Current Role at Stanford

Senior Research Scholar at the Stanford Prevention Research Center
Research Project Director for the Healthy Aging Research and Technology Solutions lab (HARTS)

Education & Certifications

  • Postdoc, Stanford University, Cardiovascular Disease Prevention (1999)
  • PhD, SDSU/UCSD Joint Doctoral Program, Clinical Psychology (1997)
  • BA, Stanford University, Psychology (1992)


  • The LIFE Study, Stanford Prevention Research Center (9/1/2009 - 12/20/2013)

    The LIFE Study is a multi-center randomized controlled trial to compare a moderate-intensity physical activity program to a successful aging health education program in sedentary older persons who are at risk of disability.


    1070 Arastradero Road Palo Alto CA 94304


    • Abby King, Professor of Health Research and Policy and of Medicine (Stanford Prevention Research Center), Stanford University School of Medicine

Service, Volunteer and Community Work

  • Advisory Board Member, Sexual Violence Advisory Board (9/1/2009)

    Sexual Violence Advisory Board


    Vaden Student Health Center, Stanford, CA

  • Advisor, Chi Omega Sorority (9/1/2005 - Present)


    Stanford University


Professional Affiliations and Activities

  • Member, Society of Behavioral Medicine (1992 - Present)


All Publications

  • Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults The LIFE Randomized Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Sink, K. M., Espeland, M. A., Castro, C. M., Church, T., Cohen, R., Dodson, J. A., Guralnik, J., Hendrie, H. C., Jennings, J., Katula, J., Lopez, O. L., McDermott, M. M., Pahor, M., Reid, K. F., Rushing, J., Verghese, J., Rapp, S., Williamson, J. D. 2015; 314 (8): 781-790
  • Using the RE-AIM framework to evaluate physical activity public health programs in Mexico BMC PUBLIC HEALTH Jauregui, E., Pacheco, A. M., Soltero, E. G., O'Connor, T. M., Castro, C. M., Estabrooks, P. A., McNeill, L. H., Lee, R. E. 2015; 15


    Physical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the program's funding source.Public health programs promoting PA were systematically identified during 2008-2013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites.In addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported (M?=?10, SD?=?3.1) and programs that were partially or wholly privately or corporately supported (M?=?12.0, SD?=?4.4).While reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established.

    View details for DOI 10.1186/s12889-015-1474-2

    View details for Web of Science ID 000350952400001

    View details for PubMedID 25881249

  • "It's got to be on this page": age and cognitive style in a study of online health information seeking. Journal of medical Internet research Agree, E. M., King, A. C., Castro, C. M., Wiley, A., Borzekowski, D. L. 2015; 17 (3)


    The extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy.This study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy.The Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing.Cognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved.The increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Greater support for those who are in the oldest cohorts and for design of interfaces that support users with different cognitive styles may be required in an age of shared medical decision making.

    View details for DOI 10.2196/jmir.3352

    View details for PubMedID 25831483

  • Randomized Clinical Trial of the Women's Lifestyle Physical Activity Program for African-American Women: 24- and 48-Week Outcomes. American journal of health promotion : AJHP Wilbur, J., Miller, A. M., Fogg, L., McDevitt, J., Castro, C. M., Schoeny, M. E., Buchholz, S. W., Braun, L. T., Ingram, D. M., Volgman, A. S., Dancy, B. L. 2015


    Purpose . To compare the effects of a physical activity (PA) intervention of group meetings versus group meetings supplemented by personal calls or automated calls on the adoption and maintenance of PA and on weight stability among African-American women. Design . Randomized clinical trial with three conditions randomly assigned across six sites. Setting . Health settings in predominately African-American communities. Subjects . There were 288 women, aged 40 to 65, without major signs/symptoms of pulmonary/cardiovascular disease. Intervention . Six group meetings delivered over 48 weeks with either 11 personal motivational calls, 11 automated motivational messages, or no calls between meetings. Measures . Measures included PA (questionnaires, accelerometer, aerobic fitness), weight, and body composition at baseline, 24 weeks, and 48 weeks. Analysis . Analysis of variance and mixed models. Results . Retention was 90% at 48 weeks. Adherence to PA increased significantly (p < .001) for questionnaire (d = .56, 128 min/wk), accelerometer (d = .37, 830 steps/d), and aerobic fitness (d =.41, 7 steps/2 min) at 24 weeks and was maintained at 48 weeks (p > .001), with no differences across conditions. Weight and body composition showed no significant changes over the course of the study. Conclusion . Group meetings are a powerful intervention for increasing PA and preventing weight gain and may not need to be supplemented with telephone calls, which add costs and complexity.

    View details for DOI 10.4278/ajhp.140502-QUAN-181

    View details for PubMedID 26158683

  • Exercise Advice by Humans Versus Computers: Maintenance Effects at 18 Months HEALTH PSYCHOLOGY King, A. C., Hekler, E. B., Castro, C. M., Buman, M. P., Marcus, B. H., Friedman, R. H., Napolitano, M. A. 2014; 33 (2): 192-196


    Objective: An automated telehealth counseling system, aimed at inactive midlife and older adults, was shown previously to achieve 12-month physical activity levels similar to those attained by human advisors. This investigation evaluated the sustained 18-month impacts of the automated advisor compared with human advisors. Methods: Following the end of the 12-month randomized, controlled trial, participants who had been randomized to either the human advisor (n = 73) or automated advisor (n = 75) arms were followed for an additional 6 months. During that period, human or automated advisor-initiated telephone contacts ceased and participants were encouraged to initiate contact with their advisor as deemed relevant. The primary outcome was moderate-to-vigorous physical activity (MVPA), measured using the Stanford Physical Activity Recall and validated during the major trial via accelerometry. Results: The two arms did not differ significantly in 18-month MVPA or the percentage of participants meeting national physical activity guidelines (ps >.50). No significant within-arm MVPA differences emerged between 12 and 18 months. Evaluation of the trajectory of physical activity change across the 18-month study period indicated that, for both arms, the greatest physical activity increases occurred during the first 6 months of intervention, followed by a relatively steady amount of physical activity across the remaining months. Conclusions: The results provide evidence that an automated telehealth advice system can maintain physical activity increases at a level similar to that achieved by human advisors through 18 months. Given the accelerated use of mobile phones in developing countries, as well as industrialized nations, automated telehealth systems merit further evaluation. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

    View details for DOI 10.1037/a0030646

    View details for Web of Science ID 000330843700011

  • The LIFE Cognition Study: design and baseline characteristics CLINICAL INTERVENTIONS IN AGING Sink, K. M., Espeland, M. A., Rushing, J., Castro, C. M., Church, T. S., Cohen, R., Gill, T. M., Henkin, L., Jennings, J. M., Kerwin, D. R., Manini, T. M., Myers, V., Pahor, M., Reid, K. F., Woolard, N., Rapp, S. R., Williamson, J. D. 2014; 9: 1425-1436

    View details for DOI 10.2147/CIA.S65381

    View details for Web of Science ID 000340871400001

  • Performance of a computer-based assessment of cognitive function measures in two cohorts of seniors INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Espeland, M. A., Katula, J. A., Rushing, J., Kramer, A. F., Jennings, J. M., Sink, K. M., Nadkarni, N. K., Reid, K. F., Castro, C. M., Church, T., Kerwin, D. R., Williamson, J. D., Marottoli, R. A., Rushing, S., Marsiske, M., Rapp, S. R. 2013; 28 (12): 1239-1250


    Computer-administered assessment of cognitive function is being increasingly incorporated in clinical trials; however, its performance in these settings has not been systematically evaluated.The Seniors Health and Activity Research Program pilot trial (N = 73) developed a computer-based tool for assessing memory performance and executive functioning. The Lifestyle Interventions and Independence for Elders investigators incorporated this battery in a full-scale multicenter clinical trial (N = 1635). We describe relationships that test scores have with those from interviewer-administered cognitive function tests and risk factors for cognitive deficits and describe performance measures (completeness, intraclass correlations [ICC]).Computer-based assessments of cognitive function had consistent relationships across the pilot and full-scale trial cohorts with interviewer-administered assessments of cognitive function, age, and a measure of physical function. In the Lifestyle Interventions and Independence for Elders cohort, their external validity was further demonstrated by associations with other risk factors for cognitive dysfunction: education, hypertension, diabetes, and physical function. Acceptable levels of data completeness (>83%) were achieved on all computer-based measures; however, rates of missing data were higher among older participants (odds ratio = 1.06 for each additional year; p < 0.001) and those who reported no current computer use (odds ratio = 2.71; p < 0.001). ICCs among clinics were at least as low (ICC < 0.013) as for interviewer measures (ICC < 0.023), reflecting good standardization. All cognitive measures loaded onto the first principal component (global cognitive function), which accounted for 40% of the overall variance.Our results support the use of computer-based tools for assessing cognitive function in multicenter clinical trials of older individuals.

    View details for DOI 10.1002/gps.3949

    View details for Web of Science ID 000326466800004

    View details for PubMedID 23589390

  • Lifestyle Interventions and Independence for Elders Study: Recruitment and Baseline Characteristics JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Marsh, A. P., Lovato, L. C., Glynn, N. W., Kennedy, K., Castro, C., Domanchuk, K., McDavitt, E., Rodate, R., Marsiske, M., McGloin, J., Groessl, E. J., Pahor, M., Guralnik, J. M. 2013; 68 (12): 1549-1558


    Recruitment of older adults into long-term clinical trials involving behavioral interventions is a significant challenge. The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled multisite trial, designed to compare the effects of a moderate-intensity physical activity program with a successful aging health education program on the incidence of major mobility disability (the inability to walk 400 m) in sedentary adults aged 70-89 years, who were at high risk for mobility disability (scoring ? 9 on the Short Physical Performance Battery) at baseline.Recruitment methods, yields, efficiency, and costs are described together with a summary of participant baseline characteristics. Yields were examined across levels of sex, race and ethnicity, and Short Physical Performance Battery, as well as by site.The 21-month recruiting period resulted in 14,812 telephone screens; 1,635 participants were randomized (67.2% women, 21.0% minorities, 44.7% with Short Physical Performance Battery scores ? 7). Of the telephone-screened participants, 37.6% were excluded primarily because of regular participation in physical activity, health exclusions, or self-reported mobility disability. Direct mailing was the most productive recruitment strategy (59.5% of randomized participants). Recruitment costs were $840 per randomized participant. Yields differed by sex and Short Physical Performance Battery. We accrued 11% more participant follow-up time than expected during the recruitment period as a result of the accelerated recruitment rate.The LIFE Study achieved all recruitment benchmarks. Bulk mailing is an efficient method for recruiting high-risk community-dwelling older persons (including minorities), from diverse geographic areas for this long-term behavioral trial.

    View details for DOI 10.1093/gerona/glt064

    View details for Web of Science ID 000326675000012

    View details for PubMedID 23716501

  • Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial ANNALS OF BEHAVIORAL MEDICINE King, A. C., Castro, C. M., Buman, M. P., Hekler, E. B., Urizar, G. G., Ahn, D. K. 2013; 46 (2): 157-168


    BACKGROUND: Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence. PURPOSE: We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes. METHODS: Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms. RESULTS: Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms. CONCLUSIONS: We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.

    View details for DOI 10.1007/s12160-013-9501-y

    View details for Web of Science ID 000324493900007

  • Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Hekler, E. B., Buman, M. P., Otten, J., Castro, C. M., Grieco, L., Marcus, B., Friedman, R. H., Napolitano, M. A., King, A. C. 2013; 10
  • The Mental Activity and eXercise (MAX) Trial A Randomized Controlled Trial to Enhance Cognitive Function in Older Adults JAMA INTERNAL MEDICINE Barnes, D. E., Santos-Modesitt, W., Poelke, G., Kramer, A. F., Castro, C., Middleton, L. E., Yaffe, K. 2013; 173 (9): 797-804


    The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in relatively small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects.To examine the combined effects of physical plus mental activity on cognitive function in older adults.Randomized controlled trial with a factorial design.San Francisco, California.A total of 126 inactive, community-residing older adults with cognitive complaints.All participants engaged in home-based mental activity (1 h/d, 3 d/wk) plus class-based physical activity (1 h/d, 3 d/wk) for 12 weeks and were randomized to either mental activity intervention (MA-I; intensive computer) or mental activity control (MA-C; educational DVDs) plus exercise intervention (EX-I; aerobic) or exercise control (EX-C; stretching and toning); a 2 × 2 factorial design was used so that there were 4 groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1, and MA-C/EX-C.Global cognitive change based on a comprehensive neuropsychological test battery.Participants had a mean age of 73.4 years; 62.7% were women, and 34.9% were Hispanic or nonwhite. There were no significant differences between the groups at baseline. Global cognitive scores improved significantly over time (mean, 0.16 SD; P < .001) but did not differ between groups in the comparison between MA-I and MA-C (ignoring exercise, P = .17), the comparison between EX-I and EX-C (ignoring mental activity, P = .74), or across all 4 randomization groups (P = .26).In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function with no evidence of difference between intervention and active control groups. These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject Identifier: NCT00522899.

    View details for DOI 10.1001/jamainternmed.2013.189

    View details for Web of Science ID 000320041800021

    View details for PubMedID 23545598

  • Applying the ecological model of behavior change to a physical activity trial in retirement communities: Description of the study protocol CONTEMPORARY CLINICAL TRIALS Kerr, J., Rosenberg, D. E., Nathan, A., Millstein, R. A., Carlson, J. A., Crist, K., Wasilenko, K., Bolling, K., Castro, C. M., Buchner, D. M., Marshall, S. J. 2012; 33 (6): 1180-1188


    To describe the intervention protocol for the first multilevel ecological intervention for physical activity in retirement communities that addresses individual, interpersonal and community influences on behavior change.A cluster randomized controlled trial design was employed with two study arms: a physical activity intervention and an attention control successful aging condition.Sixteen continuing care retirement communities in San Diego County.Three hundred twenty older adults, aged 65 years and older, are being recruited to participate in the trial. In addition, peer leaders are being recruited to lead some study activities, especially to sustain the intervention after study activities ceased.Participants in the physical activity trial receive individual, interpersonal and community intervention components. The individual level components include pedometers, goal setting and individual phone counseling. The interpersonal level components include group education sessions and peer-led activities. The community level components include resource audits and enumeration, tailored walking maps, and community improvement projects. The successful aging group receives individual and group attention about successful aging topics.The main outcome is light to moderate physical activity, measured objectively by accelerometry. Other objective outcomes included physical functioning, blood pressure, physical fitness, and cognitive functioning. Self report measures include depressive symptoms and health related quality of life.The intervention is being delivered successfully in the communities and compliance rates are high.Ecological Models call for interventions that address multiple levels of the model. Previous studies have not included components at each level and retirement communities provide a model environment to demonstrate how to implement such an intervention.

    View details for DOI 10.1016/j.cct.2012.08.005

    View details for Web of Science ID 000310825400009

    View details for PubMedID 22921641

  • Contraceptive Use and Barriers to Access Among Newly Arrested Women JOURNAL OF CORRECTIONAL HEALTH CARE LaRochelle, F., Castro, C., Goldenson, J., Tulsky, J. P., Cohan, D. L., Blumenthal, P. D., Sufrin, C. B. 2012; 18 (2): 111-119


    Incarcerated women report high rates of prior unintended pregnancies as well as low contraceptive use. Because jail could be a site of contraception care, this study aimed to assess women's access to contraception prior to their arrest. A cross-sectional survey was administered to 228 reproductive-aged, nonpregnant women arrested in San Francisco. Twenty-one percent were currently using contraception. More than half (61%) had not used contraception in the last year, yet 11% wanted to have used it. Women in this latter subset reported greater difficulty with payment, finding a clinic, and transportation compared to women who had used contraception. In addition, 60% of all women in the sample would accept contraception if offered to them in jail. Thus, jail is a potentially important and acceptable point of access to contraception, which can circumvent some preincarceration logistical barriers.

    View details for DOI 10.1177/1078345811435476

    View details for Web of Science ID 000208989000004

  • The CHOICE Study: A "taste-test" of Utilitarian vs. Leisure Walking Among Older Adults HEALTH PSYCHOLOGY Hekler, E. B., Castro, C. M., Buman, M. P., King, A. C. 2012; 31 (1): 126-129


    Utilitarian walking (e.g., walking for transport) and leisure walking (e.g., walking for health/recreation) are encouraged to promote health, yet few studies have explored specific preferences for these two forms of physical activity or factors that impact such preferences. A quasi-experimental crossover design was used to evaluate how training underactive midlife and older adults in each type of walking impacted total steps taken and how it was linked to their subsequent choice of walking types.Participants (N = 16) were midlife and older adults (M age = 64 ± 8 years) who were mostly women (81%) and white (75%). To control for order effects, participants were randomized to instruction in either utilitarian or leisure walking for 2 weeks and then the other type for 2 weeks. Participants then entered a 2-week "free choice" phase in which they chose any mixture of the walking types. Outcome variables included walking via OMRON pedometer and the ratio of utilitarian versus leisure walking during the free-choice phase. Participants completed surveys about their neighborhood (NEWS) and daily travel to multiple locations.Instruction in leisure-only, utilitarian-only, and a freely chosen mixture of the two each resulted in significant increases in steps taken relative to baseline (ps < 0.05). Having to go to multiple locations daily and traveling greater distances to locations were associated with engagement in more utilitarian walking. In contrast, good walking paths, neighborhood aesthetics, easy access to exercise facilities, and perceiving easier access to neighborhood services were associated with more leisure walking.Results from this pilot study suggest that midlife and older adults may most easily meet guidelines through either leisure only or a mixture of leisure and utilitarian walking, and tailored suggestions based on the person's neighborhood may be useful.

    View details for DOI 10.1037/a0025567

    View details for Web of Science ID 000299261200018

    View details for PubMedID 21928901

  • Physical Activity Program Delivery by Professionals Versus Volunteers: The TEAM Randomized Trial HEALTH PSYCHOLOGY Castro, C. M., Pruitt, L. A., Buman, M. P., King, A. C. 2011; 30 (3): 285-294


    Older adults have low rates of physical activity participation, but respond positively to telephone-mediated support programs. Programs are often limited by reliance on professional staff. This study tested telephone-based physical activity advice delivered by professional staff versus trained volunteer peer mentors.A 12-month, randomized, controlled clinical trial was executed from 2003-2008. Twelve volunteer peer mentors and 181 initially inactive adults ages 50 years and older were recruited from the San Francisco Bay Area. Participants were randomized to: (1) telephone-based physical activity advice delivered by professional staff, (2) telephone-based physical activity advice delivered by trained volunteer peers, or (3) an attention-control arm of staff-delivered telephone support for nutrition.Moderate-intensity or more vigorous physical activity (MVPA) was assessed at baseline, 6, and 12 months with the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire, with accelerometry validation (Actigraph) in a randomly selected subsample. Treatment fidelity was examined through analysis of quantity and quality of intervention delivery.At 6 and 12 months, both physical activity arms significantly increased MVPA relative to the control arm. Both physical activity arms were comparable in quantity of intervention delivery, but peers demonstrated more versatility and comprehensiveness in quality of intervention content.This study demonstrates that trained peer volunteers can effectively promote physical activity increases through telephone-based advice. The results support a program delivery model with good dissemination potential for a variety of community settings.

    View details for DOI 10.1037/a0021980

    View details for Web of Science ID 000290695300006

    View details for PubMedID 21553972

  • Understanding household behavioral risk factors for diarrheal disease in Dar es Salaam: a photovoice community assessment. Journal of environmental and public health Badowski, N., Castro, C. M., Montgomery, M., Pickering, A. J., Mamuya, S., Davis, J. 2011; 2011: 130467-?


    Whereas Tanzania has seen considerable improvements in water and sanitation infrastructure over the past 20 years, the country still faces high rates of childhood morbidity from diarrheal diseases. This study utilized a qualitative, cross-sectional, modified Photovoice method to capture daily activities of Dar es Salaam mothers. A total of 127 photographs from 13 households were examined, and 13 interviews were conducted with household mothers. The photographs and interviews revealed insufficient hand washing procedures, unsafe disposal of wastewater, uncovered household drinking water containers, a lack of water treatment prior to consumption, and inappropriate toilets for use by small children. The interviews revealed that mothers were aware and knowledgeable of the risks of certain household practices and understood safer alternatives, yet were restricted by the perceived impracticality and financial constraints to make changes. The results draw attention to the real economic and behavioral challenges faced in reducing the spread of disease.

    View details for DOI 10.1155/2011/130467

    View details for PubMedID 21969836

  • Results from the Active for Life process evaluation: program delivery fidelity and adaptations HEALTH EDUCATION RESEARCH Griffin, S. F., Wilcox, S., Ory, M. G., Lattimore, D., Leviton, L., Castro, C., Carpenter, R. A., Rheaume, C. 2010; 25 (2): 325-342


    Active for Life((R)) (AFL) was a large (n = 8159) translational initiative to increase physical activity (PA) in midlife and older adults. Translational research calls for a shift in emphasis from just understanding what works (efficacy) to also understanding how it works in more 'real world' settings. This article describes the process evaluation design and findings, discuss how these findings were used to better understand the translational process and provide a set of process evaluation recommendations with community-based translational research. AFL community organizations across the United States implemented one of two evidence-based PA programs (Active Living Every Day-The Cooper Institute; Human Kinetics Inc. or Active Choices-Stanford University). Both programs were based on the transtheoretical model and social cognitive theory. Overall, the process evaluation revealed high-dose delivery and implementation fidelity by quite varied community organizations serving diverse adult populations. Findings reveal most variation occurred for program elements requiring more participant engagement. Additionally, the results show how a collaborative process allowed the organizations to 'fit' the programs to their specific participant base while maintaining fidelity to essential program elements.

    View details for DOI 10.1093/her/cyp017

    View details for Web of Science ID 000275818400014

    View details for PubMedID 19325031

  • Using Ecological Momentary Assessment to Examine Antecedents and Correlates of Physical Activity Bouts in Adults Age 50+Years: A Pilot Study ANNALS OF BEHAVIORAL MEDICINE Dunton, G. F., Atienza, A. A., Castro, C. M., King, A. C. 2009; 38 (3): 249-255


    National recommendations supporting the promotion of multiple short (10+ minute) physical activity bouts each day to increase overall physical activity levels in middle-aged and older adults underscore the need to identify antecedents and correlates of such daily physical activity episodes.This pilot study used Ecological Momentary Assessment to examine the time-lagged and concurrent effects of empirically supported social, cognitive, affective, and physiological factors on physical activity among adults age 50+ years.Participants (N = 23) responded to diary prompts on a handheld computer four times per day across a 2-week period. Moderate-to-vigorous physical activity (MVPA), self-efficacy, positive and negative affect, control, demand, fatigue, energy, social interactions, and stressful events were assessed during each sequence.Multivariate results showed that greater self-efficacy and control predicted greater MVPA at each subsequent assessment throughout the day (p < 0.05). Also, having a positive social interaction was concurrently related to higher levels of MVPA (p = 0.052).Time-varying multidimensional individual processes predict within daily physical activity levels.

    View details for DOI 10.1007/s12160-009-9141-4

    View details for Web of Science ID 000275425100008

    View details for PubMedID 20052568

  • Sleep Patterns and Sleep-Related Factors Between Caregiving and Non-Caregiving Women BEHAVIORAL SLEEP MEDICINE Castro, C. M., Lee, K. A., Bliwise, D. L., Urizar, G. G., Woodward, S. H., King, A. C. 2009; 7 (3): 164-179


    This exploratory study compared objective sleep patterns and sleep-related factors between caregiving and non-caregiving women with sleep impairments, and compared the sleep patterns of the caregivers with their care recipients. Nine women caring for adults with dementia and a comparison sample of 34 non-caregiving women provided three nights of in-home polysomnography (PSG) and self-report questionnaires of sleep quality and physical and emotional well-being. Care recipients' sleep was monitored with actigraphy on the same nights of the caregivers' PSG. Caregivers and non-caregivers' sleep patterns were similar across most PSG-measured parameters. Caregivers perceived more sleep disturbances, but PSG showed minimal differences compared to non-caregivers. Caregivers reported more depressive symptoms, and depression was strongly correlated with longer sleep latency. Caregiver's sleep quantity was highly correlated with the sleep quantity of their care recipient. The results suggest that, in this sample, caregivers' sleep was not significantly different from the non-caregiving women, despite differences in perceptions. Although the sample is small, this exploratory study supports the use of multiple nights of in-home PSG to assess caregiver sleep and provides more data on sleep patterns of female dementia caregivers and their relatives.

    View details for DOI 10.1080/15402000902976713

    View details for Web of Science ID 000274049100003

    View details for PubMedID 19568966

  • Active for Life - Final results from the translation of two physical activity programs AMERICAN JOURNAL OF PREVENTIVE MEDICINE Wilcox, S., Dowda, M., Leviton, L. C., Bartlett-Prescott, J., Bazzarre, T., Campbell-Voytal, K., Carpenter, R. A., Castro, C. M., Dowdy, D., Dunn, A. L., Griffin, S. F., Guerra, M., King, A. C., Ory, M. G., Rheaume, C., Tobnick, J., Wegley, S. 2008; 35 (4): 340-351


    Most evidence-based programs are never translated into community settings and thus never make a public health impact.Active for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008.Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white).In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4.Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure.Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites.Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adult's health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

    View details for DOI 10.1016/j.amepre.2008.07.001

    View details for Web of Science ID 000259308900004

    View details for PubMedID 18779028

  • Effects of Moderate-Intensity Exercise on Polysomnographic and Subjective Sleep Quality in Older Adults With Mild to Moderate Sleep Complaints JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Pruitt, L. A., Woo, S., Castro, C. M., Ahn, D. K., Vitiello, M. V., Woodward, S. H., Bliwise, D. L. 2008; 63 (9): 997-1004


    This study sought to determine the 12-month effects of exercise increases on objective and subjective sleep quality in initially inactive older persons with mild to moderate sleep complaints.A nonclinical sample of underactive adults 55 years old or older (n=66) with mild to moderate chronic sleep complaints were randomly assigned to a 12-month program of primarily moderate-intensity endurance exercise (n=36) or a health education control program (n=30). The main outcome measure was polysomnographic sleep recordings, with additional measures of subjective sleep quality, physical activity, and physical fitness. Directional hypotheses were tested.Using intent-to-treat methods, at 12 months exercisers, relative to controls, spent significantly less time in polysomnographically measured Stage 1 sleep (between-arm difference=2.3, 95% confidence interval [CI], 0.7-4.0; p=003), spent more time in Stage 2 sleep (between-arm difference=3.2, 95% CI, 0.6-5.7; p=.04), and had fewer awakenings during the first third of the sleep period (between-arm difference=1.0, 95% CI, 0.39-1.55; p=.03). Exercisers also reported greater 12-month improvements relative to controls in Pittsburgh Sleep Quality Index (PSQI) sleep disturbance subscale score (p=.009), sleep diary-based minutes to fall asleep (p=.01), and feeling more rested in the morning (p=.02).Compared with general health education, a 12-month moderate-intensity exercise program that met current physical activity recommendations for older adults improved some objective and subjective dimensions of sleep to a modest degree. The results suggest additional areas for investigation in this understudied area.

    View details for Web of Science ID 000260074800015

    View details for PubMedID 18840807

  • A lifestyle physical activity intervention for caregivers of persons with Alzheimer's disease AMERICAN JOURNAL OF ALZHEIMERS DISEASE AND OTHER DEMENTIAS Farran, C. J., Staffileno, B. A., Gilley, D. W., McCann, J. J., Li, Y., Castro, C. M., King, A. C. 2008; 23 (2): 132-142


    The purpose of this pilot study was to examine the effects of lifestyle physical activity in caregivers (CGs) of persons with Alzheimer's disease.Fifteen CGs engaged in lifestyle physical activity during a 6-month, home-based health promotion program. Mean changes in self-reported physical activity were compared using repeated-measures analysis of variance.Fifty percent of CGs increased total self-reported minutes and 42% increased total moderate minutes of physical activity from preintervention to postintervention; however, no CG engaged in vigorous physical activity and there were no significant improvements in self-reported physical activity for the total group. Hot summer weather, heavy non-caregiving responsibilities, heavy caregiving responsibilities, and feelings of anxiety, depressive symptoms, and fatigue were the most frequently identified physical activity barriers.Incorporating an individualized, home-based program of lifestyle physical activity appears feasible; however, attention needs to be given in the future to physical activity barriers identified by this select group of CGs.

    View details for DOI 10.1177/1533317507312556

    View details for Web of Science ID 000258957000003

    View details for PubMedID 18174315

  • Promoting physical activity through hand-held computer technology AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Ahn, D. K., Oliveira, B. M., Atienza, A. A., Castro, C. M., Gardner, C. D. 2008; 34 (2): 138-142


    Efforts to achieve population-wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies. Yet few systematic efforts to evaluate the efficacy of hand-held computers and similar devices for enhancing physical activity levels have occurred. The purpose of this first-generation study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing moderate intensity or more vigorous (MOD+) physical activity levels over 8 weeks in mid-life and older adults relative to a standard information control arm.Randomized, controlled 8-week experiment. Data were collected in 2005 and analyzed in 2006-2007.Community-based study of 37 healthy, initially underactive adults aged 50 years and older who were randomized and completed the 8-week study (intervention=19, control=18).Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback, goal setting, and support. Controls received standard, age-appropriate written physical activity educational materials.Physical activity was assessed via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and 8 weeks.Relative to controls, intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity (p<0.04). Satisfaction with the PDA was reasonably high in this largely PDA-naive sample.Results from this first-generation study indicate that hand-held computers may be effective tools for increasing initial physical activity levels among underactive adults.

    View details for DOI 10.1016/j.amepre.2007.09.025

    View details for Web of Science ID 000252758300008

    View details for PubMedID 18201644

  • Ongoing physical activity advice by humans versus computers: The community health advice by telephone (CHAT) trial HEALTH PSYCHOLOGY King, A. C., Friedman, R., Marcus, B., Castro, C., Napolitano, M., Alm, D., Baker, L. 2007; 26 (6): 718-727


    Given the prevalence of physical inactivity among American adults, convenient, low-cost interventions are strongly indicated. This study determined the 6- and 12-month effectiveness of telephone interventions delivered by health educators or by an automated computer system in promoting physical activity.Initially inactive men and women age 55 years and older (N = 218) in stable health participated. Participants were randomly assigned to human advice, automated advice, or health education control.The validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. Physical activity differences by experimental arm were verified on a random subsample via accelerometry.Using intention-to-treat analysis, at 6 months, participants in both interventions, although not differing from one another, showed significant improvements in weekly physical activity compared with controls. These differences were generally maintained at 12 months, with both intervention arms remaining above the target of 150 min per week of moderate to vigorous physical activity on average.Automated telephone-linked delivery systems represent an effective alternative for delivering physical activity advice to inactive older adults.

    View details for DOI 10.1037/0278-6133.26.6.718

    View details for Web of Science ID 000250861700011

    View details for PubMedID 18020844

  • Rural family caregivers and health behaviors - Results from an epidemiologic survey JOURNAL OF AGING AND HEALTH Castro, C. M., King, A. C., Housemann, R., Bacak, S. J., McMullen, K. M., Brownson, R. C. 2007; 19 (1): 87-105


    This study examined health behaviors in a sample of rural family caregivers. In a community telephone survey of rural Missouri, Arkansas, and Tennessee, respondents were asked about their health, physical activity, nutrition, health providers, and family caregiving. Among 1,234 survey respondents, 12% self-identified as family caregivers. Caregivers reported lower fruit intake, more walking for exercise, and more provider advice about stress, fruits, and vegetables than noncaregivers. Groups did not differ in smoking, dietary fat, obesity, or self-rated health. Women caregivers reported more favorable patterns of physical activity, smoking, and provider interactions than men caregivers, and White caregivers had healthier reports of physical activity and body mass index than Black caregivers. These results provide new information about rural caregivers' health habits. Apart from nutritional intake, caregivers were not significantly different in most health behaviors. However, health providers seemed more attentive to caregivers regarding nutrition and stress.

    View details for DOI 10.1177/0898264306296870

    View details for Web of Science ID 000243528700005

    View details for PubMedID 17215203

  • Results of the first year of active for life: Translation of 2 evidence-based physical activity programs for older adults into community settings AMERICAN JOURNAL OF PUBLIC HEALTH Wilcox, S., Dowda, M., Griffin, S. F., Rheaume, C., Ory, M. G., Leviton, L., King, A. C., Dunn, A., Buchner, D. M., Bazzarre, T., Estabrooks, P. A., Campbell-Voytal, K., Bartlett-Prescott, J., Dowdy, D., Castro, C. M., Carpenter, R. A., Dzewaltowski, D. A., Mockenhaupt, R. 2006; 96 (7): 1201-1209


    Translating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults.Four community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys.Participants (n=838) were aged an average of 68.4 +/-9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index.The first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials.

    View details for DOI 10.2105/AJPH.2005.074690

    View details for Web of Science ID 000238658900020

    View details for PubMedID 16735619

  • Outcome expectations and physical activity participation in two samples of older women JOURNAL OF HEALTH PSYCHOLOGY Wilcox, S., Castro, C. M., King, A. C. 2006; 11 (1): 65-77


    Outcome expectations have received little study in physical activity (PA) research. This study examined whether initial outcome expectations and their achievement at 6 months (i.e. outcome realizations) predicted subsequent PA participation (7-12 months) in 118 older women. Initial outcome expectations were not associated with PA participation. Outcome realizations at 6 months, however, predicted subsequent PA participation (p < .05). Women with high expectations but low attainment had the lowest subsequent participation rates. Women with high attainment, regardless of expectations, had the highest rates. Findings replicate and extend an earlier study and argue for a more dynamic conceptualization of outcome expectations.

    View details for DOI 10.1177/1359105306058850

    View details for Web of Science ID 000234977400005

    View details for PubMedID 16314381

  • Modifying physical activity in a multiethnic sample of low-income women: One-year results from the IMPACT (increasing motivation for physical activity) project ANNALS OF BEHAVIORAL MEDICINE Albright, C. L., Pruitt, L., Castro, C., Gonzalez, A., Woo, S., King, A. C. 2005; 30 (3): 191-200


    Ethnic minorities or those with low socioeconomic status (SES) are at increased risk of cardiovascular disease, type 2 diabetes, and all-cause mortality, compared to higher SES Whites. National surveys also indicate that low-income, ethnic minority women have the highest rates of inactivity in the United States.This study (the Increasing Motivation for Physical ACTivity or IMPACT study) promoted adoption and maintenance of physical activity (PA) in sedentary, low-income women participating in federally funded job training programs.The study consisted of 2 months of weekly 1-hr classes, then random assignment to 10 months of either home-based telephone counseling for PA plus information and feedback via mailed newsletters (Phone + Mail Counseling condition) or just the mailed newsletters (Mail Support condition). The IMPACT intervention included behavior change strategies for PA as well as discussions related to motivational readiness for PA change. Participants completed surveys and physiological assessments at baseline after the classes ended (i.e., at 10 weeks) and at 6 and 12 months postbaseline. Seventy-three percent of randomized participants (n = 72) were Latina, with a mean age of 32 +/- 10 years. More than half the women had not completed high school, and 73% had an annual income less than 20,000 dollars.After 10 months of a home-based intervention, women in the phone + mail counseling condition had significantly greater increases in estimated total energy expenditure compared to women in the mail support condition (p < .05).Regular PA counseling delivered via the telephone and through the mail appears effective for encouraging regular PA among low-income women transitioning from welfare or job training to the workforce.

    View details for Web of Science ID 000234009600003

    View details for PubMedID 16336070

  • Comparing acculturation models in evaluating dietary habits among low-income hispanic women ETHNICITY & DISEASE Norman, S., Castro, C., Albright, C., King, A. 2004; 14 (3): 399-404


    Studies have demonstrated that Hispanic women in the United States who are more acculturated tend to consume fewer fruits and vegetables, and more fat, compared to less acculturated women. However, some studies have found an opposite trend. Such discrepancies could be caused by inconsistencies in the assessment of acculturation. The goal of the current study was to determine whether different methods of defining acculturation could identify dietary fat use practices among Hispanic women living in the United States.One hundred nineteen Hispanic women were recruited from adult education vocational rehabilitation classes, and completed questionnaires assessing dietary fat practices, acculturation, and demographic information.Years living in the United States was not associated with higher or lower fat use in this sample. A preference for speaking English at home was significantly associated with less consumption of beans and peas. Being born in the United States was significantly associated with greater consumption of convenience foods and chocolate candy. Being born in the United States and exhibiting a preference for English were significantly associated with greater consumption of convenience foods and salty snacks, as well as greater frequency of eating higher fat foods, overall.The operational definition of acculturation significantly influences whether acculturation is associated with dietary fat practices in low-income Hispanic women. The discrepancies in the conclusions about dietary fat practices between these 4 methods demonstrate the need for a better understanding of cultural influences on dietary habits, as well as a consistent measure of acculturation in this field.

    View details for Web of Science ID 000223093600012

    View details for PubMedID 15328942

  • Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project HEALTH EDUCATION RESEARCH King, A. C., Friedman, R., Marcus, B., Castro, C., Forsyth, L., Napolitano, M., Pinto, B. 2002; 17 (5): 627-636


    Physical inactivity among middle- and older-aged adults is pervasive, and is linked with numerous chronic conditions that diminish health and functioning. Counselor-directed physical activity programs may enhance extrinsic motivation (reflected in social influence theories, such as self-presentation theory) and, in turn, physical activity adherence, while the counselor is in charge of program delivery. However, external influences can undermine intrinsic motivation, making it more difficult to maintain physical activity once counselor-initiated contact ends. In contrast, programs that diminish the socially evaluative and controlling aspects of the counseling interchange may promote intrinsic motivation (described in cognitive evaluation theory), and, thus, physical activity maintenance, even when counselor-initiated contact ceases. The objective of the Community Health Advice by Telephone (CHAT) project is to compare these two theories by conducting a randomized controlled trial evaluating the effects of a telephone-administered counseling program delivered by a person (social influence enhancement) or computer (cognitive evaluation enhancement) on physical activity adoption and maintenance over 18 months. Healthy, sedentary adults (n = 225) aged 55 years and older are randomized to one of these programs or to a control arm. This study will contribute to advancing motivational theory as well as provide information on the sustained effectiveness of interventions with substantial public health applicability.

    View details for Web of Science ID 000178557500015

    View details for PubMedID 12408207

  • An exercise program for women who are caring for relatives with dementia PSYCHOSOMATIC MEDICINE Castro, C. M., Wilcox, S., O'Sullivan, P., Baumann, K., King, A. C. 2002; 64 (3): 458-468


    This study describes factors related to retention and adherence to an exercise program for women caregivers.One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization.Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence.This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.

    View details for Web of Science ID 000175791700010

    View details for PubMedID 12021419

  • Telephone-assisted Counseling for physical activity EXERCISE AND SPORT SCIENCES REVIEWS Castro, C. M., King, A. C. 2002; 30 (2): 64-68


    Different methods of intervention have been tested to promote physical activity at the individual level. The telephone is an excellent form of media for delivering exercise counseling and advice. This review highlights important clinical trials that have documented the success of telephone-assisted exercise counseling for promoting physical activity in a variety of populations.

    View details for Web of Science ID 000178735200004

    View details for PubMedID 11991539

  • Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: A randomized controlled trial JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES King, A. C., Baumann, K., O'Sullivan, P., Wilcox, S., Castro, C. 2002; 57 (1): M26-M36


    The study objective was to determine the health and quality-of-life effects of moderate-intensity exercise among older women family caregivers.This 12-month randomized controlled trial involved a volunteer sample of 100 women aged 49 to 82 years who were sedentary, free of cardiovascular disease, and caring for a relative with dementia. Participants were randomized to 12 months of home-based, telephone-supervised, moderate-intensity exercise training or to an attention-control (nutrition education) program. Exercise consisted of four 30- to 40-minute endurance exercise sessions (brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate. Main outcomes were stress-induced cardiovascular reactivity levels, rated sleep quality, and reported psychological distress.Compared with nutrition participants (NU), exercise participants (EX) showed significant improvements in the following: total energy expenditure (baseline and post-test means [SD] for EX = 1.4 [1.9] and 2.2 [2.2] kcal/kg/day; for NU = 1.2 [1.7] and 1.2 [1.6] kcal/kg/day; p <.02); stress-induced blood pressure reactivity (baseline and post-test systolic blood pressure reactivity values for EX = 21.6 [12.3] and 12.4 [11.2] mm Hg; for NU = 17.9 [10.2] and 17.7 [13.8] mm Hg; p <.024); and sleep quality (p <.05). NU showed significant improvements in percentages of total calories from fats and saturated fats relative to EX (p values <.01). Both groups reported improvements in psychological distress. Conclusions. Family caregivers can benefit from initiating a regular moderate-intensity exercise program in terms of reductions in stress-induced cardiovascular reactivity and improvements in rated sleep quality.

    View details for Web of Science ID 000173163800010

    View details for PubMedID 11773209

  • Physiological and affective responses to family caregiving in the natural setting in wives versus daughters INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE King, A. C., Atienza, A., Castro, C., Collins, R. 2002; 9 (3): 176-194


    This study examined differences in hemodynamic responses to usual caregiving duties undertaken in the natural setting by caregiving wives versus daughters. Participants were 88 women (36 daughters, 52 wives), 50 years of age or older, caring for a relative with dementia. Participants underwent 2 standard laboratory challenges (1 physical and 1 emotional) and ambulatory monitoring in the natural setting. Although wives and daughters showed similar physiological responses to the laboratory challenges, daughters evidenced greater hemodynamic responses in the natural setting relative to wives when the care recipient was present (p < .02). The increases in hemodynamic responses were accompanied by increased negative interactions with the care recipient as well as other family members (p < .0009). The results add to the small body of research indicating that family caregiving may have negative acute effects on psychosocial and physiological responses in the natural setting, particularly in daughters.

    View details for Web of Science ID 000178126900002

    View details for PubMedID 12360836

  • Telephone versus mail interventions for maintenance of physical activity in older adults HEALTH PSYCHOLOGY Castro, C. M., King, A. C., Brassington, G. S. 2001; 20 (6): 438-444


    Although telephone and mail are often used to promote physical activity adoption, their ability to produce long-term maintenance is unclear. In this study, 140 men and women aged 50-65 years received 1 year of telephone counseling to adopt higher (i.e., more vigorous) versus lower intensity (i.e., moderate) exercise. After 1 year, participants were rerandomized to a 2nd year of contact via (a) telephone and mail or (b) predominantly mail. Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail. Both strategies were similarly effective in promoting maintenance in the lower intensity condition. Results suggest that after successful adoption of physical activity with the help of telephone counseling, less intensive interventions are successful for physical activity maintenance in older adults.

    View details for DOI 10.1037//0278-6133.20.6.438

    View details for Web of Science ID 000172002200006

    View details for PubMedID 11714186

  • A prospective analysis of the relationship between walking and mood in sedentary ethnic minority women WOMEN & HEALTH Lee, R. E., Goldberg, J. H., Sallis, J. F., Hickmann, S. A., Castro, C. M., Chen, A. H. 2001; 32 (4): 1-15


    Walking for exercise is becoming widely recognized for bestowing health benefits. This study examined the association of walking for exercise and mood in sedentary, ethnic minority women over a five-month period. Ethnic minority women (N = 102) participated in a randomized, controlled trial of a 7-week behaviorally based telephone and mail intervention that promoted the adoption of walking for exercise compared to a non-behavioral minimal intervention. At 2-month post-test and 5-month follow-up, participants reported significant decreases in depressive mood and increases in vigor. Increase in walking over the course of the study was associated with change in vigor. Limited evidence was found to support a relationship between walking for exercise and mood improvement in ethnic-minority women.

    View details for Web of Science ID 000170678700001

    View details for PubMedID 11548133

  • Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Wilcox, S., Castro, C., King, A. C., Housemann, R., Brownson, R. C. 2000; 54 (9): 667-672


    Determinants of leisure time physical activity (LTPA) in rural middle aged and older women of diverse racial and ethnic groups are not well understood. This study examined: (1) urban-rural differences in LTPA by sociodemographic factors, (2) urban-rural differences in LTPA determinants, and (3) the pattern of relations between LTPA determinants and LTPA.A modified version of the sampling plan of the Behavioral Risk Factor Surveillance Survey (BRFSS) was used. Zip codes were selected with 20% or more of each of the following race/ethnic groups: African American, American Indian/Alaskan Native (AI/AN), and Hispanic. A comparison group of white women were also surveyed using standard BRFSS techniques.Rural (n=1242) and urban (n=1096) women aged 40 years and older from the US Women's Determinants Study.Rural women, especially Southern and less educated women, were more sedentary than urban women. Rural women reported more personal barriers to LTPA, cited caregiving duties as their top barrier (compared with lack of time for urban women), and had greater body mass indices. Rural women were less likely to report sidewalks, streetlights, high crime, access to facilities, and frequently seeing others exercise in their neighbourhood. Multivariate correlates of sedentary behaviour in rural women were AI/AN and African American race, older age, less education, lack of enjoyable scenery, not frequently seeing others exercise, greater barriers, and less social support (p<0.05); and in urban women, older age, greater barriers, less social support (p<0.05), and less education (p<0.09).Rural and urban women seem to face different barriers and enablers to LTPA, and have a different pattern of determinants, thus providing useful information for designing more targeted interventions.

    View details for Web of Science ID 000088819800010

    View details for PubMedID 10942445

  • Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of US middle-aged and older-aged women HEALTH PSYCHOLOGY King, A. C., Castro, C., Wilcox, S., Eyler, A. A., Sallis, J. F., Brownson, R. C. 2000; 19 (4): 354-364


    Personal, program-based, and environmental barriers to physical activity were explored among a U.S. population-derived sample of 2,912 women 40 years of age and older. Factors significantly associated with inactivity included American Indian ethnicity, older age, less education, lack of energy, lack of hills in one's neighborhood, absence of enjoyable scenery, and infrequent observation of others exercising in one's neighborhood. For all ethnic subgroups, caregiving duties and lacking energy to exercise ranked among the top 4 most frequently reported barriers. Approximately 62% of respondents rated exercise on one's own with instruction as more appealing than undertaking exercise in an instructor-led group, regardless of ethnicity or current physical activity levels. The results underscore the importance of a multifaceted approach to understanding physical activity determinants in this understudied, high-risk population segment.

    View details for DOI 10.1037//0278-6133.19.4.354

    View details for Web of Science ID 000088061600006

    View details for PubMedID 10907654

  • Do changes in physical activity lead to dietary changes in middle and old age? AMERICAN JOURNAL OF PREVENTIVE MEDICINE Wilcox, S., King, A. C., Castro, C., Bortz, W. 2000; 18 (4): 276-283


    Research examining the relationship between dietary factors and physical activity patterns has yielded conflicting findings. Few prospective studies have examined whether individuals who change their level of physical activity make corresponding changes in their diet.The current study examined, in two randomized clinical trials of physical activity, whether self-report of dietary factors changed over a 1-year period, whether these changes differed by gender or exercise-intervention group, and whether changes in physical activity led to changes in dietary factors. Participants included 268 men and women aged 50-65 years who participated in the Stanford-Sunnyvale Health Improvement Project I (SSHIP-I) and 103 men and women aged 65-82 years who participated in SSHIP-II. In both trials we recruited participants through random-digit telephone dialing and citywide promotion.Overall, participants adopted healthier diets over the 1-year period. The SSHIP-I participants decreased their consumption of total calories, total fat, saturated fat, protein, and cholesterol. The SSHIP-II participants decreased their consumption of high-fat, high-cholesterol foods. The SSHIP-I women were more likely than men to decrease their intake of total fat and protein (p < 0.01), as well as total calories, saturated fat, and cholesterol (p < 0.05). However, we found that changes in physical activity were not associated with changes in self-report measures of dietary habits.We found no evidence to support the idea that changes in physical activity are a gateway for changes in dietary factors in middle-aged and older adults.

    View details for Web of Science ID 000086903700002

    View details for PubMedID 10788729

Footer Links:

Stanford Medicine Resources: