Increasing Physical Activity in Filipino Lay Leaders
Phase: NA
Conditions: Physical Activity and Sedentary Behavior, Healthy Aging
Sponsor: University of Hawaii

1 
 
  
 Final Progress Report 
 
 
Application ID:  1 R15MD011474 
 
NIH Appl ID: 9303616 
 
 
Project Title: Increasing physical activity in Filipino Lay Leaders 
 
University of Hawaii Systems   
 
School of Nursing and Dental Hygiene 
School of Nursing 
 
Grant Period: 9/16/2017 –  5/31/2021 
 
MPIs: Albright, Cheryl Lynn   
Ceria-Ulep, Clementina Devera (contact)  
 
   
 
Last updated May 23,2023 
 
 
 
 
 
 
 

2 
 
I. Inclusion of undergraduate and graduate students in the R15 research study 
 
Over the three years of the study, we had 14 undergraduates and 32 graduate students involved in the R15 
research activities (see Table 1). Many of the students were repeatedly involved in one or more of the 10 
baseline assessments (over 2 years) conducted at churches in the community. For example, they were 
involved in fieldwork that included asking screening interviews of potential participants for eligibility to enroll 
them into the research study, providing participants with a consent form and explaining to them the key 
components of the study, checking the written baseline survey for omissions, explaining to persons, who were 
randomly selected, how long he/she should wear the accelerometer, where to place it (on their wrist), and how 
long to wear it (a week). Finally, they scheduled the participants’ first condition-specific telephone call. The 
students were required to attend a training session prior to going into the field/community (see details below). 
The average number of miles traveled to and from the university campus to go to a community church was 
21.3 miles, the farthest church was 37.6 miles from campus. The total number of miles traveled by all staff and 
students who went to the churches over the study period was 5,000 miles. 
All student volunteers participated in a one-hour training sessions where they had to prepare, in advance, for 
the onsite visits by reading the screening protocols, be trained on how to reliably deliver the screening 
protocols, and practiced reading the screening protocols to a fellow student in order to learn how to respond to 
potential participants questions about the research project or any specific screening eligibility question. At the 
baseline visit the students spent from 1-2 hours at the church helping to set-up / take-down tables and 
research equipment/materials, assisted with baseline eligibility screening of potential participants, and other 
duties as needed. Three students (two graduate/one undergraduate) were part-time paid research assistants 
who were heavily involved in various activities (some daily) of the R15 grant over its 4 years: Tracy 
Canonizado, RN, a Doctorate in Nursing Practice/DNP nursing graduate student who worked on the R15 for 
2.5 years, Uliana Kostareva, RN a PhD nursing graduate student who worked for one year, and Sarah Cain an 
undergraduate freshman nursing student from the Direct Entry in Nursing Program who worked for 1.5 yrs.   
Ms. Canonizado was a telephone coach for the light-to-moderate physical activity and sedentary time 
(LMPA/ST) condition, she created data and educational materials for the group cohesion sessions, entered 
and verified survey data into a secure database, and actively participated in the baseline visits where she 
assisted in screening, consenting, survey edit checking, scheduling of Light-to-Moderate Physical Activity/ 
Sedentary Time (LMPA/ST) intervention telephone calls, and was trained to measure participants’ height and 
weight. To serve as a telephone coach for LMPA/ST condition she was trained by Dr. Albright and Ms. Saiki to 
follow the telephone protocol in which she used motivational interviewing strategies to set PA and ST goals 
with participants while identifying and problem-solving any of their barriers to these two behavior changes. 
Tracy also helped participants keep track of their step counts to set PA goals based on daily step counts. She 
helped participants think about social support for PA and to set rewards to help them remain motivated and 
accountable to goals they were setting. Ms. Cain’s main responsibility was conducting phone calls with 
participants in the Healthy Living / Delayed Treatment (HL/DT) condition to ask them about daily symptoms via 
a 27-item checklist. Her other duties included: enrollment /screening at the baseline visit, scheduling phone 
calls at the baseline visit, mailing/emailing National Institute on Aging (NIA) health materials (not on physical 
activity or sedentary time) to HL/DT participants, data entry, and attending/ taking minutes at weekly research 
team meetings. Ms. Kostareva participated in the project’s data analysis meetings during which various study-
related results, including survey data, were discussed for the final report. In addition, we had a visiting 
professor from the University of Maryland University College (Dr. AnneMarie Gumataotao) assisted with 
various project activities including weekly meetings as well as baseline visits in the community. She is not 
included in the tables below although she devoted many months of service to this project.   
 
Table 1.  Annual Participation of Graduate and Undergraduate students* (by compensation status)   
  
Graduate (all Nursing) 
Undergraduate (by Major) 
Year 
Compensated 
Non-Compensated 
Compensated 
Non-Compensated 
1 
1 (DNP) 
22 DNP 
1 (nursing) 
4 (3 nursing, 1 math) 
2 
1 (DNP) 
6 (1 DNP, 5 PhD) 
1 (nursing) 
7 (6 nursing, 1 PH) 
3 
1 (DNP) 
1 (PhD) 
  
  
TOTAL 
3 
29 
2 
11 
* Not individual students. 3 DNP and 1 PhD students volunteered more than once 

3 
 
 
  Thus, over the three years, we had a total of 45 students enrolled at UH Manoa (the majority from the School 
of Nursing and Dental Hygiene [SONDH]) who actively participated in this research project, some participated 
in more than one research activity over the years.  
 
II. Study Design, Recruitment and Retention   
 
A. Study Design  
   Figure 1 shows the sequences and time frame for the study’s five phases. The cluster-randomized trial 
(including 36 weeks of follow up for each club randomized into the trial) was conducted from December 2017 
through January 2020. Ten Filipino Catholic clubs from 10 parishes within the OCFCC were randomly 
assigned to one of two study conditions: Light-to-Moderate Physical Activity / Sedentary Time (LMPA/ST) or 
Healthy Living / Delayed Treatment (HL/DT) conditions. Half (5) of the clubs initially received the theoretically-
based 12-week LMPA/ST telephone/group cohesion intervention designed to increase LMPA and reduce ST. 
Clubs were assigned to pairs, based on the maximum amount of distance (e.g., miles) between any two clubs 
to prevent contamination of study participants across the two conditions. For example, the shortest distance 
between two clubs paired together was 6.8 miles (St. Joseph and Our Lady of Perpetual Help) and the longest 
was 31.2 miles (Our Lady of the Mount and St. Roch). We wanted the clubs within a pair to consist of people 
who were not from adjacent parishes to reduce contamination of study intervention methods between 
conditions. However, such contamination is unlikely since each Filipino club was affiliated with its parish church 
and typically only people who live within a parish can be a member of that parish’s church. Other than the 
distances between churches, we did not stratify the clubs because the majority were located in urban areas on 
the island of Oahu. Therefore, we didn’t expect significant urban/rural differences between clubs. The club 
pairs were the unit of randomization. The order or sequence for when a pair began participation in the project 
was randomly determined (see the sequential implementation of the 5 pairs of clubs in Figure 1 below). 
Although the weather in Hawaii is temperate year-round, it was logistically and fiscally prohibitive for all the 
clubs to be randomized and, thus, all members of the clubs enrolled simultaneously. After both clubs within a 
pair completed baseline assessments, they were randomly assigned to one of the two study conditions.The 
baseline assessments were conducted in-person at the club’s church; however, follow-up surveys were mailed.  
 
Figure 1.  Study Design and five phases of the grant from October 2017 to May 2021  
 
 
Calendar Year
Grant Year
 
9
10 11 12
1
2
3
4
5
6
7
8
9
10 11 12
1
2
3
4
5
6
7
8
9
10 11 12
1
2
3
4
5
6
7
8
9
10 11 12
1
2
3
4
5
Phase 2: Enrollment / Follow-up
Blue arrow: LMPA/ST Condition
Red arrow: HL/DT Condition
      Enrollment onsite and survey
      12 week mailed survey
      24 week mailed survey
      36 week mailed survey
 
 
 
 
Phase 4. Focus Groups/analyses
Phase 5. No Cost Extension
Phase 3. Develop / Implement 
Surveys and Data Analysis  
Phase 1: Club Sessions / Finalize 
Protocols Recruitment / Train Staff
Surveys: (noted by white lines 
within, and by ends of arrows):
YEAR 1
YEAR 2
YEAR 3
Timeline for Kalusugan Project
2021
No cost extension
2018
2019
2017
2020
Pairs of Catholic Clubs
Key to what clubs receive in sequence:
LMPA / ST = Light-Moderate Physical Activity and Sedentary Time Calls and info 
Hlth Living = Healthy Living Calls and/or info
Follow Up =  No contact maintenance
LMPA/ST | Follow-Up | Hlth Living
Hlth Living |  LMPA/ST | Follow-Up
LMPA/ST | Follow-Up | Hlth Living
Hlth Living |  LMPA/ST | Follow-Up
LMPA/ST | Follow-Up | Hlth Living
Hlth Living |  LMPA/ST | Follow-Up
LMPA/ST | Follow-Up | Hlth Living
Hlth Living |  LMPA/ST | Follow-Up
LMPA/ST | Follow-Up | Hlth Living
Hlth Living |  LMPA/ST | Follow-Up

4 
 
 Table 2 shows when study measures were conducted across the 36-week study period. The baseline 
assessments were conducted in-person at the club’s church; however, all follow-up surveys were mailed. 
Table 2.  Time points for study assessments collected over the 9-month period.  
Measure 
Time point 
  
Baseline 
12 weeks 
24 weeks 
36 weeks 
Clinical Measures 
  
  
  
  
     - Height, weight 
X 
  
  
  
Fitness / Physical Activity Measure 
  
  
  
  
     - Accelerometer (10% in each club) 
X 
X 
X 
X 
Questionnaires 
  
  
  
  
     - Medical history, health status 
X 
X 
X 
X 
     - Physical activity – CHAMPS* 
X 
X 
X 
X 
     - Sedentary behaviors/outcomes 
X 
X 
X 
X 
     - Process measures (compliance with    
     intervention) 
  
X 
X 
X 
     - Moderators (include gender, BMI, age 
     neighborhood PA environment) 
X 
X 
X 
X 
     - Psychosocial measures (social support) 
X 
X 
X 
X 
* CHAMPS = Community Health Activities Model Program for Seniors  
  
   Table 3 (on this page and page 5) lists the study sample, by race, ethnicity, gender and age. A majority of the 
sample was female (80%), Asian /Filipino (97%), and 71% were over the age of 60.   
Table 3.  Enrollment by race, ethnicity, gender and age. 
Race 
Ethnicity 
Gender 
Age 
Age Unit 
Other Pacific Islander 
Hispanic or Latino 
Male 
64 
Years 
Asian 
Not Hispanic or Latino 
Male 
57 
Years 
Asian 
Not Hispanic or Latino 
Female 
62 
Years 
Asian 
Not Hispanic or Latino 
Female 
71 
Years 
Asian 
Not Hispanic or Latino 
Female 
65 
Years 
Asian 
Not Hispanic or Latino 
Female 
68 
Years 
Asian 
Not Hispanic or Latino 
Female 
71 
Years 
Asian 
Not Hispanic or Latino 
Female 
75 
Years 
Asian 
Not Hispanic or Latino 
Female 
62 
Years 
Asian 
Not Hispanic or Latino 
Female 
73 
Years 
Asian 
Not Hispanic or Latino 
Female 
75 
Years 
Asian 
Hispanic or Latino 
Male 
72 
Years 
Asian 
Not Hispanic or Latino 
Female 
60 
Years 
Asian 
Not Hispanic or Latino 
Female 
64 
Years 
Asian 
Not Hispanic or Latino 
Female 
63 
Years 
Asian 
Not Hispanic or Latino 
Female 
61 
Years 
Asian 
Not Hispanic or Latino 
Female 
56 
Years 
Asian 
Not Hispanic or Latino 
Female 
72 
Years 
Asian 
Not Hispanic or Latino 
Female 
58 
Years 
Asian 
Not Hispanic or Latino 
Female 
56 
Years 
Asian 
Not Hispanic or Latino 
Female 
66 
Years 

5 
 
Asian 
Not Hispanic or Latino 
Male 
56 
Years 
Asian 
Not Hispanic or Latino 
Female 
63 
Years 
Asian 
Not Hispanic or Latino 
Female 
73 
Years 
Asian 
Not Hispanic or Latino 
Female 
69 
Years 
Asian 
Not Hispanic or Latino 
Female 
66 
Years 
Asian 
Not Hispanic or Latino 
Female 
67 
Years 
Asian 
Not Hispanic or Latino 
Female 
55 
Years 
Asian 
Not Hispanic or Latino 
Female 
56 
Years 
Asian 
Not Hispanic or Latino 
Female 
57 
Years 
Asian 
Not Hispanic or Latino 
Female 
73 
Years 
Asian 
Not Hispanic or Latino 
Male 
66 
Years 
Asian 
Not Hispanic or Latino 
Female 
64 
Years 
Asian 
Not Hispanic or Latino 
Male 
59 
Years 
Asian 
Not Hispanic or Latino 
Male 
59 
Years 
 
B. Recruitment and Retention  
 
1. Recruitment of Catholic Clubs and study participants from the Clubs   
a) Recruitment of catholic clubs, pairing of clubs, randomization of pairs over 2 years 
In order to discuss the R15 study’s purpose and goals, including the enrollment of the 10 Filipino Catholic 
Clubs on Oahu, Drs. Ceria-Ulep and Albright attended the first quarterly meeting of the Administrative Board of 
the Oahu Council of Filipino Catholic Clubs (OCFCC) held on Jan 13, 2018. The Administrative Board of the 
OCFCC is composed of its officers (president, vice president, secretary, and treasurer), committee 
chairpersons, and the presidents of the 10 clubs within the OCFCC. There were about 10-12 officers at the 
meeting, many of whom had signed a letter of support for the grant’s NIH application. 
The secretary of the OCFCC provided Dr. Ceria-Ulep with a roster that listed the contact information for the 
10 Filipino Catholic club Presidents and the addresses of all the churches. The roster noted which Sunday of 
the month each club met (i.e., on the first or second Sunday) and approximately how many members attended 
the monthly meeting (with estimates of how many were aged 55-75). The study design included sequential 
enrollment of 5 pairs of the 10 Filipino Catholic Clubs (FCC) over two years was presented to the Board. See 
Study Design – Figure 1, page 4. We did not inform the Board of the names of the paired clubs or when any 
one club would be enrolled in the project. We asked about weekends/dates over the year that would be too 
busy for the clubs. The Board members mentioned several church holidays or church events when a baseline 
should not be scheduled. The study’s eligibility criteria were discussed (i.e., some people might need their 
physician’s approval to join a physical activity study), and the logistics of informing the club members about the 
project and its goals were outlined (i.e., one month prior to baseline visit at the church, Drs. Ceria-Ulep or 
Albright would attend a club meeting to explain the study’s purpose, eligibility criteria, timeline, and conditions’ 
components including phone calls, mailed/emailed information, etc.) This brief “information session” one month 
prior to the baseline visit was approved by the Board. The OCFCC Board suggested various project names 
then they all voted on their favorite title. The title: “The Kalusugan Project” won, “Kalusugan” is the word for 
“health” in Tagalog (a Filipino national dialect). Thus, the translation is “The healthy living project”. In addition, 
in order to maintain our collaboration with the OCFCC over the course of the study, Dr. Ceria-Ulep attended 12 
monthly OCFCC General Membership meetings that included representatives from all 10 clubs. The OCFCC 
General Membership meetings were attended by club officers, committee chairs, presidents; and additional 
members from each club. During each meeting, the Kalusugan (Healthy living) project was on the agenda and 
allotted 2-3 minutes during which Dr. Ceria-Ulep, provided information on the purpose of the study; the names 
of churches that had enrolled, to provide updates on the research project, and to facilitate recruitment efforts 
for upcoming baseline assessments and cohesion sessions. 
b) Eligibility of study participants from Catholic Clubs (onsite in the community at their church)   
In order to comply with American College of Sports Medicine guidelines for screening older adults prior to 
advising them how to increase their LMPA, we had to ask potential participants 21 eligibility screening 

6 
 
questions to determine it was safe for them to increase their physical activity level. (Riebe, Ehrman, Liguori, & 
Magal, 2018) These questions were asked in–person at the community church typically after a Sunday 
service.See criteria listed on Table 4 on the next page. 
Eligibility criteria were designed to limit enrollment to lay leaders or members of the OCFCC who were 
between the ages of 55-75 years and did not already engage in purposeful, leisure time bouts of MVPA for > 
60 min per week. Individuals were not eligible if they were planning on moving in 9 months, had a body mass 
index ( BMI) <18 or > 40, currently in treatment for cancer or physical therapy after having had a stroke or 
recent operation or surgical procedure in the last 6 months, recovering from a recent diagnosis of cancer, heart 
disease- had a heart attack, stroke, or been diagnosed with severe heart, lung, or chronic kidney disease in the 
last 6 months, used an assistive device like a cane or walker, or if a doctor recommended only medically 
supervised physical activity. A medical clearance (e.g., a note from their doctor) was needed to enroll if an 
individual had any of the following medical conditions: insulin-dependent Type 1 / Type 2 diabetes, blood 
glucose >235 mg/dl, diagnosis/treatment of cancer over the last 12 months, or a resting blood pressure 
>160/90 (without medications). Prior to the baseline visit, Drs. Ceria-Ulep and Albright held an informational 
session with each unit and explained the eligibility criteria as well as the requirement for a physician’s note if 
they had specific medical conditions. 
 
Table 4.  Eligibility criteria for Kalusugan (R15) Project        
Inclusion Criteria: 
Member in one of 10 Filipino Catholic Clubs (within the Oahu Council of Filipino Catholic Clubs) on Oahu   
Exclusion Criteria: 
Age: less than 55 years OR older than 75 years of age 
Planning to move (off the island of Oahu) in the next 9 months 
Body Mass Index: If BMI is < 18.5 or > 40 (measured height and weight to determine BMI at enrollment) 
Currently exercising: Regularly (weekly) active at a moderate intensity or higher >60 minutes a week  
Currently in Treatment: Actively having cancer treatment or in physical therapy following surgery/stroke 
A recent (in last 6 months) diagnosis of: Cancer, Heart disease, had a heart attack, Lung disease, Chronic Kidney 
Disease, Stroke, or underwent surgery 
A physician recommends that they have only supervised physical activity (i.e., in a physical therapy setting) 
Needs a cane or walker (or other assistive device) to walk especially outdoors on uneven surfaces 
Conditional Eligibility: Needs to provide health care provider's approval/clearance before 
enrollment if potential participant had the following: 
Asthma or other respiratory disease made worse by exercise 
A heart valve problem or is taking medications for a heart condition 
Severe osteoarthritis 
Insulin-dependent Type 1 or Type 2 diabetes (or often has a blood glucose > 235 mg/dl or 13mmol/L) (need MD 
clearance if do not know blood glucose) 
Diagnosis/Treatment for Cancer over the last 12 months or had a Stroke in the past (> 6 months ago) 
Resting blood pressure > 160/90 (with or without medications) (need MD clearance if do not know BP) 
Has chest pain when exercising or recently (last 4 weeks) developed any chest pain (i.e., when not exercising) 
Has tendency to lose consciousness or collapse from dizziness 
Has a bone or joint problem that could be aggravated by physical activity 
 
2. Enrollment of club members from 10 Filipino Catholic Clubs 
 From January 2018 through April 2019, study staff visited 10 different clubs within the OCFCC and gave 
presentations to the members explaining the purpose of the study and specific details related to enrollment. Of 
the 204 club members at these meetings, 135 (66%) were not interested or did not meet age criteria (i.e., most 
were older than 75y/o). Thus, 69 members (34%) were interviewed for eligibility with 35 (50.7%) of those 
interviewed being eligible and interested in participating and 34 (49.3%) of these individuals did not meet 
eligibility criteria. The most common reason for ineligibility was the person was too active (23 =67.6%), which 

7 
 
was defined as doing more than 60 minutes of purposeful MVPA per week. Thus, 35 individuals completed the 
baseline survey and were scheduled to begin their assigned condition’s first phone call the following week (i.e., 
5 clubs and 25 individuals into HL/DT condition and 5 clubs and 12 individuals into the LMPA/ST condition). 
Retention was tracked over 36 weeks at the 12, 24, and 36 week assessment points. Participants in both 
conditions received a total of $25 in gift cards to compensate for the time to complete surveys at baseline ($5), 
12 weeks ($10), 24 weeks ($5), and 36 weeks ($5). All participants were also provided a pedometer (Accusplit) 
at the beginning of the LMPA/ST intervention. 
3.  Attrition and Retention of consented participants over 9 months 
a.) Attrition - reasons for dropping out of study  
Of the 35 participants randomized into the study, 12 (34.3%) participants were either dropped by 
investigators for not completing phone calls or they chose to leave the study. Eight (22.9%) participants, 5 from 
HL/DT and 3 from LMPA/ST condition were lost to follow up because they didn’t answer 5 sequential calls (i.e., 
missed 5 calls over 5 weeks- 42% of dose) during the intervention period and were removed from the study by 
investigators (typically from 5 to 8 weeks after baseline, with the exception of one person who was lost to 
follow up 18 weeks after baseline) or because they didn’t complete the last 2 surveys of the study (loss to 
follow-up). Three (8.6%) participants (2 from LMPA/ST and 1 from HL/DT condition) asked to dropped from the 
study because they were “too busy” and one from LMPA/ST condition (2.9%) reported her doctor told her not 
to increase her PA after she was enrolled.  
b.) Retention    
Retention rates of participants enrolled in the 9-month study were 76% HL/DT and 50% for LMPA/ST) and 
average completion rates for those participants who had not dropped and were mailed surveys over 9 months 
was high (94%). The average retention over the three follow-up surveys was 72.5% for HL/DT condition and 
52.7% for LMPA/ST condition. Figure 2 is the consort figure showing recruitment and retention numbers for 
both studies over 9 months. 
 
Figure 2. Consort Figure  
 

8 
 
C. Description of conditions’ procedures and baseline sociodemographic characteristics by study condition 
1. Description of Light-to-Moderate-Physical Activity and Sedentary Time (LMPA/ST) Condition  
 Those randomized into the LMPA/ST condition received 12 weekly, personalized phone calls from the 
research staff, who were trained as health coaches using motivational interviewing strategies to set realistic 
goals for gradually increasing LMPA and ST goals, problem-solving ways to reduce barriers to increasing PA 
and decreasing ST, and enlisting social support for LMPA/ST change from other club members, family, and 
friends. At the end of the call, staff asked if any adverse (health) events (e.g., any health issue/problem for 
which medical care, emergency room, or hospitalization was required) had occurred since the last call. 
 Study staff emailed or mailed weekly resources that were specific to these goals and reduction of barriers. In 
addition, the PIs of the study attended up to 2 regular, monthly club meetings and held “group cohesion” 
sessions during the last 10-15 minutes of a meeting. The purpose of these sessions was to enlist social 
support within the club for changes in PA and ST. Participants’ achievements related to pedometer steps and 
breaks in sitting time were accumulated to create group mileage totals (i.e., total combined miles walked to 
reach a destination such as another city in the state) and total number of seats filled in a theater/stadium 
(representing people standing up) were presented.    
   After 12 weeks, participants then began a 12-week maintenance phase where there were no contacts other 
than a survey sent at 24 weeks. Over the final 12 weeks (i.e., from 24-36 weeks), these participants were 
emailed/mailed resources developed by the NIA, but were not given the symptom checker calls  
2. Description of Healthy Living / Delayed Treatment (HL/DT) Condition that received weekly telephone calls 
for symptoms and daily activities   
 This condition received 12 weekly phone calls using a previously developed contact-matched protocol that 
included asking the person about 27 different physical symptoms and how much any reported symptoms 
affected their daily activities.(Winningham, 1993)  It has been used for participants randomly assigned to a 
comparison condition or wait list control group.(Pinto, Rabin, Abdow, & Papandonatos, 2008) If they reported a 
new or unusual symptom and it more than moderately affected their daily activities, staff recommended 
participants to speak to their physician. Staff mailed or emailed healthy aging information developed by the 
NIA. Similar to the LMPA/ST condition, staff obtained specific information about any adverse events. After 12 
weeks, those in HL/DT condition then received the LMPA/ST intervention calls and group cohesion sessions. 
Following that, at 24 weeks, those in the HL/DT condition entered the maintenance phase after completing the 
LMPA/ST intervention.  
 
3. Baseline Sociodemographics by study condition 
   Table 5 (on this page and the next)  lists the baseline characteristics of our study sample by condition. There 
were no significant differences in demographics between the two study conditions. The sample is largely 
female (80%), mean age was 64.4 years, 97.1% were Filipino, 77.1% were born in the Philippines, 45.7% are 
married, 85.3% never smoked, 71.4% are employed, mean BMI is 28.7 kg/m2 and 42.9% are obese. There 
were also no differences between study conditions in the percent of people reporting specific health conditions 
(under control), including hypertension (60.0%), hyperlipidemia (40.0%); diabetes (31.4%); and arthritis 
(22.9%). The mean number of co-morbidities reported was about 2 for both conditions. The percent of 
participants who reported having two or more co-comorbidities at baseline was 52.2% for HL/DT condition and 
58.3% for LMPA/ST condition. 
 
Table 5.  Baseline Sociodemographics by Study Condition   
Characteristics 
Total (n=35) 
HL/DT (n=23) 
LMPA/ST (n=12) 
P* 
Sex, Female 
28 (80.0%) 
18 (78.3%) 
10 (83.3%) 
1.00 
Age (yrs.) 
64.4 ± 6.2 
63.8 ± 6.1 
65.5 ± 6.6 
0.46 
Race, Filipino 
34 (97.1%) 
22 (95.7%) 
12 (100%) 
1.00 
Birth Place, Philippines 
27 (77.1%) 
17 (73.9%) 
10 (83.3%) 
0.69 
Education (yrs.) 
14.1 ± 4.2 
14.0 ± 4.4 
14.5 ± 3.9 
0.78 
Marital Status: Married 
16 (45.7%) 
10 (43.5%) 
6 (50.0%) 
0.83 
Smoking Status, Never smoked 
29 (85.3%) 
19 (82.6%) 
10 (90.9%) 
0.16 
Employment: Employed  
25 (71.4%) 
17 (73.9%) 
8 (66.7%) 
0.71 
Body Mass Index, Continuous 
28.7 ± 4.7 
27.7 ± 4.0 
30.6 ± 5.7 
0.10 

9 
 
Body Mass Index, Categorical   
 
 
 
0.90 
Normal 
8 (22.9%) 
6 (26.1%) 
2 (16.7%) 
 
Overweight                         
12 (34.3%) 
8 (34.3%) 
4 (33.3%) 
 
Obese 
15 (42.9%) 
9 (39.1%) 
6 (50.0%) 
 
Hypertension 
21 (60.0%) 
13 (56.5%) 
8 (66.7%) 
0.72 
Hyperlipidemia 
14 (40.0%) 
9 (39.1%) 
5 (41.7%) 
0.88 
Diabetes 
11 (31.4%) 
8 (34.8%) 
3 (25.0%) 
0.71 
Arthritis 
8 (22.9%) 
3 (13.0%) 
4 (41.7%) 
0.09 
Number of Comorbidities 
1.9 ± 1.5 
1.9 ± 1.2 
2.0 ± 1.1 
0.81 
Number of Comorbidities 
 
 
 
1.00 
0 
6 (17.1%) 
4 (17.4%) 
2 (16.7%) 
 
1 
10 (28.6%) 
7 (30.4%) 
3 (25.0%) 
 
2+ 
19 (54.3%) 
12 (52.2%) 
7 (58.3%) 
 
n (%) or Mean ± SD. HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary 
time condition. * Fisher’s exact test or chi-square test was used for categorical variables and two sample t test was used for continuous 
variables.     
4. Baseline Results for Physical Activity / Sedentary time by study condition  
Table 6 shows PA outcomes at baseline by study condition for the CHAMPS measures. Across the two 
conditions none of the PA outcomes were significantly different between the study conditions, although 
participants in the LMPA/ST condition reported slightly higher minutes of MVPA activity (180 min) versus 
HL/DT(171 min). 
 
Table 6.  Baseline Results comparing Physical Activity Outcomes by Study Condition   
Variable 
Total 
HL/DT 
Condition 
LMPA/ST 
Condition 
P* 
Frequency per week (All) 
14.6 ± 10.3  
(0 - 36) 
14.6 ± 10.0  
(1 - 36) 
14.7 ± 11.2  
(0 - 32) 
0.98 
Number of Minutes per 
week (All) 
472 ± 348  
(30 - 1,380) 
456 ± 369  
(30 - 1,380) 
505 ± 316  
(60 - 1,065) 
0.71 
Caloric Expenditure per 
week (All) 
1517 ± 1134  
(83 - 5,116) 
1464 ± 1205 
(83 - 5,116) 
1630 ± 1013  
(196 - 3,207) 
0.70 
Frequency per week 
(MVPA) 
3.8 ± 4.2  
(0 - 18) 
4.1 ± 4.5  
(0 - 18) 
3.1 ± 3.4  
(0 - 9) 
0.51 
Number of Minutes per 
week (MVPA) 
174 ± 183  
(0 - 690) 
171 ± 175  
(0 - 690) 
180 ± 207  
(0 - 675) 
0.89 
Caloric Expenditure 
(MVPA), per week 
712 ± 696  
(0 - 2,158) 
704 ± 703  
(0 - 2,158) 
728 ± 714  
(0 - 1,944) 
0.93 
Frequency per week (HiLi) 
10.0 ± 7.5  
(0 - 30) 
9.2 ± 6.5  
(1 - 23) 
11.5 ± 9.4  
(0 - 30) 
0.42 
Number of Minutes per 
week (HiLi PA) 
370 ± 293  
(30 - 1,140) 
335 ± 300  
(30 - 1,035) 
445 ± 274  
(135 - 1,140) 
0.31 
Caloric Expenditure per 
week (HiLi) 
1060 ± 923  
(83 - 3,511) 
961 ± 971  
(83 - 3,511) 
1268 ± 815  
(300 - 3,282) 
0.37 
Mean ± SD (Range). HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary 
time condition. MVPA = Moderate-to-vigorous physical activity (note CHAMPS survey refers to this as MVI but MVPA has become the 
standard nomenclature). HiLi = High-light intensity per Hekler 2012. * Two sample t test was used. 
 
Table 7 (on the next page) shows the results for baseline sedentary time outcomes by condition, the only 
significant difference between the two conditions was for number of breaks in sitting time at home (per hour), 
with the LMPA/ST condition had 2.5 mean number of breaks per hour (P = .01) while HL/DT had 1.1 breaks. 

10 
 
Table 7. Baseline Results by study condition for Sleep, Sitting Time, and Breaks in Sitting Time                
Characteristic 
HL/DT (n=23) 
LMPA/ST (n=12) 
P* 
Daytime sleep (hrs./day) 
0.5 ± 0.6 
1.0 ± 1.3 
0.43 
Nighttime sleep (hrs./day) 
6.0 ± 0.9 
7.1 ± 1.0 
1.00 
Total Sleep Time (hrs./day) 
6.5 ± 1.0 
7.1 ± 1.0 
0.14 
Total Sitting Time (hrs./day) a   
6.3 ± 6.3 
5.4 ± 4.9 
0.96 
# of Breaks Sitting per Hour at Home    
1.1 ± 1.0 
2.5 ± 1.7 
0.01 
# of Breaks Sitting per Hour at Work   
1.5 ± 1.5 
2.6 ± 1.8 
0.09 
Mean ± SD. HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. a Total sitting 
time=watching TV, using computer, reading, socializing with friends or family, driving or riding, hobby, and other activity. Driving, watching TV, and 
socializing with friends or family were the top three most commonly listed activities reported while sitting. * Two sample t test was used.  
 
5.  Comparison of baseline sociodemographic characteristics: study completers vs. dropouts by condition. 
As seen in the Consort Figure 2 above, 23 out of 35 persons (66% retention rate) remained in the study over 
the entire 9 month period. We conducted statistical tests to determine if there were any statisticially signficiant 
differences in sociodemographic characteristics and study outcomes, by condition, between those who 
completed the study (completers) versus those who were dropouts or lost to follow up. Descriptive statistics 
were computed using mean and standard deviation for a continuous variable and frequency and percentage 
for a categorical variable. To test for significant differences between participants who dropped versus those 
who completed the study, we used Wilcoxon nonparametric test for continuous variables and chi-square tests 
or Fisher’s exact tests for categorical variables, depending on the distribution of variables. Tables 8 - 11 below 
compares the baseline results for study outcomes/measures by condition and dropout status. There were no 
significant differences in baseline sociodemographics between study completers /dropouts by study condition.   
Table 8. Baseline Sociodemographic Characteristics by Dropout Status: Total sample/ Conditions 
Variable 
Total Sample 
HL/DT condition 
LMPA/ST condition 
Completed 
(n=23) 
Dropout 
(n=12) 
P 
Completed 
(n=17) 
Dropout 
(n=6) 
P 
Completed 
(n=6) 
Dropout 
(n=6) 
P 
Sex, % Male 
5 (21.7%) 
2 (16.7%) 1.000 5 (29.4%) 
0 (0%) 
0.192 
0 (0%) 
2 (33.3%) 0.455 
Age  
63.6±5.7  
(56-75) 
66.0±7.2  
(55-75) 
0.320 
62.6±5.7  
(56-75) 
67.3±6.4  
(57-73) 
0.145 
66.3±5.2  
(60-73) 
64.7±8.2  
(55-75) 
0.639 
Ethnicity, Hispanic 
2 (8.7%) 
0 (0%) 
0.536 2 (11.8%) 
0 (0%) 
1.000 
0 (0%) 
0 (0%) 
NA 
Race, Filipino 
22 (95.6%) 12 (100%) 1.000 16 (94.1%) 
6 (100%) 
1.000 
6 (100%) 
6 (100%) 
NA 
Born in Philippines 
16 (69.6%) 11 (91.7%) 0.216 11 (64.7%) 
6 (100%) 
0.144 5 (83.3%) 
5 (83.3%) 1.000 
Years lived in HI       41.0±16.7 
(15-75) 
34.0±14.9 
(13-59) 
0.289 40.7±16.7 
(19-75) 
28.2±14.4 
(13-49) 
0.146 41.8±18.1 
(15-64) 
39.8±14.1 
(18-59) 
1.000 
Years of education   15.3±3.0  
(10-20) 
12.1±5.2 
(4-18) 
0.173 
15.2±3.3  
(10-20) 
10.5±5.4 
(4-16) 
0.116 
15.4±2.2  
(12-18) 
13.7±5.0 
(4-18) 
0.715 
Marital status:  
 
 
0.606 
 
 
0.392 
 
 
1.000 
Never married 
5 (21.7%) 
1 (8.3%) 
 
4 (23.5%) 
0 (0%) 
 
1 (16.7%) 
1 (16.7%) 
 
Married 
11 (47.8%) 5 (41.7%) 
 
8 (47.1%) 
2 (33.3%) 
 
3 (50.0%) 
3 (50.0%) 
 
Divorced 
2 (8.7%) 
1 (8.3%) 
 
2 (11.8%) 
1 (16.7%) 
 
0 (0%) 
0 (0%) 
 
Widowed 
5 (21.7%) 
5 (41.7%) 
 
3 (17.7%) 
3 (50.0%) 
 
2 (33.3%) 
2 (33.3%) 
 
Never smoked 
18 (81.8%) 11 (91.7%) 0.635 13 (76.5%) 
6 (100%) 
0.539 
5 (100%) 
5 (83.3%) 1.000 
Employed 
17 (73.9%) 8 (66.7%) 0.706 13 (76.5%) 4 (66.7%) 0.632 4 (66.7%) 
4 (66.7%) 1.000 
BMI 
29.2±4.0 
(22.1-37.8) 
27.7±6.0 
(21.6-39.3) 
0.158 
28.4±4.0 
(22.1-37.8) 
25.9±3.4 
(21.6-30.9) 
0.208 
31.5±3.1 
(28.4-36.4) 
29.6±7.7 
(21.8-39.3) 
0.397 
Normal (BMI<25) 
3 (13.0%) 
5 (41.7%) 0.159 3 (17.7%) 
3 (50.0%) 0.299 
0 (0%) 
2 (33.3%) 0.481 
Overweight 
(25≤BMI<30) 
8 (34.8%) 
4 (33.3%) 
 
6 (35.3%) 
2 (33.3%) 
 
2 (33.3%) 
2 (33.3%) 
 
Obese (BMI≥30) 
12 (52.2%) 3 (25.0%) 
 
8 (47.1%) 
1 (16.7%) 
 
4 (66.7%) 
3 (33.3%) 
 
N (%) or Mean ± SD (Range). HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time 
condition. BMI = Body mass index. NA = Non-applicable. * Fisher’s exact test or chi-square test was used for categorical variable and two sample t test 
was used for continuous variable.   

11 
 
When we analyzed number of medical conditions for the total sample and for the two study conditions, there 
were no significant differences in the type and number of medical conditions reported at baseline by those who 
later dropped out versus those who completed the study. 
 
Table 9. Baseline Medical Conditions by Dropout Status for Total sample and by Study Conditions 
Variable 
Total Sample 
HL/DT Condition 
LMPA/ST Condition 
Completed 
(n=23) 
Dropout 
(n=12) 
P 
Completed 
(n=17) 
Dropout 
(n=6) 
P 
Completed 
(n=6) 
Dropout 
(n=6) 
P 
Arthritis 
4 (17.4%) 
4 (33.3%) 0.402 
1 (5.9%) 
2 (33.3%) 0.155 3 (50.0%) 
2 (33.3%) 1.000 
Diabetes 
8 (34.8%) 
3 (25.0%) 0.709 5 (29.4%) 
3 (50.0%) 0.621 3 (50.0%) 
0 (0%) 
0.182 
Hypertension 
15 (65.2%) 6 (50.0%) 0.477 10 (58.8%) 
3 (50.0%) 1.000 5 (83.3%) 
3 (50.0%) 0.546 
Hyperlipidemia 
10 (43.5%) 4 (33.3%) 0.721 6 (35.3%) 
3 (50.0%) 0.643 4 (66.7%) 
1 (16.7%) 0.242 
# comorbidities: 
  
  
  
  
  
  
  
  
  
  
  
0 
4 (17.4%) 
2 (16.7%) 0.396 4 (23.5%) 
0 (0%) 
0.311 
0 (0%) 
2 (33.3%) 0.318 
1 
5 (21.7%) 
5 (41.7%) 
 
4 (23.5%) 
3 (50.0%) 
 
1 (16.7%) 
2 (33.3%) 
 
2+ 
14 (60.9%) 5 (41.7%) 
 
9 (52.9%) 
3 (50.0%) 
 
5 (83.3%) 
2 (33.3%) 
 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition.   
 
When we tested the total sample and compared the two study conditions, there were no significant 
differences in any of the CHAMPS physical activity outcomes reported at baseline for those who later dropped 
out versus those who completed the study (Table 10).   
 
Table 10. Baseline Physical Activity Outcomes by Dropout Status for Total sample and by Study 
Conditions 
Variable 
Total Sample 
HL/DT condition 
LMPA/ST Condition 
Complete
d (n=23) 
Dropout 
(n=11) 
P 
Completed 
(n=17) 
Dropout 
(n=6) 
P 
Completed 
(n=6) 
Dropout 
(n=5) 
P 
Frequency (All), 
per week 
14.9±10.5  
(0-36) 
14.1±10.3  
(0-31) 
0.85
5 
14.8±10.2  
(1-36) 
14.0±10.3  
(3.8-28) 
0.890 15.0±12.1  
(0-32) 
14.3±11.5  
(3-31) 
0.929 
Number of Minutes 
(All), per week 
470±347  
(30-1380) 
475±369  
(90-1365) 
0.94
2 
429±331  
(30-1380) 
533±488  
(90-1365) 
0.809 
588±396  
(60-1065) 
405±177  
(195-585) 
0.382 
Caloric 
Expenditure (All), 
per week 
1571±1201  
(83-5116) 
1405±1022  
(259-3744) 
0.68
8 
 
1476±1223 
(83-5116) 
1430±1265 
(259-3744) 
0.809 1842±1203 
(196-3207) 
1375±782  
(466-2224) 
0.431 
Frequency (MVPA) 
3.9±4.1  
(0-18) 
3.6±4.5  
(0-14) 
0.71
2 
4.0±4.3 
(0-18) 
4.3±5.6  
(0-14) 
0.754 
3.3±4.0  
(0-9) 
2.8±3.1  
(0-8) 
1.000 
Number of Minutes 
(MVPA), per week 
172±178  
(0-675) 
177±203  
(0-690) 
0.95
6 
158±142  
(0-450) 
208±263  
(0-690) 
0.945 
213±268  
(0-675) 
141±116  
(0-240) 
1.000 
Caloric 
Expenditure 
(MVPA) 
722±709  
(0-2158) 
689±701  
(0-2155) 
0.86
9 
697±675  
(0-2158) 
722±844  
(0-2155) 
0.808 
793±861  
(0-1944) 
650±577  
(0-1354) 
0.788 
Frequency (HiLi), 
per week 
10.3±8.0  
(0-30) 
9.3±6.6  
(1-21) 
0.78
4 
9.8±7.0  
(1-23) 
7.7±5.0  
(1-15) 
0.557 11.9±11.0  
(0-30) 
11.1±8.4  
(1-21) 
0.929 
Number of Minutes 
(HiLi), per week 
381±320  
(30-1140) 
348±238  
(30-720) 
0.97
1 
328±309  
(30-1035) 
353±301  
(30-720) 
0.972 
530±329  
(165-1140) 
342±167  
(135-585) 
0.338 
Caloric 
Expenditure (HiLi), 
per week 
1139±1049  
(83-3511) 
896±587  
(93-1589) 
1.00
0 
1008±1071 
(83-3511) 
828±671  
(93-1543) 
1.000 1510±973  
(491-3282) 
977±532  
(300-1589) 
0.431 
HL/DT = Healthy Living/Delayed treatment condition. . LMPA/ST = Light-to-moderate physical activity/sedentary time condition.  MVPA 
= Moderate-vigorous physical activity (note CHAMPS survey refers to this a MVI but MVPA has become the standard nomenclature) 
HiLi = High-light intensity.    
 
Table 11 (see next page) presents number of breaks, environment and social support at baseline by study 
condition. In the HL/DT condition, there is a significant difference in total social support for physical activity 
between the participants who completed at least three surveys (n=17) and the participants who dropped out 

12 
 
from the study (n=6). Participants who completed the study had a higher total social support score than the 
participants who dropped out from the study (P=0.03). However, this difference was not significant for 
completers versus dropouts for the total sample. No other comparisons for sitting time, number breaks in sitting 
time, the PANES scores, or other social support outcomes were significantly different between completers and 
dropouts.   
 
Table 11.  Number of Sitting Breaks per Hour, Environment and Social Support at Baseline by Dropout 
Status for Total Sample and by Study Conditions 
Variable 
Total Sample 
HL /DT condition 
LMPA/ST Condition 
Completed 
(n=23) 
Dropout 
(n=12) 
P 
Completed 
(n=17) 
Dropout 
(n=6) 
P 
Completed 
(n=6) 
Dropout 
(n=6) 
P 
Total Sitting Time, 
hrs/day 
6.9±6.5  
(0.7-26.1) 
4.2±3.7  
(1.1-12.8) 
0.460 
7.4±7.0 
(0.7-26.1) 
3.2±1.3 
(1.3-5.0) 
0.558 
5.6±5.1  
(0.8-15.3) 
5.1±5.1  
(1.1-12.8) 
0.697 
# Breaks per hour at 
work 
1.8±1.6  
(0-6) 
1.3±0.7  
(1-3) 
0.812 
1.2±1.1 
(0-4) 
1.0±0.0 
(1-1) 
0.856 
3.3±1.9  
(1-6) 
1.6±0.9  
(1-3) 
0.139 
# Breaks per hour at 
home 
2.0±1.9  
(0-6) 
1.6±1.2  
(0-4) 
0.670 
1.6±1.6 
(0-6) 
1.0±0.8 
(0-2) 
0.622 
3.7±2.1  
(2-6) 
2.0±1.4  
(1-4) 
0.318 
PANES total 
2.7±0.5  
(1.6-3.6) 
2.7±0.4  
(1.9-3.4) 
0.654 
2.7±0.3  
(1.9-3.3) 
2.7±0.4  
(2.2-3.1) 
1.000 
2.7±0.8  
(1.6-3.6) 
2.8±0.5  
(1.9-3.4) 
0.294 
Family Rewards & 
Punishment 
10.7±2.1  
(3-15) 
11.0±0.4  
(10-12) 
0.641 
11.2±1.3  
(9-15) 
11.0±0.0  
(11-11) 
1.000 
9.2±3.5  
(3-11) 
11.0±0.6  
(10-12) 
0.314 
Family Support PA 
13.1±6.2  
(8-28) 
12.1±5.0  
(8-21) 
0.602 
14.5±6.6  
(8-28) 
10.2±3.7  
(8-17) 
0.103 
8.8±1.8  
(8-12) 
14.0±5.7  
(8-21) 
0.166 
Friend Support PA 
11.3±4.5  
(8-22) 
11.1±5.0  
(8-24) 
0.877 
11.7±4.8  
(8-22) 
8.8±1.2  
(8-11) 
0.279 
10.2±3.5  
(8-16) 
13.3±6.4  
(8-24) 
0.409 
Total Social Support 
PA 
24.5±7.1  
(16-40) 
23.2±9.6  
(16-45) 
0.343 
26.2±7.1  
(16-340) 
19.0±4.8  
(16-28) 
 0.030 
19.0±3.3  
(16-24) 
27.3±11.7  
(16-45) 
0.328 
Mean ± SD (Range). HL/DT= Healthy Living/ Delayed treatment. LMPA/ST = Light-to-moderate physical activity/sedentary time. 
PANES = Physical Activity Neighborhood Environment Scale (range 1-4, with higher score representing more environmental support for 
physical activity, e.g., not much traffic, parks, maintained sidewalks, etc.). PA = Physical activity. * Two sample t test was used.  
  
In conclusion, almost all of the comparisons of baseline measures between subjects who completed the 
study to those who dropped out were not significantly different. Thus, we concluded there were no inherent 
bias nor were there sociodemographic differences between subjects who dropped out of study and subjects 
who completed the 9 month study.    
 
D.  Delivery of Study Protocols to Participants and Staff’s Fidelity to Study Protocols by Condition   
1. Completion of scheduled (per protocol) telephone calls by study condition.    
Of the 327 LMPA/ST intervention calls that were per protocol for subjects receiving this intervention (across 
both study conditions), 254 (77.7%) were conducted / completed. The average duration of each call was 15 
min. If a participant was not reached at the scheduled call time, the health coach attempted a max of 2 calls 
before considering this call a missed call. There were 454 call attempts and a total of 73 missed calls. 
Of the 251 symptom checker calls planned per protocol for the HL/DT condition, 135 (53.8%) were 
conducted/completed. The average duration of each call was 8:75 min. There were 383 call attempts and 116 
total missed calls.  
   We also compared the delivery of LMPA/ST intervention calls made to all participants, from both study 
conditions (i.e., comparing the LMPA/ST condition that received intervention from baseline-3months to the 
HL/DT condition that received the same intervention from 3-6 months).There were total of 12 calls on physical 
activity and sedentary time during the 3-month intervention period. The six odd numbered calls (i.e., 1, 3, 5, 7, 
9, 11) addressed physical activity goals and the six even numbered calls (i.e., 2, 4, 6, 8, 10, 12) discussed 
sedentary time goals. Two sample t tests were used for the following tables to compare completed 
/attempted/missed calls for persons who participated in the LMPA/ST intervention initially from baseline to 3 
months for those in the LMPA/ST condition and for those participants randomly selected to receive the HL/DT 
condition’s calls first then received the LMPA/ST intervention calls from 3 – 6 months. As presented in Table 
12 (next page), there were no significant differences in the delivery of the LMPA/ST intervention to both study 
conditions for all measured factors including: the number of calls completed, duration of the call, the number of 
attempts to reach participant, and the average number of missed calls during the three month period. 

13 
 
 Table 12.  Receipt of Telephone Calls during LMPA Intervention Period by Study Condition 
 
Call Type 
Total 
HL/DT  
Condition  
(3-6 month) 
LMPA/ST 
Condition 
(base-3 month) 
P* 
Total Intervention Calls 
 
 
 
 
Number Calls completed 
8.2 ± 4.2 (0 - 12) 
8.5 ± 3.7 (1 - 12) 
7.7 ± 5.0 (0 - 12) 
0.59 
Average call attempts 
2.7 ± 2.9 (1 - 13) 
2.6 ± 2.6 (1 - 12) 
2.9 ± 3.6 (1 - 13) 
0.75 
Average call duration, min 
14.1 ± 3.8 (4 - 24) 
13.3 ± 4.1 (4 - 24) 
15.5 ± 3.0 (11 - 20) 
0.14 
Average call missed 
0.7 ± 1.4 (0 - 6) 
0.6 ± 1.2 (0 - 5) 
0.8 ± 1.8 (0 - 6) 
0.73 
Physical Activity Calls 
 
 
 
 
Number Calls completed 
4.2 ± 2.0 (0 - 6) 
4.4 ± 1.7 (1 - 6) 
3.8 ± 2.6 (0 - 6) 
0.44 
Average call attempts 
2.1 ± 1.4 (1 - 6) 
2.1 ± 1.4 (1 - 6) 
2.0 ± 1.5 (1 - 6) 
0.78 
Average call duration, min 
15.9 ± 5.7 (4 - 33) 
14.6 ± 5.0 (4 - 27) 
18.3 ± 6.5 (11 - 33) 
0.10 
Average call missed 
0.4 ± 0.6 (0 - 2) 
0.4 ± 0.6 (0 - 2) 
0.3 ± 0.6 (0 - 2) 
0.58 
Sedentary Time Calls 
 
 
 
 
Calls completed 
4.1 ± 2.2 (0 - 6) 
4.3 ± 2.0 (0 - 6) 
3.8 ± 2.5 (0 - 6) 
0.55 
Average call attempts 
2.1 ± 1.3 (1 - 6) 
1.9 ± 0.9 (1 - 4) 
2.3 ± 1.7 (1 - 6) 
0.51 
Average call duration, min 
12.5 ± 4.4 (2 - 26) 
12.5 ± 4.0 (9 - 26) 
12.6 ± 5.3 (2 - 20) 
0.99 
Average call missed 
0.4 ± 0.6 (0 - 2) 
0.3 ± 0.4 (0 - 1) 
0.5 ± 0.8 (0 - 2) 
0.55 
Mean ± SD (Range). HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary 
time condition. *Two sample t test was used.   
Of those who started in the LMPA/ST condition, 5 of 12 (41.7%) received all 12 LMPA/ST calls in the 
intervention of those in the HL/DT condition none received all 12 symptom checker calls and 6 of 23 (26%) of 
those in HL/DT received all 12 LMPA/ST calls in the intervention. 
2. Fidelity to the LMPA/ST intervention calls and HL/DT symptom checker calls  
All telephone calls to study participants were recorded in order to assess fidelity to the condition-specific 
protocols. Fidelity of the staff delivering the telephone protocols were checked (via audiotaped recordings) for 
12.6% of LMPA/ST and 21.5% of symptom checker calls. These recorded counseling calls were randomly 
selected, and no health coach reviewed their own calls. Fidelity to the key intervention components (e.g., goal 
setting, barrier resolution, resources) was 97.8% for the LMPA/ST intervention calls. Fidelity to all items of the 
symptom checker and the dissemination of healthy aging resources was 97.5% for the symptom checker calls.  
 
3. Attendance of Group Cohesion Meetings     
A total of 12 group cohesion meetings were held. If there was only 1 participant in the club, a group cohesion 
session was not held. The one participant randomized in Club 6 dropped before the first meeting. See Table 13 
on next page  for attendance across clubs. The first meeting was discussed combined step counts for all the 
members (e.g. enough combined step/miles to have walked to a neighboring island) and the second meeting 
discussed sedentary time. 
 
 
 
 
See Table 13 on the next page 
 
 
 
 
 
 

14 
 
Table 13. Attendance at Group Cohesion meetings by Club during LMPA/ST intervention 
Club # 
PA Group Cohesion 
(in attendance) 
ST Group Cohesion 
(in attendance) 
Club 1 
3 
3 
Club 2 
3 
2 
Club 3 
2 
2 
Club 4 
n/a 
n/a 
Club 5 
8 
7 
Club 6 
n/a 
n/a 
Club 7 
n/a 
n/a 
Club 8 
2 
n/a 
Club 9 
2 
2 
Club 10 
2 
n/a 
 
4. Completion of study surveys   
Of the 10 clubs randomized, one was lost to follow up before 12 weeks. Survey completion for all participants 
was tracked for each of the four time points: Baseline, 12 weeks, 24 weeks, and 36 weeks.  
 At Baseline (see Table 14), 35 (100%) surveys were completed, 12 from LMPA/ST and 23 from the HL/DT 
condition. At 12 weeks, we received 24/35 surveys (68.8%) with 8 coming from LMPA/ST and 16 surveys 
being done by the HL/DT condition. At 24 weeks, we received 23 surveys (65.7%) with 6 being done by the 
LMPA/ST group condition and 17 from HL/DT. Finally, at 36 weeks, 22 of 35 surveys (62.9%) were received, 
with 5 coming from LMPA/ST and 17 coming from the HL/DT condition. See table below for summary of survey 
completions over time.  
 
Table 14.  Survey Completion (for those enrolled in study) over 4 Assessment Points by Study 
Condition 
Condition 
Survey Completion 
Baseline 
12 Weeks 
24 Weeks 
36 Weeks 
LMPA/ST 
12 
8/12 (66.7%) 
6/12 (50.0%) 
5/12 (41.7%) 
HL/DT 
23 
 16/23 (69.6%) 
17/23 (73.9%) 
17/23 (73.9%)  
TOTAL 
35 
24/35 (68.6%)  
23/35 (65.7%)  
22/35 (62.9%)  
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition.   
 
Compliance to wearing the accelerometer ranged from 55.6% to 100% across the 4 time points (Table 15).  
Across all time points 15/20 or 81.3% of persons in HL/DT condition returned the accelerometer with valid days 
and 13/16 or 75% of those in LMPA/ST condition returned accelerometer with valid days.  
 
Table 15.  Accelerometer Compliance over 36 weeks by Study Condition 
Condition 
Accelerometer Compliance 
Baseline 
12 Weeks 
24 Weeks 
36 Weeks 
LMPA/ST (those with 
valid days) 
5 (out of 5) 
4 (out of 4) 
2 (out of 4) 
2 (out of 3) 
HL/DT (those with 
valid days) 
5 (out of 5) 
3 (out of 5) 
3 (out of 5) 
4 (out of 5) 
Total 
Returned/Distributed  
10/10 (100%) 
8/9 (88.9%) 
5/9 (55.6%) 
6/8 (75%) 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition.   
 
 

15 
 
III. Measurements / Survey Schedule and Instruments 
Anthropometric data (height and weight) were collected, onsite at the church, during the baseline visit. The 
survey schedule included a survey in person at the baseline and via mail at 12 weeks, 24 weeks, and 36 
weeks. Participants were reminded via email and by phone once the survey was mailed out. If study staff didn’t 
receive a survey after 5 days, they made one more reminder attempt via email. After 9 days without receiving a 
survey, staff mailed out a shorter outcomes-only survey that included only the primary outcome questions 
(CHAMPS questionnaire and breaks in ST) and the adverse events question. A total of 8 participants 
completed these shorter Outcome-Only surveys (2 at 3 mo- both HL/DT, 4 at 6 mo- 3 HL/DT and 1 LMPA/ST, 
and 2 at 9 months- both HL/DT). At each timepoint, one participant in each club (approximately 10% of the club 
members) was randomly chosen to wear a wrist worn accelerometer (GENEActiv) for 7 days at each of 
measurement time points (i.e. baseline, 12, 24, and 36 weeks). Using the same cut-off points of CHAMPS 
metabolic equivalent for PA, we determined low-light intensity (LoLi) PA, high-light (HiLi), and MVPA. 
Sedentary time was not directly reported in GENEActiv accelerometer so it was estimated by subtracting all PA 
(LoLi PA, HiLi PA, and MVPA) and bed time.  
Study surveys included standardized instruments for physical activity/breaks in sitting that had been 
developed and validated in studies with older adults (e.g., CHAMPS, MOST, etc.). (Gardiner, Clark, et al., 
2011; Gardiner, Eakin, Healy, & Owen, 2011; Stewart, Mills, et al., 1997; Stewart, Verboncoeur, et al., 1997)  
In addition, we used validated instruments to assess neighborhood environment’s walkability (PANES) (J. F. 
Sallis et al., 2010) and social support for physical activity (GRAD) (C. L. Albright et al., 2012; R. K. Oka, King, 
& Young, 1995; R. Oka, King, & Young, 1993). The baseline survey assessed standard demographics 
including the following: age, where they were born and how long they have been in Hawaii, ethnicity/race, 
education, marital status, smoking status, employment status, caregiving status, comorbidities.  
 
A. Anthropometric Measurements 
Weight (HoMedics Model SC-476, Commerce Charter Twp, MI) and height (Portable Stadiometer Height-
Rod Seca 213, Thousand Oaks, CA) were measured without shoes or heavy clothing, following previously 
used protocols. (C.L. Albright et al., 2012)   
 
B. Accelerometer Measurement of Physical Activity   
 GENEActiv is a waterproof accelerometer that could be worn 24 hours a day, measuring activity continuously 
for up to one month without needing to be recharged. The first accelerometer was given out at the baseline 
visit. However, all future accelerometers were sent via USPS mail to the participant who was randomly 
assigned to wear it and they returned it to us via USPS mail. We tracked who wore and returned an 
accelerometer, as well as how many valid days it was worn. Valid day criteria included: 1) wear time >10 
hours, 2) wear 5 consecutive days, and 3) no zeroes for all of the physical activities of sedentary activity, low-
light intensity activity, high-light intensity activity, and MVPA.   
 
C. Primary Outcomes: Assessment of MVPA 
The Community Health Activities Model Program for Seniors (CHAMPS) survey was used to assess a variety 
of self-reported PA “in a typical week during the past 4 weeks.” (Stewart, Verboncoeur, et al., 1997)  Over the 
last 19 years during which this measure was used in numerous intervention studies with older adults, its 
validity, test-retest reliability, and sensitivity to change were found to be excellent. (Castro, Pruitt, Buman, & 
King, 2011; Wilcox et al., 2013) (A.C. King et al., 2000; Stewart, Mills, et al., 2001; Stewart, Verboncoeur, et 
al., 2001; Stewart, Mills, et al., 1997) (Hekler et al., 2012) (Cyarto, Marshall, Dickinson, & Brown, 2006; A. C. 
King, Baumann, O'Sullivan, Wilcox, & Castro, 2002; Moore et al., 2008).  Participants reported the number of 
times/week they do a specific physical activity, and then choose one of 6 time ranges that represented the 
amount of time they did that activity, from less than 1 hr/week to 9 or more hrs/week. Hekler, et al., modified 
the CHAMPS survey to measure high-light intensity (HiLi) (>2 and <3 Metabolic Equivalents (METs)) and 
MVPA activity (>3 METs). Frequency per week, number of minutes per week, and caloric expenditure per 
week was calculated by summing specific CHAMPS items to assess overall PA, HiLi, MVPA (Table 16 lists 
how these outcomes were defined using CHAMPS questions and Hekler questions). The surveys were 
administered at baseline, 12, 24, and 36-weeks post baseline.   
The CHAMPS survey measured a variety of self-reported PAs done “in a typical week during the past 4 
weeks.” Over the last 23 years during which this measure was used in numerous intervention studies with 
adults, including older adults, its validity, test–retest reliability, and sensitivity to change have been found to be 

16 
 
excellent. Participants report the number of times/week they do a specific PA, and then choose one of 6 time 
frames that represent the amount of time they did that activity, from less than one hr/week to 9 or more 
hours/week. For example, as done in other faith-based organization studies, MVPA will be the sum of six 
CHAMPS items that assessed moderate or higher intensities: walking (i.e., walking fast, walking for leisure, 
dog walking), bicycling, and jogging or running for leisure, while light-to-moderate activity included certain 
household and gardening activities along with walking for leisure and dog walking. The definitions for the 
primary outcomes using the CHAMPS PA questions are listed in Table 16. Physical activities were presented 
by frequency, number of minutes, and caloric expenditure of all, moderate and vigorous intensity (MVPA), and 
high-light intensity (HiLi) physical activities (PA) per week using the Community Health Activities Model 
Program for Seniors (CHAMPS) (Stewart, Verboncoeur, et al., 2001) and Hekler et. al. 2012 HiLi outcomes.  
(Hekler et al., 2012). Missing weight in a specific survey was imputed by the participant’s objective baseline 
weight. Caloric expenditure defined as MET*3.5*60*(Weight in lbs)*0.45359/200 (see Table 17 next page).  
 
Table 16.  Questions used for specific CHAMPS physical activity measures 
Variable Label 
Question Nos. 
Coding Algorithms 
Caloric expenditure/week in all 
exercise-related activities 
7, 9, 10, 14–16, 19–35, 
37–40 
For each activity 
1. Create new duration variables for each activity 
recorded as follows: 1=0.5, 2=1.75, 3=3.75, 4=5.75, 
5=7.75, 6=9.75; if duration variable is not answered, 
score=0. Duration is hours/week.  
2. For each recoded duration variable, create new 
weighted duration variable for each activity by 
multiplying duration variable (no. 1) by corresponding 
MET value (see Table 17).  
3. For each weighted duration variable, create caloric 
expenditure per week variable for each activity by 
multiplying weighted duration variable (no. 2) by 3.5 
and by 60 (to convert METs/minute to METs/hour) 
and by (weight in kg/200). 
4. Sum caloric expenditure per week variables across 
activities to create caloric expenditure/week. 
Caloric expenditure/week in 
moderate-intensity exercise related 
activities 
7, 9, 14-16, 19, 21, 23-
26, 29-33, 37, 38, 40 
Same as above, subset of activities with MET values 
≥3.0 
Hekler’s Caloric expenditure/week 
in high-light-intensity exercise 
related activities 
3, 10, 13, 20, 27, 28, 34, 
35, 39, Other (Dog 
walking) 
Same as above, subset of activities with MET values 
between 2 and 3 (exclusive) 
Frequency/week of all exercise-
related activities 
7, 9, 10, 14-16, 19-35, 
37-40 
Sum frequency scores/week for each of the activities 
(allow those with missing data on frequency to be 
included in the sum) 
Frequency/week of moderate-
intensity exercise-related activities 
7, 9, 14-16, 19, 21, 23-
26, 29-33, 37, 38, 40 
Sum frequency scores/week for each of the activities 
(allow those with missing data on frequency to be 
included in the sum) 
Hekler’s Frequency/week of high-
light-intensity exercise-related 
activities 
3, 10, 13, 20, 27, 28, 34, 
35, 39, Other (Dog 
walking) 
Sum frequency scores/week for each of the activities 
(allow those with missing data on frequency to be 
included in the sum) 
MET = Metabolic equivalent.  

17 
 
Table 17. Summary of metabolic weights for selected items to adjust for older adults completing 
the CHAMPS physical activity questionnaire  
Item # 
Question Item 
Metabolic 
Weight 
Category 
3 
Do volunteer work 
2.25 
HiLi 
7 
Dance 
4.5 
MVPA 
9 
Play golf, carrying or pulling your 
equipment 
5.0 
MVPA 
10 
Play golf, riding a cart 
2.0 
HiLi 
13 
Shoot pool or billiards 
2.5 
HiLi 
14 
Play singles tennis 
8.0 
MVPA 
15 
Play doubles tennis 
6.0 
MVPA 
16 
Skate (ice, roller, in-line) 
7.0 
MVPA 
19 
Do heavy work around the house (such as 
washing windows, cleaning gutters) 
4.5 
MVPA 
20 
Do light work around the house (such as 
sweeping or vacuuming) 
2.5 
HiLi 
21 
Do heavy gardening (such as spading, 
raking) 
4.4 
MVPA 
22 
Do light gardening (such as watering 
plants) 
2.25 
LoLi 
23 
Work on your car, truck, lawn mower, or 
other machinery 
3.0 
MVPA 
24 
Jog or run 
7.0 
MVPA 
25 
Walk uphill or hike uphill (count only the 
uphill part) 
6.0 
MVPA 
26 
Walk fast or briskly for exercise (do not 
count walking leisurely or uphill) 
3.5 
MVPA 
27 
Walk to errands (such as to/from a store 
or to take children to school (count walk 
time only)) 
2.5 
HiLi 
28 
Walk leisurely for exercise or pleasure 
2.5 
HiLi 
29 
Ride a bicycle or stationary cycle 
5.0 
MVPA 
30 
Do other aerobic machines such as 
rowing or step machines 
7.0 
MVPA 
31 
Do water exercises 
4.0 
MVPA 
32 
Swim moderately or fast 
8.0 
MVPA 
33 
Swim gently 
6.0 
MVPA 
34 
Do stretching or flexibility exercises 
4.0 
HiLi 
35 
Do yoga or Tai Chi 
4.0 
HiLi 
37 
Do moderate to heavy strength training 
7.0 
MVPA 
38 
Do light strength training 
3.0 
MVPA 
39 
Do general conditioning exercises, such 
as light calisthenics or chair exercises 
4.5 
HiLi 
40 
Play basketball, soccer, or racquetball 
7.1 
MVPA 
41 
Other (Walk your dog) 
2.5 
HiLi 
HiLi = High-light intensity. MVPA = Moderate-to-vigorous physical activity. Reference: 
 Stewart AL, Mills Med Sci Sports Exerc, 2001 Jul; 33(7): 1126-1141.Hekler EB, J Phys Act Health. 2012 Feb; 9(2): 225-236. 
 
D. Primary Outcomes: Assessment of Sedentary Behaviors  
Sedentary behaviors was measured via the Measure of Older Adults’ Sedentary Time (MOST), a validated 
survey with good test-retest reliability and results from ST interventions have found it sensitive to change. 
(Gardiner, Clark, et al., 2011; Gardiner, Eakin, et al., 2011)  The survey asked respondents to report the amount 
of time they spent doing 7 different types of tasks/activities (over last week) while sitting or lying (other than 
sleeping/napping/ill in bed) including: (1) TV or video/DVD watching, (2) other screen use/internet use: 
computer/tablet/Smartphone, (3) reading, (4) socializing with friends or family (in-person or when talking on 
phone), (5) driving/riding in car or city bus, (6) doing hobbies, and (7) any other activities. The total amount of 

18 
 
time spent sitting for each task/activity and total across all tasks were calculated. To assess the use of 
intervention strategies such as “breaking up” time spent sitting, we used an item from the Workplace Sitting 
Breaks Questionnaire (SITBRQ) that inquired about the past 7 days, how many breaks from sitting taken in an 
hour at work/home. This could include standing, stretching, or taking a short walk. Participants were asked to not 
count lunch breaks/coffee breaks at work (or breaks to prepare meals at home).” Similar to Sudholz et al., to 
manage extreme outliers reported for number of sitting breaks will be capped at 6 breaks per hour at work. 
(Sudholz et al., 2018)   
  
E. Environmental and Psychosocial Measures 
Neighborhood environment was measured using a standardized scale, the Physical Activity Neighborhood 
Environment Scale-PANES. (Becerra, Herring, Marshak, & Banta, 2015; J. F. Sallis et al., 2010)  This was a 
measure of environmental barriers that prevented or limited the opportunity to walk in a person’s 
neighborhood, defined an area within a 10-15 minute walk from their home. The PANES assesses land use 
mix, housing density, street connectivity, pedestrian infrastructure, accessibility to public transport systems, 
and perceived safety from traffic/ crime. (J. F. Sallis et al., 2010)  Based on Sallis et al. (2010), average 
PANES score was computed by taking a mean of 16 items including pedestrian safety and crime safety in the 
neighborhoods. The PANES score has a range of 1 to 4, with higher values indicating greater environmental 
support for PA.     
Since social support measures related specifically to PA are strong predictors of exercise adherence, (C.L. 
Albright et al., 2012; R. K. Oka et al., 1995; R. Oka et al., 1993) we used Sallis’ Family/Friend Support for 
Exercise Habits Scales (J.F. Sallis, Grossman, Pinski, Patterson, & Nader, 1987),  to assess social support for 
physical activity. It had a minimum test-retest reliability of .77 and internal consistency of .89 (alpha coefficient). 
Participants reported support from family/friends with a higher value indicating more social support. We have 
separated social support ratings for family/friends who attend church with participants versus those outside of 
church. Participants report support on a 5-point Likert scale (1=never, 5=very often), for family/friends, and a 
total of all items is calculated, with a higher value indicating more social support. There are 4 scores - total 
participation, family participation, friend participation, and rewards & punishment. 
 
F.  Process Evaluation Questions 
Process outcomes were collected and quantified the delivery of the intervention strategies by staff, the 
participants’ adherence to minutes of LMPA and intervention strategies over time, and participants’ opinions 
about and satisfaction with achieved LMPA/ST and intervention methods.    
  
IV. Data Safety Monitoring Board (DSMB) and Adverse events.  
 
A. DSMB Members 
DSMB members consisted of three members who had conducted faith based behavior change trials: 
1. Sara Wilcox, PhD (Chair). Professor in the Department of Exercise Science and the Director of the   
Prevention Research Center within the Arnold School of Public Health   
2. Melissa Bopp, PhD Associate Professor in the Department of Kinesiology in the College of Health and 
Human Development at Pennsylvania State University. 
3. Brooke Harmon, PhD. Assistant Professor Division of Social and Behavioral Sciences, School of Public 
Health, University of Memphis 
 
 
B. DSMB Meetings 
The DSMB met approximately every six months to discuss recruitment/accrual, adverse events, and 
preliminary data analyses and results by condition.   
1. Approved DSMB plan (January 9, 2018, approved by IRB Oct 4, 2018)- the plan was submitted each year 
with study’s IRB renewal (See Appendix for DSMB Plan ) 
2. Five Meeting dates: January 8, 2018, July 10, 2018, Jan 30, 2019, July 10, 2019, and March 25, 2020 
3. Duties: DSMB met every 6 months to review condition specific data for LMPA and adverse events collected 
at 12, 24, and 36 (DT condition only) weeks post baseline (prior to and after participation in the 
intervention), to determine if there were differential increases in risk (including number of adverse events) 
between the two conditions and if participants with any health problems or injuries related to the 
intervention were being adequately referred and followed by a physician. The DSMB also provided input 
and feedback on study recruitment methods and retention rates, safety precautions, study eligibility 

19 
 
determination issues, quality assurance and safety issues related to the protocols, as well as data handling 
activities. 
 
C.  DSMB Agenda for meetings  
1. Open Session: discuss study data such as recruitment progress, baseline sociodemographics, compliance 
study protocols/surveys, Pre-Post analyses, adverse events reported 
2. Closed session: Study outcomes by condition, Only DSMB and Statistician   
3. Executive Session: Only DSMB members (led by Chair) discuss adverse events/outcome by condition    
4. Debriefing session: Recommendations to MPIs   
 
D.  Adverse Events:  
Six adverse events in total were reported by five individuals (one person reported two 
different adverse events). Number Severe Adverse events = 1/6 (appendicitis) = 16%, Number /percentage 
that were possibly related to study intervention = 1/6 (knee pain) = 16%.  
Only one adverse event was considered severe and was reported to the IRB. The participant’s appendix was 
removed due to appendicitis, subject was admitted to the hospital and stayed overnight. The IRB ruled it was 
not related to the study’s intervention. The event was reported to DSMB on May 15, 2018. The DSMB 
recommended the participant obtain a note from a physician before continuing physical activity. However, the 
participant dropped out of the study before a note was obtained.   
Remaining five events were ruled not serious adverse events 
1.  Knee pain from walking, DSMB ruled this was possibly related to PA so recommended the participant 
reduce walking goal until pain free. 
2.  Neck stiffness and pain caused from looking at computer screen too long, participant reported going to the 
emergency room (no overnight stay). DSMB ruled this injury was not related to study intervention. 
3. While driving, a participant’s car was rear ended, the participant did not go to emergency room or see a 
physician; reported feeling fine, the DSMB ruled this injury was not related to study intervention, 
recommended to decrease or postpone physical activity goal if felt pain later from accident. 
4. Participant stood up and twisted a knee (with related pain), the DSMB ruled this accident was not related to 
study interventions and recommended to reduce step count goals until pain free. 
5. Same participant who reported a twisted knee later walked through pepper spray residue and was 
hospitalized briefly but released. The DSMB ruled this injury was not related to the study interventions.  
  
V. Statistical Analyses and Results 
All analyses in this section were conducted in SAS version 9.4 (SAS Inc., Cary NC) and P-value less than 
0.05 was considered statistically significant. 
 
A.  Analyses and Results for Specific Aim 1 - Change in Primary Outcomes – Physical Activity and Sedentary 
Time 
 
Specific Aim 1. Determine efficacy of 12 week personalized telephone calls and group-facilitated LMPA/ST 
intervention, designed to increase LMPA min/week and decrease ST min/week in lay leaders (55-75 years) 
from Filipino Catholic clubs. Hypothesis: Clubs randomly assigned to the LMPA/ST will have significant 
changes in LMPA/ST min/week after 12 weeks, demonstrating higher adoption of LMPA/less ST, compared 
to clubs in HL/DT.   
 
1. Physical Activity 
a) Statistical Analysis Specific Aim 1 
Descriptive statistics were reported using means and standard deviations (SDs). Two outliers larger than 3 
SD of the CHAMPS data were excluded from further analyses. We explored intraclass correlation coefficients 
within each church club at baseline. Intraclass correlation coefficients (ICCs) of baseline characteristics were 
relatively low (<0.2). To evaluate the effectiveness of the 12-week intervention from baseline, we conducted 
multilevel modeling for the repeated measures comparing the two conditions over time. In the multilevel 
models, the participants are nested within Catholic Clubs, adjusting for within-club and within-subject 
correlations. However, tests for within-club level correlation were not significant for all the outcomes. Because 
of low ICCs and insignificant club level correlations, we did not include within-club correlation in the final model. 
The model includes group, time, and the interaction between group and time, adjusting for within-subject 

20 
 
correlation. If necessary, variables were transformed using log or squared root to satisfy the model 
assumption. For each group, effect size was computed using Cohen’s d based on Wilcox et al. (2020) (Wilcox, 
Jake-Schoffman, et al., 2020; Wilcox, Saunders, Jake-Schoffman, & Hutto, 2020), i.e., difference between two 
time points in least square mean divided by standard deviation at baseline. For transformed variables, Cohen’s 
d was computed using back-transformed values. Cohen’s d can be interpreted as 0.2 small, 0.5 medium, and 
0.8 large effect.  
To report whether a participant met 150 min per week of MVPA at each time point, frequency and 
percentage were used. Then, repeated measures analysis using generalized linear model with logit link was 
conducted to evaluate to investigate the effects of time, group, and their interaction in rate of meeting the 
recommended PA, adjusting for within subject correlation. P-value less than 0.05 was considered statistically 
significant and all analyses were implemented using SAS version 9.4 (SAS Inc., Cary NC). 
b) Results for Physical Activity outcomes after 12-week intervention 
Table 18 reports descriptive analysis at baseline and 12 weeks and repeated measures analyses for the PA 
outcomes. Number of minutes were significantly different between baseline and 12 weeks for all PA (P=0.014) 
and HiLi PA (P=0.006). Caloric expenditure was significantly different between baseline and 12 weeks for all 
PA (P=0.004), MVPA (P=0.019), and HiLi PA (P=0.011). Thus, these two physical activity outcomes increased 
from baseline to 12 weeks in both HL/DT and LMPA/ST conditions with no significant interaction between the 
two conditions over time (e.g., the participants in the LMPA/ST condition did not have greater increase in PA 
compared to HL/DT). For the PA outcomes that had a significant time effect, the effect sizes of both groups 
were medium or large, ranging from 0.52 to 0.95, but interestingly, the effect sizes of HL/DT condition were 
greater than those of LMPA/ST condition. The HL/DT group had a relatively high effect size comparable to 
LMPA/ST group. The possible explanation is that participants in HL/DT group may have been affected perhaps 
because these participants knew they were in a research study designed to address physical activity (e.g., 
evidence of a Hawthorne effect or placebo effect).   
 
   Table 18  Physical Activity Outcomes by Study Condition  ( Mean ± SD (Range) 
 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. MVPA = 
Moderate and vigorous intensity. HiLi = high-light intensity. PA = Physical Activities. Int = Interaction. * Mixed effect model was 
conducted with group (between-subject), time (within-subject), and their interaction, adjusting for within-club and within-subject 
correlations. Cohen's d was computed by difference between two 
Variable 
HL/DT  
LMPA/ST 
P* 
Baseline 
12 Weeks 
Cohen’s 
d 
Baseline 
12 Weeks 
Cohen’s 
d 
Group Time 
Int 
Number of 
Minutes per 
week (All 
PA) 
 
456 ± 369  
(30 - 1380) 
 
734 ± 403  
(135 - 1275) 
0.74 
505 ± 316  
(60 - 1065) 
699 ± 329  
(300 - 1095) 
0.52 
0.88 
0.01 
0.53 
Caloric 
Expenditure 
per week (All 
PA) 
 
1464 ± 1205  
(83 - 5116) 
 
2554 ± 1584  
(489 - 5556) 
0.89 
1630 ± 1013  
(196 - 3207) 
2546 ± 1355  
(833 - 4327) 
0.82 
0.92 
<0.01 
0.68 
Number of 
Minutes per 
week 
(MVPA)  
171 ± 175  
(0 - 690) 
308 ± 268  
(0 - 840) 
0.65 
180 ± 207  
(0 - 675) 
238 ± 191  
(0 - 480) 
0.23 
0.52 
0.09 
0.46 
Caloric 
Expenditure 
per week 
(MVPA)  
704 ± 703  
(0 - 2158) 
1368 ± 1325  
(0 - 4691) 
0.95 
728 ± 714  
(0 - 1944) 
1195 ± 954  
(0 - 2510) 
0.61 
0.77 
0.02 
0.60 

21 
 
Table 19 shows PA outcomes at pre- and post-intervention for both conditions. Since the participants in the 
HL/DT condition received group-facilitated LMPA/ST intervention between 12 and 24 weeks their pre-
intervention baseline was at 12 weeks and their post-intervention was at 24 weeks. No significant effects were 
found for all of the PA outcomes. 
  
Table 19.  Pre- and Post-Intervention Physical Activity Outcomes over 12 weeks by Study Condition 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. MVPA = 
Moderate and vigorous intensity. HiLi = high-light intensity. PA = Physical Activities. Int = Interaction. * General linear model was 
conducted with group (between-subject), time (within-subject), and their interaction, adjusting for within-club and within-subject 
correlations. Cohen's d was computed by difference between two time points in least square mean (from the model) divided by 
standard deviation at baseline. 
Table 20 (see next page)  reports frequency and percentage meeting 150 min/week of MVPA (national 
recommended amount of MVPA for adults). The rates of meeting this recommendation increased from 
baseline to 12 weeks and from pre-intervention to post-intervention in both study conditions, but, the increases 
were not significant.   
Variable 
HL/DT, Mean ± SD (Range) 
LMPA/ST, Mean ± SD (Range) 
P* 
Pre: 12 
Weeks 
Post: 24 
Weeks 
Cohen’s 
d 
Pre: 
Baseline 
Post: 12 
Weeks 
Cohen’s 
d 
Group Time 
Int 
Frequency 
per week (All 
PA) 
13.5 ± 11.3 
(0 - 31) 
17.7 ± 13.0  
(0 - 43) 
0.40 
14.7 ± 11.2  
(0 - 32) 
14.2 ± 10.8  
(0 - 31) 
0.01 
0.86 
0.31 
0.33 
Number of 
Minutes per 
week (All 
PA) 
734 ± 403 
(135 - 1275) 
747 ± 434  
(165 - 1755) 
0.06 
505 ± 316  
(60 - 1065) 
699 ± 329  
(300 - 1095) 
0.52 
0.31 
0.25 
0.38 
Caloric 
Expenditure 
per week (All 
PA) 
2554 ± 1584 
(489 - 5556) 
2718 ± 1720  
(723 - 7398) 
0.13 
1630 ± 1013  
(196 - 3207) 
2546 ± 1355  
(833 - 4327) 
0.83 
0.28 
0.16 
0.38 
Frequency 
per week 
(MVPA) 
4.1 ± 4.4  
(0 - 12) 
6.3 ± 6.5  
(0 - 23) 
0.52 
3.1 ± 3.4  
(0 - 9) 
4.0 ± 4.2  
(0 - 9) 
0.26 
0.35 
0.17 
0.54 
Number of 
Minutes per 
week 
(MVPA)  
308 ± 268  
(0 - 840) 
331 ± 260  
(0 - 1005) 
0.14 
180 ± 207  
(0 - 675) 
238 ± 191  
(0 - 480) 
0.22 
0.12 
0.42 
0.83 
Caloric 
Expenditure 
per week 
(MVPA)  
1368 ± 1325  
(0 - 4691) 
1517 ± 1288  
(0 - 5136) 
0.50 
728 ± 714  
(0 - 1944) 
1195 ± 954  
(0 - 2510) 
0.61 
0.23 
0.27 
0.63 
Frequency 
per week 
(HiLi PA) 
8.9 ± 7.8  
(0 - 24) 
10.6 ± 8.1  
(0 - 28) 
0.26 
11.5 ± 9.4  
(0 - 30) 
10.9 ± 8.8  
(0 - 23) 
0.00 
0.55 
0.44 
0.42 
Number of 
Minutes per 
week (HiLi 
PA) 
493 ± 330  
(30 - 1230) 
504 ± 430  
(60 - 1515) 
-0.08 
445 ± 274  
(135 - 1140) 
626 ± 271  
(315 - 1125) 
0.55 
0.68 
0.30 
0.13 
Caloric 
Expenditure 
per week 
(HiLi PA) 
1441 ± 1155  
(98 - 4743) 
1497 ± 1521  
(179 - 5896) 
0.01 
1268 ± 815  
(300 - 3282) 
1820 ± 848  
(656 - 3153) 
0.53 
0.99  
0.22 
0.25 

22 
 
Table 20. Percentage Meeting Recommended Physical Activity Level at Baseline and 12 Weeks 
Comparison 
HL/DT, n/N (%) 
LMPA/ST, n/N (%) 
P 
Time 1 
Time 2 
Time 1 
Time 2 
Group 
Time 
Int 
Baseline vs. 12 weeks 9/23 (39.1%) 
10/16 (62.5%) 
6/11 (54.5%) 
5/7 (71.4%) 
0.529 
0.163 
0.781 
Pre vs. Post-
Intervention 
10/16 (62.5%) 14/17 (82.4%) 
6/11 (54.5%) 
5/7 (71.4%) 
0.523 
0.187 
0.791 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. Time 1 = 
Baseline or Pre-Intervention. Time 2 = 12 Weeks or Post-Intervention.  
 
 
2. Total Sitting Time and Number of Breaks in Sitting Time 
a)  Statistical Analysis 
Similar to the above LMPA outcomes, we reported descriptive statistics using means and SDs on total sitting 
time and breaks in sitting and conducted repeated measures analyses of variance to assess efficacy of 
LMPA/ST intervention with the effects of group, time, and their interaction, adjusting for within-subject 
correlation. In addition, effect size was computed using Cohen’s d for each group.  
b)  Results for Total Sitting time and Number of Breaks per hour at home and at work 
Table 21 reports analyses from baseline to 12 weeks for sitting time and breaks in sitting. The average 
number of breaks at home significantly increased from baseline to 12 weeks (P=0.01) for both groups and 
average number of breaks for both at home and at work for those in LMPA/ST condition were significantly 
higher than those in HL/DT condition (p< 0.01 and p<0.02) over 12 weeks. Total sitting time had no changes 
over time or differentially by condition. 
  
 
 Table 21 Sitting Time and Number of Breaks/ Hour in Sitting by Condition and Time point 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. MVPA = 
Moderate and vigorous intensity. HiLi = high-light intensity. PA = Physical Activities. Int = Interaction. * General linear model was 
conducted with group (between-subject), time (within-subject), and their interaction, adjusting for within-club and within-subject 
correlations. Cohen's d was computed by difference between the two time points in least square mean (from the model) divided by 
standard deviation at baseline. 
 
 
Table 22 (on the next page)  shows total sitting time and number of breaks (i.e., break up sitting by standing) 
at pre- and post-intervention for both conditions (i.e., after period where HL/DT received the intervention). 
Significant time and group effects were found in number of breaks at home and work. Compared to pre-
intervention, participants in both conditions reported a higher number of breaks after the intervention both at 
home and at work, indicating that regardless of study condition over time, both conditions reported more 
breaks in sitting time (P=0.01 and P=0.03). In addition, we found group effect in breaking up sitting time for 
home and work; thus, the mean increase in number of breaks at home and at work in the LMPA/ST condition 
was higher than those of HL/DT condition (P= 0.01 and P=0.02). Thus, the LMPA/ST intervention encouraged 
significant increases over time in number of breaks at home and at work.    
 
 
 
 
Variable 
HL/DT, Mean ± SD (Range) 
LMPA/ST, Mean ± SD (Range) 
P* 
Baseline 
12 Weeks 
Cohen’s 
d 
Baseline 
12 Weeks 
Cohen’s 
d 
Group Time 
Int 
Total sitting 
time, hrs/day 
6.3 ± 6.3  
(1 - 26) 
6.5 ± 5.1  
(1 - 19) 
-0.04 
5.4 ± 4.9  
(1 - 15) 
5.4 ± 3.9  
(1 - 10) 
-0.07 
0.59 
0.77 
0.97 
# Breaks per 
hour at home 
1.1 ± 1.0  
(0 - 4) 
1.7 ± 1.4  
(0 - 6) 
0.50 
2.5 ± 1.7  
(1 - 6) 
4.6 ± 1.5  
(3 - 6) 
1.13 
<0.01 <0.01 
0.20 
# Breaks per 
hour at work 
1.5 ± 1.5  
(0 - 6) 
1.4 ± 1.7  
(0 - 6) 
-0.12 
2.6 ± 1.8  
(1 - 6) 
4.2 ± 1.3  
(3 - 6) 
0.56 
0.02 
0.43 
0.20 

23 
 
Table 22.  Pre- and Post- Intervention Hours per day of Sitting Time and Number of Breaks per Hour by 
study condition 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. MVPA = Moderate and 
vigorous intensity. HiLi = high-light intensity. PA = Physical Activities. Int = Interaction. * General linear model was conducted with group (between-
subject), time (within-subject), and their interaction, adjusting for within-club and within-subject correlations. Cohen's d was computed by difference 
between two time points in least square mean (from the model) divided by standard deviation at baseline. 
B. Analyses and Results for Specific Aim 2 - Maintenance 
Specific Aim 2. Determine efficacy of 12week intervention to encourage maintenance of LMPA/ST changes 
over an additional 12 weeks follow-up with no calls (CHAMPS maintenance 12-24 weeks, 24-36 weeks). 
 
1. Maintenance of Physical Activity 
a) Statistical Analysis for Specific Aim 2 
Similar to the above Section A, we conducted repeated measures analyses of variance with the effects of 
group, time, and their interaction on PA outcomes at post-intervention and maintenance, adjusting for within-
subject correlation and computed Cohen’s d for each group.  
b) Results for CHAMPS Physical Activity outcomes during maintenance period 
Table 23 shows PA outcomes at post-intervention and maintenance. No significant difference (increases or 
decreases) were found between post-intervention and maintenance in all of the PA outcomes. This might 
indicate that the 12 weeks intervention also encouraged maintenance of those changes in PA outcomes over 
the additional 12 weeks follow-up with no intervention calls.   
  
Table 23  (on this page and page 24).  Maintenance in Physical Activity Outcomes following 
intervention by Study Condition and Timepoint 
Variable 
HL/DT, Mean ± SD (Range) 
LMPA/ST, Mean ± SD (Range) 
P* 
Pre: 12 
Weeks 
Post: 24 
Weeks 
Cohen’s 
d 
Pre: 
Baseline 
Post: 12 
Weeks 
Cohen’s 
d 
Group Time 
Int 
Total sitting 
time, hrs/day 
6.5 ± 5.1  
(1 - 19) 
5.9 ± 4.2  
(1 - 16) 
-0.20 
5.4 ± 4.9  
(1 - 15) 
5.4 ± 3.9  
(1 - 10) 
-0.07 
0.47 
0.45 
0.71 
# Breaks per 
hour at home 
1.7 ± 1.4  
(0 - 6) 
2.8 ± 1.8  
(1 - 6) 
0.74 
2.5 ± 1.7  
(1 - 6) 
4.6 ± 1.5  
(3 - 6) 
1.16 
0.01 
0.01 
0.54 
# Breaks per 
hour at work 
1.4 ± 1.7  
(0 - 6) 
2.3 ± 1.6 
(1 - 6) 
0.66 
2.6 ± 1.8  
(1 - 6) 
4.2 ± 1.3  
(3 - 6) 
0.83 
0.02 
0.03 
0.97 
Variable 
HL/DT, Mean ± SD (Range) 
LMPA/ST, Mean ± SD (Range) 
P* 
Post: 24 
Weeks 
Maintenance
: 36 Weeks 
Cohen’s 
d 
Post: 12 
Weeks 
Maintenance
: 24 Weeks 
Cohen’s 
d 
Group Time 
Int 
Frequency 
per week (All 
PA) 
17.7 ± 13.0  
(0 - 43) 
17.0 ± 11.0  
(0 - 33) 
-0.06 
14.2 ± 10.8  
(0 - 31) 
18.6 ± 12.6  
(0 - 37) 
0.40 
0.83 
0.59 
0.45 
Number of 
Minutes per 
week (All 
PA) 
747 ± 434  
(165 - 1755) 
829 ± 467  
(210 - 1620) 
0.18 
699 ± 329  
(300 - 1095) 
735 ± 458  
(255 - 1590) 
0.05 
0.76 
0.51 
0.68 
Caloric 
Expenditure 
per week (All 
PA) 
2718 ± 1720  
(723 - 7398) 
3031 ± 1827  
(828 - 6456) 
0.18 
2546 ± 1355  
(833 - 4327) 
2391 ± 1425  
(863 - 5078) 
-0.11 
0.57 
0.78 
0.46 
Frequency 
per week 
(MVPA) 
6.3 ± 6.5  
(0 - 23) 
6.3 ± 5.9  
(0 - 17) 
0.00 
4.0 ± 4.2  
(0 - 9) 
3.4 ± 4.9  
(0 - 13) 
0.00 
0.35 
1.00 
1.00 

24 
 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. 
MVPA = Moderate and vigorous intensity. HiLi = high-light intensity. PA = Physical Activities. Int = Interaction. * Mixed effect model 
was conducted with group (between-subject), time (within-subject), and their interaction, adjusting for within-club and within-subject 
correlations. Cohen's d was computed by difference between two time points in least square mean (from the model) divided by 
standard deviation at baseline. 
2. Maintenance in Changes in Sitting time/ breaks in sitting over 12 weeks (post intervention) 
a) Statistical Analysis 
  Similar to the above, we conducted repeated measures analyses of variance with the effects of group, time, 
and their interaction on PA outcomes at post-intervention and maintenance, adjusting for within-subject 
correlation and computed Cohen’s d for each group.  
b)  Results for maintenance of Sitting time and Number of Breaks per hour at Home and at Work 
Table 24 shows sitting time and breaks in sitting from post-intervention to maintenance (from 24 to 36 weeks 
for HL/DT and from 12 weeks to 24 weeks for LMPA/ST). Significant time and group effects were found in 
number of breaks at home and work. Compared to post-intervention, participants in both conditions reported a 
higher number of breaks in the maintenance phase both at home and at work, indicating that regardless of 
study condition over time, both conditions reported more breaks in sitting time (P=0.01 and P=0.02). We also 
found group effect in breaking up sitting time for home and work; and average number of breaks at home and 
at work for those in LMPA/ST condition were significantly higher than those in HL/DT condition (P=0.01 and 
P=0.03).  
Table 24.   Maintenance in Sitting Time and Number of Breaks per Hour by Timepoint and Condition 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/sedentary time condition. MVPA = Moderate and 
vigorous intensity. HiLi = high-light intensity. PA = Physical Activities. Int = Interaction. * Mixed effect model was conducted with group (between-
subject), time (within-subject), and their interaction, adjusting for within-club and within-subject correlations. Cohen's d was computed by difference 
between two time points in least square mean (from the model) divided by standard deviation at baseline. 
Number of 
Minutes per 
week 
(MVPA)  
331 ± 260  
(0 - 1005) 
354 ± 227  
(0 - 765) 
0.11 
238 ± 191  
(0 - 480) 
155 ± 203  
(0 - 555) 
-0.25 
0.11 
0.62 
0.29 
Caloric 
Expenditure 
per week 
(MVPA)  
1517 ± 1288  
(0 - 5136) 
1617 ± 1216  
(0 - 4381) 
0.08 
1195 ± 954  
(0 - 2510) 
639 ± 636  
(0 - 1809) 
-0.54 
0.20 
0.40 
0.22 
Frequency 
per week 
(HiLi PA) 
10.6 ± 8.1  
(0 - 28) 
9.8 ± 6.5  
(0 - 23) 
-0.10 
10.9 ± 8.8  
(0 - 23) 
14.7 ± 11.8  
(0 - 30) 
0.39 
0.44 
0.57 
0.36 
Number of 
Minutes per 
week (HiLi 
PA) 
504 ± 430  
(60 - 1515) 
550 ± 461  
(60 - 1590) 
0.11 
626 ± 271  
(315 - 1125) 
695 ± 408  
(330 - 1485) 
0.05 
0.34 
0.59 
0.76 
Caloric 
Expenditure 
per week 
(HiLi PA) 
1497 ± 1521  
(179 - 5896) 
1666 ± 1625  
(218 - 6048) 
0.11 
1820 ± 848  
(656 - 3153) 
2090 ± 1399  
(694 - 4740) 
0.18 
0.62 
0.41 
0.97 
Variable 
HL/DT, Mean ± SD (Range) 
LMPA/ST, Mean ± SD (Range) 
P* 
Post: 24 
Weeks 
Maintenance
: 36 Weeks 
Cohen’s 
d 
Post: 12 
Weeks 
Maintenance
: 24 Weeks 
Cohen’s 
d 
Group Time 
Int 
Total sitting 
time, hrs/day 
6.5 ± 5.1  
(1 - 19) 
5.9 ± 4.2  
(1 - 16) 
-0.20 
5.4 ± 4.9  
(1 - 15) 
5.4 ± 3.9  
(1 - 10) 
-0.07 
0.47 
0.45 
0.71 
# Breaks per 
hour at home 
1.7 ± 1.4  
(0 - 6) 
2.8 ± 1.8  
(1 - 6) 
0.74 
2.5 ± 1.7  
(1 - 6) 
4.6 ± 1.5  
(3 - 6) 
1.16 
0.01 
0.01 
0.54 
# Breaks per 
hour at work 
1.4 ± 1.7  
(0 - 6) 
2.3 ± 1.6 
(1 - 6) 
0.66 
2.6 ± 1.8  
(1 - 6) 
4.2 ± 1.3  
(3 - 6) 
0.83 
0.02 
0.03 
0.97 

25 
 
C.  Accelerometer Data: Compare survey PA to accelerometer PA 
1. Statistical Analysis 
 First, we screened the accelerometer data because participants could not wear it at all, might take it off 
during the day, or wear the GENEActive accelerometer on different days. For our analyses, we also wanted to 
only include days with valid information. The criteria for being a valid day are:  i) wear time > 10 hours, and ii) 
wear 5 consecutive days, and iii) no zero values for all of the physical activities: LoLi PA, HiLi PA and MVPA. 
Three participants’ data were excluded because they did not meet these criteria. Then, Pearson’s correlation 
coefficients were computed to compare the levels of PA measured between self-report and the GENEActiv 
accelerometer. 
2. Results for comparing Accelerometer with CHAMPS survey data 
 Table 25 presents Pearson’s correlation between CHAMPS survey and accelerometer. Significant 
associations were found between the subjective and objective measures. Correlations between CHAMPS 
MVPA and Accelerometer MVPA were 0.40 for frequency, 0.39 for number of minutes, and 0.37 for caloric 
expenditure. Correlation between subjects’ reported (survey) total sitting time and objective sedentary time (r = 
0.49) and between survey reported total sleep time and objective bed time (r = 0.58).   
  
Table 25.  Pearson’s correlation between Surveys and Accelerometer 
Comparison 
Pearson’s 
Correlation 
CHAMPS vs. Accelerometer 
 
Frequency of moderate or vigorous intensity physical activity 
0.40* 
Number of Minutes of moderate or vigorous intensity physical activity 
0.39* 
Caloric expenditure of moderate or vigorous intensity physical activity 
0.37* 
Frequency of high-light intensity physical activity 
-0.27 
Number of Minutes of high-light intensity physical activity 
-0.34 
Caloric expenditure of high-light intensity physical activity 
-0.37* 
Survey vs. Accelerometer 
 
Total Sitting time vs. Sedentary time 
0.49** 
Total sleep time vs. Bed time 
0.58** 
 * P < 0.05; ** P < 0.01. N = 27.   
D.  Pedometer assessment of physical activity 
1. Statistical Analysis 
Two-sample t tests or Chi-squared tests were used to compare pedometer data between two study 
conditions. Then, Pearson’s correlation coefficients were computed to assess the levels of LMPA measured by 
CHAMPS or accelerometer with pedometer.  
2. Results  
About 60% of the participants in both conditions wore the pedometer during the intervention period and they 
wore it on average for three days (Table 26 below and on next page). The mean number of steps per day was 
about 9.000 with no difference between conditions. 
  
Table 26.  Pedometer Use by Study Condition  
Variable 
Total (N=35) 
HL/DT (N=23) 
LMPA/ST 
(N=12) 
P* 
# People who wear 
pedometer at least one 
day 
21 (60%) 
14 (60.9%) 
7 (58.3%) 
0.88 
Average number of 
times of wearing a 
pedometer in 42 days 
(i.e., 6 weeks)* 
17.5 ± 10.2  
(4 – 40) 
15.6 ± 8.2  
(4 – 31) 
21.3 ± 13.3  
(7 – 40) 
0.24 

26 
 
Average number of 
times of wearing a 
pedometer per weeka 
2.9 ± 1.7  
(0.7 – 6.7) 
2.6 ± 1.4  
(0.7 – 5.2) 
3.5 ± 2.2  
(1.2 – 6.7) 
0.24 
Average number of 
steps per daya 
8867 ± 2417  
(4006 – 13356) 
8798 ± 2158  
(4006 – 11469) 
9006 ± 3057  
(5461 – 13356) 
0.86 
n (%) or Mean ± SD (Range). HL/DT = Healthy Living/Delayed Treatment. LMPA/ST = Light or Moderate Physical Activity/Sedentary 
Time. a Among people who reported pedometer data (14 for HL/DT condition, 7 for LMPA/ST condition). * Two sample t test or Chi-
square test was conducted.  
 
   Average number of steps per day were significantly correlated with moderate physical activity: 0.44 with the 
number of minutes and 0.46 with caloric expenditure (Table 27). Thus, the number of minutes of moderate to 
vigorous physical activity as reported on the CHAMPS survey were significantly correlated with average 
number of steps as measured on the pedometer.  
  
Table 27.  Pearson’s correlation with Pedometer at Post-Intervention 
CHAMPS 
Pedometer 
Average # of times of wearing a  
pedometer per week 
Average number of 
steps per day 
Frequency of all physical activity 
0.04 
0.02 
Number of Minutes of all physical activity 
0.28 
0.31 
Caloric expenditure of all physical activity 
0.22 
0.36 
Frequency of moderate or vigorous intensity 
physical activity 
0.19 
0.32 
Number of Minutes of moderate or vigorous 
intensity physical activity 
0.28 
0.44* 
Caloric expenditure of moderate or vigorous 
intensity physical activity 
0.21 
0.46* 
Frequency of high-light intensity physical 
activity 
-0.06 
-0.17 
Number of Minutes of high-light intensity 
physical activity 
0.22 
0.06 
Caloric expenditure of high-light intensity 
physical activity 
0.18 
0.05 
* P < 0.05. N = 21.   
E. Analyses and Results for Secondary Specific Aims 
Secondary Specific Aims. Mediator/Moderator analyses: Investigate whether key demographic, 
psychosocial, neighborhood environment, and group cohesion factors act as mediators (Social support) or 
moderators (age, gender, BMI, # health conditions) of change in LMPA/ST (e.g., hypothesizing increases in 
social support for PA/ST will mediate increase in LMPA, especially for those in LMPA/ST intervention).  
 
1. Moderator Analysis 
We investigated whether key demographic and physiological factors acted as moderators of the intervention. 
The following baseline variables were potential moderators: age (≥65 years vs. <65 years), obesity (BMI ≤ 29 
vs ≥30, years of education (≤12 years vs. >12 years), work status (retired, working), number of chronic 
conditions (≥2 vs. 0-1) and PANES neighborhood environment score at baseline (>2.7 [median] vs. ≤2.7).  
a) Statistical Analysis 
We evaluated the effect of the intervention within subgroups defined by important potential moderators, to 
determine if the intervention was particularly successful for persons with specific moderators listed in the 
above. Moderation effect was assessed by the F test of the 3-way interaction parameter for moderator level, 
time, and study condition. The model includes each of the potential moderator, time, and survey condition, and 
their interactions as fixed effects and a random subject effect. The adjusted mean and 95% confidence interval 
were estimated from the model. Because of a wide standard error, there were some cases with negative lower 
confidence limit. The negative values were replaced with zero. 

27 
 
b) Results 
Among the potential moderators, only one was significant. Age was a significant moderator for number of 
breaks in sitting per hour at home (Table 28). On average, all participants increased their number of breaks in 
sitting at home. Interestingly, the participants aged 65 years or older in LMPA/ST condition reported larger 
increases in the number of breaks in sitting from baseline (mean=2.17) to 12 weeks (mean=5.59), but the 
increase in the other condition (HL/DT) was relatively small. 
 
Table 28.  Adjusted Mean (95% CI) of Number of Breaks per Hour in Sitting at Home and at Work from 
Baseline to 12 weeks by Study Condition and Potential Moderator 
 
 
Number of Breaks at Home 
Number of Breaks at Work 
 
HL/DT 
Mean (95% CI)  
LMPA/ST 
Mean (95% CI) 
 
HL/DT 
Mean (95% CI)  
LMPA/ST 
Mean (95% CI) 
 
Moderators 
Baseline 12 Weeks Baseline 12 Weeks P* 
Baseline 12 Weeks Baseline 12 Weeks P* 
Age, years 
 
 
 
 
0.04 
 
 
 
 
0.31 
    < 65 
1.25 
(0.46, 2.04) 
2.00 
(1.13, 2.88) 
3.00 
(1.78, 4.22) 
3.47 
(2.15, 4.80) 
 
1.71 
(0.50, 2.91) 
1.38 
(0.11, 2.65) 
3.11 
(1.20, 5.01) 
3.63 
(1.65, 5.69) 
 
     ≥ 65 
0.94 
(0.03, 1.86) 
1.02 
(0, 2.16) 
2.17 
(1.05, 3.28) 
5.59 
(3.87, 7.32) 
 
1.69 
(0, 3.60) 
1.91 
(0, 3.89) 
2.33 
(0, 4.74) 
4.39 
(1.63, 7.15) 
 
BMI, kg/m2 
 
 
 
 
0.99 
 
 
 
 
0.31 
    25-29 
1.04 
(0.23, 1.85) 
1.56 
(0.56, 2.56) 
2.50 
(1.31, 3.69) 
4.29 
(2.35, 6.24) 
 
1.33 
(0.05, 2.61) 
1.40 
(0.05, 2.75) 
2.75 
(0.64, 4.86) 
2.98 
(0.48, 5.49) 
 
    ≥ 30 
1.25 
(0.22, 2.28) 
1.80 
(0.63, 2.97) 
2.60 
(1.29, 3.91) 
4.09 
(2.65, 5.52) 
 
2.42 
(0.69, 4.14) 
1.86 
(0.08, 3.64) 
2.67 
(0.50, 4.83) 
4.08 
(1.92, 6.24) 
 
Education  
 
 
 
 
0.26 
 
 
 
 
0.92 
 < College 
graduate 
0.83 
(0, 1.98) 
1.07 
(0, 2.61) 
3.67 
(2.05, 5.29) 
4.15 
(2.22, 6.07) 
 
1.50 
(0, 3.07) 
1.41 
(0, 3.16) 
Non-Est 
- 
3.00 
(0, 7.16) 
 
   ≥ College 
graduate 
1.23 
(0.51, 1.96) 
1.83 
(1.01, 2.66) 
2.13 
(1.13, 3.12) 
4.20 
(2.86, 5.53) 
 
1.88 
(0.56, 3.21) 
1.63 
(0.26, 3.00) 
2.86 
(1.28, 4.43) 
3.93 
(2.18, 5.68) 
 
Employment 
 
 
 
 
0.47 
 
 
 
 
NE 
 Paid part/full 
time 
1.13 
(0.40, 1.87) 
1.76 
(0.92, 2.60) 
2.43 
(1.35, 3.51) 
3.75 
(2.51, 5.00) 
 
1.82 
(0.77, 2.89) 
1.61  
(0.52, 2.71) 
3.00  
(0, 7.07) 
3.76 
(2.12, 5.40) 
 
   Not paid 
1.08 
(0, 2.25) 
1.30 
(0, 2.87) 
2.75 
(1.32, 4.18) 
5.89 
(3.24, 8.54) 
 
NE 
NE 
NE 
NE 
 
Comorbidity 
 
 
 
 
0.87 
 
 
 
 
0.46 
   0-1 
1.05 
(0.14, 1.96) 
1.50 
(0.49, 2.50) 
2.00 
(0.56, 3.44) 
4.10 
(2.14, 6.05) 
 
1.06 
(0, 2.54) 
0.88 
(0, 2.40) 
3.00 
(0.92, 5.08) 
3.25 
(0.71, 5.79) 
 
   ≥2 
1.18 
(0.31, 2.05) 
1.87 
(0.74, 3.01) 
2.86 
(1.77, 3.95) 
4.19 
(2.80, 5.58) 
 
2.32 
(0.92, 3.73) 
2.11 
(0.51, 3.65) 
2.41 
(0.26, 4.55) 
3.85 
(1.70, 5.99) 
 
Neighborhood 
Score 
 
 
 
 
0.55 
 
 
 
 
0.35 
   Low (<2.7) 
1.38 
(0.60, 2.17) 
1.73 
(0.75, 2.70) 
2.75 
(1.33, 4.17) 
3.70 
(2.09, 5.31) 
 
1.94 
(0.66, 3.22) 
1.75 
(0.36, 3.14) 
1.69 
(0, 4.23) 
3.69 
(1.14, 6.23) 
 
   High (>2.7) 
0.69 
(0, 1.69) 
1.54 
(0.40, 2.68) 
2.43 
(1.35, 3.50) 
4.64 
(3.07, 6.20) 
 
1.33 
(0, 3.05) 
1.14 
(0, 2.88) 
3.20 
(1.32, 5.08) 
3.76 
(1.67, 5.85) 
 
CI = Confidence Interval. HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical 
activity/sedentary time condition. NE = Non-estimable. * Treatment effect was assessed by the F test of the 3-way interaction parameter 
for moderator level, time, and study condition. The model includes each of the potential moderator, time and survey condition, and their 
interactions as fixed effects and a random subject effect. The adjusted mean and 95% confidence interval (CI) were estimated from the 
model. Because of a wide standard error, there were some cases with negative lower confidence limit. The negative values were 
replaced with zero.    
 
 Neighborhood score was a significant moderator on caloric expenditure per week for all PA activities, 
minutes per week for all activities (Table 29, next the page), and caloric expenditure per week for MVPA (Table 
30 on pages 30-31). Caloric expenditure per week for all PA increased from baseline to 12 weeks in HL/DT 
condition (although not significantly); however, participants with high neighborhood score (i.e., meaning greater 
environmental support for PA) in LMPA/ST condition had significant reductions in total PA minutes (e.g., from 
525min/wk at baseline to 323 minutes at 12 weeks, see Table 29 on the next page). A similar trend was found 
caloric expenditure per week of MVPA with those in LMPA/ST condition with high neighborhood 
score/environmental support for PA having reductions in MVPA from baseline to 12 weeks (see Table 30 on 
next pages).    

28 
 
Table 29.  Adjusted Mean (95% CI) for Physical Activity (All Activities) from Baseline to 12 Weeks by 
Study Condition and Potential Moderators 
Moderators 
All PA Caloric Expenditure per Week 
All PA Minutes per Week 
HL/DT 
Mean (95% CI)  
LMPA/ST 
Mean (95% CI) 
 
HL/DT 
Mean (95% CI)  
LMPA/ST 
Mean (95% CI) 
 
Baseline 12 Weeks Baseline 12 Weeks 
P* 
Baseline 12 Weeks 
Baseline 
12 
Weeks 
P* 
Age, years 
 
 
 
 
0.88 
 
 
 
 
0.88 
    < 65 
1521 
(740, 2301) 
2535 
(1699, 3372) 
1953 
(694, 3211) 
2431 
(1049, 3813) 
 
438  
(218, 658) 
699  
(462, 936) 
555  
(200, 910) 
641  
(249, 1033) 
 
     ≥ 65 
1,389 
(499, 2280) 
2,587 
(1386, 3787) 
1361 
(211, 2510) 
2572 
(1022, 4121) 
 
479  
(228, 729) 
829  
(484, 1173) 
463  
(139, 786) 
723  
(279, 1168) 
 
BMI, kg/m2 
 
 
 
 
0.80 
 
 
 
 
0.42 
    25-29 
1308 
(561, 2056) 
2622 
(1723, 3522) 
1342 
(201, 2484) 
2051 
(516, 3586) 
 
470  
(262, 679) 
859  
(606, 1113) 
425  
(107, 743) 
579  
(144, 1014) 
 
    ≥ 30 
1705 
(773, 2638) 
2462 
(1428, 3497) 
1974 
(724, 3225) 
2822 
(1451, 4194) 
 
433  
(174, 693) 
588  
(298, 878) 
600  
(252, 948) 
753  
(368, 1137) 
 
Education  
 
 
 
 
0.33 
 
 
 
 
0.16 
 < College 
graduate 
1600 
(921, 2279) 
2894 
(2127, 3661) 
1420 
(460, 2381) 
2386 
(1222, 3570) 
 
498  
(309, 687) 
837  
(623, 1052) 
407  
(140, 674) 
686  
(356, 1016) 
 
   ≥ College 
graduate 
1152 
(125, 2179) 
622 
(233, 2845) 
2188 
(619, 3756) 
2645  
(781, 4509) 
 
360  
(75, 645) 
462  
(94, 830) 
765  
(329, 1201) 
644  
(121, 1167) 
 
Employment 
 
 
 
 
0.56 
 
 
 
 
0.67 
 Paid part/full 
time 
1293 
(620, 1966) 
2587  
(1834, 3340) 
1795 
(746, 2844) 
2633 
(1423, 3842) 
 
421  
(231, 611) 
768  
(553, 982) 
514  
(218, 811) 
715  
(369, 1060) 
 
   Not paid 
1948  
(815, 3081) 
2254 
(725, 3783) 
1340  
(0, 2728) 
2090 
(217, 3964) 
 
555  
(235, 875) 
606  
(165, 1047) 
488  
(95, 880) 
576  
(36, 1116) 
 
Comorbidity 
 
 
 
 
0.27 
 
 
 
 
0.43 
   0-1 
1428  
(589, 2268) 
2843  
(1895, 3792) 
1909  
(516, 3301) 
1450  
(0, 3285) 
 
470  
(233, 708) 
823  
(551, 1095) 
533  
(139, 926) 
381  
(0, 914) 
 
   ≥2 
1496  
(692, 2300) 
2241  
(1301, 3181) 
1470  
(418, 2523) 
2818  
(1620, 4016) 
 
443  
(215, 670) 
662  
(292, 933) 
489  
(191, 786) 
779  
(436, 1123) 
 
Neighborhood 
Score 
 
 
 
 
0.02 
 
 
 
 
0.04 
   Low (<2.7) 
1110  
(427, 1792) 
2176  
(1399, 2954) 
1573  
(297, 2850) 
3517  
(2240, 4794) 
 
325  
(131, 518) 
651  
(428, 875) 
469  
(107, 831) 
919  
(557, 1281) 
 
   High (>2.7) 
2014  
(1163, 2866) 
3134  
(2137, 4131) 
1662  
(697, 2627) 
996  
(0, 2358) 
 
660  
(419, 901) 
888  
(600, 1175) 
525  
(252, 798) 
323  
(0, 721) 
 
CI = Confidence Interval. HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical 
activity/sedentary time condition. * Treatment effect was assessed by the F test of the 3-way interaction parameter for moderator level, 
time, and study condition. The model includes each of the potential moderator, time and survey condition, and their interactions as fixed 
effects and a random subject effect. The adjusted mean and 95% confidence interval (CI) were estimated from the model. Because of a 
wide standard error, there were some cases with negative lower confidence limit. The negative values were replaced with zero. 
 
See Table 30 continued on the next page 
 
Table 30. Adjusted Mean (95% CI) of Caloric Expenditure per Week (Moderate or Vigorous Physical 
Activities) from Baseline to 12 Weeks by Study Condition and Potential Moderator 
 
HL/DT 
Mean (95% CI)  
LMPA/ST 
Mean (95% CI) 
 
Moderators 
Baseline 
12 Weeks 
Baseline 
12 Weeks 
P* 
Age, years 
 
 
 
 
0.977 
    < 65 
790  
(224, 1356) 
1439  
(832, 2047) 
693  
(0, 1606) 
1105  
(102, 2108) 
 
     ≥ 65 
592  
(0, 1237) 
1255  
(382, 2129) 
757  
(0, 1590) 
1234  
(106, 2361) 
 
BMI, kg/m2 
 
 
 
 
0.984 
    25-29 
595  
(54, 1135) 
1297  
(644, 1951) 
539  
(0, 1365) 
898  
(0, 2016) 
 
    ≥ 30 
874  
(200, 1548) 
1480  
(730, 2230) 
954  
(49, 1859) 
1397  
(403, 2391) 
 
Education  
 
 
 
 
0.388 
 < College graduate 
722  
1562  
644  
942  
 

29 
 
(225, 1220) 
(1001, 2123) 
(0, 1348) 
(83, 1801) 
   ≥ College graduate 
662  
(0, 1414) 
807  
(0, 1762) 
951  
(0, 2101) 
1717  
(353, 3081) 
 
Employment 
 
 
 
 
0.523 
 Paid part/full time 
574  
(87, 1061) 
1426  
(882, 1970) 
721  
(0, 1479) 
1226  
(352, 2099) 
 
   Not paid 
1072  
(253, 1892) 
1052  
(0, 2155) 
740  
(0, 1744) 
999  
(0, 2350) 
 
Comorbidity 
 
 
 
 
0.196 
   0-1 
792  
(206, 1378) 
1882  
(1216, 2549) 
893  
(0, 1864) 
745  
(0, 2044) 
 
   ≥2 
623  
(62, 1184) 
865  
(203, 1527) 
633  
(0, 1367) 
1313  
(471, 2155) 
 
Neighborhood Score 
 
 
 
 
0.029 
   Low (<2.7) 
548  
(44, 1051) 
1100  
(526, 1673) 
614  
(0, 1556) 
1856  
(914, 2798) 
 
   High (>2.7) 
946  
(318, 1575) 
1818  
(1083, 2554) 
793  
(80, 1505) 
179  
(0, 1183) 
 
CI = Confidence Interval. HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical 
activity/sedentary time condition. * Treatment effect was assessed by the F test of the 3-way interaction parameter for moderator level, 
time, and study condition. The model includes each of the potential moderator, time and survey condition, and their interactions as fixed 
effects and a random subject effect. The adjusted mean and 95% confidence interval (CI) were estimated from the model. Because of a 
wide standard error, there were some cases with negative lower confidence limit. The negative values were replaced with zero. 
 
2. Mediation Analysis: Social Support for physical activity 
a.) Statistical Analysis 
Due to small sample size in this study, we could not conduct a structural equation model to identify 
psychosocial mediators for any intervention effect as proposed in the grant. Instead, we conducted casual 
mediation analyses using PROC CAUSALMED in SAS to investigate mediation effect of social support on 
change.    
b) Results 
No significant mediation effects were found for change in PA or ST outcomes (results not shown). However, 
sample size determination is not straightforward for mediation analysis and the total sample size of this study 
was too small to conduct reliable mediation analyses. Future studies in a large scale are needed to evaluate 
mediation effects of social support on PA.  
 
3. Analyses of Process Evaluation Questions 
a) Statistical Analysis 
Fisher’s exact test was conducted to compare responses on satisfaction and process evaluation questions 
between two study conditions. 
 
b) Results  
  There was no statistical differences between the study conditions in participant’s ratings of the helpfulness of 
the various LMPA/ST intervention components (e.g., step counter, telephone calls, setting goals, etc.), 
satisfaction with LMPA/ST time spent on intervention telephone calls, and the perceived time burden 
associated with participation in the intervention and assessments, or how likely they were to continue or 
increase LMPA/ST, and general issues (shared study information, talked to others). We compared process 
evaluations following the LMPA/ST intervention (12 wks for LMPA condition (n=7), and 24 wks for HL/DT 
condition (n=12)) to determine differences between when the intervention was delivered to the two study 
conditions (see Table 31 on the next page). A large majority (>90%) rated the components of the LMPA 
intervention as “very helpful” (e.g., setting goals, using step counter, telephone calls with coach, etc.).  
 
Participants’ ratings of satisfaction with the amount of time spent talking to the coach, and progress towards 
achieving LMPA and Sedentary Time goals were high (> 85% very satisfied) (see Table 32 on the next page). 
 
 
 

30 
 
 
Table 31.  Helpfulness Survey Post-Intervention  
Question 
HL/DT  
(24 Weeks) (n=12) 
LMPA/ST  
(12 Weeks) (n=7) 
P * 
How helpful was it to set physical activity goals 
with The Kalusugan Project's lifestyle coach? 
 
 
 
  Very helpful 
12 (100.0%) 
7 (100.0%) 
NA 
How helpful was it to set goals around breaking 
up sedentary time/sitting time with The 
Kalusugan Project's lifestyle coach? 
 
 
 
  Very helpful 
11 (91.7%) 
7 (100.0%) 
1.00 
  Somewhat helpful 
1 (8.3%) 
0 (0%) 
 
How helpful was it to use the step counter to 
monitor your total number of steps per day? 
 
 
 
  Very helpful 
12 (100.0%) 
7 (100.0%) 
NA 
How helpful were the telephone calls from The 
Kalusugan Project's lifestyle coach? 
 
 
 
  Very helpful 
12 (100.0%) 
6 (100.0%) 
NA 
How helpful were the email contacts/text contacts 
from The Kalusugan Project's lifestyle coach? 
 
 
1.00 
  Very helpful 
11 (91.7%) 
6 (100.0%) 
 
  Somewhat helpful 
1 (8.3%) 
0 (0%) 
 
How helpful were the weekly resources (sent to 
you via email or US mail)? 
 
 
1.00 
  Very helpful 
11 (91.7%) 
5 (83.3%) 
 
  Somewhat helpful 
1 (8.3%) 
1 (16.7%) 
 
Did you read the weekly resources? 
 
 
NA 
  Yes 
13 (100.0%) 
7 (100.0%) 
 
If yes, how many did you read? 
 
 
0.31 
  A few (1-4) 
0 (0%) 
1 (14.3%) 
 
  Some (5-8) 
5 (41.7%) 
1 (14.3%) 
 
  Most of them (9-12) 
7 (58.3%) 
5 (71.4%) 
 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/Sedentary time condition. * 
Fisher’s exact test was conducted. 
 
Table 32.  Satisfaction Survey Collected Post-Intervention 
Question 
HL/DT  
(24 Weeks) (n=12) 
LMPA/ST  
(12 Weeks) (n=7) 
P * 
How satisfied were you with the amount of time 
The Kalusugan Project's lifestyle coach spent 
discussing physical activity with you? 
 
 
1.00 
  Somewhat satisfied 
2 (16.7%) 
1 (14.3%) 
 
  Very satisfied 
10 (83.3%) 
6 (85.7%) 
 
How satisfied were you with the amount of time 
the Kalusugan Project's lifestyle coach spent 
discussing breaking up sed/sitting time with you? 
 
 
1.00 
  Somewhat satisfied 
2 (16.7%) 
1 (14.3%) 
 
  Very satisfied 
10 (83.3%) 
6 (85.7%) 
 
Overall, how satisfied were you with The 
Kalusugan Project? 
 
 
1.00 
  Somewhat satisfied 
1 (8.3%) 
1 (14.3%) 
 
  Very satisfied 
11 (91.7%) 
6 (85.7%) 
 
How satisfied were you with the progress you 
made with physical activity/ sedentary time over 
the past 3 months of The Kalusugan Project? 
 
 
1.00 
  Somewhat satisfied 
1 (8.3%) 
1 (14.3%) 
 
  Very satisfied 
11 (91.7%) 
6 (85.7%) 
 

31 
 
How satisfied were you with the amount of time 
The Kalusugan Project's lifestyle coach spent 
discussing physical activity with you? 
 
 
1.00 
  Somewhat satisfied 
2 (16.7%) 
1 (14.3%) 
 
  Very satisfied 
10 (83.3%) 
6 (85.7%) 
 
How satisfied were you with the amount of time 
The Kalusugan Project's lifestyle coach spent 
discussing breaking up sed/sitting time with you? 
 
 
1.00 
  Somewhat satisfied 
2 (16.7%) 
1 (14.3%) 
 
  Very satisfied 
10 (83.3%) 
6 (85.7%) 
 
Overall, how satisfied were you with The 
Kalusugan Project? 
 
 
1.00 
  Somewhat satisfied 
1 (8.3%) 
1 (14.3%) 
 
  Very satisfied 
11 (91.7%) 
6 (85.7%) 
 
HL/DT = Healthy Living/Delayed treatment condition. LMPA/ST = Light-to-moderate physical activity/Sedentary time condition. * 
Fisher’s exact test was conducted.  
 
VII. Phase 4 Specific Aim: Reporting trial’s findings to leaders of state-wide Diocesan Congress of 
Filipino Catholic Clubs (DCFCC) to discuss feasibility of adapting LMPA/ST so lay leaders act as 
change agents for their parishioners / church members on rural islands across the state of Hawaii 
A. Qualitative Methods and Theme analyses (Years 2 and 3)     
We conducted two types of focus groups. One with previous participants in the trial to obtain their input on 
“what worked” and what could be improved to meet their needs (conducted last August 2019). We also 
conducted focus groups with leaders of the Filipino Catholic Clubs (FCC) clubs who are members of the 
Diocesan Congress of Filipino Catholic Clubs (DCFCC) from across the state (Maui, Big Island, and Kauai) 
who met once a year for an annual convention. We presented our study results to them and discussed how 
their church club might include LMPA/ST as part of the club’s goals for members in the future. 
Recruitment for the August 2019 focus group (for persons who had enrolled in the study) consisted of emails 
we sent to the presidents of the first 5 clubs that were enrolled in the study and to participants who had 
completed the study by that point. This included a total of 19 people. Of these 19, 10 people responded they 
would attend and all 10 attended the focus group. Following the completion of the randomized trial, we also 
conducted focus groups with participants who had not participated in the study but were leaders from the 
Filipino Catholic Clubs on neighbor islands, particularly from the Big Island, Maui, and Kaua`i. This focus group 
session was scheduled in Year 03 on November 9, 2019 during an annual meeting of all the clubs across the 
state of Hawaii (N = 23 clubs).   
For the November 9, 2019 focus groups, individuals were recruited through email contact. Council Presidents 
(n=3) were asked to provide email addresses of Unit Presidents so they could be contacted about the 
opportunity for the focus groups. Presidents provided the Kalusugan’s project director with the emails and/or 
phone numbers of 24 members/leaders who were scheduled to attend the annual meeting. The project 
contacted 22 of them with working emails/numbers and sent an email that included information about the 
duration of the focus group, location of the session, and incentives which would be provided to participants in 
the focus group session. Those who were interested were asked to email the Kalusugan Team at the 
University of Hawaii to confirm their participation in the focus group. Reminder calls and emails were sent 
directly to individuals who reported interest in attending the focus group prior to the date of the session. There 
were 21 people who confirmed they would attend. On the day of the focus group, 20 of the 21 who RSVP’d 
attended. One of those who reported he/she could attend became ill on the day of the focus group, but another 
member of the same unit said he/she would attend instead. Thus, we had 21 club leaders attend the focus 
group. There were two focus groups simultaneously conducted consisting of approximately 10-11 participants 
per group. One group was conducted by a Co-Investigator (Dr. Felicilda-Reynaldo) and the other group was 
conducted by a Multiple Principal Investigator (Dr. Albright). Group sizes were limited to these numbers to 
ensure active and equal participation from individuals. Participants were asked to complete an anonymous 
demographic survey and sign a consent form prior to the start of the focus group session informing them that 
the session would be audio recorded. The participant demographics can be found in Table 33 below. These 
sessions provided key feedback on how receptive members of FCC clubs who did not participate in the current 
study would be “change-agents” for their club’s members and for other parishioners in the church. 
  

32 
 
Table 33.  Socio-demographics for Focus group participants (August = previous study participants and 
November = DCFCC club leaders 
Variable 
Total (n=31) 
August (n=10) 
November (n=21) 
P-value 
Categorical, n (%) 
 
 
 
 
Sex 
 
 
 
0.141 
  Male 
6 (19.4%) 
0 (0.0%) 
6 (28.6%) 
 
  Female 
25 (80.7%) 
10 (100.0%) 
15 (71.4%) 
 
Birth Place 
 
 
 
1.000 
  Hawaii 
3 (9.7%) 
1 (10.0%) 
2 (9.5%) 
 
  US 
2 (6.4%) 
1 (10.0%) 
1 (4.8%) 
 
  Other (Philippines) 
26 (83.9%) 
8 (80.0%) 
18 (85.7%) 
 
Hispanic 
 
 
 
1.000 
  Yes 
1 (3.9%) 
0 (0.0%) 
1 (5.9%) 
 
  No 
25 (96.1%) 
9 (100.0%) 
16 (94.1%) 
 
Race, most   
 
 
 
 
  Filipino 
31 (100.0%) 
10 (100.0%) 
21 (100.0%) 
NA 
Race, mixed with Filipino 
 
 
 
 
  White 
1 
0 
1 
 
  Chinese, White 
1 
1 
0 
 
  Chinese 
2 
1 
1 
 
  Portuguese 
1 
0 
1 
 
Marital Status 
 
 
 
0.017 
  Never married 
2 (6.5%) 
2 (20.0%) 
0 (0.0%) 
 
  Married 
24 (77.4%) 
5 (50.0%) 
19 (90.5%) 
 
  Divorced 
1 (3.2%) 
1 (10.0%) 
0 (0.0%) 
 
  Widowed 
4 (12.9%) 
2 (20.0%) 
2 (9.5%) 
 
Age 
 
 
 
0.704 
  45-64 years 
16 (51.6%) 
6 (60.0%) 
10 (47.6%) 
 
  ≥65 years 
15 (48.4%) 
4 (40.0%) 
11 (52.4%) 
 
Hawaii residency 
 
 
 
0.434 
  <45 years 
16 (55.2%) 
7 (70.0%) 
9 (47.4%) 
 
  ≥45 years 
13 (44.8%) 
3 (30.0%) 
10 (52.6%) 
 
, Mean + SD (range) 
 
 
 
 
Age 
65.2 ± 6.6 (56 - 81) 
63.3 ± 5.1 (56 - 73) 
66.1 ± 7.1 (56 - 81) 
0.267 
Hawaii residency in years 
41.1 ± 13.8 (18 - 69) 
37.2 ± 16.4 (18 - 65) 
43.2 ± 12.1 (18 - 69) 
0.275 
 
B. Focus Groups Theme analyses   
Project staff first identified themes mentioned throughout the focus groups (eight themes for August session 
and 7 themes for November sessions) that were applicable to each focus group (resources, support, barriers, 
etc.). Two staff independently coded the August focus group with lay leaders who had participated in The 
Kalusugan Project and found their interrater reliability was (91.4%). In this focus group, staff coded 114 
independent statements into 8 themes. Of the 8 themes, the top three most commonly mentioned were: (a) 
Examples (e.g., Zumba, standing during commercials), (b) perceived benefits, and (c) study related tasks (i.e., 
follow up calls, surveys). The two staff then identified themes similar, but not identical, in the November focus 
group with neighbor island church leaders who had not participated in The Kalusugan Project. When looking at 
transcripts from the November focus groups, project staff coded 191 independent statements into seven 
themes. Of the seven themes, the top three most commonly mentioned were: (a) resources (have vs. need), 
(b) support (social support), and (c) barriers/challenges to changing physical activity and sedentary time. 
 
C. Resources (Haves and Needs)  
Participants were asked what types of resources they have on site at their church and what resources they 
would need in order to facilitate being more active and sitting less. The participants came up with 37 
subthemes for this category between the two focus groups.  
Most participants reported that they would need music as well as financial resources to purchase exercise 
equipment to assist with becoming active. However, it was pointed out that the club might not want to take on 
the responsibility of fundraising for exercise equipment or taking on the responsibility of 
cleaning/maintaining/storing any the purchased equipment. Others indicated that cooperation and commitment 

33 
 
from team members as well as educational resources from the University of Hawai’i would be great resources 
to have along with training on how to become more physically active and sit less. Numerous participants 
specified that they would need types of physical activities provided to them in the form of videos or in-person 
classes Zumba, Cha-cha, aerobics, or yoga to help club members engage in PA.  
Participants were also able to identify many environmental resources within their church and in its 
surrounding neighborhood that could be used to increase LMPA and decrease ST such as having a yard to 
walk around, sidewalks around the church, church parking lot, cafeteria, pool, jungle gyms, and various other 
environmental resources they could use. Some even mentioned having technological resources like televisions 
and Wi-Fi that could be used with permission from the Pastor.  
 
D. Social Support/Support 
An overwhelming number of responses from participants indicated that by having less gatherings or 
meetings centered around food or having healthier food options available could help in increasing PA and 
decreasing ST since eating requires them to sit for long periods. Another commonly mentioned form of support 
participants thought would drive change was providing motivation for each other and having self-motivation. 
This included encouraging and participating in group exercises and walking “marathons” together, participate in 
PA as a group before or after FCC meetings, remind others to stand, motivate others to purchase workout 
equipment, and provide transportation if they did not have a ride to get to an exercise class. As mentioned in 
the previous section, offering classes such as Zumba would be a form of support these individuals’ identified to 
be helpful for increasing PA and decreasing ST. Individuals also mentioned that friendly competition between 
groups to lose weight could serve as another form of support while some mention that by making the activities 
fun and offering rewards or incentives would be helpful.  
  
E. Barriers/Challenges to Physical Activity and Sedentary time   
Across the two focus groups, members reported lack or conflict with time and full schedules as being the 
number one barrier or challenge to increasing PA and decreasing ST. Being tired or having lack of motivation, 
as well as lack of cooperation and lack of interest, were the second most mentioned barriers or challenges. 
Presumably with the idea of purchasing PA equipment on their mind, participants also mentioned that the cost 
of resources was a barrier. Being “too old” was the third most mentioned subtheme. Lastly, uncertainty of 
where to start and lack of training to do a specific type of exercise was also mentioned as a barrier.  
Through thematic analysis of our focus group results, similarities and differences from previously completed 
qualitative work can be identified. Similar to previous work, our focus groups found that the number one barrier 
to change in PA habits was the lack of time. (Ceria-Ulep, Tse, & Serafica, 2011; Pobutsky et al., 2015; 
Schwingel & Galvez, 2016) Pobutsky et al. (2015) specifically mentions that time constraints are due to 
socioeconomic factors, such as the need to work more than one job, resulted in very little priority given to PA 
while Schwingel et al. (2015) mentioned that time was consumed by caring for family members such as getting 
grandchildren ready for the day and participation in church activities. In our focus group, individuals   
mentioned that they just lacked the time to change their PA habits. Another barrier to changing PA habits 
mentioned in our focus group was “being too old” which mirrors findings from Ceria-Ulep, Tse & Serafica 
(2011) who reported that interfering health conditions deter individuals from engaging in structured exercise.  
Resources available and needed for changing PA and ST behaviors were also major factors that can 
motivate or deter change. One subtheme mentioned was the need for more PA resources like Zumba classes, 
dance classes, and other activities to reduce ST and increase PA which supports the data collected by 
Pobutsky et al. (2015) indicating that chronic health issues are a direct consequence of the lack of PA and 
increased ST. Alternatively, participants in our focus groups listed various resources available to them for 
walking such as the parking lots at their church and the sidewalks around their church that could indicate a 
strong intention to walk which was the preferred method of exercise in the previous FBO focus group done in 
2011 by Ceria-Ulep, Tse & Serafica. The lay leaders in these church clubs, as well as other qualitative studies, 
strongly believed the most effective way to motivate older adults to be active was when PA was incorporated 
directly into on site church activities.(Schwingel & Galvez, 2016)    
Support for motivating PA changes also paralleled responses from previous work that linked PA to changes 
in dietary habits. We found that participants believed the best form of support would be to have less food at 
gatherings or healthier food options where Pobutsky et al. (2015) indicated that their participants felt that it 
would also be helpful to have access to general health information and more education on healthy eating. 

34 
 
(Pobutsky et al., 2015) Other forms of support mentioned by our focus group participants were to form exercise 
groups /walking groups, participate in marathons / races and in group physical activities with a focus on 
“making it fun.” Other researchers also found participants wanted to have community activities, group 
exercises and creative ways to exercise such as walking or going to the beach.(Pobutsky et al., 2015)  Lastly, 
incorporating PA around time the time they spend at church or while they completed other church activities 
was mentioned as a way to support PA. See Tables 34-36 on pages 34 -36 for specific themes. 
 
Table 34.  Former Participants in the Kalusugan Project: August Focus Group Findings by Themes 
most frequently mentioned (n=10) 
Themes 
Subthemes related to Physical Activity and 
Sedentary Time 
# of times 
mentioned 
Examples of PA/ST 
 
 
 
1. 
Stretching while watching TV/Commercials and 
also at school with coworkers and with students 
3 
 
2. 
Exercise 10 min, 2 times a day with coworkers 
1 
 
3. 
Line dancing 
3 
 
4. 
Zumba (Example, mentioned Lani as leader) 
2 
 
5. 
Stair climbing (work with coworkers and mall with 
siblings, lighten load to walk up stairs) 
3 
 
6. 
Examples from benefits: limit sitting, mobile  
2 
 
7. 
Volunteer to perform (dancing) and practice before 
performance 
2 
 
8. 
Hiking with students (Camp Erdman) 
1 
 
9. 
Cleaning church 1 time a month 
1 
 
10. Walked with siblings in neighborhood and mall 
1 
 
11. Swimming 
1 
 
12. Ballroom dancing 
1 
Perceived benefits of 
PA/ST 
 
 
 
1. 
Health benefits (If I change/lost weight and became 
more active) 
2 
2. 
Health benefits (Better labs, lost weight) 
2 
3. 
Reward for PA - Eating 
1 
4. 
"Take care of health and self and it will perpetuate 
into family life" 
1 
5. 
"More bonding"/"Spending time together" 
2 
6. 
"Motivate each other" 
1 
7. 
Shared it with siblings and got together more 
1 
8. 
Increased communication when spending time 
together doing PA, childhood memories, venting, 
catching up 
5 
9. 
Time passes quickly when bonding 
1 
10. Exercise promotes a clear mind 
1 
11. Feeling happy/positive attitude 
1 
12. "Don't need knee brace as often" 
1 
Study related tasks (e.g., 
follow up calls, surveys) 
 
 
 
1. 
Follow up calls (keeping on track, encouragement) 
  2 
2. 
Brochures 
1 
3. 
Emails 
1 
4. 
Incentives (Longs GC) 
1 
5. 
Stickers 
1 
 
6. 
Team distance 
1 
 
7. 
Surveys (didn't like, need it for data, time frame 
issues x2, hard, guilt/felt bad x4 
9 
 
 

35 
 
  Table 35.    Interrater reliability for seven main themes August focus group  
Themes 
Coder 1 
Count 
Coder 2 
Count 
Total 
Agreed 
upon 
Number 
differed 
Interrater 
reliability for 
Oahu focus 
group 
Perceived benefits 
(i.e., what others get 
from PA/ST) 
22 
27 
49 
22 
3 
Barriers/challenges 
(weather, want to 
relax) 
4 
4 
8 
4 
0 
Support (social 
support) 
18 
19 
37 
18 
1 
Technology 
(pedometer, phone) 
13 
16 
29 
13 
3 
Resources (haves vs 
needs) 
18 
15 
33 
15 
3 
Examples (Zumba, 
standing during 
commercials) 
21 
23 
44 
21 
2 
Study related tasks 
(follow up calls, 
brochure, surveys) 
8 
13 
21 
8 
5 
 
Total 
104 
117 
221 
101 
17 
Interrater reliability 
OAHU focus group 
0.91  
  
Table 36.  DCFCC church leaders from across the state (n=21): November Focus Group Findings by 
Themes most frequently mentioned 
Themes 
Subthemes related to Physical Activity and 
Sedentary Time 
# of times 
mentioned 
Resources (have vs. need) 
 
 
Subtheme Resource Need 
 
 
Subtheme Resource Have 
 
 
 
1. 
Need music/radio, CD 
5 
 
2. 
Need money to purchase exercise equipment such 
as treadmill, elliptical machine, lifting machine, 
bicycle, rowing machine.   
4 
 
3. 
Have a yard to walk around which is attached to a 
school 
4 
 
4. 
Need cooperation and commitment from team 
members 
3 
 
5. 
Need encouragement, coaching and partner 
3 
 
6. 
Need more dancing in general such as Cha-cha  
3 
 
7. 
Need Zumba (at least 10 minutes before meeting) 
3 
 
8. 
Need self-commitment, good leadership 
2 
 
9. 
Need an instructor who knows how to do exercises 
safely 
2 
 
10. Need a projector to show videos from cell phone 
2 
 
11. Have a parking lot to walk 
2 
 
12. Have sidewalks around the church to walk around 
2 
 
13. Do not want responsibility for equipment, money. 
Unable to fundraising.  
2 
 
14. Need to offer incentive with musical chairs 
2 
 
15. Have a television but want to take it away to stand 
more 
2 
 
16. Have Wi-Fi 
2 

36 
 
 
17. Have a meeting room for potential exercise class 
1 
 
18. Have a nearby park 
1 
 
19. Have a playground 
1 
 
20. Have a church 
1 
 
21. Have an art room 
1 
 
22. Have Nun’s room, rectory 
1 
 
23. Have a cafeteria 
1 
 
24. Have a pool 
1 
 
25. Need to create motivational items 
1 
 
26. Need to organize a committee 
1 
 
27. Need support from the University of Hawaii 
1 
 
28. Have a basketball court and equipment 
1 
 
29. Need mats 
1 
 
30. Have TV/DVD in halls 
1 
 
31. Need approval from Pastor to use DVD player 
1 
 
32. Need opportunities for stretching 
1 
 
33. Need aerobic classes 
1 
 
34. Need yoga 
1 
 
35. Have a hall to do exercises in 
1 
 
36. Have a jungle gym 
1 
 
37. Need a trainer to train them 
1 
Support (Social 
support)/group based 
activities 
 
 
 
1. 
Less foods at gathering, healthier food options 
13 
2. 
Be an example to motivate others 
4 
3. 
Join an exercise group/walking group such as 
American Heart walks or marathons 
4 
4. 
Participate in physical activity as a group with 
planned times either before or after meetings 
3 
5. 
Offer classes such as Zumba, dance classes (line 
dance) to exercise together 
3 
6. 
Participate in physical activity with retired members 
after mass 
2 
7. 
Remind others to stand 
2 
8. 
Motivate others to buy workout equipment such as 
treadmills  
2 
9. 
Create competitions for weight loss with incentives 
and challenge each other as groups 
2 
10. Make it fun 
1 
11. Include stretching in fellowship as a group 
1 
12. Be self-motivated    
1 
13. Encourage unit members by offering treats 
1 
14. Give out rewards (ex: if a person loses 10 lbs., go 
shopping) 
1 
15. If they don’t have a ride, pick them up 
1 
16. Set a group goal 
1 
Barriers/Challenges to 
physical activity and 
sedentary time 
 
 
 
1. 
Full schedules, time conflicts, lack of time 
17 
2. 
Tired or lack of motivation 
4 
3. 
Lack of cooperation /lack of interest 
4 
4. 
Cost of resources 
2 
5. 
Too old 
2 
6. 
Unsure where to start 
1 
7. 
Lack of training 
1 
 
 

37 
 
VII. 
Key achievements (papers presentations).  
 
  Published abstract from Conference presentation March, 2019: Ceria-Ulep C, Albright CL, Saiki K,  
Felicilda-Reynaldo, RFD, Lim E, Gumataotao A, Canonizado T, Cain, S. (2019) Moving More and Sitting 
Less: The Kalusugan / Healthy Living Project with Filipino Catholic Clubs in Hawaii. Annals of Behavioral 
Medicine. March, 53 (Suppl 1), S104    
 
Published abstract from Conference in April, 2020: Ceria-Ulep CD, Albright CL, Saiki K, Felicilda-Reynaldo 
RFD, Lim E, Gumataotao A, Canonizado T, Cain S. (2020) Results of a Randomized Trial to Modify Physical 
Activity and Sedentary Time in Filipinos. Western Institute of Nursing, Communicating Nursing Research; 
20/20 and beyond: envisioning the future of nursing research, practice, and education. Section: Better 
Together: Community Partnerships. Vol 53, P20. 
  
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