Browsing by Author "Keith, NiCole"
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Item Addressing People and Place Microenvironments in Weight Loss Disparities (APP-Me): Design of a randomized controlled trial testing timely messages for weight loss behavior in low income black and white women(Elsevier, 2018) Clark, Daniel O.; Srinivas, Preethi; Bodke, Kunal; Keith, NiCole; Hood, Sula; Tu, Wanzhu; Medicine, School of MedicineBackground Behavioral interventions for weight loss have been less effective in lower income and black women. These poorer outcomes may in part be related to these women having more frequent exposures to social and physical situations that are obesogenic, i.e., eating and sedentary cues or situations. Objectives Working with obese, lower income black and white women, Addressing People and Place Microenvironments (APP-Me) was designed to create awareness of self-behavior at times and places of frequent eating and sedentary behavior. Design APP-Me is being evaluated in a randomized controlled trial with 240 participants recruited from federally qualified health centers located in a single Midwestern city. All participants complete four weeks of ecological momentary assessments (EMA) of situations and behavior. At the end of the four weeks, participants are randomized to enhanced usual care (UC) or UC plus APPMe. Methods APP-Me is an automated short messaging system (SMS). Messages are text, image, audio, or a combination, and are delivered to participants’ mobile devices with the intent of creating awareness at the times and places of frequent eating or sedentary behavior. The EMA data inform the timing of message deliveries. Summary This project aims to create and test timely awareness messages in a subpopulation that has not responded well to traditional behavioral interventions for weight loss. Novel aspects of the study include the involvement of a low income population, the use of data on time and place of obesogenic behavior, and message delivery time tailored to an individual’s behavioral patterns.Item Augmenting the Health Belief Model to Promote Knee Massage as Self-Management Among Individuals with Knee Osteoarthritis: A Roadmap for Future Research and Intervention Development(2023-08) Nemati, Raheleh; Munk, Niki; Kaushal, Navin; Keith, NiCole; Naugle, KellySelf-administered massage is a form of self-management that has been shown to alleviate symptoms among individuals with knee osteoarthritis. However, existing interventions have yielded inconsistent results in terms of promoting the practice of self-administered massage, highlighting a critical gap in the application of a theoretical or conceptual model. The current study utilized an expanded health belief model that integrates constructs from the theory of planned behavior aimed to identify the behavioral determinants associated with the practice of self-administered knee massage. An observational study was designed to address the objectives using an online survey. A total of 268 participants with knee osteoarthritis completed the survey. Data regarding the clinical characteristics of participants, including the year of diagnosis, chronicity of pain, affected knee(s), and the intensity of pain in terms of current, average, and worst levels, were collected. Structural equation modeling was used to test the predictive validity of the proposed model. The model revealed self-administered massage behavior to be predicted by intention (β = .21, p < .014). Intention was predicted by cues (β = .29, p <.001), task self-efficacy (β = .29, p <.001), affective attitudes (β = .14, p =.011), perceived severity (β = .27, p <.001), and perceived facilitators (β = .22, p <.001), but not response self-efficacy, instrumental attitudes, or barriers. Intention mediated the effects between cues (β = .06, 95% CI .025, .129) and perceived severity (β = .06, 95% CI .014, .127) and behavior. Model determinants were found to mediate between age and behavior (β = -.16, 95% CI -.224, -.093). Interventions aimed at promoting self-administered massage should focus on enhancing individuals' perception of the severity of their knee OA progression and their confidence in performing the massage by teaching them the common massage techniques.Item COVID-19: Implications for Physical Activity, Health Disparities, and Health Equity(Sage, 2021-07-27) Hasson, Rebecca; Sallis, James F.; Coleman, Nailah; Kaushal, Navin; Nocera, Vincenzo G.; Keith, NiCole; Exercise & Kinesiology, School of Health and Human SciencesPhysical activity is one of the most efficacious pathways to promoting mental and physical health, preventing disease, and, most important during the COVID-19 pandemic, bolstering a stronger immune system. Efforts to “flatten the curve” have resulted in the temporary closure of exercise facilities and gyms, suspension of sport activities, and advisories to avoid public recreational spaces. All of these changes have made traditional opportunities to be physically active difficult to access. These changes have also exacerbated existing disparities in access to social and environmental supports for physical activity, potentially contributing to a widening gap in physical activity participation among those at greatest risk for COVID-19. Physical activity can play a special role in reducing the inequitable consequences of COVID-19; however, expansion and better targeting of evidence-informed interventions are needed that address the unique barriers present in communities that have been economically and socially marginalized to achieve health equity in COVID-19 outcomes. This review highlights effective and feasible strategies that provide more equitable access to physical activity programs and spaces across the United States. With a renewed investment in physical activity, this behavior can play a crucial role in improving population health and reducing disparities during the COVID-19 pandemic and beyond.Item Exemplifying Inclusive Excellence: How Indiana University Purdue University Indianapolis Leads by Example in Kinesiology(AKA, 2022-11) Urtel, Mark; Keith, NiCole; Bahamonde, Rafael E.; Exercise & Kinesiology, School of Health and Human SciencesThis article documents the highlights achieved by the Department of Kinesiology at Indiana University Purdue University Indianapolis over the span of 25 years that culminated with their being awarded the Inclusive Excellence award as sponsored by the American Kinesiology Association. Furthermore, this journey was presented using the special issue focus on leadership. Presented experiences occurred within the typical faculty understanding of teaching, research, and service. Recognition was given to the university and campus that hosts this department as it related to the overall diversity and inclusion culture developed on the broader scale, as this is important to acknowledge. This journey could inform or inspire other similar units as they strive to enhance diversity and inclusive excellence in their respective institutions.Item Exercise Behavior Is Determined By Pandemic Distress And Task Burden Among Caregivers Of Older Adults(Oxford University Press, 2022) Nemati, Donya; Keith, NiCole; Kaushal, Navin; Medicine, School of MedicineBackground: Caregivers who have dependents with dementia are at a much higher risk of heart disease and mental illnesses compared with non-dementia caregivers. Consequently, these outcomes have been exacerbated by societal barriers that resulted from the pandemic. Engaging in regular physical activity at a moderate-to-vigorous level (MVPA) is beneficial for caregivers has it has been shown to prevent several adverse health outcomes. However, pandemic-related (COVID-19) distress likely worsened caregiver burden which in turn compromised their MVPA levels. The purpose of this study was to understand how caregiving burden impacts MVPA when accounting for physical activity determinants from an augmented Theory of Planned Behavior (TPB) model. Methods: Participants (n=127) were caregivers for older adults (65+) who have dementia. Participants completed measures of MVPA (behavior), TPB, pandemic-related distress (COVID Caregiver Risk Index) and burden scale for family caregivers. The study was investigated using a structural equation model. Results: Participants were 45.5 (SD=3.4) years old, 76.4% female. Attitudes (β=.22, p=.012) and perceived behavioral control (β=.19, p<.001) predicted intention. Attitudes and perceived behavioral control mediated the relationship between past behavior and intention (β=.17, p=.02). Covid distress predicted caregiver burden (β=.35, p<.001), and caregiver burden mediated the effects between distress and behavior (β=-.12, p=.01). Conclusions: Caregiver burden findings suggest that societal changes and demographic-specific burdens related to caregivers need to be considered for caregivers with dependents who have dementia. Taken together, exercise programs that focus on traditional behavioral determinants also need to include specific approaches to buffer caregiving burden experienced in this demographic.Item Experiential Learning in Kinesiology: A Student Perspective(SAGE Publications, 2015-09-01) de Groot, Mary; Alexander, Kisha; Culp, Brian; Keith, NiCole; Department of Medicine, IU School of MedicineOVERVIEW: Service learning is a form of experiential learning that pairs academic educational experiences and community organizations to promote training, civic engagement, and meaningful service by students to their community. Kinesiology programs have moved toward increasing experiential and service learning options in health promotion for their students, but few have evaluated the student perceptions of these programs. PURPOSE: The purpose of the current study was to conduct a qualitative evaluation of a service learning course for Kinesiology majors located in a low-income urban area. METHODS: Ten recent graduates of a department of Kinesiology were enrolled in focus groups, stratified by gender, facilitated by a graduate research assistant not affiliated with their school. Focus group discussions were audiotaped, transcribed and analyzed for themes. RESULTS: Nine themes were identified including: (1) Personal and professional experience, (2) decision to participate, (3) location decision, (4) self-efficacy, (5) perceptions of program members, (6) social interaction, (7) personal and program communication, (8) physical facilities and (9) program outcomes. Students positively evaluated the learning experience as valuable to their personal and professional development; noted changes in their perceptions of low-income communities and increases to self-efficacy and skill acquisition from the beginning to the end of the course; and observed significant needs and improvements in physical, emotional and social outcomes of community members. CONCLUSIONS: This study demonstrated multiple and varied benefits of a service learning program for Kinesiology students. On-going evaluation of service learning programs in health promotion is needed to enhance student and community outcomes.Item Greater functional aerobic capacity predicts more effective pain modulation in older adults(Office of the Vice Chancellor for Research, 2016-04-08) Ohlman, Tom; Naugle, Keith; Keith, NiCole; Riley, Zachary; Naugle, Kelly M.Endogenous pain inhibitory and facilitory function deteriorates with age, potentially placing older adults at greater risk for chronic pain. Prior research shows that self-reported physical activity predicts endogenous pain inhibitory capacity and facilitation of pain on quantitative sensory tests (QST) in healthy adults. Purpose: To investigate whether functional aerobic capacity and lower extremity strength in older adults cross-sectionally predicts pain sensitivity, pain inhibition following isometric exercise, and facilitation of pain during heat pain temporal summation (TS) tests. Methods: 42 subjects (10 male, 32 female, age=67.5±5.1) completed the 6-minute walk test (6MWT), 30-second chair stand test, and several QSTs. QSTs included: 1) Pain ratings (0-100 scale) during the submersion of the hand in a cold water bath (CWB), 2) heat pain threshold tests, 3) the amount of pain reduction following submaximal isometric exercise, and 4) degree of pain facilitation during temporal summation tests conducted at 44, 46, and 48°C. Responses on the QSTs were analyzed using hierarchical linear regression with meters on 6MWT and number of chair stands as final predictors. Results: After controlling for demographic and psychological factors, aerobic capacity on 6MWT significantly predicted CWB pain ratings (R2 change= 22.5%, Beta= -0.491), pain facilitation during TS trials at 44°C (R2 change= 16.7%, Beta= -0.446), and the amount of pain reduction following isometric exercise (R2 change= 20.7%, Beta= 0.393). All other analyses were not significant (P>0.05). Conclusions: Older adults exhibiting greater functional aerobic capacity displayed reduced cold pain sensitivity, reduced pain facilitory function, and increased pain inhibition following exercise. These findings suggest that increased aerobic fitness in older adults may be associated with more effective endogenous modulation of pain. This study was funded by the IUPUI School of PETM Faculty Research Opportunity Grant.Item Kinesiophobia Predicts Physical Function and Physical Activity Levels in Chronic Pain-Free Older Adults(Frontiers Media, 2022-04-27) Naugle, Kelly M.; Blythe, Corinthian; Naugle, Keith E.; Keith, NiCole; Riley, Zachary A.; Kinesiology, School of Health and Human SciencesAdvanced aging is associated with a general decline in physical function and physical activity. The current evidence suggests that pain-related fear of movement (i.e., kinesiophobia) is increased in the general older adult population and impacts physical activity levels in patients with chronic pain. However, whether kinesiophobia could impact physical activity and function in relatively healthy, chronic pain-free older adults remain unclear. Thus, the purpose of this study was to examine whether fear of movement due to pain predicted self-reported and objective levels of physical function and physical activity in healthy older adults without chronic pain. Fifty-two older adults were enrolled in this study. The participants completed the International Physical Activity Questionnaire (IPAQ) and wore an accelerometer on the hip for 7 days to measure physical activity. Measures of sedentary time, light physical activity, and moderate to vigorous physical activity were obtained from the accelerometer. Measures of physical function included the Physical Functioning subscale of the Short Form-36, Short Physical Performance Battery (SPPB), the 30-s Chair Stand test, and a maximal isometric hand-grip. The Tampa Scale of Kinesiophobia (TSK) was used to measure fear of movement or re-injury associated with pain. Potential covariates included self-reported activity-related pain and demographics. Hierarchical linear regressions were conducted to determine the relationship of kinesiophobia with levels of physical activity and physical function while controlling for activity-related pain and demographics. TSK scores did not predict self-reported physical activity on the IPAQ. However, TSK scores predicted self-reported physical function (Beta = -0.291, p = 0.015), 30-s Chair Stand test scores (Beta = -0.447, p = 0.001), measures from the SPPB (Gait speed time: Beta = 0.486, p < 0.001; Chair stand time: Beta = 0.423, p = 0.003), percentage of time spent in sedentary time (Beta = 0.420, p = 0.002) and light physical activity (Beta = -0.350, p = 0.008), and moderate to vigorous physical activity (Beta = -0.271, p = 0.044), even after controlling for significant covariates. These results suggest that greater pain-related fear of movement/re-injury is associated with lower levels of light and moderate to vigorous physical activity, greater sedentary behavior, and worse physical function in healthy, chronic pain-free older adults. These findings elucidate the potential negative impact of kinesiophobia in older adults who don't report chronic pain.Item Outcomes of an RCT of video‐conference vs. in‐person or in‐clinic nutrition and exercise in midlife adults with obesity(Wiley, 2019) Clark, Daniel O.; Keith, NiCole; Weiner, Michael; Xu, Huiping; Medicine, School of MedicineObjective New communication technologies have shown some promise in lifestyle weight loss interventions, but may be most effective when leveraging face‐to‐face communications. The study reported here sought to test whether weight loss program attendance and outcomes are greater when offered in‐person at community sites or remotely via videoconference versus in federally qualified health centers (FHQCs). In a three‐arm randomized trial among 150 FQHC adults, intervention delivery in community‐sites or via videoconference were tested against a clinic‐based lifestyle intervention (enhanced usual care [EUC]). Methods Twice weekly, a nutrition topic was reviewed, and exercise sessions were held in a 20‐week program delivered either in community settings or via videoconference. The primary outcome was the proportion of participants losing more than 2 kg at 6 (end of treatment) and 12 months in intent‐to‐treat analyses. Results Mean (SD) age was 53 (7) years, 82% were female, 65% were African‐American, 50% reported $18,000 or less household income, 49% tested low in health literacy, and mean (SD) body mass index was 39 (6) kg/m2. The proportion losing more than 2 kg of weight in the community site, videoconference, and EUC groups was 33%, 34%, and 24%, respectively at 6 months, and 29%, 34%, and 29% at 12 months. No differences reached significance. Attendance was poor in all groups; 45% of community site, 58% of videoconference, and 16% of EUC participants attended at least one session. Conclusion Videoconference and community‐based delivery were as effective as an FQHC‐based weight loss program.Item PARCS: A Safety Net Community-Based Fitness Center for Low-Income Adults(2016) Keith, NiCole; Mi, Deming; Alexander, Kisha; Kaiser, Stephanie; de Groot, Mary; Department of Kinesiology, School of Physical Education and Tourism ManagementBackground: Physical activity (PA) and fitness are critical to maintaining health and avoiding chronic disease. Limited access to fitness facilities in low-income urban areas has been identified as a contributor to low PA participation and poor fitness. Objectives: This research describes community-based fitness centers established for adults living in low-income, urban communities and characterizes a sample of its members. Methods: The community identified a need for physical fitness opportunities to improve residents’ health. Three community high schools were host sites. Resources were combined to renovate and staff facilities, acquire equipment, and refer patients to exercise. The study sample included 170 members older than age 18 who completed demographic, exercise self-efficacy, and quality of life surveys and a fitness evaluation. Neighborhood-level U.S. Census data were obtained for comparison. Results: The community-based fitness centers resulted from university, public school, and hospital partnerships offering safe, accessible, and affordable exercise opportunities. The study sample mean body mass index was 35 + 7.6 kg/m2 (class II obesity), mean age was 50 ± 12.5 years, 66% were Black, 72% were female, 66% completed some college or greater, and 71% had an annual household income of less than $25,000 and supported 2.2 dependents. Participants had moderate confidence for exercise participation and low fitness levels. When compared with census data, participants were representative of their communities. Conclusion: This observational study reveals a need for affordable fitness centers for low-income adults. We demonstrate a model where communities and organizations strategically leverage resources to address disparities in physical fitness and health.