Public Health Nursing Vol. 32 No. 6, pp. 625–633 0737-1209/© 2015 Wiley Periodicals, Inc. doi: 10.1111/phn.12190
POPULATIONS
AT
RISK ACROSS
THE
LIFESPAN: POPULATION STUDIES
Improving Physical Activity in Hispanics with Diabetes and their Families Jie Hu, PhD, RN, FAAN, Debra C. Wallace, PhD, RN, FAAN, Karen A. Amirehsani, PhD, FNP-BC, Thomas P. McCoy, MS, PStat, Sheryl L. Coley, DrPH, MPH, Kimberly D. Wiseman, MS, Zulema A. Silva, BS, and Christina R. Hussami, BA School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina Correspondence to: Jie Hu, School of Nursing, The University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402-6170. E-mail: [email protected]
ABSTRACT Objective: This study examined changes in physical activity among Hispanics with diabetes and their families who received an 8-week diabetes self-management intervention. Design: A quasi-experimental design was used to conduct a secondary analysis of physical activity data from two intervention studies that used the same protocols and measures. Sample: A total of 65 patients and 66 family members participated in the studies. Measures: Physical activity was measured with the International Physical Activity Questionnaire (IPAQ) and pedometers. Self-report of physical activity was collected pre- and postintervention, and pedometer data for the 8 weeks of the intervention period. Intervention: The interventions consisted of 8 weeks of educational sessions. Results: IPAQ walking Metabolic Equivalent of Task (MET)-minutes per week significantly increased for patients (p < .001) and family members (p < .001) from pre- to postintervention as did moderate activity MET-minutes/week for family members (p = .004). Based on pedometer steps, the percentage of sedentary patients declined from 38% to 17% over the intervention record; differences in pedometer steps over time were not significant for patients (p = .803) or family members (p = .144). Conclusions: Pedometers are a cost effective and user-friendly method of measuring physical activity. Pedometers can also serve as a motivator to help increase physical activity among Hispanics with diabetes and their family members. Key words: Hispanics and family members, intervention, pedometer, physical activity.
Background Physical activity (PA) is an essential element of type 2 diabetes (T2DM) self-management (Duvivier et al., 2013; Van Dijk, Tummers, Stehouwer, Hartgens, & Van Loon, 2012; Weinstock et al., 2011). Increased PA has been linked to improvements in body weight, body fat, cardiorespiratory fitness, waist circumference, HDL cholesterol, hs-CRP and HbA1c levels, and mental health status (Balducci et al., 2012; Ho, Dhaliwal, Hills, & Pal, 2012; Lincoln, Shepherd, Johnson, & Castaneda-Sceppa, 2011). PA among persons with T2DM has also been shown to reduce postprandial glucose elevations and glucose variability
independent of changes in physical fitness or adiposity (Mikus, Oberlin, Libla, Boyle, & Thyfault, 2012) and to improve insulin sensitivity and action (Lar€m, 2012; Nelson sen, Anderson, Ekblom, & Nystro et al., 2013). Current PA guidelines recommend 150 min/week of moderate-intensity aerobic activity, in addition to twice weekly muscle strengthening activities for all adults (Centers for Disease Control and Prevention, 2014), with encouragement to break PA into shorter periods of time, such as 10 min increments, if needed to achieve these goals. National U.S. data indicate that Hispanic men and women are more likely to be inactive or less
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physically active than non-Hispanic White and Black men and women (Janssen, Carson, Lee, Katzmarzyk, & Blair, 2013). Additionally, they suffer higher rates of T2DM and obesity than non-Hispanic Whites (US Department of Health and Human Services, 2014). Given the high rates of inactivity, obesity, and diabetes among Hispanics, interventions are needed to increase physical activity. Previous studies have used a variety of methods to measure physical activity such as pedometers and steps per day, activity duration and intensity, and Metabolic Equivalent of Task (MET) minutes calculated from the International Physical Activity Questionnaire (IPAQ) and other self-report measures. Walking is the most common daily activity of adults, and pedometers are an inexpensive and widely used strategy for lay persons to track their steps. However, pedometers have not been widely used as an intervention strategy for improving PA among Hispanic adults (Ainsworth et al., 2013; Coffman, Ferguson, Steinman, Talbot, & DunbarJacob, 2013; Trudnak, Lloyd, Westhoff, & Corvin, 2011); prior PA studies with Hispanics have used pedometers as a measure for only 7 days, a limited amount of time (Ainsworth et al., 2013; Coffman et al., 2013; Drieling, Goldman Rosas, Ma, & Stafford, 2014). This analysis used both pedometers and self-report to assess changes in physical activity among Hispanics with diabetes and their family members over an 8-week period. The research hypothesis was that an 8-week family-based diabetes self-management intervention would show a significant improvement in physical activity, measured with pedometer and self-report, for both participants and their family members.
Methods Design and sample A quasi-experimental design was used to examine the effects of an 8-week, family-based intervention program for Hispanic adults with T2DM (type 2 diabetes) and their family members using a secondary analysis of physical activity data from two intervention studies that used the same protocols and measures. Data on physical activity for this analysis were collected at pre- and postintervention for both participants with T2DM and their family members in the two intervention studies.
November/December 2015
A total of 131 participants (65 patients and 66 family members) completed the study. Participants were recruited for the two studies in two rural counties with limited health access. Both counties had a Federally Qualified Health Center, lowincome charity clinic or Health Department and a small general hospital (one with 94 beds and one with 145 beds). Per capita income in the two counties was $21,384 and $22,624 (lower than the U.S. rate of $27,915), the unemployment rate was 10% (higher than the national average), and the population was 6.4–10.4% Hispanic (US Census Bureau, 2012). Participants were recruited through flyers distributed by clinic and physician office staff, face-toface waiting room conversations with study research assistants, announcements, postings at church meetings and through word of mouth. Criteria for inclusion of patients with diabetes were (a) self-identification as Hispanic, (b) age 18 years or older, (c) self-report of a medical diagnosis of T2DM, and (d) an adult family member willing to participate. Inclusion criteria for family members were (a) residence in the patient’s household and (b) age 18 years or older. Both patients and family members had to be able to speak either Spanish or English. Those who were pregnant, were diagnosed with type 1 diabetes, reported prior (past year) or current participation in other diabetes self-management intervention programs, or were cognitively impaired were excluded. Bilingual and bicultural team members were available to recruit, consent, and enroll persons. Potential participants met with team members in private rooms at study sites and made an appointment for a family session. At this initial session with each family dyad, the study purpose, format of the intervention and requirements of participants were shared, and informed consent and baseline data were collected from each participant. The university IRB approved conduct of the studies.
Intervention The two 8-week family-based interventions were rooted in social cognitive theory and used a modified version of a diabetes program based on the National Diabetes Education Program and National Standards for Diabetes Self-Management Education (www.ndep.nih.gov). The eight modules were designed to increase diabetes knowledge, overcome
Hu et al.: Physical Activity barriers to self-management, and foster lifestyle behavioral changes through family support and development of self-efficacy. All study materials were administered to participants in their choice of Spanish or English. All participants received a total of $120 grocery gift cards or cash incentive for completing the 8-week intervention and were provided a new lifestyle pedometer to retain for personal use. All content was tailored to low-literacy participants and integrated cultural beliefs and values. Details on the intervention, data collection, and the measures used in the studies have been published elsewhere (Hu, Wallace, McCoy, & Amirehsani, 2014).
Measures The IPAQ was used to measure self-reported physical activity. This short 9-item IPAQ form assesses the time over 7-day periods that respondents reported walking, moderate activity, and sedentary activity. The questionnaire was completed by each participant before and after the intervention. Walking Metabolic Equivalent of Task-min/week was estimated as 3.3 9 walking minutes 9 walking days; moderate activity MET-min/week as 4.0 9 moderate-intensity activity minutes 9 moderate activity days; and vigorous MET-min/week as 8.0 9 vigorous activity minutes 9 vigorous activity days. Total physical activity MET-min/ week was estimated as the total walking, moderate, and vigorous MET-min/week. Reliability and validity for the IPAQ have been established in studies conducted in 12 countries and for patients with T2DM (Centers for Disease Control and Prevention, 2010). Omron HJ-112 pedometers were used to measure 7-day step counts for each participant. The Omron pedometer has a 7-day memory and clock that automatically resets to zero at midnight each day, and it retains data on aerobic and daily step counts and walking distance. It is valid within the recommended 3% of steps walked, as confirmed in previous research (Holbrook, Barreira, & Kang, 2009; Zhu & Lee, 2010). Pedometers were given to participants at the first group meeting with instructions for use, correct wearing site, and use of “clips” to attach to clothing. The instructions included a reminder to wear the pedometer each day from the time when participants woke up until they went to bed at night for 7 consecutive days. In addition,
627
participants were asked to bring the pedometers to each of the 8-week intervention sessions. Steps were collected each week over the 8-week intervention period by study staff and recorded on separate data sheets for each participant. All participants were encouraged to look over the number of steps recorded each week to monitor their progress. Demographic data were also collected on all participants.
Analytic strategy Descriptive statistics including frequencies and percentages were used to summarize categorical measures, and means (M), standard deviations (SD), medians, minimums, and maximums were used to summarize continuous measures. Analyses were performed separately for patients and family members. To investigate the research hypothesis, repeated measures analyses were conducted using mixedeffects modeling to account for follow-up time and correlations among repeated observations for subjects using random effects. Because continuous measures were right skewed, Gamma mixed-effects regression with a log link function was performed. Gamma regression has been previously used to model skewed physical activity outcomes and in particular, METs estimated from the IPAQ (Lee, Xiang, & Hirayama, 2010). Values of zero were recoded as 0.1 for this modeling (zeroes were not prevalent except for vigorous activities). Vigorous activities were dichotomized into any vigorous activity or none and similarly analyzed using mixed-effects logistic regression. Pedometer steps were collected each week of the intervention period from both participants and family members. The first day of the first week and the last day of the last week were excluded from the analysis because less than a full day may have occurred on those days. Steps per day were calculated using total steps in a week divided by number of days of pedometer use for each participant. Modeling was performed, again using a repeated measures Gamma regression approach with covariance pattern modeling (Fitzmaurice, Laird, & Ware, 2004). Multivariable regression models were estimated in the analyses using gender, study period, age at preintervention, body mass index (BMI) at preintervention, and years having diabetes at preinter-
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Number 6
vention as covariates previously identified in research on physical activity using a simultaneous regression approach (Polit, 2010). These adjusted models controlled for the effects of these covariates while estimating the change in physical activity to investigate the research hypothesis. Sensitivity analyses for missing data were conducted using multiple imputation with 20 imputations, and similar conclusions were found for all analyses. Analyses were performed in SAS v9.3 (SAS, 2014) and STATA v13 (STATA, 2013). A two-sided p-value 0) Total MET-min/week at T1 Total MET-min/week at T2 Total kilocalories/week at T1 Total kilocalories/week at T2 Pedometer steps per day Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Successful use for at least 5 of 7 days: Week 1 Successful use for at least 5 of 7 days: Week 2 Successful use for at least 5 of 7 days: Week 3 Successful use for at least 5 of 7 days: Week 4 Successful use for at least 5 of 7 days: Week 5 Successful use for at least 5 of 7 days: Week 6 Successful use for at least 5 of 7 days: Week 7 Successful use for at least 5 of 7 days: Week 8
Family members (n = 66)
1,113.1 1,550.6 3,431.0 3,336.2 1,867.8 2,262.2 18 16 6,113.7 6,987.4 8,277.1 9,583.8
2,013.9 [346.5] 2,372.2 [643.5] 4,314.9 [1,440.0] 3,785.0 [1,560.0] 4,432.3 [0.0] 4,781.7 [0.0] (28) (25) 6,427.8 [3,906.0] 7,796.6 [4,105.5] 8,675.6 [5,132.1] 10,492.9 [6,338.3]
1,237.2 2,415.2 3,384.3 4,549.4 2,503.7 3,330.4 20 22 6,779.5 9,590.7 8,729.1 13,097.1
2,482.9 [392.0] 3,501.7 [476.2] 4,140.8 [1,440.0] 4,176.5 [3,600.0] 6,077.5 [0.0] 6,184.4 [0.0] (30) (33) 8,841.9 [3,835.2] 10,446.2 [6,673.5] 10,632.3 [5,323.4] 15,009.3 [8,587.5]
4,939.7 4,510.0 5,012.1 5,129.8 5,000.1 5,105.2 5,031.9 5,949.5 32 40 48 42 33 31 37 17
3,702.2 [4,571.7] 3,193.4 [4,087.7] 3,483.7 [4,740.7] 3,508.3 [4,250.6] 3,361.6 [4,960.4] 3,128.0 [4,861.7] 3,521.7 [4,363.4] 3,572.6 [5,614.2] (49) (62) (74) (65) (51) (48) (57) (26)
5,373.2 4,971.2 5,080.7 5,230.7 4,370.2 4,840.7 4,451.9 4,141.7 29 27 30 32 33 27 31 16
3,462.7 [5,228.3] 3,206.1 [5,344.0] 2,834.8 [4,500.5] 3,350.2 [4,456.4] 2,882.8 [4,049.1] 3,369.7 [4,532.8] 2,899.0 [3,780.5] 3,165.7 [3,988.6] (44) (41) (45) (48) (50) (41) (47) (24)
TABLE 3. Repeated Measures Regression Results of IPAQ Measures (N = 131)1 Exp(b)2 (95% CI for Exp(b)) P-value Measure Walking MET-min/week Moderate MET-min/week Any vigorous activities3 Total MET-min/week Total Kilocalories/week
Patients (n = 65) 1.088 0.986 0.977 0.999 0.998
(1.049, 1.127)
POPULATIONS
AT
RISK ACROSS
THE
LIFESPAN: POPULATION STUDIES
Improving Physical Activity in Hispanics with Diabetes and their Families Jie Hu, PhD, RN, FAAN, Debra C. Wallace, PhD, RN, FAAN, Karen A. Amirehsani, PhD, FNP-BC, Thomas P. McCoy, MS, PStat, Sheryl L. Coley, DrPH, MPH, Kimberly D. Wiseman, MS, Zulema A. Silva, BS, and Christina R. Hussami, BA School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina Correspondence to: Jie Hu, School of Nursing, The University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402-6170. E-mail: [email protected]
ABSTRACT Objective: This study examined changes in physical activity among Hispanics with diabetes and their families who received an 8-week diabetes self-management intervention. Design: A quasi-experimental design was used to conduct a secondary analysis of physical activity data from two intervention studies that used the same protocols and measures. Sample: A total of 65 patients and 66 family members participated in the studies. Measures: Physical activity was measured with the International Physical Activity Questionnaire (IPAQ) and pedometers. Self-report of physical activity was collected pre- and postintervention, and pedometer data for the 8 weeks of the intervention period. Intervention: The interventions consisted of 8 weeks of educational sessions. Results: IPAQ walking Metabolic Equivalent of Task (MET)-minutes per week significantly increased for patients (p < .001) and family members (p < .001) from pre- to postintervention as did moderate activity MET-minutes/week for family members (p = .004). Based on pedometer steps, the percentage of sedentary patients declined from 38% to 17% over the intervention record; differences in pedometer steps over time were not significant for patients (p = .803) or family members (p = .144). Conclusions: Pedometers are a cost effective and user-friendly method of measuring physical activity. Pedometers can also serve as a motivator to help increase physical activity among Hispanics with diabetes and their family members. Key words: Hispanics and family members, intervention, pedometer, physical activity.
Background Physical activity (PA) is an essential element of type 2 diabetes (T2DM) self-management (Duvivier et al., 2013; Van Dijk, Tummers, Stehouwer, Hartgens, & Van Loon, 2012; Weinstock et al., 2011). Increased PA has been linked to improvements in body weight, body fat, cardiorespiratory fitness, waist circumference, HDL cholesterol, hs-CRP and HbA1c levels, and mental health status (Balducci et al., 2012; Ho, Dhaliwal, Hills, & Pal, 2012; Lincoln, Shepherd, Johnson, & Castaneda-Sceppa, 2011). PA among persons with T2DM has also been shown to reduce postprandial glucose elevations and glucose variability
independent of changes in physical fitness or adiposity (Mikus, Oberlin, Libla, Boyle, & Thyfault, 2012) and to improve insulin sensitivity and action (Lar€m, 2012; Nelson sen, Anderson, Ekblom, & Nystro et al., 2013). Current PA guidelines recommend 150 min/week of moderate-intensity aerobic activity, in addition to twice weekly muscle strengthening activities for all adults (Centers for Disease Control and Prevention, 2014), with encouragement to break PA into shorter periods of time, such as 10 min increments, if needed to achieve these goals. National U.S. data indicate that Hispanic men and women are more likely to be inactive or less
625
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Number 6
physically active than non-Hispanic White and Black men and women (Janssen, Carson, Lee, Katzmarzyk, & Blair, 2013). Additionally, they suffer higher rates of T2DM and obesity than non-Hispanic Whites (US Department of Health and Human Services, 2014). Given the high rates of inactivity, obesity, and diabetes among Hispanics, interventions are needed to increase physical activity. Previous studies have used a variety of methods to measure physical activity such as pedometers and steps per day, activity duration and intensity, and Metabolic Equivalent of Task (MET) minutes calculated from the International Physical Activity Questionnaire (IPAQ) and other self-report measures. Walking is the most common daily activity of adults, and pedometers are an inexpensive and widely used strategy for lay persons to track their steps. However, pedometers have not been widely used as an intervention strategy for improving PA among Hispanic adults (Ainsworth et al., 2013; Coffman, Ferguson, Steinman, Talbot, & DunbarJacob, 2013; Trudnak, Lloyd, Westhoff, & Corvin, 2011); prior PA studies with Hispanics have used pedometers as a measure for only 7 days, a limited amount of time (Ainsworth et al., 2013; Coffman et al., 2013; Drieling, Goldman Rosas, Ma, & Stafford, 2014). This analysis used both pedometers and self-report to assess changes in physical activity among Hispanics with diabetes and their family members over an 8-week period. The research hypothesis was that an 8-week family-based diabetes self-management intervention would show a significant improvement in physical activity, measured with pedometer and self-report, for both participants and their family members.
Methods Design and sample A quasi-experimental design was used to examine the effects of an 8-week, family-based intervention program for Hispanic adults with T2DM (type 2 diabetes) and their family members using a secondary analysis of physical activity data from two intervention studies that used the same protocols and measures. Data on physical activity for this analysis were collected at pre- and postintervention for both participants with T2DM and their family members in the two intervention studies.
November/December 2015
A total of 131 participants (65 patients and 66 family members) completed the study. Participants were recruited for the two studies in two rural counties with limited health access. Both counties had a Federally Qualified Health Center, lowincome charity clinic or Health Department and a small general hospital (one with 94 beds and one with 145 beds). Per capita income in the two counties was $21,384 and $22,624 (lower than the U.S. rate of $27,915), the unemployment rate was 10% (higher than the national average), and the population was 6.4–10.4% Hispanic (US Census Bureau, 2012). Participants were recruited through flyers distributed by clinic and physician office staff, face-toface waiting room conversations with study research assistants, announcements, postings at church meetings and through word of mouth. Criteria for inclusion of patients with diabetes were (a) self-identification as Hispanic, (b) age 18 years or older, (c) self-report of a medical diagnosis of T2DM, and (d) an adult family member willing to participate. Inclusion criteria for family members were (a) residence in the patient’s household and (b) age 18 years or older. Both patients and family members had to be able to speak either Spanish or English. Those who were pregnant, were diagnosed with type 1 diabetes, reported prior (past year) or current participation in other diabetes self-management intervention programs, or were cognitively impaired were excluded. Bilingual and bicultural team members were available to recruit, consent, and enroll persons. Potential participants met with team members in private rooms at study sites and made an appointment for a family session. At this initial session with each family dyad, the study purpose, format of the intervention and requirements of participants were shared, and informed consent and baseline data were collected from each participant. The university IRB approved conduct of the studies.
Intervention The two 8-week family-based interventions were rooted in social cognitive theory and used a modified version of a diabetes program based on the National Diabetes Education Program and National Standards for Diabetes Self-Management Education (www.ndep.nih.gov). The eight modules were designed to increase diabetes knowledge, overcome
Hu et al.: Physical Activity barriers to self-management, and foster lifestyle behavioral changes through family support and development of self-efficacy. All study materials were administered to participants in their choice of Spanish or English. All participants received a total of $120 grocery gift cards or cash incentive for completing the 8-week intervention and were provided a new lifestyle pedometer to retain for personal use. All content was tailored to low-literacy participants and integrated cultural beliefs and values. Details on the intervention, data collection, and the measures used in the studies have been published elsewhere (Hu, Wallace, McCoy, & Amirehsani, 2014).
Measures The IPAQ was used to measure self-reported physical activity. This short 9-item IPAQ form assesses the time over 7-day periods that respondents reported walking, moderate activity, and sedentary activity. The questionnaire was completed by each participant before and after the intervention. Walking Metabolic Equivalent of Task-min/week was estimated as 3.3 9 walking minutes 9 walking days; moderate activity MET-min/week as 4.0 9 moderate-intensity activity minutes 9 moderate activity days; and vigorous MET-min/week as 8.0 9 vigorous activity minutes 9 vigorous activity days. Total physical activity MET-min/ week was estimated as the total walking, moderate, and vigorous MET-min/week. Reliability and validity for the IPAQ have been established in studies conducted in 12 countries and for patients with T2DM (Centers for Disease Control and Prevention, 2010). Omron HJ-112 pedometers were used to measure 7-day step counts for each participant. The Omron pedometer has a 7-day memory and clock that automatically resets to zero at midnight each day, and it retains data on aerobic and daily step counts and walking distance. It is valid within the recommended 3% of steps walked, as confirmed in previous research (Holbrook, Barreira, & Kang, 2009; Zhu & Lee, 2010). Pedometers were given to participants at the first group meeting with instructions for use, correct wearing site, and use of “clips” to attach to clothing. The instructions included a reminder to wear the pedometer each day from the time when participants woke up until they went to bed at night for 7 consecutive days. In addition,
627
participants were asked to bring the pedometers to each of the 8-week intervention sessions. Steps were collected each week over the 8-week intervention period by study staff and recorded on separate data sheets for each participant. All participants were encouraged to look over the number of steps recorded each week to monitor their progress. Demographic data were also collected on all participants.
Analytic strategy Descriptive statistics including frequencies and percentages were used to summarize categorical measures, and means (M), standard deviations (SD), medians, minimums, and maximums were used to summarize continuous measures. Analyses were performed separately for patients and family members. To investigate the research hypothesis, repeated measures analyses were conducted using mixedeffects modeling to account for follow-up time and correlations among repeated observations for subjects using random effects. Because continuous measures were right skewed, Gamma mixed-effects regression with a log link function was performed. Gamma regression has been previously used to model skewed physical activity outcomes and in particular, METs estimated from the IPAQ (Lee, Xiang, & Hirayama, 2010). Values of zero were recoded as 0.1 for this modeling (zeroes were not prevalent except for vigorous activities). Vigorous activities were dichotomized into any vigorous activity or none and similarly analyzed using mixed-effects logistic regression. Pedometer steps were collected each week of the intervention period from both participants and family members. The first day of the first week and the last day of the last week were excluded from the analysis because less than a full day may have occurred on those days. Steps per day were calculated using total steps in a week divided by number of days of pedometer use for each participant. Modeling was performed, again using a repeated measures Gamma regression approach with covariance pattern modeling (Fitzmaurice, Laird, & Ware, 2004). Multivariable regression models were estimated in the analyses using gender, study period, age at preintervention, body mass index (BMI) at preintervention, and years having diabetes at preinter-
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Number 6
vention as covariates previously identified in research on physical activity using a simultaneous regression approach (Polit, 2010). These adjusted models controlled for the effects of these covariates while estimating the change in physical activity to investigate the research hypothesis. Sensitivity analyses for missing data were conducted using multiple imputation with 20 imputations, and similar conclusions were found for all analyses. Analyses were performed in SAS v9.3 (SAS, 2014) and STATA v13 (STATA, 2013). A two-sided p-value 0) Total MET-min/week at T1 Total MET-min/week at T2 Total kilocalories/week at T1 Total kilocalories/week at T2 Pedometer steps per day Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Successful use for at least 5 of 7 days: Week 1 Successful use for at least 5 of 7 days: Week 2 Successful use for at least 5 of 7 days: Week 3 Successful use for at least 5 of 7 days: Week 4 Successful use for at least 5 of 7 days: Week 5 Successful use for at least 5 of 7 days: Week 6 Successful use for at least 5 of 7 days: Week 7 Successful use for at least 5 of 7 days: Week 8
Family members (n = 66)
1,113.1 1,550.6 3,431.0 3,336.2 1,867.8 2,262.2 18 16 6,113.7 6,987.4 8,277.1 9,583.8
2,013.9 [346.5] 2,372.2 [643.5] 4,314.9 [1,440.0] 3,785.0 [1,560.0] 4,432.3 [0.0] 4,781.7 [0.0] (28) (25) 6,427.8 [3,906.0] 7,796.6 [4,105.5] 8,675.6 [5,132.1] 10,492.9 [6,338.3]
1,237.2 2,415.2 3,384.3 4,549.4 2,503.7 3,330.4 20 22 6,779.5 9,590.7 8,729.1 13,097.1
2,482.9 [392.0] 3,501.7 [476.2] 4,140.8 [1,440.0] 4,176.5 [3,600.0] 6,077.5 [0.0] 6,184.4 [0.0] (30) (33) 8,841.9 [3,835.2] 10,446.2 [6,673.5] 10,632.3 [5,323.4] 15,009.3 [8,587.5]
4,939.7 4,510.0 5,012.1 5,129.8 5,000.1 5,105.2 5,031.9 5,949.5 32 40 48 42 33 31 37 17
3,702.2 [4,571.7] 3,193.4 [4,087.7] 3,483.7 [4,740.7] 3,508.3 [4,250.6] 3,361.6 [4,960.4] 3,128.0 [4,861.7] 3,521.7 [4,363.4] 3,572.6 [5,614.2] (49) (62) (74) (65) (51) (48) (57) (26)
5,373.2 4,971.2 5,080.7 5,230.7 4,370.2 4,840.7 4,451.9 4,141.7 29 27 30 32 33 27 31 16
3,462.7 [5,228.3] 3,206.1 [5,344.0] 2,834.8 [4,500.5] 3,350.2 [4,456.4] 2,882.8 [4,049.1] 3,369.7 [4,532.8] 2,899.0 [3,780.5] 3,165.7 [3,988.6] (44) (41) (45) (48) (50) (41) (47) (24)
TABLE 3. Repeated Measures Regression Results of IPAQ Measures (N = 131)1 Exp(b)2 (95% CI for Exp(b)) P-value Measure Walking MET-min/week Moderate MET-min/week Any vigorous activities3 Total MET-min/week Total Kilocalories/week
Patients (n = 65) 1.088 0.986 0.977 0.999 0.998
(1.049, 1.127)
