The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone.
To compare the effect of a long-term, structured ...physical activity program with that of a health education intervention on the proportion of patient assessments indicating major mobility disability (MMD) (that is, MMD burden) and on the risk for transitions into and out of MMD.
Single-blinded, parallel-group, randomized trial. (ClinicalTrials.gov: NCT01072500).
8 U.S. centers between February 2010 and December 2013.
1635 sedentary persons, aged 70 to 89 years, who had functional limitations but could walk 400 m.
Physical activity (n = 818) and health education (n = 817).
MMD, defined as the inability to walk 400 m, was assessed every 6 months for up to 3.5 years.
During a median follow-up of 2.7 years, the proportion of assessments showing MMD was substantially lower in the physical activity (0.13 95% CI, 0.11 to 0.15) than the health education (0.17 CI, 0.15 to 0.19) group, yielding a risk ratio of 0.75 (CI, 0.64 to 0.89). In a multistate model, the hazard ratios for comparisons of physical activity with health education were 0.87 (CI, 0.73 to 1.03) for the transition from no MMD to MMD; 0.52 (CI, 0.10 to 2.67) for no MMD to death; 1.33 (CI, 0.99 to 1.77) for MMD to no MMD; and 1.92 (CI, 1.15 to 3.20) for MMD to death.
The intention-to-treat principle was maintained for MMD burden and first transition out of no MMD, but not for subsequent transitions.
A structured physical activity program reduced the MMD burden for an extended period, in part through enhanced recovery after the onset of disability and diminished risk for subsequent disability episodes.
National Institute on Aging, National Institutes of Health.
Affective responses are posited to be key predictors of the uptake and maintenance of health behaviors. However, few studies have examined how individuals’ affective response to physical activity, as ...well as the degree to which their affect response changes, may predict changes in physical activity and sedentary time during behavioral weight loss treatment.
The current study examined how baseline momentary affective response (i.e., stress and anxiety) to moderate-to-vigorous physical activity (MVPA) and the degree of pre--post intervention change in this response predicted change in daily sedentary, light, and MVPA time during a three-month internet-based weight loss program.
Women with overweight/obesity (final N = 37) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after the intervention.
Women who had more reinforcing responses to MVPA (i.e., greater reductions in anxiety and stress response following MVPA bouts) at baseline had greater increases in overall MVPA at the end of the intervention. Those who had greater anxiety reductions after MVPA bouts at baseline also evidenced less sedentary time at the end of the intervention. Changes in affective responses across the intervention were not related to changes in physical activity levels.
Findings suggest initial levels of affective reinforcement from MVPA bouts predict future change in MVPA and sedentary time during behavioral weight loss. Future work is needed to examine the utility of more precisely targeting affective responses to physical activity to optimize intervention approaches.
•Affect response to physical activity (PA) may contribute to PA uptake and maintenance.•Women with overweight/obesity were assessed at the beginning and end of a weight loss program.•Ecological momentary assessment and accelerometers measured affect response to PA.•More improvement in stress and anxiety after PA predicted better PA outcomes.•Changes in affective response to PA were not related to PA outcomes.
CATH version 3.3 (class, architecture, topology, homology) contains 128 688 domains, 2386 homologous superfamilies and 1233 fold groups, and reflects a major focus on classifying structural genomics ...(SG) structures and transmembrane proteins, both of which are likely to add structural novelty to the database and therefore increase the coverage of protein fold space within CATH. For CATH version 3.4 we have significantly improved the presentation of sequence information and associated functional information for CATH superfamilies. The CATH superfamily pages now reflect both the functional and structural diversity within the superfamily and include structural alignments of close and distant relatives within the superfamily, annotated with functional information and details of conserved residues. A significantly more efficient search function for CATH has been established by implementing the search server Solr (http://lucene.apache.org/solr/). The CATH v3.4 webpages have been built using the Catalyst web framework.
Purpose of Review
The purpose of this review paper is to provide an overview of the recent research using physical activity monitors in rheumatic populations including those with osteoarthritis, ...rheumatoid arthritis, systemic lupus erythematosus, and fibromyalgia.
Recent Findings
Recent research demonstrates increased use of physical activity monitors in these populations, especially in those with osteoarthritis. Results from cross-sectional, longitudinal, and intervention studies highlight that physical activity levels are below recommended guidelines, yet evidence suggests benefits such as improving pain, fatigue, function, and overall well-being.
Summary
While the use of physical activity monitors in rheumatic populations is increasing, more research is needed to better understand physical activity levels in these populations, the effects of activity on relevant clinical outcomes, and how monitors can be used to help more individuals reach physical activity guidelines.
Study designThis is a descriptive qualitative study.ObjectivesTo explore recommended strategies employed by healthcare providers to support individuals with SCI in weight management.SettingFourteen ...veteran administration hospitals in the United States and the Shirley Ryan AbilityLab (SRALab) SCI Model Systems in Illinois.MethodsSemi-structured interviews were conducted with interprofessional SCI providers involved in weight management with individuals living with SCI. Thematic analysis methods were used.ResultsA total of 25 interprofessional providers were interviewed. Providing clinical expertise to assist in weight management included (1) checking progress or status of weight over time, (2) monitoring and tracking other health-related indicators, (3) stressing weight-related health risks, (4) providing education, (5) encouraging healthy behaviors, and (6) identifying and accessing resources. Fostering provider–patient relationships included (1) establishing and maintaining rapport and (2) tailoring/individualizing weight management treatment. Coordinating a team approach included (1) involving a dietitian or nutritionist, (2) communicating the same message, and (3) involving the informal caregiver/family.ConclusionWeight management strategies should incorporate patient preferences and goals, informed through provider expert and personalized clinical advice, and supported within the context of interprofessional team collaboration that includes caregivers and family.
Objective To determine the extent to which validated techniques for behavior change have been infused in commercially available fluid consumption applications (apps). Materials and Methods Coders ...evaluated behavior change techniques represented in online descriptions for 50 fluid consumption apps and the latest version of each app. Results Apps incorporated a limited range of behavior change techniques (<20% of taxonomy). The number of techniques varied by operating system but not as a function of whether apps were free or paid. Limitations include the lack of experimental evidence establishing the efficacy of these apps. Conclusion Patients with urolithiasis can choose from many apps to support the recommended increase in fluid intake. Apps for iOS devices incorporate more behavior change techniques compared to apps for the Android operating system. Free apps are likely to expose patients to a similar number of techniques as paid apps. Physicians and patients should screen app descriptions for features to promote self-monitoring and provide feedback on discrepancies between behavior and a fluid consumption goal.
Objective
Physical activity has numerous benefits for those with symptomatic knee osteoarthritis (KOA) or knee replacement, yet many individuals engage in insufficient activity. The purpose of this ...study was to explore beliefs about sedentary behavior, barriers to standing, and program preferences for adults with symptomatic KOA or knee replacement.
Methods
Forty‐two individuals ≥50 years with symptomatic KOA or knee replacement completed an online survey assessing current knee pain and function, sitting time, physical activity participation, beliefs about sedentary behavior, and preferences for a sedentary reduction program.
Results
Participants indicated barriers to standing were pain, discomfort, or working on a computer. Most participants shared interest to participate in a program to reduce sitting time. Participants chose education, self‐monitoring, and activity tracking as most preferable components for an intervention design.
Conclusion
Future interventions to reduce sedentary time may utilize these results to tailor programs for those with symptomatic KOA or knee replacement.
Aims and objectives
To examine perceived social and environmental barriers and facilitators for healthy eating and activity before and after knee replacement.
Background
Many patients undergoing knee ...replacement surgery are overweight or obese. While obesity treatment guidelines encourage diet and activity modifications, gaps exist in understanding social and environmental determinants of these behaviours for knee replacement patients. Identifying these determinants is critical for treatment, as they are likely amplified due to patients’ mobility limitations, the nature of surgery and reliance on others during recovery.
Design
This qualitative study used semi‐structured interviews.
Methods
Twenty patients (M = 64.7 ± 9.8 years, 45% female, 90% Caucasian, body mass index 30.8 ± 5.5 kg/m2) who were scheduled for or had recently undergone knee replacement were interviewed. Participants were asked to identify social and environmental factors that made it easier or harder to engage in healthy eating or physical activity. Deidentified transcripts were analysed via constant comparative analysis to identify barriers and facilitators to healthy eating and activity. This paper was written in accordance with COnsolidated criteria for REporting Qualitative research standards.
Results
Identified social and environmental healthy eating barriers included availability of unhealthy food and attending social gatherings; facilitators included availability of healthy food, keeping unhealthy options “out of sight,” and social support. Weather was the primary activity barrier, while facilitators included access to physical activity opportunities and social support.
Conclusions
Results provide salient factors for consideration by clinicians and behavioural programmes targeting diet, activity, and weight management, and patient variables to consider when tailoring interventions.
Relevance to clinical practice
Practitioners treating knee replacement patients would be aided by an understanding of patients’ perceived social and environmental factors that impede or facilitate surgical progress. Particularly for those directly interacting with patients, like nurses, physiotherapists, or other professionals, support from health professionals appears to be a strong facilitator of adherence to diet and increased activity.
Objective: The Make Better Choices 1 trial demonstrated that participants with unhealthy diet and activity behaviors who were randomized to increase fruits/vegetables and decrease sedentary leisure ...achieved greater diet and activity improvement than those randomized to change other pairs of eating and activity behaviors. Participants randomized to decrease saturated fat and increase physical activity achieved the least diet-activity improvement. This study examined which psychological mechanisms mediated the effects of the study treatments on healthy behavior change. Methods: Participants (n = 204) were randomized to 1 of 4 treatments: increase fruits/vegetables and physical activity; decrease saturated fat and sedentary leisure; decrease saturated fat and increase physical activity; increase fruits/vegetables and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. Mediational analyses were performed to examine whether changes in positive and negative affect, and self-efficacy, stages of readiness to change, liking, craving and attentional bias for fruit/vegetable intake, saturated fat intake, physical activity, and sedentary leisure explained the impact of the treatments on diet-activity improvement. Results: Greater diet-activity improvement in those randomized to increase fruits/vegetables and decrease sedentary leisure was mediated by increased self-efficacy (indirect effect estimate = 0.04; 95% bias corrected CI, 0.003-0.11). All treatments improved craving, stage of change and positive affect. Conclusion: Accomplishing healthy lifestyle changes for 3 weeks improves positive affect, increases cravings for healthy foods and activities, and enhances readiness to make healthy behavior changes. Maximal diet and activity improvement occurs when interventions enhance self-efficacy to make multiple healthy behavior changes.
This study examined the acute effect of a bout of walking on hunger, energy intake, and appetite-regulating hormones acylated ghrelin and glucagon-like peptide-1 (GLP-1) in 19 overweight/obese women ...(BMI: 32.5
±
4.3
kg/m
2). Subjects underwent two experimental testing sessions in a counterbalanced order: exercise and rest. Subjects walked at a moderate-intensity for approximately 40
min or rested for a similar duration. Subjective feelings of hunger were assessed and blood was drawn at 5-time points (pre-, post-, 30-, 60-, 120-min post-testing). Ad libitum energy intake consumed 1–2
h post-exercise/rest was assessed and similar between conditions (mean
±
standard deviation; exercise: 551.5
±
245.1
kcal 2.31
±
1.0
MJ vs. rest: 548.7
±
286.9
kcal 2.29
±
1.2
MJ). However, when considering the energy cost of exercise, relative energy intake was significantly lower following exercise (197.8
±
256.5
kcal 0.83
±
1.1
MJ) compared to rest (504.3
±
290.1
kcal 2.11
±
1.2
MJ). GLP-1 was lower in the exercise vs. resting condition while acylated ghrelin and hunger were unaltered by exercise. None of these variables were associated with energy intake. In conclusion, hunger and energy intake were unaltered by a bout of walking suggesting that overweight/obese individuals do not acutely compensate for the energy cost of the exercise bout through increased caloric consumption. This allows for an energy deficit to persist post-exercise, having potentially favorable implications for weight control.
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