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Lower rates of leisure time physical activity are typically reported by individuals in blue-collar or hourly wage occupations This relationship is not limited to the United States According to data from the 1995 Australian National Health Survey, insufficiently active men and women were more likely to be employed in blue-collar jobs and were also more likely to be older, smokers, obese, and perceive their health as poor (Burton & Turrell, 2000) Biomedical Status There is evidence for a genetic contribution to resting metabolic rate, but also to sports participation and daily physical activity (Beunen & Thomis, 1999) Several correlational studies have been published describing estimates of the heritability of various characteristics related to exercise behavior (eg, Maia, Thomis, & Beunen, 2002; Stubbe, Boomsma, & de Geus, 2005).

More relevant for adherence is the data from the HERITAGE Family Study that showed a genetic influence in how individuals respond to an exercise training program (Wilmore et al, 1997) Some individuals will adapt quickly and show substantial increases in fitness components Others will demonstrate little change over time regardless of the exercise prescription Genetic influences on rate and potential for fitness changes can have implications for adherence, particularly for those slow adapters who are not experiencing physiologically based reinforcements from regular physical activity, such as increased endurance Health status can also affect physical activity In reviews of physical activity and older adults, poor health is commonly cited as the most frequent barrier to physical activity and exercise (Schutzer & Graves, 2004) Overweight and obesity are also negatively associated with exercise and leisure time physical activity (Trost et al.

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, 2002) in a variety of populations and age groups (Janssen, Katzmarzyk, Boyce, King, & Pickett, 2004; Kaplan, Huguet, Newsom, McFarland, & Lindsay, 2003; Mack et al, 2004; Martinez-Gonzalez et al, 2001) Overweight and obese individuals are the target of public health campaigns to increase physical activity and reduce caloric intake, although only about half of the participants in the US 1998 National Health Interview Survey who were trying to lose weight reported using exercise (Kruger, Galuska, Serdula, & Kohl, 2005) Past and Present Behaviors Socioeconomic status, occupation, smoking, and overweight may represent underlying factors that reinforce sedentary living or create barriers to adopting or maintaining physical.

a Extaction method: principal component analysis; rotation method: varimax with Kaiser normalization. Rotation converged in three iterations.

4 40% 3,456 5 $2,074 1,500 Total accumulated depreciation (expense) Cost Accumulated depreciation: $16,000

3. Clinical psychology has been slow to respond to the industrialization of health care, and specifically the industrialization of behavioral health care. Managed care has become the dominant mode of health care financing and delivery, yet our doctoral clinical psychology programs are not preparing graduates for careers commensurate with their doctorate: program planning, business and finance, management, clinical directors, and even CEOs. Our graduates, trained mostly in traditional services, are left to compete with a vast pool of masters-level cheap labor. Also, when industrialized behavioral care is demanding cost-effective therapies that yield measurable results, clinical psychology training programs are falling prey to postmodernist relativism, the very antithesis of what the marketplace requires of our graduates. What do you think the most significant trend is in clinical psychology The next phase in the evolution of behavioral health care is the recognition and implementation of behavioral care as a primary care profession. Vast research consistently demonstrates that as many as 60% to 70% of all patients seen in primary care are suffering predominately from psychological distress and emotional stress. Either they are somatizing this distress, or the stress is exacerbating physical illness and interfering with treatment compliance and recovery. Estimates vary, but this somatization is a significant drain on health care resources. The integration of behavioral care with primary care will result in a seamless delivery where the patient s primary care encompasses when necessary behavioral care that is co-located with primary care within the primary care setting. Behavioral care providers will work side by side with primary care physicians, with offices interspersed in the same location. This future is proceeding faster than would have been anticipated when we wrote our textbook several years ago