Introduction Office employees are exposed to hazardous levels of sedentary work. Interventions that integrate health promotion and health protection elements are needed to advance the health of ...sedentary workers. This study tested an integrated intervention on occupational sedentary/physical activity behaviors, cardiometabolic disease biomarkers, musculoskeletal discomfort, and work productivity. Design Two-group, RCT. Data were collected between January and August 2014. Setting/participants Overweight/obese adults working in sedentary desk jobs were randomized to: (1) a health protection–only group (HPO, n =27); or (2) an integrated health protection/health promotion group (HP/HP, n =27). Intervention HPO participants received an ergonomic workstation optimization intervention and three e-mails/week promoting rest breaks and posture variation. HP/HP participants received the HPO intervention plus access to a seated activity permissive workstation. Main outcome measures Occupational sedentary and physical activity behaviors (primary outcomes), cardiometabolic health outcomes, musculoskeletal discomfort, and work productivity (secondary outcomes) were measured at baseline and post-intervention (16 weeks). Results The HP/HP group increased occupational light intensity physical activity over the HPO group and used the activity permissive workstations 50 minutes/work day. Significant associations were observed between activity permissive workstation adherence and improvements in several cardiometabolic biomarkers (weight, total fat mass, resting heart rate, body fat percentage) and work productivity outcomes (concentration at work, days missed because of health problems). Conclusions The HP/HP group increased occupational physical activity and greater activity permissive workstation adherence was associated with improved health and work productivity outcomes. These findings are important for employers interested in advancing the well-being of sedentary office workers. Trial registration This study is registered at www.clinicaltrials.gov NCT02071420.
Highlights • Self management is independently associated with disease specific quality of life in COPD. • Positive/negative Affect Ratio mediates the association of self-management-quality of life. • ...Significant self management domains in COPD: investment in behaviors and self-efficacy. • Age and lung function are not significantly associated to self-management abilities in COPD.
Prolonged sitting induces endothelial dysfunction in healthy young adults, which has been demonstrated to be offset by intermittent fidgeting and standing. No information exists on the effect of ...sitting and endothelial dysfunction in sedentary middle-age adults, and whether common workplace counterinterventions (i.e., desk standing/desk pedaling) mitigate sitting-induced endothelial dysfunction.
PURPOSEThe objective of this study was to examine whether breaking up prolonged sitting with intermittent standing or underdesk pedaling prevents sitting-induced popliteal artery endothelial dysfunction in middle-age sedentary, overweight/obese office workers.
HYPOTHESISWe tested the hypothesis that sitting-induced leg endothelial dysfunction would be prevented by intermittent standing or desk pedaling.
METHODSThirteen middle-age, sedentary overweight/obese subjects (10 men, 3 women; age, 38 ± 3 yr; body mass index, 29.7 ± 2 kg·m) participated in three separate testing sessions in a randomized order1) 4 h of uninterrupted sitting, 2) 4 h of sitting interrupted with four 10-min bouts of standing, and 3) 4 h of sitting interrupted with four 10-min bouts of light-intensity desk pedaling. Doppler ultrasound–measured popliteal artery flow-mediated dilation and associated measures (e.g., shear rate, blood velocity) were measured immediately before and immediately after each intervention (sit, stand, and desk pedaling).
RESULTSFour hours of uninterrupted sitting induced a significant impairment in popliteal artery flow-mediated dilation (baseline3.1% ± 0.3%, post1.6% ± 0.5%; P < 0.05). Interestingly, neither intermittent standing (baseline3.2% ± 0.4%, post1.9% ± 0.5%; P < 0.05) nor intermittent desk pedaling (baseline3.2% ± 0.4%, post1.9% ± 0.4%; P < 0.05) was effective at preventing excessive sitting–induced endothelial dysfunction.
CONCLUSIONSProlonged sitting–induced leg endothelial dysfunction cannot be prevented by brief intermittent bouts of standing or desk pedaling in middle-age sedentary overweight/obese adults.
Pulmonary rehabilitation is an effective treatment for patients with COPD, but patient uptake and adherence to the current offering of center-based pulmonary rehabilitation is modest due to ...transportation, access, poverty, and frailty, and even more so in the context of the COVID pandemic. Home-based options have been proposed and were found noninferior to center-based rehabilitation; however, there is a lack of home-based programs, and more understanding is needed. We aimed to test the feasibility, uptake, and adherence to a home-based program for COPD rehabilitation with health coaching.
We conducted a randomized trial with a wait-list controlled design to evaluate the effects of a home-based program with health coaching on breathlessness in subjects with moderate to severe COPD unable to attend the regular pulmonary rehabilitation program. The 8-week intervention consisted of video-guided exercises to be done 6 times a week and captured with a computer tablet. Health coaching was done weekly over the telephone to review subject activity and symptoms and to provide an opportunity for the subject to define their weekly goals. The primary outcomes were uptake, adherence, and Chronic Respiratory Questionnaire (CRQ) Dyspnea Domain. Secondary outcomes were self-management abilities and CRQ Emotions-Mastery-Fatigue.
154 subjects with moderate to severe COPD were randomized. Subject adherence was 86% to the proposed 6-times a week exercise routine. There (
= .062) was no significant difference in breathlessness (CRQ dyspnea). There was a significant improvement in self-management abilities (
< .001). The results of the qualitative interviews showed high levels of acceptability of the program.
The tested home-based rehabilitation program with health coaching was feasible, highly acceptable, showed a high degree of adherence, and improved self-management abilities. This study offers seminal information for home-based rehabilitation programs to design alternative options of rehabilitation to individuals with COPD that cannot attend to the well-established center-based pulmonary rehabilitation. (ClinicalTrials.gov registration NCT02557178.).
This study aimed to 1) examine the relationship between dietary intake and cancer prevention nutrition recommendations among Hispanic families, 2) differences in daily dietary intake by acculturation ...category and nativity (US born vs non-US born) status. Baseline data was used from a randomized clinical trial evaluating the efficacy of an obesity preventive intervention in Hispanic youth. Participants were 280 Hispanic parents (11.8% males, 88.2% females, M
age
=41.87 ± 6.49; M
Body Mass Index (BMI)
=30.62 ± 5.68) and their adolescents (47.9% males, 52.1% females, M
age
=13.01 ± 0.83; M
BMI Percentile
=94.55 ± 4.15). Intake of added sugar, dairy, whole grains, and fruits/vegetables were obtained. Participants were categorized into four acculturation categories based on Berry's acculturation model: Marginalization, Integration, Separation, and Assimilation. Results indicated that sugar intake was significantly higher than the recommendations among all adolescents' cultural categories but not in parents. Among adolescents the consumption of whole grains was lower in integration and assimilation, dairy was lower in integration, separation, and assimilation, and fruits/vegetables was lower among marginalization, integration, and assimilation categories than the recommendations. Parents' daily intake of whole grains, dairy, and fruits/vegetables were significantly lower than the recommendations across all the acculturation categories. Participants did not meet the healthy recommendations for cancer prevention regardless of their acculturation and nativity status.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Chronic obstructive pulmonary disease (COPD) is a disease associated with dyspnea, fatigue, and exercise intolerance. The degree of functional debility and level of exercise capacity greatly ...influences quality of life and mortality in patients with COPD, and the measures of exercise capacity are to be an integral part of patient assessment but often not feasible in routine daily practice, resulting in likely suboptimal care. There is a need for simple ways to identify functional decline in the clinical setting in order to guide resources to preventive interventions or proper care, including palliative care. Gait speed, or measuring how long it takes for a patient to walk a short distance, takes very little time and space, and can serve as a candidate measure of physical function in COPD. Gait speed has been shown to be an indicator of disability, health care utilization, and survival in older adults. It is a simple, reliable, and feasible measure to perform in the clinic and has been promoted as the next vital sign, providing insight into patients' functional capacity. Gait speed is mainly determined by exercise capacity but reflects global well-being as it captures many of the multisystemic effects of disease severity in COPD rather than pulmonary impairment alone. It is an excellent screening measure for exercise capacity and frailty; in COPD, the usual gait speed (4-m course with rolling start) has been very accurate in identifying clinically relevant benchmarks of the 6-minute walk test, poor (<350 m) and very poor (<200 m) 6-minute walk test distances. A specific cut-off point of 0.8 m · s(-1) had a positive predictive value of 69% and negative predictive value of 98% in predicting very poor exercise capacity. The increasing evidence on gait speed is promising as a simple test that can inform the clinician about many important functional aspects of the COPD patient. Further work will likely show the strength of gait speed as a predictive marker of hospitalizations, re-admissions, and mortality. Instead of relying on the "eyeball test" regarding the patient's frailty or exercise capacity, a gait speed in its simplicity represents a much more solid assessment. Furthermore, repeat measures over serial clinic visits may show a pattern and further guide a change in therapy, whether it be medications, rehabilitation, or even initiation of palliative care discussions.
Abstract Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD which increases their risk of ...postoperative complications and their likelihood of being considered “inoperable.” Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention to decrease surgical morbidity but there is no established protocol and no randomized study has been published to date. We tested two preoperative PR interventions in patients undergoing lung cancer resection and with moderate-severe COPD in a randomized single blinded design. Outcomes were length of hospital stay and postoperative complications. The first study tested 4 weeks of guideline-based PR vs. usual care: that study proved to be very difficult to recruit as patients and providers were reluctant to delay surgery. Nine patients were randomized and no differences were found between arms. The second study tested ten preoperative PR sessions using a customized protocol with nonstandard components (exercise prescription based on self efficacy, inspiratory muscle training, and the practice of slow breathing) ( n = 10) vs. usual care ( n = 9). The PR arm had shorter length of hospital stay by 3 days ( p = 0.058), fewer prolonged chest tubes (11% vs. 63%, p = 0.03) and fewer days needing a chest tube (8.8 vs. 4.3 days p = 0.04) compared to the controlled arm. A ten-session preoperative PR intervention may improve post operative lung reexpansion evidenced by shorter chest tube times and decrease the length of hospital stay, a crude estimator of post operative morbidity and costs. Our results suggest the potential for short term preoperative pulmonary rehabilitation interventions in patients with moderate-severe COPD undergoing curative lung resection. 4 weeks of conventional preoperative PR seems non feasible.
The measurement of daily physical activity (PA) has become a significant outcome in patients with chronic obstructive pulmonary disease (COPD). Recent data have shown the independent association ...between PA markers, hospitalizations, and mortality. Daily PA can be quantified by direct observation, assessment of energy expenditure, questionnaires, and activity monitors (motion sensors). This review aims to describe the methods used to quantify daily PA in COPD on the basis of the published literature and to suggest potential applications of activity monitoring methods in clinical research and daily care of COPD patients.
There is no conclusive evidence about the way to a promote behavior change in self-management programs for patients with chronic obstructive pulmonary disease (COPD). The latter is a significant ...knowledge gap as there is a need to promote a sustained effect in interventions like Pulmonary Rehabilitation or Supporting Programs. Embracing patient’s values seems to be a key ingredient to ignite genuine motivation for behavior change. This manuscript describes two pilot qualitative studies carried out in patients with severe COPD aimed to engage the patient inner experience and promote self-management: a trial testing motivational interviewing (MI) as one style of helping patients with severe COPD make changes in their behavior and second a trial testing a mindfulness-based intervention. The MI study consisted of a 3-month program of weekly coaching phone calls after one face-to-face visit. The following themes were outstanding: patients value the supportive communication with coach and believe the MI-based coaching created increased level of awareness and accountability. They perceived an increase in physical activity and reported “feeling better” or other benefits not directly related to exercise. The Mindfulness for Health Program was a mandatory 8-week program that consisted on 2-hour classes aimed to cultivate nonjudgmental attention in the moment (through different meditative practices and sharing) plus monthly face-to-face encounters aimed to sustain practice and sharing of life experiences for 1 year. The following themes (at 1 year) were outstanding: appreciating life by seeing hardships as opportunities, valuing the self through compassion and awareness, cultivating connectedness with others, acquiring joy, and adopting healthy behaviors. In the search for the “holy grail” for self-management programs that can promote a behavior change, mindfulness and MI seem promising for cultivating a way to live a life in which people are fully present and consciously agree with.
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