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Elizabeth Morghen Sikes,1 Robert W Motl,1 Jayne M Ness2 1Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; 2Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham, AL, USA Purpose: Pediatric-onset multiple sclerosis (POMS) accounts for ~5% of all multiple sclerosis cases, and has a prevalence of ~10,000 children in the USA. POMS is associated with a higher relapse rate, and results in irreversible disability on average 10 years earlier than adult-onset multiple sclerosis. Other manifestations of POMS include mental and physical fatigue, cognitive impairment, and depression. We believe that the health behaviors of physical activity, diet, and sleep may have potential benefits in POMS, and present a scoping review of the existing literature. Methods: We identified papers by searching three electronic databases (PubMed, GoogleScholar, and CINAHL). Search terms included: pediatric multiple sclerosis OR pediatric onset multiple sclerosis OR POMS AND health behavior OR physical activity OR sleep OR diet OR nutrition OR obesity. Papers were included in this review if they were published in English, referenced nutrition, diet, obesity, sleep, exercise, or physical activity, and included pediatric-onset multiple sclerosis as a primary population. Results: Twenty papers were identified via the literature search that addressed health-promoting behaviors in POMS, and 11, 8, and 3 papers focused on diet, activity, and sleep, respectively. Health-promoting behaviors were associated with markers of disease burden in POMS. Physical activity participation was associated with reduced relapse rate, disease burden, and sleep/rest fatigue symptoms. Nutritional factors, particularly vitamin D intake, may be associated with relapse rate. Obesity has been associated with increased risk of developing POMS. POMS is associated with better sleep hygiene, and this may benefit fatigue and quality of life. Discussion: Participation in health behaviors, particularly physical activity, diet, and sleep, may have benefits for POMS. Nevertheless, there are currently no interventions targeting promotion of these behaviors and examining the benefits of managing the primary and secondary manifestations of POMS. Keywords: POMS, health promotion, physical activity, diet, sleep

Cognitive impairment is prevalent, disabling, and poorly managed in persons with multiple sclerosis (MS). This cross-sectional study examined the associations among physical activity, cognitive processing speed, and learning and memory in 33 persons with MS who underwent neuropsychological assessments and wore a physical activity monitor for 7 days. Cognitive impairment was greatest in cognitive processing speed. Physical activity was significantly correlated with cognitive processing speed (pr = .35), but not learning and memory (pr = .20), after controlling for sex, age, and education. Researchers should examine exercise training and physical activity effects on cognitive performance, particularly processing speed, in MS. [ABSTRACT FROM AUTHOR]

The rambling-trembling analysis of postural control maintains that the center of pressure (COP) trajectory can be decomposed into deviations resulting from supraspinal (i.e., rambling; RM) and spinal processes (i.e., trembling; TM). The purpose of this investigation was to test the rambling and trembling hypothesis by comparing persons with multiple sclerosis (MS) who had either elevated or normal spinal reflexes to healthy controls. 16 subjects with MS and 16 age and gender matched control subjects completed a postural control task. The persons with MS were divided into groups with high (MShigh) or low (MSlow) H-reflex amplitude. The MShigh group had an elevated ratio of TM to COP compared with healthy controls, but no differences in the ratio between RM and COP. The findings are congruent with the assumptions of the rambling-trembling hypothesis. Further work is needed to determine if RM and TM represent distinct spinal and supraspinal mechanisms to postural control. [ABSTRACT FROM AUTHOR]

The article presents a randomized controlled trial (RCT) of the efficacy of a behavioral intervention that targets symptoms and physical activity of patients with multiple sclerosis (MS). It examines the effectiveness of an Internet-delivered behavioral intervention to improve depression, fatigue, pain, anxiety and sleep quality in ambulatory persons with MS. Results showed behavioral intervention targeting lifestyle physical activity as an alternative approach for MS symptoms treatment.

Background: Studies proposed that the physical activity and quality of life (QoL) relationship may not be entirely direct but mediated through other variables; however, few studies have examined these relationships in diverse population's older adults. Purpose: This study aims to examine the roles of self-efficacy and mental health difficulties in the physical activity and QoL relationship and to determine if demographic characteristics alter these relationships. Methods: One hundred ninety-six older adults completed measures of physical activity, self-efficacy, mental health difficulties, and QoL. Two-multilevel structural models were tested to determine the relationship between physical activity and QoL. Results: Both structural models suggested that the relationship between physical activity and QoL is indirect, but the models were not significantly different. In model 1, we observed a positive linear relationship between physical activity and self-efficacy. In turn, self-efficacy was negatively associated with poor mental health difficulties and positively associated with QoL. Mental health difficulties were also negatively associated with QoL. In model 2, physical activity was positively associated with self-efficacy and negatively associated with mental health difficulties; in turn, self-efficacy was positively associated with QoL, whereas mental health difficulties were negatively associated with QoL. Conclusions: Overall, our findings suggest that self-efficacy and mental health have intermediary roles in the relationship between physical activity and QoL in a diverse sample of older adults. Prospective studies are needed to determine whether self-efficacy and mental health difficulties are complementary or one or the other accounts for more variance in the relationship between physical activity and QoL. [ABSTRACT FROM AUTHOR]

We compared the explanatory power of two symptom clusters that consisted of either three or five symptoms as correlates of physical activity in individuals with relapsing-remitting multiple sclerosis (RRMS; N = 218). The data were primarily analyzed using covariance modeling in Mplus 3.0. A symptom cluster of fatigue, depression, and pain had a moderate, negative relationship with physical activity, and this relationship was comparable inmagnitude with a symptom cluster of fatigue, depression, pain, perceived cognitive dysfunction, and poor sleep quality. The relationships were attenuated after controlling for exercise history and neurological impairment. Such findings further support the consideration of a narrowly defined cluster of three symptoms as an independent correlate of physical activity in persons with RRMS. [ABSTRACT FROM AUTHOR]

Objective. This study examined the structural and external aspects of score validity for the abbreviated Late Life-Function and Disability Inventory (LL-FDI) as well as its longitudinal measurement invariance and responsiveness in individuals with multiple sclerosis (MS). Methods. The sample included 292 individuals with MS who completed a battery of questionnaires on two occasions separated by 6 months. The battery included the abbreviated LL-FDI along with measures of mobility disability; neurological impairments; symptoms of fatigue, anxiety, depression and pain; health status; and quality of life. The data were analysed using Analysis of Moment Structures (AMOS) and Statistical Package for the Social Sciences (SPSS), versions 16.0. Results. Confirmatory factor analysis supported the structural validity and longitudinal measurement invariance of the disability and functional limitations components of the abbreviated LL-FDI. MANOVA and bivariate correlations supported the external aspects of score validity based on differences in mean scores as a function of clinical MS course (relapsing vs. progressive) and level of mobility disability (mild vs. moderate mobility disability) and associations with measures of neurological impairments, symptoms, health status and QOL, respectively. ANOVA established the responsiveness (i.e., sensitivity for reflecting clinically important differences in health status across time) of the functional limitations and disability components of the abbreviated LL-FDI for detecting changes in mobility disability across 6-months. Conclusion. Such findings provide a new option for the measurement of functional limitations and disability using the abbreviated LL-FDI in persons with MS. [ABSTRACT FROM AUTHOR]

Background: There has been an increased interest by researchers and clinicians in the study of physical activity behavior and its determinants and consequences in persons with multiple sclerosis (MS). Objective: This paper provides an overview of the objective monitoring of physical activity in persons with MS using motion sensors such as pedometers and accelerometers. Major findings: Accumulating evidence supports the reliability and validity of pedometers, particularly the Yamax SW-200, as a measure of physical activity in fully ambulatory and ambulatory impaired persons with MS. There is some degree of inaccuracy with the Yamax SW-200 pedometer during self-selected and slow walking speeds. By comparison, substantial evidence from multiple approaches, across a range of researchers, and with different units/manufacturers supports the validity of accelerometers as a measure of physical activity in fully ambulatory and ambulatory impaired persons with MS. There is no concern regarding the inaccuracy of accelerometers for measuring steps taken during slow walking. Conclusion: Researchers and clinicians now have a better set of motion sensors that provide objective, valid, and reliable measures of physical activity in persons with MS. This should support an expanding interest and study of physical activity and its determinants and consequences in MS as well as monitoring physical activity and its change in clinical practice. Importantly, there is a major concern with the application of motion sensors as a pure measure of physical activity in persons with MS, and researchers and clinicians should be aware of this conundrum in any application of accelerometers. [ABSTRACT FROM AUTHOR]

CONTEXT: There is abundant evidence that quality of life (QOL) is compromised in persons with multiple sclerosis (MS), but researchers have not yet examined the possible association between co-occurring symptoms and QOL in this population. OBJECTIVES: The objective of this study was to examine the symptom cluster of fatigue, pain, depression, and perceived cognitive complaints and its association with QOL in individuals with MS. METHODS: The sample included 133 individuals with a definite diagnosis of MS who completed a battery of self-report measures as part of a cross-sectional study of symptoms and physical activity. The battery included the Fatigue Severity Scale, the Center for Epidemiological Studies-Depression Scale, the short form of the McGill Pain Questionnaire, the Perceived Deficits Questionnaire, and the Multiple Sclerosis Impact Scale. RESULTS: Results indicated that 1) there were moderate bivariate correlations between fatigue, depression, pain, and perceived cognitive complaint scores; 2) the correlations between scores from the pairs of symptoms were attenuated when expressed as partial correlations controlling for the covariance of the remaining pair of symptoms; 3) exploratory and confirmatory factor analyses supported a single-factor model for the associations among fatigue, depression, pain, and perceived cognitive complaint scores; 4) cluster analysis identified three subgroups differing in experiences of fatigue, depression, pain, and perceived cognitive complaints; and 5) analysis of variance indicated a possible dose-response relationship between worsening symptoms and psychological and physical domains of QOL. CONCLUSION: Such findings provide emerging support for a dose-response relationship between worsening symptoms of fatigue, pain, depression, and perceived cognitive complaints and QOL in persons with MS. [ABSTRACT FROM AUTHOR]

This study examined overall and specific symptoms as cross-sectional correlates of physical activity in persons with relapsing-remitting multiple sclerosis (RRMS). We expected that overall symptoms would be inversely associated with physical activity, and that the association would be accounted for by fatigue, depression, and pain. The sample included 269 individuals with a definite diagnosis of RRMS who completed a battery of questionnaires and then wore an accelerometer for 7 days. Data were analyzed using covariance modeling in Mplus. The primary model (chi square = 13.89, df = 10, p = 0.18, SRMR = 0.03, comparative fit index = 0.99) demonstrated that the path between overall symptoms and physical activity was indirect by way of fatigue (indirect path coefficient = -0.15) and depression (indirect path coefficient = -0.10). Such findings provide support for an indirect association between overall symptoms and physical activity by way of fatigue and depression in RRMS. [ABSTRACT FROM AUTHOR]

We examined overall and specific symptoms as correlates of physical activity in individuals with multiple sclerosis (MS). Participants (N = 133) completed questionnaires that measured overall symptoms; and specific symptoms of depression, pain, and fatigue; difficulty walking; and physical activity. Initial analyses indicated that higher levels of overall symptoms (r = -.50), fatigue (r = -.26), and difficulty walking (r = -.46) were associated with lower levels of physical activity. Path analysis demonstrated that higher levels of overall symptoms were directly and indirectly associated with lower levels of physical activity; the indirect pathway involved difficulty walking ([gamma][beta] = -.17). Such findings indicate that walking difficulty may partially explain the negative relationship between overall symptoms and physical activity behavior in MS. © 2008 Wiley Periodicals, Inc. Res Nurs Health 31:466-475, 2008 [ABSTRACT FROM AUTHOR]

This study examined the relationships among physical activity, glucocorticoid use, body composition, and bone health in ambulatory women with multiple sclerosis (MS). Twenty-nine white women (mean +/- standard deviation: age 45.1 +/- 9.0 yr, Expanded Disability Status Scale 2.9 +/- 1.2) diagnosed with MS were assessed for whole body (WB), proximal femur (PF) and lumbar spine (LS) bone status (bone mineral content [BMC], bone mineral density [BMD], and quantitative ultrasound index [QUI] by calcaneal quantitative ultrasound) and body composition by dual energy X-ray absorptiometry; for physical activity by pedometer and accelerometer; and for glucocorticoid medication exposure by self-report. Accelerometer counts were related to PF BMC (r = 0.50, p = 0.010) when we controlled for age, fat and lean mass, MS disease duration, and glucocorticoid use. Glucocorticoid use was not associated with bone measures. When we controlled for age and fat mass, lean mass was associated with WB BMC (r = 0.41, p = 0.04), PF BMC (r = 0.61, p = 0.001), and speed of sound (SOS) (r = 0.44, p = 0.02), whereas fat mass was associated with SOS and QUI (r =0.43, p = 0.03, and r = 0.44, p = 0.02, respectively). Lean mass was an independent predictor of WB BMC ( p = 0.04) and PF BMC ( p = 0.001), whereas fat mass was an independent predictor of LS BMD (p = 0.05). In conclusion, physical activity and lean mass are associated with femoral bone mass in women with MS who are ambulatory. [ABSTRACT FROM AUTHOR]

Physical inactivity is a major health problem in the United States, particularly in elderly and disabled populations. Little research exists examining the relationships between aspects of the built environment and physical activity in older adults and individuals with multiple sclerosis (MS). We adopted a social cognitive perspective to examine the independent roles of perceptions of the environmental, self-efficacy and functional limitations in understanding physical activity levels among elderly women and women with MS. Older women (n = 136) and women diagnosed with MS (n = 173) were recruited to participate in separate cross-sectional studies. Individuals completed a battery of questionnaires and wore an activity monitor for 7 days. All measures were issued and collected through the mail with the use of self-addressed, pre-paid envelopes. Initial correlational analyses indicated that self-efficacy, functional limitations and environmental perceptions were significantly related to physical activity. Among older women, self-efficacy, functional limitations and street connectivity demonstrated independent contributions to physical activity behavior. Only self-efficacy and functional limitations demonstrated significant associations among women with MS. The prospective contributions of the environment and individual factors to changes in physical activity need to be determined. [ABSTRACT FROM AUTHOR]

This study examined the correlation of physical activity with neurological impairment and disability in persons with multiple sclerosis (MS). Eighty individuals with MS wore an accelerometer for 7 days and completed the Symptom Inventory (SI), Performance Scales (PS), and Expanded Disability Status Scale. There were large negative correlations between the accelerometer and SI (r = -0.56; rho = -0.58) and Expanded Disability Status Scale (r = -0.60; rho = -0.69) and a moderate negative correlation between the accelerometer and PS (r = -0.39; rho = -0.48) indicating that physical activity was associated with reduced neurological impairment and disability. Such findings provide a preliminary basis for using an accelerometer and the SI and PS as outcome measures in large-scale prospective and experimental examinations of the effect of physical activity behavior on disability and dependence in MS. [ABSTRACT FROM AUTHOR]

Purpose. There is limited information about the demographic characteristics associated with participation in physical activity among those with multiple sclerosis (MS). Hence, the present study examined 12 demographic variables in association with physical activity in a sample of individuals with MS. Method. Participants were 196 individuals with MS from the Midwestern portion of the United States. The participants provided demographic information and then wore a pedometer for a seven-day period. Results. Analyses indicated that increasing age, use of a cane for ambulation, unemployment, and primary and secondary progressive MS were independently associated with less physical activity participation in this sample of MS patients. Conclusion. Individuals with those characteristics are likely to be inactive and in need of a targeted intervention for increasing their participation in physical activity. [ABSTRACT FROM AUTHOR]

This study examined the effects of exercise self-efficacy on enjoyment of physical activity in a sample of low to moderately active college-aged women (N = 28). Participants were randomized into a low- or high-efficacy condition, and efficacy beliefs for engaging in moderate intensity physical activity were manipulated by providing bogus feedback after a maximal incremental exercise test. All participants completed a 30-min moderate intensity cycling session 2-3 d after the efficacy manipulation. Enjoyment of physical activity was assessed after both the maximal exercise test and the moderate intensity cycling exercise session. Our results indicated that the efficacy manipulation significantly influenced enjoyment of the maximal incremental exercise test. Participants in the low-efficacy condition reported lower enjoyment scores relative to high-efficacy participants following the maximal exercise test. However, enjoyment after the moderate intensity exercise bout did not differ between the two conditions. These results imply that efficacy may be an important influence of physical activity enjoyment, particularly at higher intensities. [ABSTRACT FROM AUTHOR]

This study examined the validity of scores from measures of physical activity among individuals with multiple sclerosis. Participants (N = 196) completed 2 self-report measures of physical activity, and wore a pedometer and an accelerometer for a 7-day period. There was a large correlation between scores from the objective devices (r = 0.82) and a moderate correlation between scores from the self-report surveys (r = 0.37). The correlations across measurement methods were moderate-to-large in magnitude (range of r = 0.32-0.53). Our results provide a stronger and more compelling basis for the validity of scores from measures of physical activity among individuals with multiple sclerosis. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the development of an original scale that measures perceived school climate for active travel in fourth- and fifth-grade girls and boys. METHODS: The data were analyzed using confirmatory factor analysis (CFA) to provide evidence of factorial validity, factorial invariance, and construct validity. RESULTS: The CFA supported the fit of a 3-factor (encouragement, praise, and importance) correlated model for the school climate for active travel measure. This hierarchical model was invariant between sex and across a 7-month time period, and initial evidence for construct validity was provided. CONCLUSIONS: School climate for active travel is a measurable construct, and preliminary evidence suggests relationships with more support for active travel from friends and family. [ABSTRACT FROM AUTHOR]

Using social-cognitive theory, we examined the associations among symptoms, self-efficacy, and physical activity in 196 individuals with multiple sclerosis (MS). Participants completed symptoms, self-efficacy, and physical activity measures and wore an accelerometer for 7 days. There was a moderate inverse correlation between symptoms and physical activity (varphi = -.42). Subsequent analyses indicated that symptoms had direct negative relationships with self-efficacy (gamma = -.32) and physical activity (gamma = -.24), and self-efficacy had a direct positive relationship with physical activity (beta = .57). This study provides initial support for symptoms as a correlate of physical activity in individuals with MS. Monitoring symptoms during a physical activity program and altering the exercise prescription during symptom exacerbation might be a method for increasing exercise adherence. [ABSTRACT FROM AUTHOR]

Previous reports have indicated a small, positive relationship between physical activity and cognition. However, the majority of research has focused on older adults, with few studies examining this relationship during earlier periods of the life span. This study examined the relationship of physical activity to cognition in a cross-section of 241 community-dwelling individuals 15-71 years of age with a task requiring variable amounts of executive control. Data were analyzed with multiple regression, which controlled for age, sex, and IQ. Participants reported their physical activity behavior and were tested for reaction time (RT) and response accuracy on congruent and incongruent conditions of a flanker task, which manipulates interference control. After controlling for confounding variables, an age-related slowing of RT was observed during both congruent and incongruent flanker conditions. However, physical activity was associated with faster RT during these conditions, regardless of age. Response accuracy findings indicated that increased physical activity was associated with better performance only during the incongruent condition for the older cohort. Findings suggest that physical activity may be beneficial to both general and selective aspects of cognition, particularly among older adults. ((c) 2006 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Purpose. The literature suggests that individuals with multiple sclerosis (MS) engage in less physical activity than non-diseased individuals. That conclusion, however, depends upon the validity of scores from measures of physical activity among the MS population. This study evaluated the validity of scores from two self-report surveys, a pedometer, and an accelerometer and during seven days of free-living conditions among individuals with MS. Method. Participants were 30 individuals (28 females, two males) with an established definite diagnosis of MS. The participants wore a pedometer and a single-axis accelerometer during the waking hours of a 7-day period. After the 7-day period, participants returned to the lab and completed a self-administered physical activity questionnaire and then underwent a 7-day physical activity recall. Results. There were strong correlations (a) between scores from the two self-report measures of physical activity and (b) between scores from the two objective measures of physical activity, and (c) weaker, but moderate-to-strong correlations between scores from the self-report and objective measures of physical activity. Conclusion. Our results support the quantification of physical activity among those with MS using validated self-report and objective measures. [ABSTRACT FROM AUTHOR]

This study examined the validity of Geriatric Depression Scale--5 (GDS-5) scores among older sedentary adults based on its structural properties and relationship with external criteria. Participants from two samples (Ns = 185 and 93; M ages = 66 and 67 years) completed baseline assessments as part of randomized controlled exercise trials. Confirmatory factor analysis supported a single-factor model for the GDS-5, the GDS-5 exhibited adequate sensitivity and specificity for screening depression, and scores from the 30 and 5 item GDS were strongly related. GDS-5 scores were strongly related with happiness and morale and moderatelyrelatedwithsatisfactionwithlife,loneliness,optimis stress, negative health symptoms, and self-esteem. As expected, GDS-5 scores were weakly related with self-efficacy, cardiorespiratory fitness, and functional fitness. Support is provided for the validity of GDS-5 scores as a measure of depression among older sedentary adults participating in exercise studies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To test an original scale assessing perceived school climate for girls' physical activity in middle school girls. METHODS: Confirmatory factor analysis (CFA) and structural equation modeling (SEM). RESULTS: CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers' and boys' behaviors, respectively, fit the data well in both sixth and eighth graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls' self-reported physical activity. CONCLUSIONS: School climate for girls' physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity. [ABSTRACT FROM AUTHOR]

PURPOSE: The study evaluated whether targeted changes in factors influencing enjoyment of physical education (PE), physical activity enjoyment, and self-efficacy beliefs about participating in physical activity mediated the effect of the Lifestyle Education for Activity Program (LEAP) intervention on participation in physical activity. METHODS: High schools (N=24) paired on enrollment size, racial composition, urban or rural location, and class structure were randomized into control (N=12) or experimental (N=12) groups. Of the 4044 girls enrolled and eligible, 2087 (51.6%) participated in the measurement component of the study. There were 1038 girls in the control group and 1049 girls in the experimental group. INTERVENTION: LEAP was a comprehensive school-based intervention emphasizing changes in instruction and school environment designed to increase physical activity among black and white adolescent girls. It was organized according to the Coordinated School Health Program and included a PE component with core objectives of promoting enjoyment of PE, physical activity enjoyment, and self-efficacy. RESULTS: Latent variable structural equation modeling indicated that: 1) the intervention had direct, positive effects on physical activity and factors influencing enjoyment of PE, which subsequently explained the effects of increased physical activity enjoyment and self-efficacy on increased physical activity; and 2) an additional, indirect effect of physical activity enjoyment on physical activity operated by an influence on self-efficacy. CONCLUSIONS: Increases in enjoyment partially mediated the positive effect of the LEAP intervention. To our knowledge, we have provided the first experimental evidence from a randomized controlled trial linking increased enjoyment with increased physical activity among black and white adolescent girls. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate social support and theory of planned behavior (TPB) constructs in explaining physical activity in adolescent girls. METHODS: One thousand seven hundred ninety-seven 8th-grade girls completed a survey measuring social provisions, family support, TPB constructs, moderate-to-vigorous physical activity (MVPA), and team sport involvement (TSI). RESULTS: Structural equation modeling (SEM) indicated statistically significant direct effects from TPB constructs and social provisions to intention; social provisions, family support, and intention to MVPA; and social provisions and family support to TSI. CONCLUSIONS: Social variables play a greater role in explaining TSI than in explaining MVPA in this sample. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the factorial and construct validity of the Head Injury Scale (HIS) among a sample of male and female collegiate athletes. DESIGN AND SETTING: Using a cross-sectional design, we established the factorial validity of the HIS scale with confirmatory factor analysis and the construct validity of the HIS with Pearson product moment correlation analyses. Using an experimental design, we compared scores on the HIS between concussed and nonconcussed groups with a 2 (groups) x 5 (time) mixed-model analysis of variance. SUBJECTS: Participants (N = 279) in the cross-sectional analyses were predominately male (n = 223) collegiate athletes with a mean age of 19.49 +/- 1.63 years. Participants (N = 33) in the experimental analyses were concussed (n = 17) and nonconcussed control (n = 16) collegiate athletes with a mean age of 19.76 +/- 1.49 years. MEASUREMENTS: All participants completed baseline measures for the 16-item HIS, neuropsychological testing battery, and posturography. Concussed individuals and paired controls were evaluated on days 1, 2, 3, and 10 postinjury on the same testing battery. RESULTS: Confirmatory factor analysis indicated that a theoretically derived, 3-factor model provided a good but not excellent fit to the 16-item HIS. Hence, the 16-item HIS was modified on the basis of substantive arguments about item-content validity. The subsequent analysis indicated that the 3-factor model provided an excellent fit to the modified 9-item HIS. The 3 factors were best described by a single second-order factor: concussion symptoms. Scores from the 16-item HIS and 9-item HIS were strongly correlated, but there were few significant correlations between HIS scores and scores from the neuropsychological and balance measures. A significant group-by-day interaction was noted on both the 9-item HIS and 16-item HIS, with significant differences seen between groups on days 1 and 2 postconcussion. CONCLUSIONS: We provide evidence for the factorial and construct validity of the HIS among collegiate athletes. This scale might aid in return-to-play decisions by physicians and athletic trainers. [ABSTRACT FROM AUTHOR]

This study examined the role of self-efficacy and physical function performance in the relationship between physical activity and functional limitations. Older women (age, M = 68.2 years) completed measures of physical activity, self-efficacy, physical function performance, and functional limitations at the baseline of an ongoing study. Analyses indicated that physical activity was associated with self-efficacy for exercise, efficacy for gait and balance, and physical function performance. Both measures of efficacy and physical functional performance were associated with functional limitations. Demographic and health status variables did not differentially influence these relationships. Although cross-sectional in nature, our findings suggest that physical activity, self-efficacy, and functional performance may all play a role in reducing functional limitations. Of particular relevance is the fact that both physical activity and self-efficacy represent important, modifiable factors that can enhance function. [ABSTRACT FROM AUTHOR]

We examined the structure of the expanded version of the Exercise and Self-Esteem Model in a sample of older adults (N = 174; age, M = 66.7 years) across a 4-year period. A panel analysis revealed support for the indirect effects of physical activity (PA) and self-efficacy (SE) on physical self-worth and global esteem through subdomain levels of esteem. These relationships were consistent across the 4-year period. Over time, older adults reporting greater reductions in SE and PA also reported greater reductions in subdomain esteem. This is one of the first studies to examine these relationships longitudinally in the PA domain and offers further support for the hierarchical and multidimensional nature of self-esteem at the physical level. We recommend further testing of the Exercise and Self-Esteem Model, with special attention being paid to assessing multiple aspects of PA and SE. [ABSTRACT FROM AUTHOR]