Enhancing the efficacy of behavior therapy for obesity: Effects of aerobic exercise and a multicomponent maintenance program.

Tested whether the efficacy of behavior therapy for obesity might be improved by the programmatic additions of an aerobic exercise regimen during treatment and a multicomponent maintenance program following treatment. 14 male and 76 female obese 22–60 yr olds were randomly assigned to 2 treatment conditions (behavior therapy or behavior therapy plus aerobic exercise) and 2 posttreatment conditions (no further contact or a multicomponent maintenance program). The exercise regimen consisted of 80 min/week of brisk walking or stationary cycling. The maintenance program included therapist contact by telephone and mail and peer self-help group meetings. At posttreatment, Ss in the behavior therapy plus aerobic exercise condition lost significantly more weight than those who received behavior therapy only. Over an 18-mo follow-up period, maintenance program participants demonstrated significantly better weight-loss progress than Ss in the no-further-contact condition. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone.

129 21–57 yr old moderately obese volunteers who averaged 57% over ideal weight were randomly assigned to 1 of 6 experimental conditions in a 3?×?2 factorial design. Three treatment conditions (nonbehavioral therapy, behavior therapy, or behavior therapy plus relapse prevention training) were crossed with 2 posttreatment conditions (posttreatment client–therapist contact by telephone and mail or no posttreatment contact). All treatments produced substantial initial weight losses, but Ss tended to regain weight during the follow-up period. Posttreatment client–therapist contact by mail and telephone significantly enhanced the maintenance of weight loss for groups that received nonbehavioral treatment or behavior therapy plus relapse prevention training, but it did not improve maintenance for groups that received behavior therapy only. At 12-mo follow-up, the only condition that maintained its mean posttreatment weight loss was the one that received behavior therapy plus relapse prevention training and posttreatment contact. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of peer support and therapist contact on long-term weight loss.

This study evaluated the effectiveness of two posttreatment programs designed to enhance the maintenance of weight loss. Eighty-five obese clients were randomly assigned to either (a) behavior therapy plus a peer-support maintenance program, (b) behavior therapy plus a therapist-contact maintenance program, or (c) behavior therapy only. At a 7-month follow-up session, the therapist-contact program resulted in significantly greater maintenance of weight loss compared with the peer support and behavior therapy only conditions. However, by the time of an 18-month follow-up assessment, overall relapse rates were equivalent across conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy for obesity: A comparative investigation of long-term efficacy.

Both individual and group behavior therapies were compared to a stringent social pressure program in the treatment of 72 obese females (mean age, 41.5 yrs) with a long-standing history of obesity (mean, 15.9 yrs) and inability to lose weight or maintain a weight loss. Following an 8-wk treatment phase, half of each treatment condition received 4 additional booster sessions and the remaining half simply reported for regularly scheduled follow-up weigh-ins at 3, 6, 9, and 12 mo, respectively. Both behavioral treatments were significantly superior to the social-pressure therapy at posttreatment. However, whereas the 2 group treatments resulted in successful maintenance of treatment-produced weight reduction, Ss treated with individual behavior therapy showed substantial relapse at long-term follow-up. It is hypothesized that initial treatment success and subsequent maintenance of weight loss are governed by partially different processes. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of antiemetics and reduced radiation fields on acute gastrointestinal morbidity of adjuvant radiotherapy in stage I seminoma of the testis: a randomized pilot study

OBJECTIVE: To assess the long term effects of weight loss with and without additional aerobic and weight training exercises on exercise tolerance and cardiorespiratory fitness in obese women. EXPERIMENTAL DESIGN: Randomized prospective study for an approximately one-year community setting. PATIENTS: 31 healthy obese women volunteers (age 42.8 yrs +/- 6 SD) recruited by community advertisement. INTERVENTION: All subjects underwent a weight loss program consisting of low calorie diet and behavior therapy for a minimum of 46 weeks. They were randomly assigned to one of the four groups. Group A: diet alone, Group B: diet plus aerobic exercise program in a supervised group setting, Group C: Diet plus weight training and Group D: diet plus weight training plus aerobic exercise program. MEASURES: Exercise time (Tex) peak sustained workload (Wp), peak oxygen consumption (VO2), oxygen pulse and the rate of change of VO2 on recovery (VO2rec) were measured at the beginning and after 47.5 weeks +/- 1.5 SD, of the program. RESULTS: All subjects lost weight and achieved increased Tex and lowered resting VO2. VO2 peak and VO2 peak kg-1 increase in Groups B and D only. O2 pulse and VO2rec improved in group D. Improvements in exercise time correlated significantly with initial exercise time and weight loss. CONCLUSIONS: Weight loss increase Tex irrespective of participation in an exercise program. However, evidence of improved aerobic fitness occurred only in groups performing aerobic exercise.     

A comparison of weight control and weight control plus body image therapy for obese men and women.

Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive–behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive–behavioral weight control program is effective as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative evaluation of minimal therapist contact and 15-session treatment for female orgasmic dysfunction.

Compared a 4-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. 14 couples were treated in the MTC format, 29 couples in the FTC format. All spouses (aged 20–52 yrs) completed the Locke-Wallace Marital Adjustment Test, a sexual interaction inventory, and a sexual history form at intake, pretreatment, posttreatment, and 3-mo follow-up. Both programs were effective in producing female orgasm in masturbation, but the MTC program resulted in more frequent orgasms with vibrator stimulation. The programs were comparably effective in producing orgasm with the spouse both by manual stimulation and intercourse. Both programs resulted in improvements in satisfaction with the sexual relationship, and women in the MTC treatment reported greater happiness in marriage. It is concluded that for this sexual dysfunction, therapist contact time can be greatly reduced without loss of effectiveness. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing cost-effectiveness in obesity treatment through use of self-help behavioral manuals and decreased therapist contact.

126 community Ss (mean age 39.4 yrs) participated in a 10-wk weight reduction program; 4 groups used a behavioral manual, 4 groups used an alternate manual under varying degrees of therapist guidance, and 1 group served as a delayed-treatment control. Results at posttreatment and 3-, 6-, and 16-mo follow-ups supported the behavioral manual's effectiveness in producing modest weight loss. The manual could be applied under varying degrees of therapist guidance without significant differences in effectiveness, but with increased cost-effectiveness as therapist contact decreased. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Competition in a minimal-contact weight-loss program.

The present study evaluated in a controlled setting the effects of competition on a bibliotherapy weight loss program offered in a clinic setting. Fifty-nine subjects were randomly assigned to either bibliotherapy, competition, or bibliotherapy plus competition conditions. Results indicate that use of the combined competition and behavioral program produced weight losses greater than those produced by either element alone. The superiority of the bibliotherapy plus competition condition was maintained even after the contingencies of the competition were withdrawn. The results are discussed in terms of enhancing weight loss and maintenance in minimal contact programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled trial of very low calorie diet, behavior therapy, and their combination in the treatment of obesity.

Assessed the effectiveness of a combined program of low calorie diet (400–500 kcal) and behavior therapy in treating obesity. 50 women (average age 43.9 yrs) and 9 men (average age 44.7 yrs), averaging 89% overweight, were randomly assigned to 1 of 3 conditions: (a) low calorie diet alone, (b) behavior therapy alone, or (c) low calorie diet plus behavior therapy (combined treatment). Mean weight losses for the 3 conditions at the end of treatment were 14.1, 14.3, and 19.3 kg, respectively; losses for combined treatment were significantly greater than those for the other 2 conditions. At 1-yr follow-up, mean weight losses for the diet alone, behavior therapy alone, and combined-treatment conditions were 4.6, 9.5, and 12.9 kg, respectively; and losses for combined treatment were significantly greater than for the diet alone condition. 29% of the combined-treatment and 44% of the behavior therapy alone Ss maintained weight losses within 2 kg of their end-of-treatment weight; none of the diet-alone Ss met this criterion. Ss in all 3 conditions achieved significant reductions in blood pressure at posttreatment, but only those receiving behavior therapy alone and combined treatment showed significant decreases in depression. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a self-control manual, rapid smoking, and amount of therapist contact on smoking reduction.

Evaluated a self-help treatment manual consisting of stimulus control, rapid smoking, and coping relaxation techniques. 69 Ss, average age 32.6 yrs, who smoked at least 20 cigarettes/day were randomly assigned to (a) a self-help manual with minimal (2 sessions) therapist contact, (b) a self-help manual with high (7 sessions) therapist contact, (c) a high-therapist-contact rapid smoking condition, or to (d) a high-therapist-contact normal-paced smoking condition. Results indicate that while the overall program was moderately effective, groups did not differ on percentage of baseline smoking or on number of Ss abstinent at posttreatment or 3-mo or 6-mo follow-up. Informant reports of Ss' smoking behavior and carbon monoxide analyses of expired air samples confirmed these findings. Ss in the minimal contact condition generally followed through on their programs, required less therapist time, and were at least as successful as those in other groups in terms of long-term results. Implications for self-help manuals for smoking reduction are discussed. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior modification for obesity: The evaluation of exercise, contingency management, and program adherence.

Investigated crucial aspects of behavioral programs for obesity including (a) the assumption that Ss actually engage in requested behaviors and that these behaviors mediate weight loss, (b) the effect of exercise on weight loss, and (c) the problem of long-term maintenance and generalization to the clinically obese. Exercise and self-managed contingency components were compared in a 2?×?2 factorial design on 44 obese Ss and were evaluated after 10 wks of treatment and 3-mo and 1-yr follow-ups. Significant weight loss was observed for all groups at program termination and the 3-mo follow-up, with only those exposed to exercise and/or contingency management maintaining weight loss after 1 yr. There were no main effects or interactions at program termination or at the 3-mo follow-up. However, the influence of exercise at the 1-yr follow-up was noticeable. Assessment of program adherence indicated that Ss engaged in program behaviors, yet only 1 of 10 such behaviors was related to weight loss. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of group- versus home-based exercise in the treatment of obesity.

This study examined the effects of 2 aerobic exercise regimens on exercise participation, fitness, eating patterns, treatment adherence, and weight changes in 49 obese women undergoing a year-long behavioral weight loss program. Participants were assigned randomly to weight loss treatment plus either group- or home-based exercise. All participants were instructed to complete a moderate-intensity walking program (30 min/day, 5 days/week). Group exercise participants were provided with 3 supervised group exercise sessions per week for the 1st 26 weeks and with 2 sessions per week thereafter. Home exercise participants were instructed to complete all exercise in their home environment. After 6 months, both conditions displayed significant improvements in exercise participation, fitness, eating patterns, and weight loss. At 12 months, the home-based program showed superior performance to the group condition in exercise participation and treatment adherence; at 15 months, participants in the home program demonstrated significantly greater weight losses than those in the group program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-help books and amount of therapist contact in smoking cessation programs.

Evaluated 2 self-help behavior therapy books (B. G. Danaher and E. Lichtenstein, 1978; O. F. Pomerleau and C. S. Pomerleau, 1977) for stopping smoking against a widely available minimal treatment program. A 3?×?2 factorial design was employed to evaluate the 3 treatments under both self-administered and therapist-administered conditions. 85 chronic cigarette smokers (mean age 37.3 yrs) participated in the 8-wk treatment programs and a 6-mo follow-up. Dependent variables included self-monitored number of cigarettes smoked daily, CO concentrations in expired breath samples, dosage scores based on topographical aspects of smoking behavior, and adherence and cost-effectiveness measures. Under self-administered conditions, the minimal treatment program was at least as effective as the behavior therapy books. On the self-report measures, therapist contact was associated with improved treatment outcome for the behavior therapy programs but not for the control condition. Reliable between-groups differences were not consistently observed on CO levels. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Broad-spectrum behavioral approach to smoking cessation: Effects of social support and paraprofessional training on the maintenance of treatment effects.

Conducted 2 treatment programs to determine the efficacy of a multi-component smoking intervention and various maintenance procedures. Prior to Program 1, 60 smokers were randomly assigned to 1 of 3 experimental conditions—a smoking abstinence program (SAP), a smoking abstinence program plus social support (SAP-SS), a smoking abstinence program plus social support and paraprofessional training (SAP-SS-PT)—or to 1 of 2-control conditions—effort control (EC) or a waiting list (WL). Individuals assigned to EC and WL conditions became treatment participants (EC-SAP-SS, WL-SAP-SS) during Program 2 and received training from SAP-SS-PT Ss. Results indicate that social support and paraprofessional training tended to facilitate maintenance, although 6-mo follow-up data revealed considerable relapse across treatment conditions. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of behavioral therapy for chronic low back pain: A component analysis.

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildy disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Energy requirements of middle-aged men are modifiable by physical activity

BACKGROUND: Energy requirements for weight maintenance decrease with age. Often, this decline is not proportionately matched by reduced energy intake, resulting in weight gain. OBJECTIVE: We hypothesized that energy requirements for total daily weight maintenance in healthy, sedentary, middle-aged men would increase after regular aerobic exercise or aerobic exercise plus weight loss to levels comparable with those in middle-aged athletes. DESIGN: Weight-maintenance energy requirements were determined during weight stability (+/- 0.25 kg) in 14 lean, sedentary (LS) men; 18 obese, sedentary (OS) men; and 10 male athletes of comparable ages (x +/- SEM: 58 +/- 1 y). Studies were done at baseline and after 6 mo of aerobic exercise (LS men) or aerobic exercise plus weight loss (OS men) or 3 mo of deconditioning (athletes). RESULTS: The interventions raised maximal oxygen uptake (VO2max) by 15% in the LS men and by 13% in the OS men and decreased it by 14% in athletes (all P < 0.01), eliminating the differences among groups at baseline. Body fat was reduced significantly in LS and OS men; fat-free mass decreased in OS men. Average daily energy requirements increased by 8% in LS men and by 5% in OS men (both P < 0.01) to levels comparable with the baseline requirements of athletes and correlated with VO2max (r2 = 0.22, P < 0.0001) and fat-free mass (r2 = 0.05, P < 0.02) across the range of VO2max achieved by all subjects. CONCLUSIONS: Under free-living conditions, aerobic exercise eliminated the difference in weight-maintenance energy requirements between middle-aged sedentary and athletic men, suggesting that energy requirements of healthy, middle-aged men are modifiable by regular physical activity.     

Exercise and the maintenance of weight loss: 1-year follow-up of a controlled clinical trial.

This study reports results 1 year after treatment for 77 obese women who had been treated for 48 weeks by diet combined with supervised (a) aerobic exercise, (b) strength training, (c) aerobic plus strength training combined, or (d) no exercise. Mean (± SD) end-of-treatment weight losses for the 4 conditions ranged from 13.5?±?9.1 kg to 17.3?±?10.3 kg, but there were no statistically significant differences among groups. Participants in all 4 conditions regained approximately 35% to 55% of their weight loss in the year after treatment; again, there were no significant differences among groups. Participants, however, who reported exercising regularly in the 4 months preceding the follow-up assessment regained significantly less weight than did nonexercisers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and smoking cessation and maintenance.

Examined the role of social support in smoking cessation and maintenance in 2 longitudinal, prospective studies with 64 Ss each (mean ages 38.4 yrs and 38.8 yrs). Three kinds of support factors were assessed: support from a partner directly related to quitting, perceptions of the availability of general (i.e., nonsmoking) support resources, and the presence of smokers in Ss' social networks. Ss were smokers in cessation programs. Corroborated smoking status was obtained through 12 mo posttreatment. There was evidence for all 3 support factors, but they operated at different points in the process of cessation and maintenance. High levels of partner support and of the perceived availability of general support were associated with cessation and with short-term (to 3 mo posttreatment) maintenance of abstinence. The presence of smokers in Ss' social networks was a hindrance to maintenance and significantly differentiated between relapsers and long-term (12-mo) abstainers. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exercise in the treatment of obesity: Effects of four interventions on body composition, resting energy expenditure, appetite, and mood.

This study investigated changes in body composition, resting energy expenditure (REE), appetite, and mood in 128 obese women who were randomly assigned to 1 of 4 treatment conditions: diet alone, diet plus aerobic training, diet plus strength training, or diet combined with aerobic and strength training (i.e., combined training). All women received the same 48-week group behavioral program and were prescribed the same diet. Exercising participants were provided 3 supervised exercise sessions per week for the 1st 28 weeks and 2 sessions weekly thereafter. Participants across the 4 conditions achieved a mean weight loss of 16.5 ±6.8 kg at Week 24, which decreased to 15.1 ±8.4 kg and Week 48. There were no significant differences among conditions at any time in changes in weight or body composition. Women who received aerobic training displayed significantly smaller reductions in REE at Week 24 than did those who received strength training. There were no other significant differences among conditions at any time on this variable or in changes in appetite or mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)