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Forging trandisciplinary bridges to meet the physical inactivity challenge in the 21st century

2002; Elsevier BV; Volume: 23; Issue: 2 Linguagem: Inglês

10.1016/s0749-3797(02)00481-6

1873-2607

­Abby C. King, Adrian Bauman, David B. Abrams,

Physical Activity and Health

As with many scientific activities aimed at pushing the intellectual boundaries of a field, the Cooper Institute specialty conference and resultant papers contained in this supplement to the American Journal of Preventive Medicine raised as many issues and questions as they sought to answer. Among those issues and conundrums challenging the field are the following: 1.Building consensus on specific definitions of concepts that are key to developing better behavioral prediction and intervention development in the physical activity arena. Leading scientists in the physical activity intervention field both conceptualize as well as operationalize concepts such as "moderators," "mediators," and "confounders" differently. This gap widens further when scientists from other fields (e.g., urban planning, transportation) are brought into the discussion. A concrete "next step" may be to convene a consensus conference aimed at developing specific construct definitions that then could be regularly applied in the field. In addition, new statistical methods are being developed1Mâsse L.C. Dassa C. Gauvin L. Giles-Corti B. Motl R. Emerging measurement and statistical methods in physical activity.Am J Prev Med. 2002; 23: 44-55Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar which could benefit the physical activity behavioral epidemiology and intervention fields with respect to broadening measurement and analysis of physical activity-related behavior and interventions.2.Encouraging continued theory development in the physical activity intervention field. Theories and conceptual models such as Social Cognitive Theory, the Theory of Planned Action/Behavior, and the transtheoretical model have provided a heuristic foundation on which to build initial intervention efforts. However, many scientists agree that such theories fall short of capturing all of the issues and domains that are specific to physical activity behavior. These behavioral theories also share redundancies and overlap in definitions of measures and constructs that can lead to conceptual confusion, particularly when different terms are used for similar constructs. For instance, concern has been raised that emergent theories may only provide new labels for old constructs.2Bandura A. Self-efficacy. Freeman, New York1997Google Scholar, 3Bandura A. The anatomy of stages of change.Am J Health Promotion. 1997; 12: 8-10Crossref PubMed Scopus (410) Google Scholar, 4Ashworth P. Breakthrough or bandwagon? Are interventions tailored to stage of change more effective than non-staged interventions?.Health Educ J. 1997; 56: 166-174Crossref Scopus (41) Google Scholar, 5Weinstein N.D. Rothman A.J. Sutton S.R. Stage theories of health behavior conceptual and methodological issues.Health Psychol. 1998; 17: 290-299Crossref PubMed Scopus (504) Google Scholar In order to move the field forward, it is important that there be a common language in theories and a standardization of measures that avoid redundancy. Only then will we know if breakthrough ideas truly add unique explanatory variance to what is already known. It may behoove scientists in the field to work toward the development of a "meta-theory" specific to physical activity behavior that addresses the above issues. Such theory development will need to include conceptual frameworks that extend beyond behavioral sciences alone and include other disciplines (e.g., environmental and urban planning).3.Forging a bridge with other disciplines that share a stake in a more active population. The inability of any single discipline to assess comprehensively the wide array of influences on a complex behavior such as physical activity is consistent with emerging trends toward transdisciplinary thinking in health arenas such as cancer and in lifestyle behaviors such as tobacco.6Abrams D.B. Nicotine addiction paradigms for research in the 21st century.Nic Tob Res. 1999; 1: S211-S215Crossref PubMed Scopus (11) Google Scholar, 7Abrams D.B. Transdisciplinary paradigms for tobacco prevention research.Nic Tob Res. 1999; 1: S15-S23Crossref PubMed Scopus (25) Google Scholar A common thread in the Cooper conference papers found in this supplement,1Mâsse L.C. Dassa C. Gauvin L. Giles-Corti B. Motl R. Emerging measurement and statistical methods in physical activity.Am J Prev Med. 2002; 23: 44-55Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar, 8Bauman A.D. Sallis J.F. Dzewaltowski D.A. Own N. Toward a better understanding of the influences on physical activity the role of determinants, correlates, causal variables, mediators, moderators, confounders.Am J Prev Med. 2002; 23: 5-14Abstract Full Text Full Text PDF PubMed Scopus (749) Google Scholar, 9King A.C. Stokols D. Talen E. Brassington G.S. Killingsworth Theoretical approaches to the promotion of physical activity.Am J Prev Med. 2002; 23: 15-25Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar, 10Lewis B.A. Marcus B.H. Russell R.P. Dunn A.L. Psychosocial mediators of physcial activity behavior among adulsts and children.Am J Prev Med. 2002; 23: 26-35Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar is the need for ongoing transdisciplinary communication. Differences in language and methods have resulted in limited communication even among closely related disciplines. As we extend the concept of "health enhancing physical activity" (HEPA) to include active transportation and better designed city planning and urban space, this gap in language and research methods widens further. Yet, research to elucidate mediating mechanisms to improve population levels of physical activity is being revealed as a complex interaction of individual and contextual factors that no one discipline or level of analysis can adequately address. Systematically bringing representatives from different disciplines together, as was done at the Cooper conference, is a critical step toward beginning to address physical inactivity at the population level.4.Gaining an increased understanding of environmental influences. As evident in several papers,11Craig C.L. Brownson R.C. Cragg S.E. Dunn A.L. Exploring the effect of the environment on physical activity a study examining walking to work.Am J Prev Med. 2002; 23: 36-43Abstract Full Text Full Text PDF PubMed Scopus (274) Google Scholar, 12Fridinger F. Macera C. Cordell H.K. The use of surveillance data and market research to promote physical activity.Am J Prev Med. 2002; 23: 56-63Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 13Handy S.L. Boarnet M.G. Ewing R. Killinsworth R.E. How the buildt environmnet affects physcial activity views from urban planning.Am J Prev Med. 2002; 23: 64-73Abstract Full Text Full Text PDF PubMed Scopus (1237) Google Scholar, 14Berrigan D. Troiano R.P. The association between urban form and physcial activity in U.S. Adults.Am J Prev Med. 2002; 23: 74-79Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar there is an increasing interest in measuring proximal as well as more distal contextual/environmental factors, as well as examining these factors in interaction with individual biobehavioral (e.g., genetic) and cognitive factors. Most efforts to assess potential interactions of environmental (nested and hierarchical contextual variables) and individual level factors are limited to individuals' perceptions of their environment, as opposed to independent measures of the micro-, meso-, and macro-level forces within which individuals are embedded. Such individual and nested contextual factors may be further viewed as incorporating different levels of analysis ranging from subcellular to societal and transnational (global).5.Incorporating the dimension of time. While national and community physical activity trends are generally measured in time increments of years or decades, intervention trials as well as laboratory-based research are typically focused on changes that occur in hours, weeks, or months. How do mechanisms that occur over minutes or hours within individuals become linked to individual change and maintenance of change over weeks, months, or years? One approach to capturing such time trends involves examining patterns of physical activity or inactivity within the context of trajectories of change over time.15King A.C. Kiernan M. Ahn D.K. Wilcox S. The effects of marital transitions on physical activity levels results from a 10-year community study.Ann Behav Med. 1998; 20: 1-6Crossref PubMed Scopus (69) Google Scholar Such time trajectories have been used with promising results in understanding uptake in the etiology of youth tobacco use.16Chassin L. Presson S.J. Pitts S.C. Sherman S.J. The natural history of cigarette smoking from adolescence to adulthood in a Midwestern community sample multiple trajectories and their psychosocial correlates.Health Psychol. 2000; 19: 223-231Crossref PubMed Scopus (409) Google Scholar Another approach to capturing time influences is the application of a lifespan-based, developmental perspective (e.g., childhood to adolescence to adulthood to old age) as a means of understanding how physical activity patterns change across time. Modeling trajectories over developmental life transitions ideally requires four or more time points, longer periods of assessment (or use of multiple cohorts), and inclusion of true contextual level variables as well as innovative statistical methods such as latent class/latent growth and structural equation modeling.17Collins L.M. Sayer A.G. New methods for the analysis of change. American Psychological Association, Washington, DC2001Crossref Google Scholar Unfortunately, there is currently a dearth of longitudinal studies that simultaneously incorporate biologically relevant domains, cognitive-behavioral factors, and contextual/environmental factors. In addition, the use of an intergenerational approach in developing physical activity interventions may allow us to more effectively capture the natural synergy in physical activity patterns across different age groups and family systems.6.Gaining a broader understanding of genetic/environmental interactions. The physical activity field would be served by gaining a better understanding of the genetic and shared environmental components of physical activity. Specifically, future studies of macro-, meso-, and micro-environments could include direct sampling of individual differences within nested subgroups that capitalize on recent developments in the sciences of genotyping, biomarkers, and measures of susceptibility or protection.18Maia J.A. Thomis M. Beunen G. Genetic factors in physical activity level a twin study.Am J Prev Med. 2002; 23: 87-91Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar The rapidly evolving area of research into gene-environmental interactions has great potential for informing physical activity research and applications.19Lanouette C.M. Chagnon Y.C. Rice T. et al.Uncoupling protein 3 gene is associated with body composition changes with training in HERITAGE study.J Applied Physiol. 2002; 92: 1111-1118PubMed Google Scholar, 20Feitosa M.F. Rice T. Rosmond R. et al.A genetic study of cortisol measured before and after endurance training the HERITAGE Family Study.Metabolism. 2002; 51: 360-365Abstract Full Text PDF PubMed Scopus (17) Google Scholar The process that leads to transdisciplinary thinking of sufficient sophistication to produce innovative new research strategies, studies, and hypotheses does not occur easily or overnight, and requires considerable investment of time in face-to-face debate among investigators from different disciplines. The practice of transdisciplinary research means more than simply grafting a measure from one discipline onto a research study designed by scientists from another discipline. Kahn and Prager21Kahn R.L. Prager D.J. Interdisciplinary collaborations are a scientific and social imperative.Scientist. 1994; July: 12Google Scholar identified four requirements for transdisciplinary synthesis to occur: (1) listening across the gulfs that separate disciplines and scientists; (2) conceptual translation among scientists from various disciplines; (3) engaging in joint projects (e.g., on new measures or methods that emerge from integrating two or more disciplines); and (4) full collaboration on research that bridges the disciplines in a true synthesis of theory, methods, and measures, and that can result in the testing of new theory. The Cooper Conference provided an avenue for beginning to address the first of these requirements. Clearly, however, our efforts have just begun in this arena.