1. PEDS 409 Group 1 Nicholas Jendzjowsky Cameron McKnight Emily Motyka Kristen Rosichuk Physician Advice to the Elderly About Physical Activity

2. Also called sample surveys Also called sample surveys Uses surveys to directly study the characteristics of populations Uses surveys to directly study the characteristics of populations Tools used in survey research are: Tools used in survey research are: Interviews Interviews Focus groups (small group of respondents are interviewed and re-interviewed) Focus groups (small group of respondents are interviewed and re-interviewed) Mail questionnaires Mail questionnaires

3. Alseny Balde- Cecil County Health Department, Elkton, MD. Alseny Balde- Cecil County Health Department, Elkton, MD. Jaime Figuras- Public health officer, City of Wilmington, DE. Jaime Figuras- Public health officer, City of Wilmington, DE. Dawn A. Hawking- Health Care Financing Administration, Baltimore, MD. Dawn A. Hawking- Health Care Financing Administration, Baltimore, MD. John R. Miller- Network to Improve Community Health, Greenbelt, MD. John R. Miller- Network to Improve Community Health, Greenbelt, MD.

4. Do Physicians counsel their elderly patients to exercise? Do Physicians counsel their elderly patients to exercise? Do patients follow their doctors' advice? Do patients follow their doctors' advice? Does it make a difference in the patient's health status? Does it make a difference in the patient's health status?

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

6. Two Part Questionnaire Two Part Questionnaire (Adapted from Cartmel & Moon, 1992; Godin & Shephard, 1985) (Adapted from Cartmel & Moon, 1992; Godin & Shephard, 1985) 1 st : demographic information 1 st : demographic information 2 nd : height, weight, general health, physician advice about physical activity, and type of physical activity performed. 2 nd : height, weight, general health, physician advice about physical activity, and type of physical activity performed. 146 Completed (36.5% completion rate) 146 Completed (36.5% completion rate)

7. Characteristics of the elderly who were or were not counseled to exercise were compared using univariate analysis. Characteristics of the elderly who were or were not counseled to exercise were compared using univariate analysis. Categorical variables were assessed using chi-square tests. Categorical variables were assessed using chi-square tests. Continuous variables were assessed using Students t tests. Continuous variables were assessed using Students t tests.

8. How Health Status was Determined How Health Status was Determined Health risk determined by BMI, and self- reported health status. Health risk determined by BMI, and self- reported health status. Men with a BMI of 27.8 or more and women with a BMI of 27.3, are considered overweight, and people with a BMI of 30 or more are considered obese. Men with a BMI of 27.8 or more and women with a BMI of 27.3, are considered overweight, and people with a BMI of 30 or more are considered obese.

9. 46.4% surveyed were overweight, (higher incidence for women than men, 51.2% vs. 28.9%.) 46.4% surveyed were overweight, (higher incidence for women than men, 51.2% vs. 28.9%.) 38% of participants with college education were overweight, 46% with a high school education were overweight, and 45% of those with less than a high school education were overweight. 38% of participants with college education were overweight, 46% with a high school education were overweight, and 45% of those with less than a high school education were overweight. 28% of women were obese, compared with 21% of men. 28% of women were obese, compared with 21% of men. 29% of White participants were obese, 19% of racial minority racial groups were obese. 29% of White participants were obese, 19% of racial minority racial groups were obese. 30% of participants self-reported their health status to be poor. 30% of participants self-reported their health status to be poor.

10. Physician Counseling Physician Counseling 94% had visited doctor in past year, but only 61.6% reported receiving advice about physical activity. 94% had visited doctor in past year, but only 61.6% reported receiving advice about physical activity. Mean age of those receiving physician advice was 77.0, versus 79.2 for those who were not receiving advice. Mean age of those receiving physician advice was 77.0, versus 79.2 for those who were not receiving advice. Those with a higher BMI, reported more physician advice on activity. ( BMI 28.7 for those receiving advice vs. BMI of 26.2 who did not receive advice.) Those with a higher BMI, reported more physician advice on activity. ( BMI 28.7 for those receiving advice vs. BMI of 26.2 who did not receive advice.)

11. 3 Classifications of Physical Activity. 3 Classifications of Physical Activity. Sitting Physical Activities: sewing, playing musical instrument, knitting. Sitting Physical Activities: sewing, playing musical instrument, knitting. Light Physical Activities: sweeping, mopping, grocery shopping Light Physical Activities: sweeping, mopping, grocery shopping Moderate to Heavy Activities: walking, cycling, running Moderate to Heavy Activities: walking, cycling, running

12. The number of times per week sitting and light physical activities did not vary according to physician advice. The number of times per week sitting and light physical activities did not vary according to physician advice. Those who participated in moderate to heavy physical activity had received advice. Mean= 4.4 times/week for those receiving advice vs. 3.1 times/week for those not receiving advice. Those who participated in moderate to heavy physical activity had received advice. Mean= 4.4 times/week for those receiving advice vs. 3.1 times/week for those not receiving advice.

13. Prevalence of physician advice was higher among men, than women. Prevalence of physician advice was higher among men, than women. Those who were married reported more advice than those who were single, divorced, or widowed. Those who were married reported more advice than those who were single, divorced, or widowed. There was no difference in race or education There was no difference in race or education for those who received advice and those who did not. for those who received advice and those who did not.

14. Counseling on physical activity is not offered as often as recommended for elderly patients. Counseling on physical activity is not offered as often as recommended for elderly patients. Physician counseling could be improved if the physician made a stronger effort to counsel patients on a more regular basis. Physician counseling could be improved if the physician made a stronger effort to counsel patients on a more regular basis. Counseling should be provided to all patients, and should not be a result of gender or health status. Counseling should be provided to all patients, and should not be a result of gender or health status.

15. 1. SAMPLING Chose a limited population Chose a limited population Senior citizens living in public housing Senior citizens living in public housing High-rise building with low incomes High-rise building with low incomes Homogeneous study group Homogeneous study group The lack of a diverse population for sampling will result in a poor ability to generalize the results of the survey to the greater elderly population.

16. 2. SURVEY RESPONSE Distributed 400 surveys and received 146 completed surveys back Distributed 400 surveys and received 146 completed surveys back 36.5% response 36.5% response The non-responders might be part of a qualitatively distinct group from those who did respond resulting in inaccurate results The researchers needed to return to the buildings and distribute the survey again.

17. 3. SELF-REPORTED HEALTH STATUS Recall errors Recall errors Elderly may have problems with their memory (Alzheimer's) Elderly may have problems with their memory (Alzheimer's) May lie on their questionnaires May lie on their questionnaires

18. 4. CLARIFYING THE OBJECTIVE Closed-ended questions Closed-ended questions Survey did not specify on the amount and quality of counseling Survey did not specify on the amount and quality of counseling Lack of knowledge in the duration of each activity Lack of knowledge in the duration of each activity

19. What do elderly populations perceive Phys. Act. to be? What do elderly populations perceive 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. in elderly populations and how great an effect does this have on present health status (rate past phys. act. In categories of intensity, duration and type) What is the past history of Phys. Act. in elderly populations and how great an effect does this have on present health status (rate past phys. act. In categories of intensity, duration and type)

20. Self efficacy of elderly populations and exercise Self efficacy of elderly populations and exercise Physicians self efficacy on prescribing exercise Physicians self efficacy on prescribing exercise Adherence by the elderly to phys. act. Adherence by the elderly to phys. act. Did the elderly engage in phys. act. After the recommendation by their doctor Did the elderly engage in phys. act. After the recommendation by their doctor Other populations? Other populations?

21. W.r.t. to this design. It could have also: W.r.t. to this design. It could have also: Describe Describe Gather information Gather information No intervention No intervention Simple Observation Simple Observation Elderly population’s perceived notion of importance of physical activity Elderly population’s perceived notion of importance of physical activity What it is elderly population’s think to be fitness activities? What it is elderly population’s think to be fitness activities?

22. Elderly population’s perceived efficacy of their physician on this matter of physical activity Elderly population’s perceived efficacy of their physician on this matter of physical activity Do the elderly think that they need to engage in physical activity for health purposes? Do the elderly think that they need to engage in physical activity for health purposes?

23. Survey or questionnaire type research seeks to find answer to direct questions Survey or questionnaire type research seeks to find answer to direct questions Describe a certain problem Describe a certain problem More research is conducted to find solutions to the problem questioned More research is conducted to find solutions to the problem questioned

24. Balde, A., Figueras, J., Hawking, D.A., Miller, J.R. (2003) Physician Advice to the Elderly About Physical Activity. Journal of Aging and Physical Activity, 11:90-8. Balde, A., Figueras, J., Hawking, D.A., Miller, J.R. (2003) Physician Advice to the Elderly About Physical Activity. Journal of Aging and Physical Activity, 11:90-8.