FNCE 2023
Session 357. Providing MNT for the Pediatric Type 1 Diabetes Population: What Does the Evidence Show?
Monday, October 9, 8:30 AM - 9:30 AM

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H/A: Physical Activity (2009)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

The purpose of this investigation was to identify and explore relations among physical activity, social support, and health-related quality of life in persons with HIV disease who were living in community settings.

Inclusion Criteria:
  • Without cognitive impairment
  • Could read or understand English
  • Not been hospitalized for an HIV- or AIDS-related illness within a previous four-week period.
Exclusion Criteria:

None listed.

Description of Study Protocol:


  • Convenience sample
  • Received primary care at an infectious disease clinic (N=68) or community support at a local agency (N=10).


Correlational using a HRQOL model

Blinding used (if applicable)

Assumed for laboratory measures

Intervention (if applicable)

Statistical Analysis

  • When appropriate, univariate statistics were used to describe selected demographic characteristics and PA data
  • Pearson product-moment correlation coefficients with two-tailed tests of significance identify relations between and among the major variables of interest
  • Standard or full-entry regression analysis, recommended when the first goal is to describe relations between independent and dependent variables, was used to determine the ability of the independent variables (PA, social support) to predict the dependent variable (HRQOL)
  • Multicollinearity was not a problem for the independent variables (tolerance equals 0.94, variance inflation factor equals 1.06).
Data Collection Summary:

Timing of Measurements

Data collection occurred during normally scheduled clinic and agency hours, Monday through Friday

Dependent Variables

  • Medical Outcomes Survey-HIV (MOS-HIV; Wu 1996): 35 items measuring dimensions of general health perceptions, mental health, physical function, role function, social function, cognitive function, pain, energy-fatigue or vitality, health distress, quality of life and health transition.
  • Scores on the one-item overall quality of life were used to measure HRQOL
  • Internal consistency for this sample was alpha equals 0.96 for the 35 items and 0.79 for the well-being subscale that contains this single item.

Independent Variables

  • Physical Activity Questionnaire (PAQ): composed of questions from Module 11 of the 1999 Behavioral Risk Factor Surveillance Survey; quantifies the type, amount, duration, and frequency of PA; includes walking as well as moderate, vigorous, and strengthening questions; elicits frequency (days per week) and duration (minutes per week).
  • Norbeck Social Support Survey (NSSQ; Norbeck, 1995): Based on Kahn's (1979) dimensions of social support; self-administered and quantifies structural (network size) social support and its properties (duration and frequency of contact); functional social support scale scores include two subscales: emotional social support and aid social support.

Control Variables

None listed

Description of Actual Data Sample:


Initial N

90 individuals initially agree to participate

Attrition (final N)

  • 78 (70 men and eight women)
  • 12 (13%) failed to complete questionnaires with the primary reason given as transportation problems.


40.4 years (SD=8.33 years)


  • African American 51.3%
  • White, non-Hispanic 33.3%
  • Other 5.1%.

Other relevant demographics

  • Marital status: Single, divorced or lives alone 70.5%; married or partnered 28.2%; widowed 1.3%
  • Education: Less than high school diploma 14.1%; high school and some post-high school 64.1%; completed college and greater 20.5%
  • Employment: Not employed 35.9%; employed part-time 17.9%; employed full-time or more 43.6%
  • Income: Less than $10,000 annually 25.6%; $10,000 to $20,999 32.1%; $21,000 to $40,999 24.4%.


None given

Disease information

  • HIV transmission: Sexual 67.9%; intravenous drug use 10.3%; blood transmission 2.6%; do not know 19.2%
  • AIDS diagnosis: Yes N=33; No N=45
  • 70.5% identified taking one or more medications for HIVD (types of medications were not listed)
  • 45 participants could identify their most recent CD4 cell count (M=386.2/mm3, SD=321.76/mm3
  • 39 participants could identify their most recent HIV-RNA counts (M=32108.15 copies per mL, SD=73236.12 copies per mL).


 Infectious disease clinic or local community agency

Summary of Results:

 Table 2. Mean, Standard Deviation, and Range of Medical Outcome Survey-HIV Scale Scores

 Scale  SD  R
Overall health 47.95  26.96  0-100 
Physical function 75.18  25.04  0-99.96 
Role function 57.69  44.19  0-100 
Social function a 74.87 29.27  0-100 
Cognitive function 77.12  25.58  10-100 
Pain 66.09  29.63  0-99 
Mental health 66.21  24.81  0-100 
Energy/fatigue 56.67  26.61  0-100 
Health distress  66.99  30.18  0-100 
Quality of lifea  58.01 24.34 0-100

 aSingle items

Other Findings

  • The most common (85.9%, N=67) leisure time PA identified by participants was walking
  • 57 (73.08%) participants reported engaging in moderate PA, but few (28.21%, N=22) identified meeting Healthy People 2010 recommendations for moderate PA
  • 15 (19.23%) persons engaged in vigorous PA and 6 (7.7%) reported meeting Healthy People 2010 recommendations for vigorous PA
  • 58 (74.36%) individuals reported engaging in either moderate or vigorous PA for at least 30 minutes daily and 30 (51.72%) persons reported engaging in PA for recommended weekly frequency. Weekly frequency was greater (M=four days per week) for moderate PA than for vigorous (M=three days per week) PA.
  • Participants identified a mean network size of 6.03 (SD=4.04, range equals one to 24 persons) and an average duration of relationships of 4.58 years, with an average contact of four times per week.
  • Scores on the emotional subscale (M=82.5, SD=61.45) were approximately twice the scores on the aid social support subscale (M=37.46, SD=30.07)
  • Mean total functional social support (sum of emotional and aid support) was 119.96 (SD=90.60)
  • Participants identified more family members (N=198) as sources of social support than friends (N=156), and a greater proportion (88.5%) of participants identified family support than the proportion (67.9%) who identified friend support
  • There was a significant negative correlation between HRQOL and meeting Healthy People 2010 recommendations for moderate (r= -0.23) or vigorous (r= -0.27) PA.
  • There was a significant (r=0.49, P<0.01) relation between HRQOL and weekly frequency (number of days per week) of at least 30 minutes per day of moderate or vigorous PA
  • Average family (r=0.36, P<0.01; r=0.41, P<0.01) and average friend (r=0.31, P<0.05; r=0.36, P<0.01) social support were significantly associated with both emotional and aid social support, respectively, only average friend social support was significantly (P<0.01) related (r=0.45) to HRQOL.
  • Weekly frequency of moderate or vigorous PA for at least 30 minutes daily and average friend social support were regressed on HRQOL. Weekly PA frequency and average friend social support explained 37.3% of the variance in HRQOL, F(2, 52)=16.44, P<0.000. Standardized beta weights for PA frequency was 0.457, t=4.04, P<0.000; and for average friend support 0.337, t=2.98, P<0.01.


Author Conclusion:
  • The finding that average friend social support, not family, was significantly associated with HRQOL is in agreement with others
  • In this study, one could hypothesize that when persons with HIV disease are satisfied with family social support, they also perceive family support may increase in terms of their PA behaviors.

Limitations as listed by authors

  • Small convenience sample of predominantly men; small number of women did not reflect the usual HIV disease prevalence for women
  • Urban vs. rural setting.

Implications as listed by authors

Assessing the quantity and quality of social support networks and including those networks in educational interventions for persons with HIV disease could lead to lifestyle changes that promote HRQOL.

Funding Source:
Other: not listed
Reviewer Comments:
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? No
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? N/A
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? ???
  10.1. Were sources of funding and investigators' affiliations described? ???
  10.2. Was the study free from apparent conflict of interest? ???