhysician Counseling 94% had visited doctor in past year, but only 94% had visited doctor in past year, but only

61.6% reported receiving advice about 61.6% reported receiving advice about physical activity.physical activity.

Mean age of those receiving physician advice Mean age of those receiving physician advice was 77.0, versus 79.2 for those who were not was 77.0, versus 79.2 for those who were not receiving advice.receiving advice.

Those with a higher BMI, reported more Those with a higher BMI, reported more physician advice on activity. ( BMI 28.7 for physician advice on activity. ( BMI 28.7 for those receiving advice vs. BMI of 26.2 who did those receiving advice vs. BMI of 26.2 who did not receive advice.)not receive advice.)

3 Classifications of Physical Activity.3 Classifications of Physical Activity.Sitting Physical Activities: sewing, Sitting Physical Activities: sewing,

playing musical instrument, knitting.playing musical instrument, knitting.Light Physical Activities: sweeping, Light Physical Activities: sweeping,

mopping, grocery shoppingmopping, grocery shoppingModerate to Heavy Activities: walking, Moderate to Heavy Activities: walking,

cycling, runningcycling, running

The number of times per week sitting The number of times per week sitting and light physical activities did not and light physical activities did not vary according to physician advice.vary according to physician advice.

Those who participated in moderate Those who participated in moderate to heavy physical activity had to heavy physical activity had received advice. Mean= 4.4 received advice. Mean= 4.4 times/week for those receiving times/week for those receiving advice vs. 3.1 times/week for those advice vs. 3.1 times/week for those not receiving advice.not receiving advice.

Prevalence of physician advice was Prevalence of physician advice was higher among men, than women.higher among men, than women.

Those who were married reported Those who were married reported more advice than those who were more advice than those who were single, divorced, or widowed.single, divorced, or widowed.

There was no difference in race or There was no difference in race or education education

for those who received advice and for those who received advice and those who did not.those who did not.

Counseling on physical activity is not Counseling on physical activity is not offered as often as recommended for offered as often as recommended for elderly patients.elderly patients.

Physician counseling could be Physician counseling could be improved if the physician made a improved if the physician made a stronger effort to counsel patients on stronger effort to counsel patients on a more regular basis.a more regular basis.

Counseling should be provided to all Counseling should be provided to all patients, and should not be a result patients, and should not be a result of gender or health status.of gender or health status.

1. SAMPLING1. SAMPLING Chose a limited Chose a limited

populationpopulation Senior citizens living in Senior citizens living in

public housingpublic housing High-rise building with High-rise building with

low incomeslow incomes Homogeneous study Homogeneous study

groupgroup

The lack of a diverse The lack of a diverse population for sampling population for sampling will result in a poor ability will result in a poor ability to generalize the results of to generalize the results of the survey to the greater the survey to the greater elderly population.elderly population.

2. SURVEY RESPONSE2. SURVEY RESPONSE Distributed 400 surveys Distributed 400 surveys

and received 146 and received 146 completed surveys backcompleted surveys back

36.5% response36.5% response

The non-responders might The non-responders might be part of a qualitatively be part of a qualitatively distinct group from those distinct group from those who did respond who did respond resulting in inaccurate resulting in inaccurate resultsresults

The researchers needed to The researchers needed to return to the buildings return to the buildings and distribute the survey and distribute the survey again.again.

3.3. SELF-REPORTED HEALTH STATUSSELF-REPORTED HEALTH STATUS Recall errors Recall errors Elderly may have problems with their Elderly may have problems with their

memory (Alzheimer's)memory (Alzheimer's) May lie on their questionnairesMay lie on their questionnaires

4.4. CLARIFYING THE CLARIFYING THE OBJECTIVEOBJECTIVE

Closed-ended Closed-ended questionsquestions

Survey did not Survey did not specify on the specify on the amount and amount and quality of quality of counselingcounseling

Lack of knowledge Lack of knowledge in the duration of in the duration of each activityeach activity

What do elderly populations perceive What do elderly populations perceive Phys. Act. to be?Phys. Act. to be?

What the importance of Phys. Act. is?What the importance of Phys. Act. is?What is the past history of Phys. Act. What is the past history of Phys. Act.

in elderly populations and how great in elderly populations and how great an effect does this have on present an effect does this have on present health status (rate past phys. act. In health status (rate past phys. act. In categories of intensity, duration and categories of intensity, duration and type)type)

Self efficacy of elderly populations and Self efficacy of elderly populations and exerciseexercise

Physicians self efficacy on prescribing Physicians self efficacy on prescribing exerciseexercise

Adherence by the elderly to phys. act.Adherence by the elderly to phys. act.Did the elderly engage in phys. act. Did the elderly engage in phys. act.

After the recommendation by their After the recommendation by their doctordoctor

Other populations?Other populations?

W.r.t. to this design. It could have W.r.t. to this design. It could have also: also: DescribeDescribeGather informationGather informationNo interventionNo interventionSimple ObservationSimple ObservationElderly population’s perceived notion of Elderly population’s perceived notion of

importance of physical activityimportance of physical activityWhat it is elderly population’s think to What it is elderly population’s think to

be fitness activities? be fitness activities?

Elderly population’s perceived Elderly population’s perceived efficacy of their physician on this efficacy of their physician on this matter of physical activitymatter of physical activity

Do the elderly think that they need Do the elderly think that they need to engage in physical activity for to engage in physical activity for health purposes? health purposes?

Survey or questionnaire type Survey or questionnaire type research seeks to find answer to research seeks to find answer to direct questions direct questions

Describe a certain problem Describe a certain problem More research is conducted to find More research is conducted to find

solutions to the problem questioned solutions to the problem questioned

Balde, A., Figueras, J., Hawking, D.A., Balde, A., Figueras, J., Hawking, D.A., Miller, J.R. (2003) Physician Miller, J.R. (2003) Physician

Advice to Advice to the Elderly About the Elderly About Physical Activity. Physical Activity. Journal of Aging Journal of Aging and Physical Activity, and Physical Activity, 11:90-8.11:90-8.