Annals of Behavioral Medicine

, Volume 29, Issue 2, pp 20–28 | Cite as

Screening, safety, and adverse events in physical activity interventions: Collaborative experiences from the behavior change consortium

  • Marcia Ory
  • Barbara Resnick
  • Patricia J. Jordan
  • Mace Coday
  • Deborah Riebe
  • Carol Ewing Garber
  • Leslie Pruitt
  • Terry Bazzarre
Article

Abstract

Researchers who conduct physical activity (PA) intervention studies provide an invaluable opportunity to further the prevention science knowledge base for implementing and delivering PA programs. Despite recommendations that screening is important to increase patient safety, the specific screening criteria best suited for different community applications are unknown. To add to the limited knowledge base, we examined the screening procedures and the occurrence of adverse events among more than 5,500 participants from 11 diverse PA interventions participating in a trans-National Institutes of Health (NIH) collaborative known as the Behavior Change Consortium (BCC). Numerous adverse events occur in sedentary, chronically ill, or older populations, although few are attributed to activity/exercise interventions. No serious study-related adverse events (SRAEs) were reported across different screening practices, interventions, and/or populations. Relatively few minor SRAEs were reported (primarily musculoskeletal injuries), emphasizing the need to be aware of potential musculoskeletal sequelae during exercise interventions. One common characteristic of these studies is that they recommended “start low and go slow” strategies, with moderate intensity PA as the goal behavior. Recommendations to reframe the meaning and use of screening criteria to initiate PA in the community are discussed. Although we were unable to conduct generalizable quantitative analyses from our data, the combined experience of the BCC studies provides a unique opportunity to examine PA-related screening and safety issues across diverse populations, settings, and intervention programs.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. (1).
    Gill TM, DiPietro L, Krumholz HM: Exercise stress testing for older persons starting an exercise program.Journal of the American Medical Association. 2000,84:25–91.Google Scholar
  2. (2).
    Gill TM, DiPietro L, Krumholz HM: Role of exercise stress testing and safety monitoring for older persons starting an exercise program.Journal of the American Medical Association. 2000,284:342–349.PubMedCrossRefGoogle Scholar
  3. (3).
    Singh MA: Exercise comes of age: Rationale and recommendations for a geriatric exercise prescription.Journals of Gerontology. A: Biological Sciences and Medical Sciences. 2002,57:M262-M282.PubMedGoogle Scholar
  4. (4).
    Morey MC, Sullivan {jrJr}. RJ: Medical assessment for health advocacy and practical strategies for exercise initiation.American Journal of Preventive Medicine. 2003,25:204–208.PubMedCrossRefGoogle Scholar
  5. (5).
    U.S. Department of Health and Human Services.Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.Google Scholar
  6. (6).
    U.S. Department of Health and Human Services.Healthy People 2010.Washington, DC, U.S. Department of Health and Human Services, Public Health Service, 2000.Google Scholar
  7. (7).
    U.S. Department of Health and Human Services.Promoting Physical Activity: A Guide for Community Action. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 1999.Google Scholar
  8. (8).
    Partnership for Prevention:Creating Communities for Active Aging. Retrieved December 6, 2004, from http://www.prevent. org/publications/Active_Aging.pdfGoogle Scholar
  9. (9).
    Centers for Disease Control and Prevention.Preventing Obesity and Chronic Diseases Through Good Nutrition and Physical Activity. Retrieved December 6, 2004, from http://www.cdc. gov/nccdphp/pe_factsheets/pe_pa.htmGoogle Scholar
  10. (10).
    Martinson BC, Crain AL, Pronk NP, O’Connor PJ, Maciosek MV: Changes in physical activity and short-term changes in health care charges: A prospective cohort study of older adults.Preventive Medicine. 2003,37:319–326.PubMedCrossRefGoogle Scholar
  11. (11).
    Pronk NP, Goodman MJ, O’Connor PJ, Martinson BC: Relationship between modifiable health risks and short-term health care charges.Journal of the American Medical Association. 1999,282:2235–2239.PubMedCrossRefGoogle Scholar
  12. (12).
    Thompson PD, Buchner D, Pina IL, et al.: Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular 27 disease: A statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity).Arteriosclerosis Thrombosis and Vascular Biology. 2003,23:E42-E49.CrossRefGoogle Scholar
  13. (13).
    Katzmarzyk PT, Perusse L, Rao DC, Bouchard C: Familial risk ratios for high and low physical fitness levels in the Canadian population.Medicine and Science in Sports and Exercise. 2000,32:614–619.PubMedCrossRefGoogle Scholar
  14. (14).
    Booth FW, Chakravarthy MV, Gordon SE, Spangenburg EE: Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy.Journal of Applied Physiology. 2002,93:3–30.PubMedGoogle Scholar
  15. (15).
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL: Actual causes of death in the United States, 2000.Journal of the American Medical Association. 2004,291:1238–1245.PubMedCrossRefGoogle Scholar
  16. (16).
    Mokdad AH, Ford ES, Bowman BA, et al.: Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.Journal of the American Medical Association. 2003,289:76–79.PubMedCrossRefGoogle Scholar
  17. (17).
    Mokdad AH, Serdula MK, Dietz WH, et al.: The continuing epidemic of obesity in the United States.Journal of the American Medical Association. 2000,284:1650–1651.PubMedCrossRefGoogle Scholar
  18. (18).
    Ory MG, Dowdy D, Sanner S, et al.:Translating Research Into Practice: Real World Evaluation and Measurement Issues in Moving From Efficacy to Effectiveness Research. Champaign, IL: Human Kinetics Publishers, 2004.Google Scholar
  19. (19).
    Carlson JE, Ostir GV, Black SA, et al.: Disability in older adults. 2: Physical activity as prevention.Behavioral Medicine. 1999,24:157–168.PubMedGoogle Scholar
  20. (20).
    Ostir GV, Carlson JE, Black SA, et al.: Disability in older adults. 1: Prevalence, causes, and consequences.Behavioral Medicine. 1999,24:147–156.PubMedGoogle Scholar
  21. (21).
    International Longevity Center-USA, Ltd. Maintaining Healthy Lifestyles:A Lifetime of Choices, workshop report. Retrieved December 6, 2004, from http://www.ilcusa.org/_lib/pdf/health.pdfGoogle Scholar
  22. (22).
    DiPietro L: Physical activity in aging: changes in patterns and their relationship to health and function.Journals of Gerontology A: Biological Sciences and Medical Sciences. 2001,56(Suppl. 2):13–22.PubMedGoogle Scholar
  23. (23).
    Houde SC, Melillo KD: Cardiovascular health and physical activity in older adults: an integrative review of research methodology and results.Journal of Advanced Nursing. 2002,38:219–234.PubMedCrossRefGoogle Scholar
  24. (24).
    {au{fnBush} {gnGW}}:The President’s Health and Fitness Initiative, Executive Summary. Retrieved December 6, 2004, from http://www. whitehouse.gov/news/releases/2003/07/20030718-6.htmlGoogle Scholar
  25. (25).
    U.S. Department of Health and Human Services, Steps to a Healthier U.S.:A Program and Policy Perspective: The Power of Prevention. Retrieved December 6, 2004, from www. healthierus.gov/ steps/summit/prevportfolio/power_of_prevention. pdfGoogle Scholar
  26. (26).
    AARP:Be Active for Life. Retrieved December 6, 2004, from http://www. aarp.org/health-active/Google Scholar
  27. (27).
    AARP:Exercise Attitudes and Behaviors: A Survey of Midlife and Older Adults. Retrieved December 6, 2004, from http:// research. aarp.org/health/exercise.htmlGoogle Scholar
  28. (28).
    Ory MG, Hoffman M, Hawkins M, Sanner B, Mockenhaupt R: Challenging aging stereotypes: designing and evaluating physical activity programs.American Journal of Preventive Medicine. 2003,25:164–217.PubMedCrossRefGoogle Scholar
  29. (29).
    Robert Wood Johnson Foundation: National blueprint for increasing physical activity among adults 50 and over: Creating a strategic framework and enhancing organizational capacity for change.Journal of Aging and Physical Activity. 2000,9(Suppl.):5–28.Google Scholar
  30. (30).
    American College of Sports Medicine:Guidelines for Exercise Testing and Prescription (6th Ed.). Philadelphia: Lippincott, Williams and Wilkins, 2000.Google Scholar
  31. (31).
    American College of Sports Medicine: ACSM position stand on exercise and physical activity in older adults.Medicine and Science in Sports and Exercise. 1998,30:992–1008.CrossRefGoogle Scholar
  32. (32).
    Cardinal BJ, Cardinal MK: Preparticipation physical activity screening within a racially diverse, older adult sample: comparison of the original and Revised Physical Activity Readiness Questionnaires.Research Quarterly for Exercise and Sport. 2000,71:302–307.PubMedGoogle Scholar
  33. (33).
    Thomas S, Reading J, Shephard RJ: Revision of the Physical Activity Readiness Questionnaire (PAR-Q).Canadian Journal of Sport Sciences. 1992,17:338–345.PubMedGoogle Scholar
  34. (34).
    Herbert D, Herbert W:Legal Aspects of Preventive Rehabilitation and Recreation Exercise Programs (4th Ed.). Canton, OH: PRC, 2002.Google Scholar
  35. (35).
    Gibbons RJ, Balady GJ, Timothy BJ, et al.: ACC/AHA 2002 guideline update for exercise testing: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines).Journal of the American College of Cardiology. 2002,40:1531–1540.PubMedCrossRefGoogle Scholar
  36. (36).
    Mora S, Redberg RF, Cui Y, et al.: Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: A 20-year follow-up of the lipid research clinics prevalence study.Journal of the American Medical Association. 2003,290:1600–1607.PubMedCrossRefGoogle Scholar
  37. (37).
    Jette AM, Keysor JJ: Disability models: Implications for arthritis exercise and physical activity interventions.Arthritis and Rheumotology. 2003,49:114–120.CrossRefGoogle Scholar
  38. (38).
    Keysor JJ, Jette AM: Have we oversold the benefit of late-life exercise?Journals of Gerontology A: Biological Sciences and Medical Sciences. 2001,56:M412-M423.PubMedGoogle Scholar
  39. (39).
    Colbert LH, Hootman JM, Macera CA: Physical activity-related injuries in walkers and runners in the aerobics center longitudinal study.Clinical Journal of Sports Medicine. 2000,10:259–263.CrossRefGoogle Scholar
  40. (40).
    Hootman JM, Macera CA, Ainsworth BE, et al.: Association among physical activity level, cardiorespiratory fitness, and risk of musculoskeletal injury.American Journal of Epidemiology. 2001,154:251–258.PubMedCrossRefGoogle Scholar
  41. (41).
    Hootman JM, Macera CA, Ainsworth BE, et al.: Epidemiology of musculoskeletal injuries among sedentary and physically active adults.Medicine and Science in Sports and Exercise. 2002,34:838–844.PubMedCrossRefGoogle Scholar
  42. (42).
    Hootman JM, Macera CA, Ainsworth BE, et al.: Predictors of lower extremity injury among recreationally active adults.Clinical Journal of Sports Medicine. 2002,12:99–106.CrossRefGoogle Scholar
  43. (43).
    Hootman JM, Macera CA, Helmick CG, Blair SN: Influence of physical activity-related joint stress on the risk of self-reported hip/knee osteoarthritis: A new method to quantify physical activity.Preventive Medicine. 2003,36:636–644.PubMedCrossRefGoogle Scholar
  44. (44).
    Sutton AJ, Muir KR, Mockett S, Fentem P: A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey.Annals of Rheumotological Diseases. 2001,60:756–764. 28CrossRefGoogle Scholar
  45. (45).
    Conn JM, Annest JL, Gilchrist J: Sports and recreation related injury episodes in the US population, 1997-99.Injury Prevention. 2003,9:117–123.PubMedCrossRefGoogle Scholar
  46. (46).
    Hootman JM, Macera CA, Ainsworth BE, et al.: Predictors of lower extremity injury among recreationally active adults.Clinical Journal of Sports Medicine. 2002,12:99–106.CrossRefGoogle Scholar
  47. (47).
    Nicholl JP, Coleman P, Williams BT: The epidemiology of sports and exercise related injury in the United Kingdom.British Journal of Sports Medicine. 1995,29:232–238.PubMedCrossRefGoogle Scholar
  48. (48).
    Albert CM, Mittleman MA, Chae CU, et al.: Triggering of sudden death from cardiac causes by vigorous exertion.New England Journal of Medicine. 2000,343:1355–1361.PubMedCrossRefGoogle Scholar
  49. (49).
    Albert CM, Chae CU, Grodstein F, et al.: Prospective study of sudden cardiac death among women in the United States.Circulation. 2003,107:2096–2101.PubMedCrossRefGoogle Scholar
  50. (50).
    Lemaitre RN, Siscovick DS, Raghunathan TE, et al.: Leisure-time physical activity and the risk of primary cardiac arrest.Archives of Internal Medicine. 1999,159:686–690.PubMedCrossRefGoogle Scholar
  51. (51).
    Siscovick DS: Exercise and its role in sudden cardiac death.Cardiology Clinics. 1997,15:467–472.PubMedCrossRefGoogle Scholar
  52. (52).
    Siscovick DS, Weiss NS, Fletcher RH, Lasky T: The incidence of primary cardiac arrest during vigorous exercise.New England Journal of Medicine 1984,311:874–877.PubMedCrossRefGoogle Scholar
  53. (53).
    Thompson PD: The cardiovascular complications of vigorous physical activity.Archives of Internal Medicine. 1996,156:2297–2302.PubMedCrossRefGoogle Scholar
  54. (54).
    Thompson PD, Funk EJ, Carleton RA, Sturner WQ: Incidence of death during jogging in Rhode Island from 1975 through 1980.Journal of the American Medical Association. 1982,247:2535–2538.PubMedCrossRefGoogle Scholar
  55. (55).
    Tofler GH, Mittleman MA, Muller JE: Physical activity and the triggering of myocardial infarction: the case for regular exercise.Heart. 1996,75:323–325.PubMedCrossRefGoogle Scholar
  56. (56).
    Hootman JM, Macera CA, Ainsworth BE, et al.: Epidemiology of musculoskeletal injuries among sedentary and physically active adults.Medicine and Science in Sports and Exercise. 2002,34:838–844.PubMedCrossRefGoogle Scholar
  57. (57).
    {au{fnButler} {gnRN}}, {au{fnEstrine} {gnJ}}, {au{fnNyberg} {gnJ}}:Walk to a Healthy Future, International Longevity Center Briefing Report. New York: International Longevity Center, 2003. Retrieved December 6, 2004, from http:// www.ilcusa.org/_lib/pdf/walkingib.pdfGoogle Scholar
  58. (58).
    Ory MG, Jordan PJ, Bazzarre T: The Behavior Change Consortium: Setting the stage for a new century of health behavior-change research.Health Education Research. 2002,17:500–511.PubMedCrossRefGoogle Scholar
  59. (59).
    Fletcher GF, Balady G, Froelicher VF, et al.: Exercise standards. Astatement for healthcare professionals from the American Heart Association.Writing Group. Circulation. 1995,91:580–615.Google Scholar
  60. (60).
    U.S. Preventive Services Task Force:Screening for Coronary Heart Disease. Retrieved December 6, 2004, from http:// www.ahcpr.gov/ clinic/uspstf/uspsacad.htmGoogle Scholar
  61. (61).
    National Institute on Aging:Exercise: A Guide from the National Institute on Aging. Retrieved December 6, 2004, from http:// www.nia.nih.gov/exercisebook/index.htmGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2005

Authors and Affiliations

  • Marcia Ory
    • 1
  • Barbara Resnick
    • 2
  • Patricia J. Jordan
    • 3
  • Mace Coday
    • 4
  • Deborah Riebe
    • 5
  • Carol Ewing Garber
    • 6
  • Leslie Pruitt
    • 7
  • Terry Bazzarre
    • 8
  1. 1.Department of Behavioral and Social Health, School of Rural Public HealthTexas A&M University SystemCollege Station
  2. 2.School of NursingUniversity of MarylandMaryland
  3. 3.Pacific Telehealth & Technology HuiUSA
  4. 4.University of Tennessee Health Science CenterUSA
  5. 5.University of Rhode IslandIsland
  6. 6.Northeastern UniversityUSA
  7. 7.Stanford UniversityUSA
  8. 8.The Robert Wood Johnson FoundationUSA

Personalised recommendations