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)     

The efficacy and safety of exercise programs in cardiac rehabilitation

Physical activity performed by patients with coronary heart disease is a two-edged sword. A number of biological changes produced by regular exercise may reduce the risk of future cardiac events, while the increase in cardiac work produced by this same exercise can predispose the patient to sudden cardiac death. Data from observational studies as well as randomized clinical trials demonstrate a lower cardiac mortality rate for men participating in exercise rehabilitation programs vs nonparticipants. Overall, exercise program participants appear to experience a reduction of approximately 25% in cardiac and all-cause mortality, but no single study has provided definitive results. During medically supervised exercise, the risk of cardiac death based on reports of programs in the United States is approximately one event in every 60,000 participant-hours of exercise. At this rate, a typical rehabilitation program that has 95 patients exercising 3 h.wk-1 could expect a sudden cardiac death during an exercise session once every 4 yr. No data have been published on the morbidity or mortality benefits or risks of home-based exercise or for women participants. Also, the contribution of continuous electrocardiographic monitoring to the safety of exercise training of cardiac patients is yet to be defined.     

Mind-body fitness: encouraging prospects for primary and secondary prevention

In recent years health promotion programs have generated many worthwhile psychologic and physiologic benefits but frequently with less than optimal long-term adherence. Incorporating approaches such as mind-body exercise with existing health promotion and cardiac rehabilitation services can improve self-efficacy and long-term adherence to healthy behaviors as well as improve personal stress management skills. Mind-body exercise couples muscular activity with an internally directed focus so that the participant produces a temporary self-contemplative mental state. This internal focus is in contrast to conventional body-centered aerobic and muscular fitness exercise in which there is little or no mindful component. Research on mind-body exercise programs such as yoga and tai chi reveal they have significant mental and physical value. There also are numerous primary and secondary preventive indications for cardiovascular disease in which mind-body exercise can play a primary or complementary role. Mind-body exercise programs will be a welcome and necessary addition to evolving disease management models that focus on self-care and decreased health care use.     

Scanning electron microscopic study of the development of crystalline lens fiber

Examines types of social support that best predicts adherence at different time points during a 1-year endurance exercise program in 269 women and men ages 50 to 65 years. Results indicate that social support had similar effects on exercise participation for women and men, and support specific to exercise was a better predictor of exercise adherence than general social support. A preference for receiving a lesser amount of initial support from exercise staff was the strongest social support-related predictor of exercise adherence during the initial 6 months of the program. Support currently received from family and friends and exercise staff at Month 6 was found to be the strongest predictor of adherence during Months 7 to 12. Format of exercise was also a strong predictor of exercise adherence with home-based programs related to greater adherence. Additionally, divorced nonsmokers appear to be at increased risk for poor early exercise adherence and should be targeted in interventions to promote exercise participation.     

Factor affecting adherence to rehabilitation interventions for individuals with fibromyalgia.

Examined treatment adherence of 87 Ss (mean age 43.96 yrs) with fibromyalgia syndrome enrolled in a rehabilitation clinical trial study and randomly assigned to 1 of 3 treatment groups: (1) biofeedback, (2) exercise, (3) combination (biofeedback and exercise) or to an attention control condition. Ss completed a 6-wk training program, questionnaires, and a physical exam. Between-group differences on an adherence measure were examined, and multiple regression analyses were used to determine the best model for predicting adherence. Results show that adherence among people with fibromyalgia is multidetermined. Those in the biofeedback intervention were more adherent, suggesting that treatment factors impact adherence. Furthermore, the best model for predicting adherence suggests that subject characteristics like age and education also influence adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing the effectiveness of different educational programs for patients with total knee arthroplasty

PURPOSE: To compare the effects of preadmission and postadmission educational programs for patients with total knee arthroplasty. DESIGN: Quasiexperimental study. SAMPLE: 60 total knee arthroplasty patients. METHODS: Subjects in the experimental group received preadmission preoperative teaching with an instruction booklet during a preoperative outpatient clinic visit. Upon admission to the hospital, they were presented with an educational video tape. The control group received only postadmission preoperative teaching with the same instruction booklet and no video. PREADMISSION AND POSTADMISSION: Preoperative anxiety level, knowledge about postoperative care, exercise performance and postoperative recovery were used as outcome measures. FINDINGS: The research results found: 1. there was no significant difference between the two groups in reduction of preoperative anxiety score: 2. the experimental group had a significantly higher knowledge level than the control group; 3. the experimental group performed exercise more regularly and correctly than those in the control group; 4. the experimental group had greater flexion of the operative knee joint than the control group. CONCLUSION: Preadmission teaching with a videotape program and a health manual for patients with total knee arthroplasty is recommended. IMPLICATIONS FOR NURSING RESEARCH: More indicators such as postoperative pain and patient satisfaction can be used to investigate the effectiveness of intervention. In addition, increasing the sample size is recommended for future studies.     

Humanistic psychology and rehabilitation programs in mental hospitals

A humanistic growth-oriented theory, specifically Maslow's need-satisfaction theory, was used as a basis for examining the contributions work and employment make toward rehabilitation of the state mental hospital patient. Research literature reviewed indicated that if the rehabilitation program is to be viable and optimally effective, satisfying the belongingness and esteem needs of the patient is important. Research that stresses the therapeutic benefit of work, as well as research that raises the issue of workshops inhibiting independence and fostering dependence are presented. Modifications of rehabilitation programs that resulted in reports of increased program effectiveness are discussed. Fundamental features of these alternative or ancillary programs were: 1. a definite structure that allows various levels of advancement; 2. group participation; 3. patient initiative; 4. an orientation that reflects the competitive nature of employment; and 5. early community involvement. The importance of evaluating each client's needs and planning for growth before his/her job placement is considered vital to the program and to the individual.     

Occupation and visual/vestibular interaction in vestibular rehabilitation

Otolaryngologists often prescribe head movement exercise programs for patients with vestibular disorders, although the effectiveness of these programs and the critical features of the exercises are poorly understood. Because many patients who dislike exercising do not follow through with their exercises, alternatives to the traditional repetitive exercises would be useful. Subjects diagnosed with vestibular disorders were treated for 6 weeks with either an outpatient exercise program that incorporated interesting, purposeful activities or a simple home program of head movements, comparable with the exercises otolaryngologists often give their patients when they do not refer to rehabilitation. Both treatments incorporated repetitive head movements in all planes in space, graduated in size and speed. Subjects were all tested before and after treatment with standard measures of vestibulo-ocular reflex and balance, level of vertigo, gross motor skills, and self-care independence. Subjects in both groups improved significantly on the functional measures, with slightly greater improvements in the occupational therapy group. The results were maintained 3 months after the cessation of intervention. These data suggest that graded purposeful activities are a useful alternative for treating this patient population and that the essential factor in any exercise program is the use of repetitive head movements.     

Reproductive health in adolescent students: knowledge, attitudes, and behavior in both sexes, in a community of Santiago

Nine hundred forty eight teenagers (600 females) from a public school of one of the poorest communities of Santiago were surveyed about knowledge and practices on sexuality and reproductive health. Twenty four percent of females and 40% of males did not talk about their problems at home, instead they talked preferentially with their friends. Half of the sample attributed a risk a pregnancy to the first sexual intercourse; 67% did not know the infertile phase of the menstrual cycle and 20% did not identify two sexually transmitted diseases. Sixty percent considered rhythm technique as a safe fertility control method, 60% of males and 50% of females considered masturbation as risky, 57% of males and 49% of females estimated that condoms could be reused and between 5 and 16% of the sample correctly identified AIDS modes of transmission. Fifty percent had a couple and 23% of males and 17% of females had a sexual intercourse in the last six months; of these, 45% of women and 27% of men used a contraceptive method. Four percent of women and 6% of men became involved in a pregnancy and 57% of these terminated in abortions. It is concluded that knowledge about sexuality and reproductive biology among low income teenagers is scanty.     

Comparison of programs for teaching personal safety skills to preschoolers.

We compared the relative effectiveness of two educational approaches for teaching personal safety skills with 100 preschoolers. A behavioral skills training program was compared with a feelings-based program, which instructs children to trust their feelings when making safety decisions. Children's abilities to discriminate between appropriate- and inappropriate-touch requests, their prevention skills, and levels of emotional distress were assessed before, immediately, and one month after program participation. Parents and teachers were surveyed regarding children's reactions. Compared with a control presentation, both programs were effective in enhancing children's knowledge and prevention skills without making them fearful, suggesting that preschool children can benefit from such programs. However, children in the feelings-based program had difficulty recognizing the appropriateness of certain touch requests, suggesting that this approach may have limited utility with preschool-age children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of adherence to a structured exercise program for older women.

This study examined whether psychological, physiological, and health and lifestyle measures were associated with adherence to a structured exercise program for older women. Women aged 60 to 85 years (N?=?102), randomly recruited from the community, were assessed on these measures before and after a 12-month exercise trial. Sixty-nine women completed the trial, and 54 continued participation after the trial for at least 6 months. Adherence was examined at various stages during the trial. Multiple regression analysis revealed that reduced muscle strength, slow reaction time, and psychoactive drug use explained most of the variance in adherence during the trial. In contrast, muscle strength, reasoning ability, depression, and self-reported improvement in strength best predicted continued participation after the trial. The findings have implications for community-based exercise programs and research trials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute stress increases thyroid hormone levels in rat brain

BACKGROUND: In experimental animals, exposure to uncontrollable stress induces a number of behavioral and biochemical changes that resemble symptoms seen in human depression and other psychiatric conditions. The present study used a yoked design to examine the effects of uncontrollable footshock stress on brain thyroid hormones in male and female rats. METHODS: Animals in one group received 15 trials where footshock could be terminated by pressing a lever (escapable shock). Rats in a second group received the same amount of shock, but had no control over shock termination (inescapable shock). Control rats received no shock. RESULTS: No significant differences were found among the three groups, for either males or females, in whole brain levels of thyroxine (T4) 3 hours after the footshock session. In contrast, significant group differences in brain levels of triiodothyronine (T3) were found for both males and females. In males, brain T3 was elevated by 21% in the inescapable shock group when compared to controls (p < .012). In females, brain T3 increased by 19% in the escapable shock group when compared to controls (p < .026). Plasma levels of both T3 and T4 were at control levels for all groups. CONCLUSIONS: These results provide the first demonstration that brain T3 levels change rapidly in response to acute stress. The data further suggest that the effects of stress controllability on brain T3 levels may be different for males and females.     

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)     

Effect of formula supplemented with docosahexaenoic acid and gamma-linolenic acid on fatty acid status and visual acuity in term infants

This study identified factors associated with exercise participation and adherence in a sample of 102 sedentary, functionally limited, community-dwelling adults aged 60 to 94 years who participated in a home-based resistance training program. Stepwise regression analyses revealed that baseline physical factors (i.e., higher levels of mobility, weaker muscle strength, and fewer numbers of new medical conditions) were associated with higher rates of participation in the home program. Positive attitudes and a sense of control toward exercise, lower levels of confusion and depressive moods, and the development of fewer new medical problems during the program were related to higher levels of adherence to the program. Findings revealed that although physical health variables were the primary indicators of an older person's overall participation in the program, it was the psychological factors that were most important to adherence to this home-based program.     

Effect of residential cardiac rehabilitation following bypass surgery. Observations in Switzerland

BACKGROUND: Cardiac rehabilitation in central Europe traditionally involves isolating patients in a residential idyllic setting where exercise is performed frequently but in a relatively unstructured fashion. Few studies have been performed on the effects of these programs among patients who have undergone bypass surgery. Recent data suggest that postbypass patients may enter these programs too soon after surgery or that exercise is not structured enough to distinguish the benefits of rehabilitation from those experienced by a control group. METHODS: Forty-two male patients (mean age, 58 +/- 7 years) were divided into exercise and control groups approximately 1 month after undergoing bypass surgery. Exercise training consisted of 1 h of group walking twice daily, with the intensity stratified into four levels based on initial exercise capacity. Using a crossover design, patients in the exercise group participated in rehabilitation for 1 month, followed by 1 month of usual care, while control patients underwent the opposite sequence. At 1, 2, and 3 months, patients in both groups underwent pulmonary function testing and maximal ramp exercise testing using lactate and gas exchange analysis. RESULTS: A main effect for maximal oxygen uptake was observed; significant improvements within each group occurred across each testing period (range, 5 to 13%; p < 0.05). However, there was no significant interaction between groups. Mean lactate levels throughout exercise were reduced within both groups (p < 0.01). A reduction in oxygen uptake for test 2 at the lactate threshold in the exercise group resulted in differences between groups in lactate, heart rate, and other gas exchange variables at this point. CONCLUSION: Similar changes occur in the functional status of postbypass surgery patients regardless of their participation in the short but concentrated programs common in central Europe. This suggests that a significant spontaneous effect of healing occurs in the recovery phase after surgery. These programs may have greater efficacy if they began later after surgery, lasted longer, or were more structured, and studies are needed to determine their effect on psychosocial factors and return to work.     

The efficacy of polychemotherapy programs in treating multiple myeloma patients

AIM: To compare efficiency of the programs MCVP, VCAP and ARA-COP in the treatment of multiple myeloma (MM) as regards completeness of the response, duration of the remission and toxicity. MATERIALS AND METHODS: A total of 41 MM patients entered the study (27 females, 14 males, age from 41 to 72 years, MM duration from 1 month to 8 years). 16, 10 and 15 patients were treated according to MCVP, VCAP and ARA-COP programs. RESULTS: Both in the resistant and primary patients the response was the highest to ARA-COP treatment. The remission or stabilization was achieved in 93.4% of patients. VCAP program was less effective. However, clinicohematological remission was achieved in 50% of patients. This program is rather heart toxic. MCVP program was the least effective. Survival was followed up in 16 patients (10 MCVP, 3 VCAP and 3 ARA-COP patients). The survival was 20-62, 16-36, 23.6-64.8 months for ARA-COP, VCAP and MCVP, respectively. CONCLUSION: ARA-COP program proved most effective of the three programs both in primary and drug-resistant patients. VCAP and MCVP programs are less effective but can be used in primary management of MM patients.     

The importance of prognostic factors in the interpretation of two EORTC metastatic prostate cancer trials. European Organization for Research and Treatment of Cancer (EORTC) Genito-Urinary Tract Cancer Cooperative Group

Rehabilitation following anterior cruciate ligament (ACL) reconstruction is varied. Patients are usually prescribed an independent home exercise program, although some patients may attend physical therapy for additional supervised exercise. It is not known whether additional supervised exercise provides any further benefit. The purpose of this study was to compare efficacy for two types of rehabilitation following ACL reconstruction. A randomized controlled trial of 31 ACL-reconstructed patients was used to test the hypothesis that a home program plus supervised rehabilitation (Group S) is more effective than a home program (Group H) alone. Function, activity level, anterior tibial translation, and muscle strength were measured preoperatively and at 3 and 6 months postoperatively. Improvement of function, activity level, muscle strength, and anterior tibial translation was evident in both groups, but no significant differences were found between groups even though the sample size was sufficient to detect small treatment effects. It was concluded that supervised exercise, in addition to a home program, has minimal extra benefit for patients who have undergone ACL reconstruction.     

Improving adherence to physical activity.

Tested the efficacy of G. A. Marlatt and I. R. Gordon's (1980, 1985) relapse-prevention approach in increasing attendance during an exercise program and continuation of exercise activities for 12 wks following termination of the formal program. The 350 Ss in Study 1 and 243 Ss in Study 2 were registrants in 10-wk exercise groups (jogging, aerobic dance, and pre-ski training). The intervention, designed to increase awareness of obstacles to exercise and to develop appropriate techniques for coping with them, was delivered by group leaders within the context of the regular program. Results indicate a small but consistent superiority of adherence in the experimental condition compared to the control condition. The low cost of this intervention, however, makes even small gains cost effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)