Factors that influence exercise activity among women post hip fracture participating in the Exercise Plus Program

Figures & data

Figure 1 Full hypothesized model.

Table 1 Description of study measures

Measure	Description	Score range and interpretation	Reliability and validity
Self-efficacy for Exercise: (Resnick and Jenkins 2000)	A nine item measure that focuses on self-efficacy expectations related to the ability to continue to exercise in the face of barriers to exercising.	0 (no confidence) to 10 (high confidence). Higher scores indicate stronger self-efficacy.	Evidence of internal consistency (alpha=0.93), and validity based on a significant relationship between efficacy expectations and moderate exercise, and confirmatory factor analysis. (Resnick and Jenkins 2000).
Outcome expectations for Exercise (Resnick et al 2000, 2001):	A nine item measure that focuses on the perceived consequences of exercise for older adults.	1 (strongly disagree) to 5 (strongly agree). Higher scores indicate stronger outcome expectations.	Evidence of internal consistency (alphas ranging from 0.88 to 0.93), and validity based on a significant relationship between outcome expectations and moderate exercise, and confirmatory factor analysis. (Resnick and Jenkins 2000).
The SF-36 (Ware and Sherbourne 1992).	An eight dimension measure of health status that focuses on: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The 8 subscales are combined to constitute mental and physical health scores.	0 to 14 for mental health; and 0 to 100 representing the percentage of total possible score achieved.	There is support for the reliability (Chronbach’s alpha for subscales ranging from 0.75 to 0.86) and validity of this measure (based on contrasting groups and factor analysis) when used with older adults (Stewart 1993, 1988;Walters and Munro 2004).
Yale Physical Activity Survey (YPAS) (DiPietro et al 1993)	A five category physical activity survey that focuses on time spent in: housework, caregiving, yardwork, exercise, and recreational activities performed during a typical week. Only the exercise subscale was utilized in this study.	0 to 1440 minutes per week.	Evidence of test-retest reliability (r = 0.63, p < 0.001), and validity based on significant correlations with physiological variables that are indicative of habitual activity (Dipietro et al 1993; Pescatello et al 1994; Kolbe-Alexander et al 2006).
Center for Epidemiological Studies Depression Scale (CESD) (Radloff 1977; Turk and Okifuji 1994).	The possible range of scores is 0 to 60.	0 to 5. Higher scores indicate more depressive symptoms.	Prior use of these measures provides evidence of their reliability and validity when used with older adults (Radloff 1977; Turk and Okifuji 1994Caracciolo and Giaquinto 2002; Bohannon et al 2003;).
Numeric Rating Scale (NRS) for Pain (Herr and Mobily 1991)	A single item measure that focuses on pain over the previous week.	0 (no pain) to 10 (the worst pain). Higher scores indicate more pain.	Evidence of test-retest reliability (Spearman rank correlations from 0.67 to 0.85) (Taylor et al 2005), and concurrent validity with other pain measures (r = 0.56 to 0.90) (Herr and Mobily 1993; Herr et al 2004; Ware et al 2006)
Fear of Falling (Jorstad et al 2005Resnick 1998)	A single item measure that focuses on fear of falling.	0 (no fear) to 4 (a lot of fear). Higher scores indicate greater fear of falling.	Evidence of validity with fear of falling significantly associated with functional performance in older adults (Resnick 1998Jorstad et al 2005)
The Tinetti Mobility Scale (Tinetti 1986)	A 17 item performance measure that focuses on mobility and includes: nine balance maneuvers and eight assessments related to gait.	0 to 26. Higher scores indicate better mobility.	Evidence of inter-rater reliability (r = 0.90), and construct validity with a significant relationship between mobility and falls (Tinetti 1986).
The Social Support for Exercise Habits Scale (Sallis et al 1987)	Includes three separate subscales of the same 15 items that reflect social interactions that might influence exercise behavior from friends, family, and experts.	Possible ranges from 23 to 67. Lower scores reflect lower social support	Evidence of internal consistency (alphas ranging from 0.61 to 0.91) and test retest reliability (r = 0.55 to 0.79). Evidence of validity was based on statistically significant relationships between the social support scale and exercise behavior (Sallis et al 1986) (Resnick et al 2002b).

Table 2 Means (SE) for selected outcome measures by treatment group (total n = 208; treatment group n = 157; control = 51)

Variable		Mean	Std. Deviation
Stage of change 2 months	Control	1.8	1.6
	Treatment	1.9	1.6
Stage of change 6 months	Control	1.2	1.7
	Treatment	1.9	1.8
Stage of change 12 months	Control	1.0	1.5
	Treatment	2.2	1.9
Outcome expectations 2 months	Control	3.9	0.56
	Treatment	3.9	0.64
Outcome expectations 6 months	Control	3.8	0.64
	Treatment	3.9	0.59
Outcome expectations 12 months	Control	3.7	0.66
	Treatment	3.9	0.61
Self-efficacy expectations 2 months	Control	6.5	2.3
	Treatment	6.5	2.8
Self-efficacy expectations 6 months	Control	5.8	3.1
	Treatment	7.2	2.5
Self-efficacy expectations 12 months	Control	6.3	3.2
	Treatment	7.4	2.4
CESD score at 2 months (larger = depressed)	Control	12.2	9.3
	Treatment	9.9	9.1
CESD score at 6 months (larger = depressed)	Control	11.8	9.2
	Treatment	9.2	8.7
CESD score at 12 months (larger = depressed)	Control	9.0	7.7
	Treatment	9.2	7.9
Summary gait and balance score 2 months	Control	18.5	6.9
	Treatment	20.6	4.5
Summary gait and balance score 6 months	Control	17.3	5.7
	Treatment	17.5	6.8
Summary gait and balance score 12 months	Control	20.2	5.2
	Treatment	20.3	5.4
Physical health status 2 months	Control	31.3	11.8
	Treatment	35.7	11.7
Physical health status 6 months	Control	36.9	14.6
	Treatment	40.8	13.6
Physical health status 12 months	Control	40.3	15.6
	Treatment	43.3	14.0
Mental health status 2 months	Control	40.9	13.8
	Treatment	45.9	9.9
Mental health status 6 months	Control	47.8	12.0
	Treatment	50.3	9.8
Mental health status 12 months	Control	49.7	10.1
	Treatment	50.9	9.3
Yale: total exercise time 2mo, hrs/wk	Control	1.7	2.3
	Treatment	1.8	2.2
Yale: total exercise time 6mo, hrs/wk	Control	2.6	3.2
	Treatment	2.2	2.9
Yale: total exercise time 12mo, hrs/wk	Control	0.92	1.4
	Treatment	3.1	3.8
Pain 2 months	Control	3.7	2.2
	Treatment	4.1	2.8
Pain 6 months	Control	4.0	3.0
	Treatment	3.6	3.0
Pain 12 months	Control	3.7	2.9
	Treatment	3.1	2.9
Fear 2 months	Control	2.6	1.4
	Treatment	2.3	1.4
Fear 6 months	Control	2.4	1.4
	Treatment	2.0	1.5
Fear 12 months	Control	2.1	1.4
	Treatment	1.9	1.4
Social support experts 2 months	Control	17.5	6.4
	Treatment	18.9	4.1
Social support experts 6 months	Control	17.8	4.5
	Treatment	26.1	8.2
Social support experts 12 months	Control	17.5	6.4
	Treatment	18.9	18.9
Social support friends 2 months	Control	17.4	2.6
	Treatment	17.6	3.6
Social support friends 6 months	Control	18.2	3.8
	Treatment	18.0	3.6
Social support friends 12 months	Control	17.4	2.6
	Treatment	17.6	3.6
Social support family 2 months	Control	22.2	7.8
	Treatment	22.2	6.0
Social support family 6 months	Control	19.6	4.7
	Treatment	20.9	6.5
Social support family 12 months	Control	21.1	8.9
	Treatment	19.8	5.6

Table 3 Path coefficients for significant paths in hypothesized models

Path Tested	2 Month Model	6 Month Model	12 Month Model
Cognitive status → Self-efficacy	0.29(0.00)
Comorbidities → Self-efficacy	−0.15(0.04)
Physical health → Self-efficacy		0.20 (0.04)	0.37(0.00)
Mental health → Self-efficacy		0.27(0.01)
Social Support Experts → Self-efficacy		−0.20(0.01)
Treatment group → Self-efficacy		0.20(0.01)
Fear → Self-efficacy			−0.25(0.00)
Age → Outcome expectations		−0.20 (0.01)
Mental Health → Outcome expectations		0.28(0.01)
Social Support Friend → Outcome expectations	0.29(0.00)	0.19(0.01)
Social Support Experts → Outcome expectations			0.15(0.04)
Fear → Outcome expectations		−0.23(0.00)	−0.23(0.00)
Self-efficacy → Outcome expectations	0.39(0.00)		0.39(0.00)
Self-efficacy → Stage of change		0.24(0.00)	0.26(0.00)
Outcome expectations → Stage of change	0.44(00)	0.33(0.00)	0.36(0.00)
Self-efficacy → Exercise time	0.25(0.00)
Stage of change → Exercise time	0.15(0.04)	0.20(0.01)	0.42(0.00)
Treatment group*→ Exercise time		0.20(0.01)	0.17(0.02)

* Exposure to any component of the intervention (Exercise only, Motivation only, Exercise Plus Motivation) versus routine care

Figure 2 Two month model significant paths only.

Figure 3 Six month model significant paths only.

Figure 4 Twelve month model significant paths only.

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