Browsing by Author "Kolbe-Alexander, Tracy"

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    Open Access
    Are point-of-decision prompts in a sports sciece and medicine centre effective in changing the prevalence of stair usage? A preliminary study
    (2009) Pillay, Julian D; Kolbe-Alexander, Tracy; Achmat, Masturah; Carstene, Madelaine; Lambert, Estelle V
    Objective. To determine the impact of a signed intervention on promoting stair versus lift usage in a health and fitness facility. Design. A 3-week observational study in which a simple timeseries design of collecting data before, during and after the introduction of an intervention was used. Setting. The Sports Science Institute of South Africa (SSISA): a 5-storey building with a centrally located lift lobby and internal stairwell. Method. Observers were placed unobtrusively on the ground floor, with good visibility of lift/stairwell, to observe ascending movement of students, staff, tenants, visitors and patients 4 hours/day (07h00 - 09h00, 16h00 - 18h00), 4 days/week for 3 weeks. During week 2, motivational signs were displayed on the wall next to the lift and stairs and on the floor leading to the stairwell. In week 3, signage was removed. Factors considered in predicting stair use were gender, phase of intervention, and whether persons were staff/students or visitors. Results. A total of 4 256 person-counts were recorded. Prevalence of stair use increased from 43% before the intervention to 53% during the intervention to 50% after the intervention. Odds of using the stairs during the intervention increased by 45% (odds ratio (OR) 1.45, 95% confidence interval (CI) 1.25 - 1.68) (p<0.00001), were 41% higher for staff/students compared with visitors (p<0.00001) and were 55% greater for women (p<0.00001). These effects did not change significantly after the intervention and stair use remained modestly higher than before the intervention. Conclusion. Signed intervention produced significant increases in stair usage during and after the intervention. These findings support the effectiveness of point-of-decision prompts for changing behaviour, and highlight potential factors influencing the impact of such messages.
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    Clustering of risk factors for non-communicable disease and healthcare expenditure in employees with private health insurance presenting for health risk appraisal: a cross-sectional study
    (BioMed Central Ltd, 2013) Kolbe-Alexander, Tracy; Conradie, Jaco; Lambert, Estelle
    BACKGROUND: The global increase in the prevalence of NCD's is accompanied by an increase in risk factors for these diseases such as insufficient physical activity and poor nutritional habits. The main aims of this research study were to determine the extent to which insufficient physical activity (PA) clustered with other risk factors for non-communicable disease (NCD) in employed persons undergoing health risk assessment, and whether these risk factors were associated with higher healthcare costs. METHODS: Employees from 68 companies voluntarily participated in worksite wellness days, that included an assessment of self-reported health behaviors and clinical measures, such as: blood pressure (BP), Body Mass Index (BMI), as well as total cholesterol concentrations from capillary blood samples. A risk-related age, 'Vitality Risk Age' was calculated for each participant using an algorithm that incorporated multiplicative pooled relative risks for all cause mortality associated with smoking, PA, fruit and vegetable intake, BMI, BP and cholesterol concentration. Healthcare cost data were obtained for employees (n = 2 789). RESULTS: Participants were 36+/-10years old and the most prevalent risk factors were insufficient PA (67%) and BMI[greater than or equal to]25 (62%). Employees who were insufficiently active also had a greater number of other NCD risk factors, compared to those meeting PA recommendations (chi2 = 43.55; p < 0.0001). Moreover, employees meeting PA guidelines had significantly fewer visits to their family doctor (GP) (2.5 versus 3.11; p < 0.001) than those who were insufficiently PA, which was associated with an average cost saving of ZAR100 per year (p < 0.01). Furthermore, for every additional year that the 'Vitality Risk Age' was greater than chronological age, there was a 3% increased likelihood of at least one additional visit to the doctor (OR = 1.03; 95% CI = 1.01 - 1.05). CONCLUSION: Physical inactivity was associated with clustering of risk factors for NCD in SA employees. Employees with lower BMI, better self-reported health status and readiness to change were more likely to meet the PA guidelines. These employees might therefore benefit from physical activity intervention programs that could result in improved risk profile and reduced healthcare expenditure.
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    Community-Based Approaches to Reducing Health Inequities and Fostering Environmental Justice through Global Youth-Engaged Citizen Science
    (2021-01-21) King, Abby C; Odunitan-Wayas, Feyisayo A; Chaudhury, Moushumi; Rubio, Maria Alejandra; Baiocchi, Michael; Kolbe-Alexander, Tracy; Montes, Felipe; Banchoff, Ann; Sarmiento, Olga Lucia; Bälter, Katarina; Hinckson, Erica; Chastin, Sebastien; Lambert, Estelle V; González, Silvia A; Guerra, Ana María; Gelius, Peter; Zha, Caroline; Sarabu, Chethan; Kakar, Pooja A; Fernes, Praveena; Rosas, Lisa G; Winter, Sandra J; McClain, Elizabeth; Gardiner, Paul A; on behalf of the Our Voice Global Citizen Science Research Network
    Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.
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    Evaluation of a school-based physical activity intervention in Alexandra Township
    (2010) Draper, Catherine E; de Kock, Lauren; Grimsrud, Anna T; Rudolph, Michael; Nemutandani, Simon; Kolbe-Alexander, Tracy; Lambert, Estelle V
    Objectives. Non-communicable diseases and limited participation in school physical education have become increasing concerns in South Africa. In response to these concerns, a schoolbased physical activity intervention, Healthnutz, was implemented in three primary schools in Alexandra Township, Johannesburg. Evaluation of Healthnutz included assessing its feasibility and acceptability, and short-term changes in learners’ physical fitness, knowledge and attitudes. Methods. To assess feasibility and acceptability, a situational analysis and focus groups with teachers and programme monitors were conducted. Pre-post fitness testing (3-month interval) was conducted with learners, and a questionnaire assessed changes in learners’ knowledge, attitudes, self-efficacy, and perceived barriers to physical activity, in control and intervention schools. Results. At implementation, teachers identified the need for more physical activity in the school environment and were positive about Healthnutz. Follow-up focus group discussions suggested that it was positively impacting teachers, learners and the school in general. Scores for sit and reach (p<0.001), sit ups (p<0.02) and shuttle run (p<0.0001) improved significantly in intervention but not control schools. A significant decrease was observed in learners’ perceived external barriers to physical activity (p<0.0001) along with a positive change in learners’ self-efficacy for physical activity (p<0.05). Conclusions. Healthnutz raised awareness of the importance of physical activity in intervention schools. Findings indicate that even limited exposure to a physical activity intervention can lead to a significant improvement in aspects of learners’ fitness, knowledge, attitudes and perceptions regarding physical activity. Furthermore, training and support of teachers needs to be nonjudgemental and empowering.
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    Factors associated with participation in a phase three cardiac rehabilitation programme
    (2013) Noorbhai, Mohammed Habib; Kolbe-Alexander, Tracy; Draper, Catherine E
    Background Patients with cardiovascular diseases (CVDs) and non-communicable diseases (NCDs) benefit from participating in cardiac rehabilitation programmes (CRPs). The aim of this research project was to evaluate the factors associated with participation in a phase three CRP, the Prime Time programme (PTP). A secondary aim was to compare attendance and baseline measures between Prime Time (PT) and non-Prime Time (NPT) members at a commercial gym. Methodology The first chapter comprised of focus group discussions (n = 3) and key-informant interviews (n = 5 current members and n = 5 ex-members). Staff participants (n = 9) included the Biokineticists, programme managers and sales consultants who participated in key-informant interviews and provided their perceptions and experiences while working on the programme. Atlas.ti was used for the data analysis and a thematic coding framework was used to analyse the focus groups and interviews. The second chapter, which was a pilot study, employed a case-control research design to compare attendance and baseline data between PT (n = 11) and NPT (n = 40) members at a commercial gym. Three age-matched controls for every case were included in this pilot study. Descriptive statistics (means and standard deviations), one-way analysis of variance (used to determine if there were any significant differences between groups at baseline for continuous variables) and Chi-square analysis (used to determine if there were any significant differences between groups at baseline for categorical variables) were performed. The level of significance was set at p<0.05.
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    A formative assessment of nurses' lifestyle behaviours and health status
    (2015) Phiri, Lindokuhle P; Kolbe-Alexander, Tracy; Lambert, Estelle V
    Background: Previous research has identified health care workers (HCWs) and shift workers as having an increased risk for non-communicable diseases (NCDs). Nurses in particular have a high prevalence of obesity, poor eating habits and insufficient physical activity and are at an increased risk for NCDs. Nurses are required to work non-traditional hours, outside the parameters of traditional day shift. Furthermore, shift work is associated with obesity and lower levels of physical activity. Even though nurses' occupations require them to be active in doing ward rounds and other duties, it is possible for these professionals to be physically active, yet highly sedentary. Sedentary behaviours such as occupational sitting, leisure-time sitting and television (TV) viewing may be associated with overweight and obesity independent of physical activity. Aim: The primary aim of this mini-dissertation was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa. The mini-dissertation included two different research methods. Study 1: The main purpose of this qualitative descriptive study was to describe health concerns, health priorities and determinants of healthy lifestyle behaviours among nurses. The objectively measured and self-reported physical activity and sedentary behaviour in day and night shift nurses were compared in Study 2. Combined, the results of these studies may be used to inform the development of worksite-related interventions for South African nurses. Methods: Participants for the first study were purposively sampled from public hospitals based in Cape Town, South Africa. The participants included 103 nurses, of whom 57 worked night shift and 36 worked day-shift. Twelve focus group discussion (FGD's) were conducted with nursing staff to obtain insight into their health concerns, lifestyle behaviours and the nature of and access to worksite health promotion programmes (Whip's). Nine hospital management personnel participated in key informant interviews (KII) to gain their perspective on health promotion in the worksite. The FGDs and interviews were conducted by a trained facilitator using guided questions. These included questions such as: 'What are your main personal health concerns?' and 'How does your work affect your lifestyle behaviours and health?' Thematic analysis was used 12 to analyse the qualitative data with the assistance of (Atlas.ti Qualitative Data Analysis Software (Scientific Software Development GmbH, Berlin, Germany). In a sub-study, 64 nurses (day shift n=30 and night shift n=34) working at two of the five public hospitals volunteered to complete a socio-demographic questionnaire and wear the ActiGraph GT3x accelerometer for 7 consecutive days to measure physical activity levels. Valid data was defined as ≥ 600 minutes wear time per day, minimum of 4 days (2 shift days and 2 non-shift days). In addition, self-reported physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). Statistical analyses included a T-test to determine differences in PA and SB between day and night shift nurses. If data were normally distributed, ANOVA (analyses of variance) was performed to determine the significant differences in continuous outcome variables between day and night shift nurses. If data were not normally distributed, such as the GPAQ data, a non-parametric comparison Mann Whitney U test was applied. Results: Study 1: Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. The hospital environment was perceived to have a negative influence on the nurses' lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling and advisory services, an online employee wellness programme. The Western Cape Department of Health also offered wellness days in which clinical outcomes, such as blood glucose were measured. Most nurses identified a preference for WHPPs that provided access to fitness facilities or support groups. Both nurses and management personnel frequently mentioned lack of time to prepare healthy meals and/or participate in physical activity due to being overtired from the long working hours. Furthermore, both management and nurses reported a stressful working environment. The fact that the nurses were most concerned with the problems of overweight, obesity and living with NCDs such as diabetes and hypertension indicate that there is a need and desire for WHPP's aimed at addressing these concerns. Study 2: Based on the objectively-measured results from accelerometry, all the nurses in the sub-study met the physical activity recommendations of 150 minutes or more of moderate to vigorous intensity physical activity per w eek. The day shift nurses reported more leisure-time moderate and vigorous intensity physical activity than the night shift nurses (p=0.028). Objectively-measured physical activity also showed that night shift nurses accumulated significantly more moderate intensity physical activity than the day shift nurses ( 16.6 ± 5.6 hrs/week versus 12.1 ± 13 4.5 hrs/week, respectively, p=0.001). In addition, night shift nurses accumulated more steps per day than day shift nurses (10324 ± 3414 versus 8022 ± 3245, p=0.013). Self-reported sedentary behaviour was similar for the two shifts, 3.0 ± 1.8 hours versus 4.0 ± 2.6 hours a day, for day and night shift, respectively. Objectively-measured sedentary behaviour (SB) was significantly lower (as a % of wake time) in night shift compared to day shift workers, 66% and 69%, respectively, p= 0.047. These differences between groups remained significant, even after adjusting for differences in body size and age. Furthermore, results from the Bland – Altman plots indicate that the nurses significantly underreported their sedentary time. Summary: The nurses in this study were concerned about NCDs and being overweight. They expressed an interest and willingness to participate in future hospital-based intervention programmes. The most frequently identified preference for WHPPs was access to fitness facilities or support groups. Despite the fact that all the nurses met the current public health recommendations for physical activity, objectively-measured SB was substantial, with both day and night shift nurses spending an average of 13 hours a day in SB. Findings from this study highlight the need for WHPPs that minimize sedentary behaviour and create a more supportive environment for physical activity.
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    Measurement of physical activity and associated health and functional outcomes in older South Africans
    (2004) Kolbe-Alexander, Tracy; Lambert, Vicki
    The aim of the first study was to measure validity and reliability of two PA questionnaires, the Yale Physical Activity Survey for older adults (YPAS) and the short version of the International Physical Activity Questionnaire (IPAQ), in a group of South African older adults.
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    Nurses’ lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study
    (BioMed Central, 2014-11-28) Phiri, Lindokuhle P; Draper, Catherine E; Lambert, Estelle V; Kolbe-Alexander, Tracy
    Background: Nurses have an increased risk for non-communicable diseases (NCDs), along with a high prevalence of obesity, poor eating habits and insufficient physical activity. The aim of this study was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa. Methods: Participants were purposively sampled (n = 103), and included management personnel (n = 9), night shift (n = 57) and day-shift nurses (n = 36). Twelve focus groups (FGDs) were conducted with nursing staff to obtain insight into nurses’ health concerns, lifestyle behaviours and worksite health promotion programmes (WHPPs). Seven key informant interviews (KII) were conducted with management personnel, to gain their perspective on health promotion in the worksite. Thematic analysis was used to analyse the data with the assistance of Atlas.ti Qualitative Data Analysis Software. Results: Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. Being overweight was perceived to have a negative impact on work performance. All nurses identified backache and exposure to tuberculosis (TB) as occupation-related health concerns, and both management and nurses frequently reported a stressful working environment. Nurses frequently mentioned lack of time to prepare healthy meals due to long working hours and being overtired from work. The hospital environment was perceived to have a negative influence on the nurses’ lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling services, an online employee wellness programme offered by the Department of Health and wellness days in which clinical measures, such as blood glucose were measured. Nurses identified a preference for WHPPs that provided access to fitness facilities or support groups. Conclusions: Public hospitals are a stressful work environment and shift work places an additional strain on nurses. The risk of NCDs and exposure to infectious disease remains a concern in this working population. Our findings highlight the need for WHPPs that support nurses in managing stress and transforming the work environment to facilitate healthy lifestyles.
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    Physical activity, physical fitness, functional capacity and cognitive performance in older adults: effects of interactive video gaming
    (2022) Ramnath, Udhir; Kolbe-Alexander, Tracy; Lambert, Estelle Victoria
    The ageing process is inevitable and is associated with a progressive decline in physical fitness, functional ability as well as cognitive performance due to the deterioration of the various biological, neuro-physiological and social systems. This may lead to an increased vulnerability for age-related diseases and a dependent lifestyle. In addition to the ageing process, sedentary behaviour is a contributing factor that can lead to decreased functional independence. The decline in physical, functional and cognitive performance with age, along with the increased possibility of becoming sedentary as one gets older may highlight the importance of participating in physical activity to acquire health and wellness benefits as well as to maintain independence. The health and wellness benefits of physical activity have been widely studied within the ageing population. Physical activity can be defined as any bodily movement produced by skeletal muscles that will lead to an increase in resting energy expenditure. According to the World Health Organization guidelines on physical activity, adults should accumulate at least 150 minutes of moderate levels of physical activity or at least 75 minutes of vigorous levels of physical activity throughout the week or an equal combination of both levels. Much of the existing research to date has utilized more conventional physical activity interventions, including the use of various training components such as cardiorespiratory, motor coordination, agility, flexibility, balance and strength. These interventions have been shown to improve physical and cognitive parameters in older adults. In recent times, alternative forms of physical activity interventions such as Tai Chi, Yoga, and Interactive Video Games (IVG) have become increasingly popular among older adults. However, there is limited research on the effectiveness of IVG interventions in older adults, particularly for those with memory complaints. IVG involves combining physical activity and exercise with video game play. It allows the individual to control the “avatar” on screen by using various body movements (e.g. if the individual moves to the right, the onscreen character will also move to the right). This provides an opportunity for individuals to increase their energy expenditure by actively participating in these video games. In addition to increasing energy expenditure, IVG incorporates cognitive skills such as executive function, visuospatial skills, attention, working memory and coordination (hand and eye / foot and eye). Recent review articles have identified that a combination of physical and cognitive training intervention's show greater effects on cognitive performance than single-domain physical and cognitive training and subsequently applied physical and cognitive training. IVG has been shown to intensify the effects of physical exercise by controlling neuroplastic changes via additional cognitive exercise. These neuroplastic changes identified after participation in IVG are referred to as improvements in a specialized neural network and a lower dependency on compensational support. Therefore, IVG combines physical skills and abilities with cognitive skills, creating a cognitively stimulating type of physical activity, which may be different to more conventional physical activity. While these positive neuroplastic changes have been identified in some research studies, the underlying neurophysiological mechanism of IVG on cognitive performance and brain function is still poorly understood. Although some research studies have been conducted showing the potential benefits of IVG on physical function and cognitive performance in different population groups over various time frames, not many studies have investigated whether IVG can improve cognitive function in older persons with memory complaints. In addition, to our knowledge, no other studies have compared IVG to conventional multimodal supervised standing and seated exercise in individuals with memory complaints. Therefore, the aim of this thesis was to determine the effects of a 12-week IVG intervention using the X-Box 360 gaming console with Kinect Sports and Adventures games on cognitive performance in older adults, and specifically, in South African older adults, some with memory complaints. The IVG intervention was compared to a conventional multimodal supervised exercise intervention. We hypothesized that the IVG intervention would show greater improvements in measures of cognitive performance and functional ability than the conventional multimodal exercise intervention. The results showed a significant relationship between the number of the correct responses on the Modified Stroop task and scores on the 6-Item Cognitive Impairment test (r=-0.52, p< 0.001) and Grip Strength (r=0.42, p< 0.01). In addition, a significant inverse association was found between incorrect responses on the Modified Stroop task and Functional Reach (r=-0.45, p< 0.01). The final multivariate regression model included age, Functional Reach and right arm Grip Strength, and described 28% of the variance in performance of the Modified Stroop task. In summary, the study illustrated that measures of physical function were related to cognitive performance in high functioning independent living South African older adults. The extent to which a physical exercise intervention can improve these physical function parameters and its effects on cognitive performance warranted further research within South African older adults. Study 2: The aim of the second study was to explore the feasibility of IVG in South African, normal functioning, healthy older adults. We hypothesized that those individuals with lower functional and cognitive performance would perceive the IVG as more difficult. Twenty normal functioning, healthy community-dwelling older adults with a mean age of 70.5 ±5.5 years were invited to participate in the study. Functional ability was assessed using the Dynamic Balance, ‘Timed Up and Go', Functional Reach and Grip Strength tests while cognitive ability was assessed using the Modified Stroop task. Participants played in an IVG session using the X-Box Kinect Adventures software package which comprised of 5 games, including: 20000 leaks, River Rush, Rally Ball, Reflex Ridge and Halo Popper. Heart rate was recorded throughout the session to measure the intensity while playing the game. An interviewer-administered questionnaire was completed after the IVG session, in which participants reported on their levels of enjoyment and the perceived difficulty of each game during the gaming session, using a Likert scale. The mean resting heart rate for the gaming session was 73.4bpm ±12.6. Rally Ball produced the highest average heart rate of 88.0bpm ±14.4 with 20000 Leaks producing the lowest average heart rate of 82.6bpm ±12.3. The average heart rate response for all games was between 55.2% and 58.7% of age-predicted maximum heart rate, suggesting IVG equates to moderate intensity physical activity according to the American College of Sports Medicine criteria. Non-dominant handgrip strength (kg) was inversely associated with the perceived level of difficulty, (High perceived level of difficulty = 19.5kg; Moderate perceived level of difficulty = 27.0kg; Low perceived level of difficulty = 29.1kg; p=0.034). There were significant relationships between some components of functional ability and cognitive performance with the perceived difficulty of the gaming session. Individuals that perceived the game as more difficult had significantly lower cognitive performance scores than those reporting moderate and low levels of difficulty. Most (95%) participants reported that they were interested in participating in IVG in the future. They perceived the games as fun and enjoyable, as a form of stress reduction and a means to improve physical well-being. In addition, our results indicate that older adults enjoyed the IVG and showed interest in participating regularly. In summary, the study showed that IVG was an enjoyable activity for older adults and associated with functional and physical well-being. Future research is needed to determine if IVG can result in improved health, functional ability and cognitive performance in older adults. Study 3: Therefore, the aim of the third study was to measure the effects of a 12- week IVG intervention, using the X-Box 360 Kinect gaming console on cognitive performance and functional ability in healthy older adults, without any known diagnosis of cognitive impairment. A total of 41 healthy participants with a mean age of 72.7 ±6.6 years were recruited from 4 different retirement homes and clusterrandomized into either the IVG group (n=21) or the Cognitively Stimulating Table Games group (n=20). The IVG group participated in moderate intensity X-Box Kinect Adventure games twice a week for one hour while the comparison group participated in Cognitively Stimulating Table games (Board and Card games) for the same duration. Both groups had high attendance rates with all participants completing all 24 of their respective sessions. Baseline physical activity level was assessed using the Yale Physical Activity Survey. Pre-post measures included the 6-Minute Walk test, Dynamic Balance, Timed Up and Go, Grip Strength, Functional Reach, 6-Item Cognitive Impairment test and the Modified Stroop task. Most participants' highest level of education was at primary school level and the most frequent medical condition was hypertension in both groups. More than half of the participants were prescribed medication for various chronic diseases. Functional Reach was the only significant improvement post intervention in favour of the IVG group (p=0.049). The comparison group's average reaction time for all correct responses improved significantly on the Modified Stroop task post intervention compared to the intervention group. After the variables were log transformed, the comparison group showed significant improvement in average reaction time for all correct responses on the Modified Stroop task (p=0.028). The IVG group showed a significant improvement in balance, measured by the Functional Reach test. Cognitively Stimulating Table Games showed significant improvements in reaction time measures of the Modified Stroop task illustrating benefits of such games on improving cognitive performance. In summary, functional ability and cognitive performance improved for most outcomes in both groups, however, many changes were not statistically significant. Therefore, IVG as an intervention program could serve to preserve cognitive and physical function, especially in high functioning, healthy older adults. The results of the first three studies (chapters 2, 3 and 4) showed that physical function was related to cognitive performance in high functioning, independently living older adults. IVG was identified as a fun and enjoyable activity, a means to improve physical health and it equated to moderate intensity physical activity. Furthermore, a 12-week IVG intervention using the X-Box 360 Kinect gaming console and Kinect Adventures games significantly improved balance in healthy older adults when compared to Cognitively Stimulating Table Games. Cognitively Stimulating Table Games significantly improved executive function measured by the Modified Stroop task post intervention. We also found that most functional ability and cognitive performance outcomes improved after 12-weeks of IVG however, many did not reach a level of significance in our cognitively healthy older adult participants. In South Africa, the prevalence of diagnosed MCI is 27% while research on the prevalence of subjective memory complaints is scares. Previous research from systematic reviews and meta-analysis has shown positive effects of physical activity and exercise on cognitive performance in older adults with MCI and memory complaints. This led us to my fourth study, which aimed to examine the efficacy of IVG in older adults with self-reported and objectively determined memory complaints. A few studies have investigated whether active gaming can improve cognitive performance in older adults with subjective memory complaints, however, to our knowledge; no study has been conducted comparing the benefits of IVG to conventional multimodal supervised exercise in older adults with memory complaints. Study 4: The aim of the fourth study was to determine the effects of a 12-week IVG intervention, using the X-Box 360 gaming console with Kinect Sports games, on cognitive performance in South African older adults with subjective and objectively determined memory complaints. This intervention was compared to a conventional multimodal supervised exercise program that served as the comparison group. We hypothesized that the individuals in the intervention group would show greater improvements in measures of cognitive function and functional ability than the comparison group. Forty-five participants with a mean age of 72.4 ±5.4 years were recruited and screened from 6 retirement homes and cluster-randomized into the IVG group (n=23) or the Conventional Multimodal Supervised Exercise (CM; n=22) group. All participants from both groups completed all 24 of their respective exercise sessions. An interviewer-administered questionnaire was conducted to determine demographic, health and physical activity levels at baseline for each participant. Prepost measurements for physical function included the 6-Minute Walk test, Dynamic Balance, Timed Up and Go and Functional Reach. Cognitive performance was measured by the Mini-Mental State Examination (global cognitive function), N-Back task (working memory) and the Modified Stroop task (executive function). The IVG group demonstrated significant improvements in the total number correct responses on the Modified Stroop task (p=0.028) and for average reaction time of correct colour-words (p=0.024), compared to the CM group. Furthermore, the IVG group showed significant improvements in global cognitive function (p=0.005) measured by the Mini-Mental State Examination (MMSE) when compared to the CM group. Functional ability improved significantly in the IVG group, including the 6-Minute walk (p=0.017), Dynamic Balance (p=0.03), Timed Up and Go (p< 0.001) and Functional Reach (p< 0.001). We concluded that the IVG intervention was more effective than 36 Conventional Multimodal Supervised exercise in improving executive and global cognitive performance and functional capacity in older adults with subjective memory complaints. In summary, measures of physical function which included functional reach, grip strength and dynamic balance were associated with cognitive performance in high functioning older adults. Furthermore, older adults enjoyed participating in IVG as a form of physical activity which was also associated with physical well-being. The feasibility and acceptability of the IVG among older adults prompted the study comparing IVG to table games over a 12-week period in healthy older adults. Both, the IVG intervention and table games were effective in improving functional and cognitive measures in healthy older adults but did not reach a level of statistical significance. Therefore, we conducted a similar study using IVG in older adults with subjective and objectively determined memory complaints to determine its effectiveness on cognitive performance and functional ability. In conclusion, IVG was more effective than conventional multimodal supervised exercise in improving measures of cognitive performance and functional ability in older persons with memory complaints. IVG is recommended to help preserve and maintain quality of life and independent living in healthy older adults residing in low-to-middle income countries such as South Africa while greater cognitive and functional benefits may be achieved in those with some level of memory complaints.
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    The relationship between the built environment and habitual levels of physical activity in South African older adults: a pilot study
    (BioMed Central Ltd, 2015) Kolbe-Alexander, Tracy; Pacheco, Kyla; Tomaz, Simone; Karpul, David; Lambert, Estelle
    BACKGROUND: Previous research has shown that the built environment plays a role in habitual levels of physical activity (PA), however much of this research has been conducted in adults and higher income countries. The aim of this pilot study was to examine the strength of association between the built environment and PA in South African older adults. METHODS: Participants were recruited (n=44, mean age 65+/-8.5years) from two suburbs, representing either a high socioeconomic (HSA) or low socioeconomic area (LSA). Self-reported PA, and subjective assessments of neighborhood walkability (Neighborhood Environment Walkability Scale, NEWS) was measured. Participants wore Actigraph GT3x accelerometers to objectively quantify PA. RESULTS: HSA participants reported significantly more leisure-time and less transport PA. Objectively measured and self-reported MVPA was significantly higher in HSA participants. NEWS 'Land-use Mix' was negatively associated with leisure-time MVPA, (r2=0.20; p<0.02). In addition, neighborhood aesthetics was positively associated with leisure-time physical activity (r2=0.33; p=0.02). 'Safety from traffic' was inversely associated with travel-related PA (r2=0.14, p=0.01). None of the other NEWS scores were associated with PA for the total group. CONCLUSION: Leisure-time and transport-related PA was influenced by socio-economic status. Attributes of the perceived built environment associated with leisure-time and total MVPA in older South Africa adults were different in low- and high- income settings.
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    Risk factors for non-communicable disease and healthcare expenditure in South African employees with private health insurance presenting for health risk appraisal
    (2013) Kolbe-Alexander, Tracy; Lambert, Estelle V
    The main aims of this research study were to determine the extent to which insufficient physical activity clustered with other risk factors for noncommunicable disease (NCD), with specifically cardiovascular and metabolic disease, and whether these risk factors were associated with higher healthcare costs.
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    Self-reported measures versus objective measures of physical activity and sedentary behaviour : impacts of cardiovascular fitness and physical activity
    (2014) Tomaz, Simone Annabella; Kolbe-Alexander, Tracy; Lambert, Vicki
    Physical activity (PA) and sedentary behaviour (SB) can be quantified with both self-report and objective measures, using questionnaires and accelerometers, respectively. There is a paucity of research investigating the possible influence that cardiorespiratory fitness and PA might have on the accuracy of self-reported of PA and SB. This is especially important with the increasing evidence around the risks of SB, independent of PA. The aim of this research study is to describe the difference between self-reported measures of moderate PA, vigorous PA and SB against their objectively measured counterparts. The secondary aim is to identify factors influencing the error in self-report measures; including cardiorespiratory fitness and levels of PA.
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    Steps that count! : The development of a pedometer-based health promotion intervention in an employed, health insured South African population
    (BioMed Central Ltd, 2012) Pillay, Julian; Kolbe-Alexander, Tracy; Proper, Karin; van Mechelen, Willem; Lambert, Estelle
    BACKGROUND: Physical activity (PA) has been identified as a central component in the promotion of health. PA programs can provide a low cost intervention opportunity, encouraging PA behavioral change while worksites have been shown to be an appropriate setting for implementing such health promotion programs. Along with these trends, there has been an emergence of the use of pedometers as a self-monitoring and motivational aid for PA.This study determines the effectiveness of a worksite health promotion program comprising of a 10-week, pedometer-based intervention ("Steps that Count!"), and individualized email-based feedback to effect PA behavioral change. METHODS: The study is a randomized controlled trial in a worksite setting, using pedometers and individualized email-based feedback to increase steps per day (steps/d). Participant selection will be based on attendance at a corporate wellness event and information obtained, following the completion of a Health Risk Appraisal (HRA), in keeping with inclusion criteria for the study. All participants will, at week 1 (pre-intervention), be provided with a blinded pedometer to assess baseline levels of PA. Participants will be provided with feedback on pedometer data and identify strategies to improve daily PA towards current PA recommendations. Participants will thereafter be randomly assigned to the intervention group (INT) or control group (CTL). The INT will subsequently wear an un-blinded pedometer for 10 consecutive weeks.Individualized feedback messages based on average steps per day, derived from pedometer data (INT) and general supportive/motivational messages (INT+CTL), will be provided via bi-weekly e-mails; blinded pedometer-wear will be conducted at week 12 (post-intervention: INT+CTL).DISCUSSION:The purpose of this paper is to outline the rationale behind, and the development of, an intervention aimed at improving ambulatory PA through pedometer use, combined with regular, individualized, email-based feedback. Pedometer-measured PA and individualized feedback may be a practical and easily applied intervention.TRIAL REGISTRATION:Number: DOH-27-0112-3951
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    Steps that count! : the use of pedometry for physical activity and health promotion in South Africa.
    (2013) Pillay, Julian; Lambert, EV; Kolbe-Alexander, Tracy; van Mechelen, W; Proper, KI
    Pedometers have been demonstrated as a practical tool for measurement and motivation of ambulatory physical activity, typically providing information on volume of steps/day. Recent developments in steps/day research have, however, emphasised the importance of intensity-based steps as part of steps/day recommendations. Such steps/day recommendations are also directed towards current physical activity guidelines, so as to provide further options for achieving guidelines. To complement these developments in steps/day recommendations, technological advancements in pedometry afford the opportunity to provide information on intensity-based steps/day. We therefore use this application to provide further insight into the association between pedometer-based physical activity and fitness and health outcomes. Particular reference is made to intensity-based steps/day, through a series of studies.
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    Working on wellness (WOW): A worksite health promotion intervention programme
    (BioMed Central Ltd, 2012) Kolbe-Alexander, Tracy; Proper, Karin; Lambert, Estelle; van Wier, Marieke; Pillay, Julian; Nossel, Craig; Adonis, Leegale; Van Mechelen, Willem
    BACKGROUND: Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease. METHODS: The intervention mapping (IM) protocol was used in the planning and design of WOW. Focus group discussions and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite. Based on the employees' preference for individual counselling, and previous evidence of the effectiveness of this approach in the worksite setting, we decided to use motivational interviewing as part of the intervention strategy. Thus, as a cluster-randomised, controlled control trial, employees at increased risk for CVD (N=928) will be assigned to a control or an intervention group, based on company random allocation. The sessions will include motivational interviewing techniques, comprised of two face-to-face and four telephonic sessions, with the primary aim to increase habitual levels of PA. Measures will take place at baseline, 6 and 12months. Secondary outcomes include changes in nutritional habits, serum cholesterol and glucose concentrations, blood pressure and BMI. In addition, healthcare expenditure and absenteeism will be measured for the economic evaluation. Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12months.DISCUSSION:The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention.TRIAL REGISTRATION:United States Clinical Trails Register NCT 01494207