Efficacy of Alternative Cardiac Rehabilitation Delivery Formats in Improving Psychological Symptoms after Coronary Artery Bypass Grafting

Background: Health-care systems always strive for alternative cardiac rehabilitation (CR) models to ensure that options available to patients better fit their needs, risk factor profiles, and preferences. We assessed the effects of hospital-based cardiac rehabilitation (HBCR) and hybrid cardiac rehabilitation (HCR) on psychological symptoms (i.e., anxiety, depression, and stress) among patients following coronary artery bypass graft surgery (CABG). Methods: This cross-sectional study recruited 115 CABG patients who were referred to the Department of Cardiac Rehabilitation at Imam Ali Hospital in the Iranian city of Kermanshah between January and May 2016. The patients were assigned to 1 of the 2 programs of HBCR (26 sessions) and HCR (10 sessions). The study population’s psychological symptoms were assessed using the Depression, Anxiety, and Stress Scale (DASS) before and after the intervention, and the data were analyzed using paired t-tests and ANCOVA. Results: A total of 105 (91%) patients concluded the CR program. Respectively, 50.8% and 26.2% of the participants in the HBCR and HCR programs were female. The mean age was 59.6±9.2 years in the HBCR group and 58.7±6.1 years in the HCR group. The ANCOVA results indicated that both HBCR and HCR programs were equally effective in reducing anxiety (P=0.001 vs. P=0.015) and stress (P=0.002 vs. P=0.003) among the CABG patients, while only HBCR was effective in alleviating depressive symptoms (P=0.001). Conclusion: Our results demonstrated the efficacy of HBCR and HCR in diminishing stress and anxiety levels among the CABG patients. However, depression was affected only by HBCR.  

Subjective correlates of stress management in outpatient cardiac rehabilitation: the predictive role of perceived heart risk factors

Introduction: The causal attributions and perceived risk factors can affect patients’ health behaviors. Therefore, the present study aimed to assess (i) the effect of an outpatient cardiac rehabilitation (CR) program on perceived heart risk factors (PHRFs) and on psychological stress, and (ii) the role of changes of PHRFs at pre-post CR in predicting changes in psychological stress.

Methods: In this longitudinal study, 110 CR patients were assessed from June to November 2016 in a hospital in Iran. Perceived heart risk factors and perceived stress were investigated using the PHRFs scale and the Depression, Anxiety, Stress Scale-21, respectively. PHRFs and DASS-21 Stress scale scores were compared before and after 26 sessions of exercise-based CR through paired sample t-tests. In addition, we investigated the effect of PHRF’s change scores on DASS-21 Stress scale scores using linear regression analysis.

Results: Results showed that CR has a little impact in improving the patients’ perception of heart risk factors, However, CR is significantly effective in reducing stress (P < 0.05). Regression analysis evidenced that improvements in patients’ perception of risk factors can significantly predict a reduction in psychological stress (P = 0.030). The model explained 11.2% of the variance in the results.

Conclusion: PHRFs appear to be significant predictive components of CR’s stress reduction. Practitioners should focus on patients’ perception of risk factors to facilitate stress management in CR program.

Exploring the perceived factors that affect self-medication among nursing students: a qualitative study

Background

Self-medication is the use of one or more medications without physician’s diagnosis, opinion, or prescription and supervision, which includes the use of herbal or chemical drugs. Todays, self-medication is one of the biggest socio-health and economic problems among nursing students of various societies, including Iran, and because this issue can affected by contextual factors, this study aimed to explore the perceived factors that affect self-medication among nursing students.

Methods

In this qualitative study, a semi-structured interview was conducted with 11 nursing students. The transcript of each interview was reviewed several times and classified into main categories and sub-categories by content analysis. To evaluate this study, Guba and Lincoln’s four criteria, including credibility, transferability, dependability, and confirmability were considered for trustworthiness.

Results

After analyzing the qualitative content of the interviews, four main categories, including educational backgrounds, nature of the disease, access to the media, and beliefs and personal experiences, and ten subcategories, including contact with clinical environment, relative knowledge about medications, simplicity of the disease, recurrence of the disease, influence of the media, use of the internet, believing in own knowledge, positive experiences of traditional medicine, and using own and others’ experiences, were extracted.

Conclusions

It seems that, having a relative awareness about various diseases and medications, which is sometimes associated with taking a few educational courses with an internship, creates a false confidence in student for self-medication and prescribing drugs to others. It would be beneficial if the education system and associated tutors could inform the students about the possible consequences of this issue. By knowing the internal and subjective factors that influence the self-medication, this arbitrary practice can be largely prevented.

Barriers for the referral to outpatient cardiac rehabilitation: A predictive model including actual and perceived risk factors and perceived control

OBJECTIVE

To assess the roles of demographic factors, actual and perceived risk factors, and perceived control in the referral to cardiac rehabilitation (CR) after coronary artery bypass graft (CABG).

METHODS

In this cross-sectional study, data related to 312 CABG patients in a hospital of the Western part of Iran, gathered through demographics and actual risk factors' checklist, open single item of perceived heart risk factors, life stressful events scale, and perceived control questionnaire. Data analyzed by binary logistic regression.

RESULTS

The results showed that only 8.3% of CABG patients refer to CR. The facilitators of this referral included official employment (P < 0.05), coronary history (P = 0.016), and hyperlipidemia (P = 0.030) but more distance to the CR center (P = 0.042) and perceived physiological risk factor (P = 0.025) are concerned as the barriers for the referral to CR.

CONCLUSION

Providing appropriate awareness about the benefits of CR for patients with regard to their job status, coronary history, and perception about the illness risk factors can be effective in referral to CR. In addition, the presence of CR centers in towns and facilitated achievement to these centers can play a significant role in patients' participation.

Musculoskeletal Disorders as Common Problems among Iranian Nurses: A Systematic Review and Meta-analysis Study

BACKGROUND

Considering the importance of musculoskeletal disorders (MSDs) as one of the health consequences of job stress among nurses and significant contradictions in prevalence in different parts of the body, this study was carried out to determine the prevalence of MSDs among Iranian nurses.

METHODS

All published studies from June 2000 until June 2015 were considered in reliable databases such as PubMed, Google Scholar, Google search, Scopus, ScienceDirect, and Persian databases such as SID, Iran Medex, and Magiran. These studies, after quality control, were entered into meta-analysis using the random effects model, a total of 41 papers were assessed between 2004 and 2015.

RESULTS

The prevalence rate of these disorders was 60.98%, 47.76%, 46.53%, 44.64%, 42.8%, 36.8%, 24.61%, and 17.5%, respectively, obtained for the back, neck, knees, upper back, ankles, shoulders, hands, hips, thighs, and elbows. Prevalence of MSDs will lead to high costs of medical, absenteeism from work, or even unemployment.

CONCLUSIONS

Due to high prevalence of these disorders among Iranian nurses, providing effective training in the field of ergonomics and undergoing appropriate exercises are necessary to control it.

Prevalence of burnout among nurses in Iran: a systematic review and meta-analysis

AIM

This study aimed to summarize the available information in the literature to make an accurate estimate of the prevalence of burnout among Iranian nurses.

BACKGROUND AND INTRODUCTION

Burnout is a work-related stress syndrome that has negative impact on healthcare providers, patients and healthcare delivery systems.

METHOD

A comprehensive search of literature using international [PubMed, Scopus and the Institute for Scientific Information (ISI)] and Iranian scientific data bases [Scientific Information Database (SID), IranMedex and Magiran] was conducted to identify English and Persian language studies, published between 2000 and 2016, that examined the prevalence of burnout among nurses in Iran. The I-squared test and Chi-squared-based Q-test suggested heterogeneity of reported prevalence among the qualified studies; thus, a random-effects model was applied to estimate the overall prevalence of burnout among nurses in Iran.

RESULTS

Based on 21 selected articles with 4180 participants, the overall prevalence of burnout among Iranian nurses was estimated to be 36% [95% confidence interval (CI), 20-53%] in Iran. Meta-regression indicated that sample size and year of data collection, mean age of samples, female to male ratio and geographic regions were not statistically significantly associated with the prevalence of burnout. Also, based on Egger's test and funnel plot, there is no publication bias among studies included in the analysis.

CONCLUSION

Professional burnout affects more than one-third of nursing staff in Iran; thus, effective interventions and strategies are required to reduce and prevent burnout among nurses.

IMPLICATION FOR NURSING AND HEALTH POLICY

Due to the negative consequences of burnout on patients, nurses and organizations, nursing and healthcare managers should intervene to prevent and reduce burnout among nurses in Iran. Policy attention should focus on developing effective interventions to prevent and minimize the burden of burnout among nurses in Iran. Nurses' involvement in the policy-making process is crucial in the implementation of effective programs and initiatives tailored to address the higher prevalence of burnout among Iranian nurses.

A hybrid cardiac rehabilitation is as effective as a hospital-based program in reducing chest pain intensity and discomfort

Background

Health care services effort to provide alternative cardiac rehabilitation (CR) models to serve patients according to their preferences and needs. So, the present study aimed to assess and compare the effects of hospital-based and hybrid CR programs on chest pain intensity and discomfort in cardiac surgery patients.

Methods

In this prospective study, 110 cardiac surgery patients were invited to the CR department of a hospital in the western part of Iran between March and July 2016. Patients were divided into two groups: hospital-based and hybrid CR. The hospital-based program included 26 sessions, and the hybrid program included 10 training sessions and exercise. The Brief Pain Inventory and Pain Discomfort Scale were used as research instrument, and data were analyzed using the paired t-test and ANCOVA.

Results

The results indicated that both hospital-based and hybrid CR are effective in reducing the chest pain intensity and discomfort of cardiac surgery patients (P < 0.05). In addition, the comparison of scores before and after treatment using ANCOVA shows that no significant differences were observed between the two programs (P > 0.05).

Conclusions

Traditional hospital-based CR delivery is still the first choice for treatment in developing countries. However, hybrid CR is as effective as a hospital-based program in reducing pain components and it includes only 38% of the total cost in comparison to hospital-based delivery. So, we recommend using hybrid CR according with the recommendations of American Heart Association about using CR for the management of angina symptoms.

Coronary artery bypass graft patients' perception about the risk factors of illness: Educational necessities of second prevention

Background:

Patients’ beliefs about the cause of cardiac disease (perceived risk factors) as part of the global psychological presentation are influenced by patients’ health knowledge. Hence, the present study aimed to assess the relationship between actual and perceived risk factors, identification of underestimated risk factors, and indication of underestimation of every risk factor.

Materials and Methods:

In this cross-sectional study, data of 313 coronary artery bypass graft (CABG) patients admitted to one hospital in the west of Iran were collected through a demographic interview, actual risk factors’ checklist, open single item of perceived risk factors, and a life stressful events scale. Data were analyzed by means of Spearman's correlation coefficients and one-sample Z-test for proportions.

Results:

Although there are significant relations between actual and perceived risk factors related to hypertension, family history, diabetes, smoking, and substance abuse (P < 0.05), there is no relation between the actual and perceived risk factors, and patients underestimate the role of actual risk factors in disease (P < 0.001). The patients underestimated the role of aging (98.8%), substance abuse (95.2%), overweight and obesity (94.9%), hyperlipidemia (93.1%), family history (90.3%), and hypertension (90%) more than diabetes (86.1%), smoking (72.5%), and stress (54.7%).

Conclusion:

Cardiac patients seem to underestimate the role of aging, substance abuse, obesity and overweight, hyperlipidemia, family history, and hypertension more than other actual risk factors. Therefore, these factors should be highlighted to patients to help them to (i) increase the awareness of actual risk factors and (ii) promote an appropriate lifestyle after CABG surgery.

Evaluating service quality in the higher education sector in Iran: an examination of students’ perspective

Purpose

Education is a human right and access to high quality education is key to sustainable socioeconomic development. Improving the quality of higher education institutes is essential for generating the productive human resources. Assessing the quality of higher education from the students’ perspective can be considered a crucial factor in the monitoring of service quality in universities. The purpose of this paper is to evaluate the quality of educational services in a higher education institute, the Kermanshah University of Medical Sciences (KUMS), in the west of Iran.

Design/methodology/approach

A multistage sampling method was used to select 346 students from the KUMS, who were enrolled in the second semester of the academic year 2015-2016. The SERVQUAL questionnaire was used to gather data on students’ perceptions and their expectations about the quality of educational services. The authors used a statistical significance level of 0.05 to examine the gap between the students’ expectations and their perceptions of service quality in five dimensions, namely tangibles, responsiveness, reliability, empathy and assurance.

Findings

The results showed that there was a negative service quality gap in all five dimensions. The overall mean score of students’ expectations and their perceptions was 3.19±0.44 and 2.4±0.45, respectively. The score gap between the overall mean score of perceptions and expectations of students was −0.79, which was statistically significant (p<0.0001). The highest and lowest quality gaps were related to the assurance (−0.84) and tangible (−0.70) dimensions, respectively.

Originality/value

The study indicated that the quality of educational services provided in the KUMS did not meet students’ expectations in five dimensions of service quality. Thus, it warrants further investigations to determine how to improve the quality of educational services in higher education institutes such as the KUMS.

The Role of Oral Contraceptive Pills on Increased Risk of Breast Cancer in Iranian Populations: A Meta-analysis

BACKGROUND

Cancer is one of the main public health issues in the world. Breast cancer is one of the most common types of cancer among women. It is also the second cause of mortality in women. The association between the use of oral contraceptive pills and breast cancer is controversial and a main issue in public health. Some findings have shown that taking these pills does not have a significant effect in increasing the risk of breast cancer, while others have confirmed the carcinogenic effect of these products. These contradictory findings necessitated this meta-analysis, through of all correlated studies in Iran.

METHODS

All published studies were considered from June 2000 until June 2015, using reliable Latin databases like PubMed, Google Scholar, Google search, Scopus, and Science Direct, and Persian database like SID, Irandoc, IranMedex, and Magiran. Finally, 26 papers were selected: 24 studies were case control while two were population based studies. A total of 26 papers with 46,260 participants were assessed since 2001.

RESULTS

Overall estimate of OR for the effect of oral contraceptive pills on breast cancer is 1.521 (CI = 1.25-1.85), which shows that the intervention group had more chance (52%) compared to the control group (P = 0.001). Using these pills increased the risk of breast cancer up to 1.52 times.

CONCLUSIONS

Because of directly increasing levels of estrogen and the role of estrogen in gaining weight indirectly, oral contraceptive pills can stimulate the occurrence of breast cancer. More studies should be conducted for controlling the period of pill use.

Autophagy levels are elevated in barrett's esophagus and promote cell survival from acid and oxidative stress

Autophagy is a highly conserved mechanism that is activated during cellular stress. We hypothesized that autophagy may be induced by acid reflux, which causes injury, and inflammation, and therefore, contributes to the pathogenesis of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). Currently, the role of autophagy in BE and EAC is poorly studied. We quantitatively define autophagy levels in human BE cell lines, a transgenic mouse model of BE, and human BE, and EAC biopsies. Human non-dysplastic BE had the highest basal number of autophagic vesicles (AVs), while AVs were reduced in normal squamous cells and dysplastic BE cells, and nearly absent in EAC. To demonstrate a functional role for autophagy in BE pathogenesis, normal squamous (STR), non-dysplastic BE (CPA), dysplastic BE (CPD), and EAC (OE19) cell lines were exposed to an acid pulse (pH 3.5) followed by incubation in the presence or absence of chloroquine, an autophagy inhibitor. Acid exposure increased reactive oxygen species (ROS) levels in STR and CPA cells. Chloroquine alone had a small impact on intracellular ROS or cell survival. However, combination of chloroquine with the acid pulse resulted in a significant increase in ROS levels at 6 h in STR and CPA cells, and increased cell death in all cell lines. These findings establish increased numbers of AVs in human BE compared to normal squamous or EAC, and suggest that autophagy functions to improve cell survival after acid reflux injury. Autophagy may thus play a critical role in BE pathogenesis and progression. © 2015 Wiley Periodicals, Inc.

The Effects of Transcutaneous Electrical Acupoint Stimulation (TEAS) on Fatigue in Haemodialysis Patients

INTRODUCTION

Fatigue is one of the most common symptom in End-stage renal disease (ESRD) patients receiving haemodialysis treatment. In recent years, researchers investigated the role of alternative medicine methods such as acupuncture in treatment of the chronic disease; however, there is a paucity of information regarding the fatigue of haemodialysis patients.

AIM

To evaluate the effects of Trans Cutaneous Electrical Acupoint Stimulation (TEAS) on fatigue among ESRD patients receiving haemodialysis treatment.

MATERIALS AND METHODS

This randomized clinical trial was conducted over a five month, in Kermanshah-Iran haemodialysis centers in 2009. Fifty six patients who had undergone haemodialysis and meeting the inclusion criteria, were divided into two groups by simple random sampling; TEAS (28 cases) and TEAS-Sham group (28 cases). The data was gathered through the Brief Fatigue Inventory (BFI), entered into SPSS-16 software and analysed by descriptive and inferential statistics.

RESULTS

Out of 56, 38 patients (67.9%) were male and 45 (80.4%) were married. The mean and standard deviation of age were 52.29±15.26 years. The inferential tests showed no differences in the clinical and the demographic characteristics of patients among two groups (p > 0.05). The mean rank of fatigue score in TEAS and TEAS-Sham groups was 30.68 and 26.32 respectively (p=0.317) at the first of study. The results of the Mann-Whitney U-test indicated that there were significant differences between the TEAS and Sham groups after intervention (p = 0.002).

CONCLUSION

Findings of the present study revealed that application of the TEAS on these acupoints had produced a better recovery rate of fatigue in TEAS group than Sham group after a course of ten session intervention. So, it is suggested that this plan be provided to the haemodialysis patients.

Surveying the effects of an exercise program on the sleep quality of elderly males

BACKGROUND

Old age is a stage of life featured with many physiological and mental changes. The Iranian population is aging, and one of the problems that the elderly are faced with is sleep disorders. The present study is an attempt to examine the effectiveness of an exercise program on the sleep quality of the elderly.

METHODS

A semi-experimental study was carried out on the elderly males referred to the Shahid Yari Elderly Center, Kermanshah, Iran. The sample group comprised of 46 participants: 23 in the experimental group and 23 in the control group. The study was carried out for a period of 2 months and follow-up was conducted every week. To improve the quality of sleep of the participants, a four-stage exercise program was implemented and the collected data were analyzed by SPSS version 20.

RESULTS

The results of a Mann-Whitney test showed that the quality of sleep of the majority in the experimental group improved compared with that of the control group (P<0.05). In addition, a Wilcoxon test showed improvement of the Petersburg's sleep quality index based on subelements and the results of a total score of sleep in the experimental group after the intervention.

CONCLUSION

The study showed effectiveness of scheduled exercising on the quality of sleep of the elderly. It is recommended, therefore, to add an exercise program to the daily program of the elderly.

Sociodemographic Predictors in Failure to Complete Outpatient Cardiac Rehabilitation

Objective

To investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR).

Methods

This was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis.

Results

Only 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001).

Conclusion

Paying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation.

Which Factors Unexpectedly Increase Depressive Symptom Severity in Patients at the End of a Cardiac Rehabilitation Program?

OBJECTIVE

To investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program.

METHODS

The design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis.

RESULTS

The results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance.

CONCLUSION

The results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables.

The relationship between brain behavioral systems and the characteristics of the five factor model of personality with aggression among Iranian students

Background:

Aggression is one of the negative components of emotion and it is usually considered to be the outcome of the activity of the Behavioral Inhibition and the Behavioral Activation System (BIS/BAS): components which can be considered as predisposing factors for personality differences. Therefore, the purpose of this study was to investigate the relationship between brain behavioral systems and the characteristics of the five factor model of personality with aggression among students.

Methods:

The present study has a correlation descriptive design. The research population included all of the Razi University students in the academic year of 2012-2013. The sampling was carried out with a random stratified method and 360 people (308 female and 52 male) were studied according to a table of Morgan. The study instruments were Buss and Perry Aggression Questionnaire, NEO Personality Inventory (Short Form), and Carver and White scale for BAS/BIS. Finally, SPSS20 was utilized to analyze the data using Pearson correlation, regression analysis, and canonical correlation.

Results:

The data showed a significant positive relationship between the neurosis and agreeableness personality factors with aggression; but there is a significant negative relationship between the extroversion, openness, and conscientiousness personality factors with aggression. Furthermore, there is a significant positive relationship between all the components of brain behavioral systems (impulsivity, novelty seeking, sensitivity, tender) and aggression. The results of regression analysis indicated the personality characteristics and the brain behavioral systems which can predict 29 percent of the changes to aggression, simultaneously.

Conclusions:

According to a predictable level of aggressiveness by the personality characteristics and brain behavioral systems, it is possible to identify the personality characteristics and template patterns of brain behavioral systems for the students which be presented to them as a necessary training in order to control and manage of anger and aggression.

U.S. Cohort Differences in Body Composition Outcomes of a 6-Month Pedometer-Based Physical Activity Intervention: The ASUKI Step Study

Background:

Regular physical activity (PA) enhances health and is an important factor in disease prevention and longevity. The 2008 U.S. Physical Activity Guidelines recommends that all healthy adults attain at least 150 minutes per week of moderate intensity aerobic PA (e.g., brisk walking) to maintain and promote PA.

Objectives:

This study determined the effects of a 6-month pedometer-based worksite walking intervention with participants focusing on a goal of achieving 10,000 steps per day, on body composition in adults with a wide range of body mass index (BMI) values and compares the changes with outcomes of similar studies.

Materials and Methods:

The design was a single group, quasi-experimental study. All participants received a pedometer and were asked to register the daily number of steps. Men and women (n = 142; age = 41 ± 11.5 years; BMI = 27.2 ± 7.25 kg.m^-2) received body composition measures at 1, 3, and 6 months. A multilevel growth modeling approach was used to explore change over time and to predict change by steps, age, gender, and fat category categorized as normal and overweight/obese.

Results:

Significant individual differences in linear slopes and change over time were observed for waist circumference (WC) (-3.0 cm) only in unconditional model (t = -0.67, P = 0.02).

Conclusions:

A 3.0 cm loss in WC shows that a 10,000 step per day walking program has the potential to influence changes in body composition measures that are correlated with adverse health outcomes. While significant changes did occur there are some limitations. The analysis did not consider the data regarding completing of 10,000 steps per day and other potential factors that could influence the results. Compliance to the walking dose and initial physical activity and body composition levels are important to consider when studying body composition changes in such programs.

Effects of a 6-Month Walking Study on Blood Pressure and Cardiorespiratory Fitness in U.S. and Swedish Adults: ASUKI Step Study

Purpose

The aim of this study was to assess the effects of a six-month pedometer-based workplace intervention on changes in resting blood pressure (BP) and cardiorespiratory fitness (CRF).

Methods

A subsample of ASUKI Step participants (n= 355) were randomly selected to have changes in their BP and CRF monitored during the intervention. Pedometers were used to monitor steps taken with a goal of walking more than 10,000 steps/day. Systolic and diastolic BP were taken using an Omron automated BP cuff. Estimated VO₂ max was obtained using the Åstrand-Rhyming cycle ergometer test. A multi-level growth modeling approach, and a mixed model ANOVA were used to predict changes in systolic and diastolic BP, and estimated VO₂ max over time by steps, age, gender, and university site.

Results

Steps/day averaged 12,256 (SD = 3,180) during month 1 and steadily decreased to month 6. There were significant linear and quadratic trends in systolic and diastolic BP over time. Age was positively related to initial starting values for systolic and diastolic BP, and approached significance for systolic BP changes over time. Steps/day approached significance for linear changes in systolic BP. There was a significant difference between ASU and KI participants’ estimated VO₂ max. There was a significant change over time in the estimated VO₂ max. The number of steps taken was significantly related to changes in estimated VO₂ max over time.

Conclusions

The results of the present study indicate that healthy individuals who took part in a pedometer intervention improved several cardiovascular disease risk factors.

"ASUKI Step" pedometer intervention in university staff: rationale and design

BACKGROUND

We describe the study design and methods used in a 9-month pedometer-based worksite intervention called "ASUKI Step" conducted at the Karolinska Institutet (KI) in Stockholm, Sweden and Arizona State University (ASU) in the greater Phoenix area, Arizona.

METHODS/DESIGN

"ASUKI Step" was based on the theory of social support and a quasi-experimental design was used for evaluation. Participants included 2,118 faculty, staff, and graduate students from ASU (n = 712) and KI (n = 1,406) who participated in teams of 3-4 persons. The intervention required participants to accumulate 10,000 steps each day for six months, with a 3-month follow-up period. Steps were recorded onto a study-specific website. Participants completed a website-delivered questionnaire four times to identify socio-demographic, health, psychosocial and environmental correlates of study participation. One person from each team at each university location was randomly selected to complete physical fitness testing to determine their anthropometric and cardiovascular health and to wear an accelerometer for one week. Study aims were: 1) to have a minimum of 400 employee participants from each university site reach a level of 10,000 steps per day on at least 100 days (3.5 months) during the trial period; 2) to have 70% of the employee participants from each university site maintain two or fewer inactive days per week, defined as a level of less than 3,000 steps per day; 3) to describe the socio-demographic, psychosocial, environmental and health-related determinants of success in the intervention; and 4) to evaluate the effects of a pedometer-based walking intervention in a university setting on changes in self-perceived health and stress level, sleep patterns, anthropometric measures and fitness.Incentives were given for compliance to the study protocol that included weekly raffles for participation prizes and a grand finale trip to Arizona or Sweden for teams with most days over 10,000 steps.

DISCUSSION

"ASUKI Step" is designed to increase the number of days employees walk 10,000 steps and to reduce the number of days employees spend being inactive. The study also evaluates the intra- and interpersonal determinants for success in the intervention and in a sub-sample of the study, changes in physical fitness and body composition during the study.

TRIAL REGISTRATION

Current Controlled Trials NCT01537939.