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Description
This study examines cognitive and motor function in typical older adults following acute exercise. Ten older adults (Mage = 65.1) completed a single session of assisted cycling (AC) (i.e., exercise accomplished through the use of a motor), voluntary cycling (VC) (self-selected cadence), and a no cycling (NC) control group. These sessions were randomized and separated by approximately one week. Both ACT and VC groups rode a stationary bicycle for 30-minutes each session. These sessions were separated by at least two days. Participants completed cognitive testing that assessed information processing and set shifting and motor testing including gross and fine motor performance at the beginning and at the end of each session. Consistent with our hypothesis concerning manual dexterity, the results showed that manual dexterity improved following the ACT session more than the VC or NC sessions. Improvements in set shifting were also found for the ACT session but not for the VC or NC sessions. The results are interpreted with respect to improvements in neurological function in older adults following acute cycling exercise. These improvements are balance, manual dexterity, and set shifting which have a positive effects on activities of daily living; such as, decrease risk of falls, improve movements like eating and handwriting, and increase ability to multitask.
ContributorsSemken, Keith (Author) / Ringenbach, Shannon (Thesis advisor) / Der Ananian, Cheryl (Committee member) / Buman, Matthew (Committee member) / Arizona State University (Publisher)
Created2015
Description
The purpose of this phenomenological study was to explore the cultural, social, environmental, and gender factors that may influence physical activity (PA) in older Mexican American (MA) men living in Tucson, Arizona. The Mexican origin population is the fastest growing Hispanic subgroup in our nation, increasing from 20.6 million in the year 2000 to 31.8 million in 2010. Arizona has the sixth largest Hispanic population in the United States and the Mexican origin population accounts for 91% of Arizona's Hispanics. Despite the fast growing Mexican population, there are a limited number of studies that examine MAs and PA. There are even fewer interventions created to foster PA among older (≥65 years old) MA men. Fourteen individual interviews were conducted with older MA men living in Tucson, Arizona. Data was collected, organized, and analyzed according to the methodologies of Clark Moustakas and the Social Ecology Model for Health Promotion framework. Six themes emerged which reflected the older MA male's perception of health, masculinity, and physical activity: a) Retirement promotes self-care behaviors, b) Women, health care providers, and the Internet are important in promoting health, c) Aging changes physical activity, d) I take care of myself, e) Physical activity is a personal choice and lifestyle, and f) I learn and make adjustments as needed. Themes were used to create textural and structural descriptions of their experiences. Descriptions were formed into the essence of the phenomenon. The results of this study increase our understanding of health, masculinity, and physical activity in older MA men. This research will inform the development of an evidence-based PA intervention to promote cardiovascular (CV) health in older MA men that may be implemented in a variety of community-based settings.
ContributorsDowling, Evangeline M (Author) / Hooker, Steven (Thesis advisor) / Grando, Victoria (Committee member) / Der Ananian, Cheryl (Committee member) / Larkey, Linda (Committee member) / Arizona State University (Publisher)
Created2015
Effect of a Wii Fit® intervention on balance, muscular fitness, and bone health in middle-aged women
Description
Sustaining a fall can be hazardous for those with low bone mass. Interventions exist to reduce fall-risk, but may not retain long-term interest. "Exergaming" has become popular in older adults as a therapy, but no research has been done on its preventative ability in non-clinical populations. The purpose was to determine the impact of 12-weeks of interactive play with the Wii Fit® on balance, muscular fitness, and bone health in peri- menopausal women. METHODS: 24 peri-menopausal-women were randomized into study groups. Balance was assessed using the Berg/FICSIT-4 and a force plate. Muscular strength was measured using the isokinetic dynamometer at 60°/180°/240°/sec and endurance was assessed using 50 repetitions at 240°/sec. Bone health was tracked using dual-energy x-ray absorptiometry (DXA) for the hip/lumbar spine and qualitative ultrasound (QUS) of the heel. Serum osteocalcin was assessed by enzyme immunoassay. Physical activity was quantified using the Women's Health Initiative Physical Activity Questionnaire and dietary patterns were measured using the Nurses' Health Food Frequency Questionnaire. All measures were repeated at weeks 6 and 12, except for the DXA, which was completed pre-post. RESULTS: There were no significant differences in diet and PA between groups. Wii Fit® training did not improve scores on the Berg/FICSIT-4, but improved center of pressure on the force plate for Tandem Step, Eyes Closed (p-values: 0.001-0.051). There were no significant improvements for muscular fitness at any of the angular velocities. DXA BMD of the left femoral neck improved in the intervention group (+1.15%) and decreased in the control (-1.13%), but no other sites had significant changes. Osteocalcin indicated no differences in bone turnover between groups at baseline, but the intervention group showed increased bone turnover between weeks 6 and 12. CONCLUSIONS: Findings indicate that WiiFit® training may improve balance by preserving center of pressure. QUS, DXA and osteocalcin data confirm that those in the intervention group were experiencing more bone turnover and bone formation than the control group. In summary, twelve weeks of strength /balance training with the Wii Fit® shows promise as a preventative intervention to reduce fall and fracture risk in non-clinical middle aged women who are at risk.
ContributorsWherry, Sarah Jo (Author) / Swan, Pamela D (Thesis advisor) / Adams, Marc (Committee member) / Der Ananian, Cheryl (Committee member) / Sweazea, Karen (Committee member) / Vaughan, Linda (Committee member) / Arizona State University (Publisher)
Created2014
Description
Research indicates that adults are not acquiring enough physical activity. Increasing the use of stairs is an accessible way to weave high intensity physical activity into the daily routine. The purpose of this study is to test the effect of four environmental changes on ascending stair use in a mixed population of college students, faulty, and staff on a southwest college campus. The study design included a 10-week time series design with alternating baseline and intervention phases, including a directional cue represented by footprints on the ground, a positive prompt, a deterrent prompt and a combination phase. Data was collected with both an in-person tally and a video recording device. The study included 6,140 observations and coded variables included stair use, sex, number of bags carried, temperature, and volume. Rater reliability ranged from .81 to 1.0. Multivariate logistic regression was used to perform the statistic analysis. Stair use increased significantly from Washout 1 and the positive prompting phase with a 7% absolute increase and an odds ratio of 1.35 (95% CI 1.080-1.696). Stair use during the footprint phase, deterrent phase and combination phase did not increase significantly compared to the previous baseline or washout phases. Day of the week (Monday=reference, Tuesday CI=1.626, 95% CI 1.298-2.011, Wednesday OR=0.457, 95% CI 0.248-0.841, Thursday OR=1.434, 95% CI 1.164-1.766), sex (OR=1.376, 95% CI 1.173-1.613) and volume (OR=1.007, 95% CI 1.005-1.008) were significantly correlated to stair use. Women used the stairs more than men and higher volume situations were related to increased stair use. Temperature and baggage number were not related to stair use. The results of this study indicate that positive prompting with an environmental message theme is an effective method to increase stair use in a university setting.
ContributorsFord, Marley (Author) / Adams, Marc (Thesis advisor) / Der Ananian, Cheryl (Committee member) / Vaughan, Linda (Committee member) / Arizona State University (Publisher)
Created2015
Description
Background and purpose: Regular physical activity (PA) provides benefits for cognitive health and helps to improve or maintain quality of life among older adults. Objective PA measures have been increasingly used to overcome limitations of self-report measures. The purpose of this study was to investigate the association of objectively measured PA and sedentary time with cognitive function among older adults.
Methods: Participants were recruited from the parent REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. ActicalTM accelerometers provided estimates of PA variables, including moderate-to-vigorous PA (MVPA), high light PA (HLPA), low light PA (LLPA) and sedentary time, for 4-7 consecutive days. Prevalence and incidence of cognitive impairment were defined by the Six-Item Screener. Letter fluency, animal fluency, word list learning and Montreal Cognitive Assessment (orientation and recall) were conducted to assess executive function and memory.
Results: Of the 7,339 participants who provided accelerometer wear data > 4 days (70.1 ± 8.6 yr, 54.2% women, 31.7% African American), 320 participants exhibited impaired cognition. In cross-sectional analysis, participants in the highest MVPA% quartile had 39% lower odds of cognitive impairment than those in the lowest quartile (OR: 0.61, 95% C.I.: 0.39-0.95) after full adjustment. Further analysis shows most quartiles of MVPA% and HLPA% were significantly associated with executive function and memory (P<0.01). During 2.7 ± 0.5 years of follow-up, 3,385 participants were included in the longitudinal analysis, with 157 incident cases of cognitive impairment. After adjustments, participants in the highest MVPA% quartile had 51% lower hazards of cognitive impairment (HR: 0.49, 95% C.I.: 0.28-0.86). Additionally, MVPA% was inversely associated with change in memory z-scores (P<0.01), while the highest quartile of HLPA% was inversely associated with change in executive function and memory z-scores (P<0.01).
Conclusion: Higher levels of objectively measured MVPA% were independently associated with lower prevalence and incidence of cognitive impairment, and better memory and executive function in older adults. Higher levels of HLPA% were also independently associated with better memory and executive function. The amount of MVPA associated with lower risk of cognitive impairment (259 min/week) is >70% higher than the minimal amount of MVPA recommended by PA guidelines.
Methods: Participants were recruited from the parent REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. ActicalTM accelerometers provided estimates of PA variables, including moderate-to-vigorous PA (MVPA), high light PA (HLPA), low light PA (LLPA) and sedentary time, for 4-7 consecutive days. Prevalence and incidence of cognitive impairment were defined by the Six-Item Screener. Letter fluency, animal fluency, word list learning and Montreal Cognitive Assessment (orientation and recall) were conducted to assess executive function and memory.
Results: Of the 7,339 participants who provided accelerometer wear data > 4 days (70.1 ± 8.6 yr, 54.2% women, 31.7% African American), 320 participants exhibited impaired cognition. In cross-sectional analysis, participants in the highest MVPA% quartile had 39% lower odds of cognitive impairment than those in the lowest quartile (OR: 0.61, 95% C.I.: 0.39-0.95) after full adjustment. Further analysis shows most quartiles of MVPA% and HLPA% were significantly associated with executive function and memory (P<0.01). During 2.7 ± 0.5 years of follow-up, 3,385 participants were included in the longitudinal analysis, with 157 incident cases of cognitive impairment. After adjustments, participants in the highest MVPA% quartile had 51% lower hazards of cognitive impairment (HR: 0.49, 95% C.I.: 0.28-0.86). Additionally, MVPA% was inversely associated with change in memory z-scores (P<0.01), while the highest quartile of HLPA% was inversely associated with change in executive function and memory z-scores (P<0.01).
Conclusion: Higher levels of objectively measured MVPA% were independently associated with lower prevalence and incidence of cognitive impairment, and better memory and executive function in older adults. Higher levels of HLPA% were also independently associated with better memory and executive function. The amount of MVPA associated with lower risk of cognitive impairment (259 min/week) is >70% higher than the minimal amount of MVPA recommended by PA guidelines.
ContributorsZhu, Wenfei (Author) / Hooker, Steven P (Thesis advisor) / Wadley, Virginia (Committee member) / Ainsworth, Barbara (Committee member) / Der Ananian, Cheryl (Committee member) / Buman, Matthew (Committee member) / Arizona State University (Publisher)
Created2015
Description
Purpose: This study explored the potential correlates of exercise self-efficacy among older adults with a self-reported diagnosis of arthritis. Methods: This study was a secondary data analysis and used a cross-sectional design. Data was collected from a convenience sample of Non-Hispanic White and Non-Hispanic Black individuals between 2006-2008 (N=208). Descriptive statistics were run to assess means and frequencies within the sample. Bivariate statistics (Pearson and Spearman correlations, T-tests and one-way analysis of variance) were run to examine relationships between the independent and dependent variables. Multiple linear regression analyses were conducted to examine independent predictors of self-efficacy for exercise (SEE) and barriers self-efficacy for exercise (BSE). Results: Participants were predominantly female (85.6%), white (62.9%), retired (58.1%) and had a mean age of 66.6 [10.7] years. For education level, 23.4% reported a Master’s degree or higher and 18.6% reported they had at most a high school degree or GED. Nearly 47% of the sample were classified as obese based on self-reported body mass index (BMI) and 68.3% of the sample were not meeting the American College of Sports Medicine physical activity (PA) recommendations. Participants reported a relatively high BSE (22.6) and an average SEE (22.7). Significant positive associations were seen with outcome expectation for exercise (EOE), social support, and total minutes of PA and negative associations with BMI, physical function, pain, and negative affect with SEE and BSE. Meeting the PA guidelines (t134.5=4.60, 95%CI= 4.7(6.71-2.68), p<0.001) and being white (t164=2.82, 95%CI=2.82(0.57-5.08), p=0.014) were associated with SEE and BSE (t165=3.42, 95%CI= 4.37(6.89-1.85), p=0.001) and (t164=2.34, 95%CI= 2.95(0.46-5.43), p=0.021), respectively. In regression analyses, significant predictors of SEE were education (p=.006), physical function (p=.006) and EOE (p<.001). Significant predictors of BSE were physical function (p=.020), social support (p=.031), EOE (p=<.001), education level (p=.037), and total minutes of PA (p=.022). The variables in the SEE model accounted for 50.5% (R=.737, R2=.505) of the total variance and the variables in BSE model accounted for 41.1% (R=.672, R2=.411) of the total variance of the model. Discussion: EOE appears to be an important predictor of SEE and BSE. Examining the temporal relationship between EOE and SEE is warranted.
ContributorsDhālīwāla, Simarana (Author) / Der Ananian, Cheryl (Thesis advisor) / Sebren, Ann (Committee member) / Hrncir, Shawn (Committee member) / Arizona State University (Publisher)
Created2016
Description
ABSTRACT
The purpose of this study was two-fold. In Specific Aim One, we examined the associations between education level, personal trainer credentials and characteristics, and knowledge of exercise science and personal training principles. In Specific Aim Two we examined associations between education, personal trainer credentials and knowledge of personal trainers with client retention. This study utilized a cross-sectional research design. An anonymous electronic survey was used to collect the data. Eligible participants (N=226) were individuals who were providing one-on-one personal training services for at least one client. All data were assessed for normality prior to data analysis. Descriptive statistics were used to evaluate sample characteristics. Mean and standard deviations, median and interquartile range [IQR] or frequency and percentages were reported for the sample characteristics. Bivariate associations were examined with dependent t-tests and one-way ANOVAs for normally distributed data. Mann- Whitney U and Kruskal-Wallis tests were used for non-normally distributed variables. The median knowledge score for the sample was 6.0 [3.00] points, out of a possible 24, with 92.5% of the sample scoring 10 or lower. Sex (Male/Female), education level, having a degree in the field, certification status (yes
o) and number of certifications were not associated with knowledge scores (p > 0.05). Years of experience in personal training was positively associated with mean knowledge scores (H(3) = 9.280, p = 0.026). Sex of the personal trainer, having a degree in the field (yes
o), the number of personal trainer certifications, the cost of training, the type of facility, the type of employment of the personal trainer and knowledge scores were not associated with client retention (p > 0.05). Education level (F3,87 = 8.176, p < 0.001), personal training certification (yes
o) (t38 = 2.277, p = 0.029), years of experience (F3, 87 = 3.169, p = 0.028), facility size (F4,84 = 8.049, p < 0.001), and exercise science degree type (F3,48 = 6.008, p = 0.001) were all associated with client retention. This study provides insight on knowledge retention of active personal trainers on subject matter deemed foundational by four certifying organizations. The findings should influence both the preparatory learning and well as continuing education approaches of both certifying organizations and institutions of higher learning.
The purpose of this study was two-fold. In Specific Aim One, we examined the associations between education level, personal trainer credentials and characteristics, and knowledge of exercise science and personal training principles. In Specific Aim Two we examined associations between education, personal trainer credentials and knowledge of personal trainers with client retention. This study utilized a cross-sectional research design. An anonymous electronic survey was used to collect the data. Eligible participants (N=226) were individuals who were providing one-on-one personal training services for at least one client. All data were assessed for normality prior to data analysis. Descriptive statistics were used to evaluate sample characteristics. Mean and standard deviations, median and interquartile range [IQR] or frequency and percentages were reported for the sample characteristics. Bivariate associations were examined with dependent t-tests and one-way ANOVAs for normally distributed data. Mann- Whitney U and Kruskal-Wallis tests were used for non-normally distributed variables. The median knowledge score for the sample was 6.0 [3.00] points, out of a possible 24, with 92.5% of the sample scoring 10 or lower. Sex (Male/Female), education level, having a degree in the field, certification status (yes
o) and number of certifications were not associated with knowledge scores (p > 0.05). Years of experience in personal training was positively associated with mean knowledge scores (H(3) = 9.280, p = 0.026). Sex of the personal trainer, having a degree in the field (yes
o), the number of personal trainer certifications, the cost of training, the type of facility, the type of employment of the personal trainer and knowledge scores were not associated with client retention (p > 0.05). Education level (F3,87 = 8.176, p < 0.001), personal training certification (yes
o) (t38 = 2.277, p = 0.029), years of experience (F3, 87 = 3.169, p = 0.028), facility size (F4,84 = 8.049, p < 0.001), and exercise science degree type (F3,48 = 6.008, p = 0.001) were all associated with client retention. This study provides insight on knowledge retention of active personal trainers on subject matter deemed foundational by four certifying organizations. The findings should influence both the preparatory learning and well as continuing education approaches of both certifying organizations and institutions of higher learning.
ContributorsPreston, John H. (Author) / Der Ananian, Cheryl (Thesis advisor) / Berger, Christopher G (Committee member) / Vezina, Jesse (Committee member) / Arizona State University (Publisher)
Created2018
Description
The promulgation of the thin-ideal is associated with bulimia, dieting, supplement use, negative affect, and body dissatisfaction. “Fitspiration” was created as an “antidote” to the thin-ideal through the promotion of healthy eating and exercise; however, research indicates Fitspiration continues to promote the thin-ideal with similarly detrimental outcomes. Recently, research has shifted from a focus on body disturbance to concepts of positive body image (Halliwell, 2015), often researched through the concept of body appreciation. While the research is limited, a few studies have shown increases in body appreciation and mood after viewing body positive images. Therefore, the purpose of this study was to experimentally examine the impact of exposure to body positive and Fitspiration Instagram images on the body satisfaction, body appreciation, and mood of undergraduate women. Participants were 98 female undergraduate students (18-29 years old) currently attending Arizona State University. Participants were randomly assigned to view Fitspiration, Body Positive, or appearance neutral Instagram images. Dependent variables of state body appreciation, state body dissatisfaction, and state mood were measured using Visual Analogue Scales. Trait thin-ideal internalization, trait social comparison, and body mass index (BMI) were included as covariates. Qualitative short-answer questions were included as an exploratory aim. A one-way analysis of covariance (ANCOVA) was used to examine group differences in post-test scores followed by post-hoc analyses using the Bonferroni correction when significant. After controlling for baseline score, trait thin-ideal internalization, trait social comparison, and BMI, post-test body appreciation scores within Fitspiration condition were significantly lower than the control (MD= 9.818, SE=3.743, p=.031) and Body Positive condition (MD=9.372, SE=3.492, p=0.26). After controlling for baseline score, trait thin-ideal internalization, trait social comparison, and BMI, the Body Positive condition demonstrated significantly higher post-test body satisfaction scores than the control (MD= 11.134, SE=3.093, p=.002) and Fitspiration condition (MD=17.312, SE=3.092, p=<.001). After controlling for baseline scores, mean post-test positive mood scores within the Fitspiration group were significantly lower than the Body Positive condition (MD=-0.378, SE=.135, p=.019). There were no differences in post-test negative mood across conditions. Findings suggest short-term exposure to body positive images may improve body appreciation, Body Positivity, and positive mood among undergraduate females.
ContributorsSerlin, Danielle Nicole (Author) / Der Ananian, Cheryl (Thesis advisor) / Chisum, Jack (Committee member) / Sebren, Ann (Committee member) / Arizona State University (Publisher)
Created2020
Description
This study aimed to investigate the effects of specific macronutrient feedings on competitive golf performance and perceived levels of fatigue and alertness. Participants played three, nine hole rounds of golf, consuming an isocaloric beverage as a control (CON), with the addition of carbohydrate (CHO), or combination of protein and carbohydrate (COM). Physiological and performance measurements were taken before, during, and following each nine hole round. Performance measurements include driving accuracy (DA), driving distance (DD), iron accuracy (IA), chipping accuracy (CA), and putting accuracy (PA). Pre-golf hydration status (urine specific gravity [USG]) and Sweat Rate during golf performance showed no significant differences between trials. All nine hole rounds were performed in ~2 hours. Environmental conditions were similar for all three testing days (mean WBGT=10.946). No significant differences were seen in Driving Distance, Driving Accuracy, and Iron Accuracy for all nine holes between groups receiving different macronutrient feedings. Chipping Accuracy was significantly better in CON trial compared to CHO (p=0.004) and COM (p=0.019). No significant differences were seen in putting make percentages. COM trial significantly lowered Perceived Levels of Fatigue (p=0.019) compared to CON. The CHO trial showed significant improvements in DA compared to CON (13.7 vs. 44.1, p=0.012) and COM (13.7 vs. 33.6, p=0.004) in the first four holes. In the last five holes, the COM trial showed significant improvements in DA compared to CHO (17.5 vs. 29.7, p=0.007). Low Handicap golfers (3 +/- 3) performed significantly better than High Handicap golfers (14 +/- 3.6) in DD (265 vs. 241, p<0.001), DA (15.0 vs. 29.3, p=0.004), IA (15.2 vs. 25.2, p<0.001), CA (52.0 vs. 61.5, p=0.027), and PA 5ft (64% vs. 40%, p=0.003). High Handicap players showed no significant differences between the three trials for any golf performance measurements. Low Handicap players showed significant improvements in DA for COM trial compared to CON trial (13.6 vs. 27.6, p=0.003). The results suggest that carbohydrates at the start and a combination of carbohydrate and protein is beneficial at the second part of 9 holes to improve golf performance and maintain levels of fatigue, however, it needs to be investigated how this knowledge will relate to playing more holes.
ContributorsThompsett, Daniel James (Author) / Wardenaar, Floris (Thesis advisor) / Der Ananian, Cheryl (Committee member) / Hondula, David M. (Committee member) / Arizona State University (Publisher)
Created2020
Description
Background: Exercise is Medicine (EIM) is a health promotion strategy for addressing physical inactivity in healthcare. However, it is unknown how to successfully implement the processes.
Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.
Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.
Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.
Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.
Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.
Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.
Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.
Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.
ContributorsBirchfield, Natasha R (Author) / Der Ananian, Cheryl (Thesis advisor) / Krasnow, Aaron (Committee member) / Doebbeling, Bradley (Committee member) / Adams, Marc (Committee member) / Swan, Pamela (Committee member) / Arizona State University (Publisher)
Created2019