1
|
Livzan MA, Lyalyukova EA, Druk IV, Safronova SS, Khalashte AA, Martirosian KA, Petrosian VY, Galakhov YS. Obesity: current state of the problem, multidisciplinary approach. (based on the consensus of the World Gastroenterological Organization “Obesity 2023” and the European guideline on obesity care in patients with gastrointestinal and liver diseases, 2022). EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2024:5-47. [DOI: 10.31146/1682-8658-ecg-218-10-5-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Obesity is the largest pandemic in the world, and its prevalence continues to increase. The purpose of the presented publication is to raise awareness of doctors about modern methods of diagnosing obesity and approaches to therapy, using an interdisciplinary team approach similar to that used in other chronic diseases, such as diabetes, heart disease and cancer. The article presents data from the World Gastroenterological Organization (2023) and the European Guidelines for the Treatment of Obesity in patients with diseases of the gastrointestinal tract and liver (2022). According to modern approaches, obesity should be considered as a chronic recurrent progressive disease, the treatment of which requires a comprehensive interdisciplinary approach involving psychologists and psychiatrists, nutritionists/nutritionists, therapists, endoscopists and surgeons, including lifestyle changes, a well-defined diet and exercise regimen, drug therapy, endoscopic or surgical methods of treatment. Conclusions. In order to stop the growing wave of obesity and its many complications and costs, doctors, insurance companies and health authorities should make systematic efforts to raise public awareness of both the adverse health risks associated with obesity and the potential reduction of risks through a comprehensive approach to therapy.
Collapse
|
2
|
Godziuk K, Prado CM, Forhan M. Protocol for the POMELO (Prevention Of MusclE Loss in Osteoarthritis) randomized pilot feasibility trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100312. [PMID: 36474794 PMCID: PMC9718278 DOI: 10.1016/j.ocarto.2022.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Individuals with advanced knee osteoarthritis (OA) and a large body size [a body mass index (BMI) ≥35 kg/m2] have a higher risk of complications with total knee arthroplasty (TKA), and hence may be ineligible for surgery unless they reduce their BMI. However, pre-TKA weight-loss has not been shown to reduce surgical infection risk and may inadvertently increase risk for muscle loss and development of sarcopenic obesity (low muscle and low strength with higher fat mass). This suggests that a knee OA management approach that doesn't focus on weight change (weight-neutral) may be beneficial. This study examines if a weight-neutral behavioural intervention is feasible and acceptable to participants, and improves muscle mass and physical function in comparison to usual care. Design This pilot randomized clinical trial compares a 12-week multimodal intervention [including targeted nutrition, progressive resistance exercise, and arthritis self-management support] to usual care. Co-primary outcomes are feasibility and acceptability, with secondary outcomes of change in lean soft tissue and physical function within and between groups at 3-months and 9-months from baseline. Change in waist circumference, fat mass, blood biomarkers, energy metabolism, OA-related pain and function, health-related quality of life, self-efficacy for arthritis management, and interest in pursuing a TKA within and between groups will be explored. Conclusion This study will inform future development of more personalized knee OA treatment approaches for adults with larger bodies. Further, this will contribute to effective alternative treatment pathways that reduce inequities in access to OA care for this understudied patient population.
Collapse
Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Paravlic AH, Meulenberg CJ, Drole K. The Time Course of Quadriceps Strength Recovery After Total Knee Arthroplasty Is Influenced by Body Mass Index, Sex, and Age of Patients: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865412. [PMID: 35692543 PMCID: PMC9174520 DOI: 10.3389/fmed.2022.865412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. Design General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps’ MVS pre-to post-surgery. Results Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps’ MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. Conclusion The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients’ recovery, further research should include specific analyses considering these moderators.
Collapse
Affiliation(s)
- Armin H. Paravlic
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Armin H. Paravlic,
| | - Cécil J. Meulenberg
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
| | - Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
4
|
Brady N, Lewis J, McCreesh K, Dejaco B, McVeigh JG. Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol. HRB Open Res 2022; 4:40. [PMID: 35155988 PMCID: PMC8808320 DOI: 10.12688/hrbopenres.13239.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/20/2022] Open
Abstract
Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. Virtual Reality has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.
Collapse
Affiliation(s)
- Niamh Brady
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Evolve Health, Cork, Ireland
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Beate Dejaco
- Sports Medical Centre Papendal, Arnhem, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | |
Collapse
|
5
|
Smith JD, Schroeder AN. Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Physical Therapy vs. Glucocorticoid Injection for Osteoarthritis of the Knee. Am J Phys Med Rehabil 2021; 100:e147-e152. [PMID: 33587453 DOI: 10.1097/phm.0000000000001715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jeffrey D Smith
- From the Department of Physical Medicine & Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (JDS); and Department of Physical Medicine & Rehabilitation, Mayo Clinic, Minneapolis, Minnesota (ANS)
| | | |
Collapse
|
6
|
Brady N, Lewis J, McCreesh K, Dejaco B, McVeigh JG. Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol. HRB Open Res 2021; 4:40. [PMID: 35155988 PMCID: PMC8808320 DOI: 10.12688/hrbopenres.13239.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/04/2023] Open
Abstract
Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. VR has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.
Collapse
Affiliation(s)
- Niamh Brady
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Evolve Health, Cork, Ireland
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Beate Dejaco
- Sports Medical Centre Papendal, Arnhem, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | |
Collapse
|
7
|
Maula A, LaFond N, Orton E, Iliffe S, Audsley S, Vedhara K, Kendrick D. Use it or lose it: a qualitative study of the maintenance of physical activity in older adults. BMC Geriatr 2019; 19:349. [PMID: 31830900 PMCID: PMC6909612 DOI: 10.1186/s12877-019-1366-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Lack of physical activity (PA) is a recognised global public health problem, which is increasing in prevalence with a detrimental impact on the pattern of disease worldwide. In the UK, older adults comprise the most sedentary group, with only 57% of males and 52% of females aged 65-74 years and 43% of males and 21% of females aged 75-84 years meeting PA recommendations. PA confers multiple health benefits including increased stamina, muscle, bone and joint strength, increased independence and reduced risk of falls in old age. Despite benefits experienced during time-limited PA programmes, increased PA is not always continued. This study aimed to provide a better understanding of PA maintenance behaviours in older people. METHODS Face to face semi-structured interviews were conducted with adults who completed one of two strength and balance exercise programmes as part of the ProAct65+ trial: group (FaME) and home based (OTAGO) exercises. Five GP practices in Nottingham and Derby were recruited and invited people aged 65 years and older who met eligibility criteria. Interviews were conducted in participants' homes. Interviews explored PA levels pre and post intervention, perceived health benefits, facilitators, barriers and use of technology for PA maintenance. The interviews were transcribed verbatim and analysed using framework analysis and the software NVivo10. RESULTS Fifteen participants from each intervention group were interviewed. The FaME group consisted of 10 females and 5 males, age range of 70-88 years. The OTAGO group consisted of 12 females and 3 males aged 72-95 years. Important themes identified were physical, social, psychological and environmental facilitators and barriers. These included increased physical autonomy, enjoyment, positive evaluation of the activity and physical benefits, importance of social interaction, positive feedback, development of behaviour considered normal or habitual, motivation and self-efficacy. Some participants used technologies not included in the original interventions, like pedometers and smart phones to motivate themselves. CONCLUSIONS A range of modifiable factors influence continued participation in PA at the end of exercise programmes. The findings from this study will inform the commissioning and quality improvement of future PA programmes and development of an intervention to enhance continuation of PA after exercise interventions in older adults.
Collapse
Affiliation(s)
- Asiya Maula
- School of Medicine, University of Nottingham, Floor 14 Room 1401, Tower building, University Park, Nottingham, NG7 2RD UK
| | - Natasher LaFond
- School of Medicine, University of Nottingham, Floor 14 Room 1401, Tower building, University Park, Nottingham, NG7 2RD UK
| | - Elizabeth Orton
- School of Medicine, University of Nottingham, Floor 14 Room 1401, Tower building, University Park, Nottingham, NG7 2RD UK
| | - Steve Iliffe
- Research department of Primary Care & Population Health, University College London, Gower Street, WC1E 6BT London, UK
| | - Sarah Audsley
- School of Medicine, University of Nottingham, Floor 14 Room 1401, Tower building, University Park, Nottingham, NG7 2RD UK
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Floor 14 Room 1401, Tower building, University Park, Nottingham, NG7 2RD UK
| | - Denise Kendrick
- School of Medicine, University of Nottingham, Floor 14 Room 1401, Tower building, University Park, Nottingham, NG7 2RD UK
| |
Collapse
|
8
|
Ledingham A, Cohn ES, Baker KR, Keysor JJ. Exercise adherence: beliefs of adults with knee osteoarthritis over 2 years. Physiother Theory Pract 2019; 36:1363-1378. [PMID: 30652930 DOI: 10.1080/09593985.2019.1566943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Exercise is an established treatment to alleviate pain and improve function among adults with knee osteoarthritis (KOA). However, long-term adherence to exercise is poor and effective approaches to support adherence are limited. Here, we report on an ancillary study to a randomized controlled trial (RCT) where the primary outcome was 2-year adherence to a home based strength-training program. The aims of this current study were to (i) explore experiences, feelings, and perspectives related to long-term adherence to exercise among adults with painful KOA participating in a 2-year RCT, and (ii) identify factors that influenced long-term adherence to exercise. Methods: We purposively recruited 25 subjects and conducted in-depth interviews at the 2-year RCT assessment. In the RCT participants completed a 6-week group exercise program followed by automated telephone calls. Findings: Three conceptual categories describing beliefs about exercise were identified: (1) monitoring; (2) knowledge of how to manage their exercise behaviors; and (3) benefits of exercise. Monitoring provided by peers and instructors during group exercise, and telephone technology were valued by participants. Participants who reported low adherence expressed ambivalence about the benefits of exercise and a desire for more social support. Those who reported high adherence exhibited self-determination and self-efficacy. Conclusions: A novel finding is the conceptual link of self-determination to high adherence to strength-training exercises over 2 years among adults with KOA. Implications for physical therapists include identifying patients' autonomy, competence, and relatedness needs to foster intrinsic control for exercise behavior.
Collapse
Affiliation(s)
- Aileen Ledingham
- Department of Physical Therapy, Boston University Sargent College of Health and Rehabilitation Sciences , Boston, MA, USA
| | - Ellen S Cohn
- Department of Occupational Therapy, Boston University Sargent College of Health and Rehabilitation Sciences , Boston, MA, USA
| | - Kristin R Baker
- Department of Health Sciences, Franklin Pierce University , Rindge, NH, USA
| | - Julie J Keysor
- Department of Physical Therapy, MGH Institute of Health Professions , Boston, MA, USA
| |
Collapse
|
9
|
Lin YH, Huang H. Eight-week of low-intensive lifestyle modification does improve insulin resistance in adults with metabolic syndrome. Diabetes Metab Syndr Obes 2019; 12:613-621. [PMID: 31118723 PMCID: PMC6509938 DOI: 10.2147/dmso.s201526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose: Improvements in insulin resistance have been observed by following lifestyle modification (LM) for adults with metabolic syndrome (MetS). However, these improvements are associated with relatively intensive and long-term duration LM, which is unlikely to be a part of routine practice for most people. This study examined the impact of a short-term (eight-week) low-intensive LM program on anthropomorphic parameters and insulin resistance in a community-based population. Patients and methods: A total of 174 adults (67 with MetS) were enrolled in this retrospective observational study. The effects of the eight-week LM program on anthropomorphic parameters and glucose homeostasis were investigated. Results: After the LM program, most anthropomorphic parameters in both groups were significantly improved (P<0.05). Glucose homeostasis significantly was improved (P<0.001) in the MetS group. A change in the homeostasis model assessment of insulin resistance (HOMA-IR) was positively associated with the baseline HOMA-IR level (R=0.75, P<0.001). Conclusion: A low-intensive eight-week LM program is an effective and efficient way to improve the anthropomorphic parameters and to reduce insulin resistance, especially for adults with MetS.
Collapse
Affiliation(s)
- Yi-Hsin Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hsuan Huang
- Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
- Correspondence: Hsuan HuangDepartment of Surgery, Mackay Memorial Hospital, No.424, Sec. 2, Bade Rd., Songshan District, Taipei10556, TaiwanTel +886 2 771 8151Email
| |
Collapse
|
10
|
Choi J, Choi JY, Shin A, Lee SA, Lee KM, Oh J, Park JY, Lee JK, Kang D. Trends and Correlates of High-Risk Alcohol Consumption and Types of Alcoholic Beverages in Middle-Aged Korean Adults: Results From the HEXA-G Study. J Epidemiol 2018; 29:125-132. [PMID: 30146528 PMCID: PMC6414807 DOI: 10.2188/jea.je20170296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background We aimed to report the prevalence and correlates of high-risk alcohol consumption and types of alcoholic beverages. Methods The baseline data of the Health Examinees-Gem (HEXA-G) study participants, including 43,927 men and 85,897 women enrolled from 2005 through 2013, were used for analysis. Joinpoint regression was performed to estimate trends in the age-standardized prevalence of alcohol consumption. Associations of demographic and behavioral factors, perceived health-related effects, social relationships, and the diagnostic history of diseases with alcohol consumption were assessed using multinomial logistic regression. Results The prevalence of alcohol consumption remained higher in men during the study period and increased in women. The amount of alcohol consumed has increased in women, especially that from beer and makgeolli, a traditional Korean fermented rice wine. Older participants were less likely to be high-risk drinkers (men and women who drink more than 40 or 20 g/day of alcohol, respectively) and drink Soju, a distilled liquor, and beer, and more likely to drink makgeolli. Educational level was negatively associated with high-risk drinking. However, it was positively associated with the consumption of strong spirits and wine. Smoking was associated with high-risk drinking and the consumption of soju and strong spirits. Engaging in regular exercise and having stress were associated with drinking all types of beverages except for soju. Conclusions Sex-specific trends in alcohol consumption were influenced by demographic, behavioral, and perceived health-related factors. The findings will help improve the understanding of alcohol-related problems and provide evidence for establishing country-specific policies and campaigns in Korea.
Collapse
Affiliation(s)
- Jaesung Choi
- Department of Biomedical Sciences, Seoul National University Graduate School
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National University Graduate School.,Department of Preventive Medicine, Seoul National University College of Medicine.,Cancer Research Institute, Seoul National University
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine.,Cancer Research Institute, Seoul National University
| | - Sang-Ah Lee
- Department of Preventive Medicine, Kangwon National University School of Medicine
| | - Kyoung-Mu Lee
- Department of Environmental Health, College of Natural Science, Korea National Open University
| | - Juhwan Oh
- JW Lee Center for Global Medicine, Seoul National University College of Medicine
| | - Joo Yong Park
- Department of Biomedical Sciences, Seoul National University Graduate School
| | - Jong-Koo Lee
- JW Lee Center for Global Medicine, Seoul National University College of Medicine.,Department of Family Medicine, Seoul National University College of Medicine
| | - Daehee Kang
- Department of Biomedical Sciences, Seoul National University Graduate School.,Department of Preventive Medicine, Seoul National University College of Medicine.,Cancer Research Institute, Seoul National University.,Institute of Environmental Medicine, Seoul National University Medical Research Center
| |
Collapse
|
11
|
Morais VP, Encantado J, Santos MI, Almeida P, Leal IP, Carvalho C. Increasing physical activity in older adults: Walking by prescription in primary care. PSYCHOLOGY, COMMUNITY & HEALTH 2017. [DOI: 10.5964/pch.v6i1.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim
The present study (PTDC/SAU-SAP/110799/2009) funded by the Portuguese Government (Fundação para a Ciência e Tecnologia – FCT) aimed to test the effectiveness of a behaviour based intervention combined with a cognitive based one, designed to increase physical activity levels in older adults at Primary Health Care Centres.
Method
A total of 108 participants aged over 65 years participated in the study. Participants were referred by their General Practitioner (GP) and randomized by gender and marital status at the moment they started the program (single vs. couple), and allocated into one of three conditions: goal intention, action planning, action planning and coping planning. All participants received a pedometer and a logbook and were asked to register their daily number of steps for a period of 24 weeks. Study follows a longitudinal design with five assessments over a 6-month after baseline.
Results
The test between subjects’ effects revealed an interaction between condition and participating in the study as single vs. couple. Older adults participating as singles walked more steps on average in the condition goal intention plus action planning and coping planning, whereas participants that entered in the study with their spouse, goal intention without any other planning intervention was the most effective intervention.
Conclusion
The 24-week physical activity program based on the recent developments of behavioural-cognitive framework, has proven useful increasing older adults daily walking behaviour.
Collapse
|
12
|
Harmelink KEM, Zeegers AVCM, Tönis TM, Hullegie W, Nijhuis-van der Sanden MWG, Staal JB. The effectiveness of the use of a digital activity coaching system in addition to a two-week home-based exercise program in patients after total knee arthroplasty: study protocol for a randomized controlled trial. BMC Musculoskelet Disord 2017; 18:290. [PMID: 28679400 PMCID: PMC5498982 DOI: 10.1186/s12891-017-1647-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is consistent evidence that supervised programs are not superior to home-based programs after total knee arthroplasty (TKA), especially in patients without complications. Home-based exercise programs are effective, but we hypothesize that their effectiveness can be improved by increasing the adherence to physical therapy advice to reach an adequate exercise level during the program and thereafter. Our hypothesis is that an activity coaching system (accelerometer-based activity sensor), alongside a home-based exercise program, will increase adherence to exercises and the activity level, thereby improving physical functioning and recovery. The objective of this study is to determine the effectiveness of an activity coaching system in addition to a home-based exercise program after a TKA compared to only the home-based exercise program with physical functioning as outcome. METHODS This study is a single-blind randomized controlled trial. Both the intervention (n = 55) and the control group (n = 55) receive a two-week home-based exercise program, and the intervention group receives an additional activity coaching system. This is a hand-held electronic device together with an app on a smartphone providing information and advice on exercise behavior during the day. The primary outcome is physical functioning, measured with the Timed Up and Go test (TUG) after two weeks, six weeks and three months. Secondary outcomes are 1) adherence to the activity level (activity diary); 2) physical functioning, measured with the 2-Minute Walk Test (2MWT) and the Knee Osteoarthritis Outcome Score; 3) quality of life (SF-36); 4) healthcare use up to one year postoperatively and 5) cost-effectiveness. Data are collected preoperatively, three days, two and six weeks, three months and one year postoperatively. DISCUSSION The strengths of the study are the use of both performance-based tests and self-reported questionnaires and the personalized tailored program after TKA given by specialized physical therapists. Its weakness is the lack of blinding of the participants to treatment allocation. Outcomes are generalizable to uncomplicated patients as defined in the inclusion criteria. TRIAL REGISTRATION The trial is registered in the Dutch Trial Register ( www.trialregister.nl , NTR 5109) (March 22, 2015).
Collapse
Affiliation(s)
- Karen E M Harmelink
- FysioHolland Twente, Geessinkbrink 7, 7544 CW, Enschede, the Netherlands. .,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - A V C M Zeegers
- Medisch Spectrum Twente (MST), Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - Thijs M Tönis
- Roessingh Research & Development (RRD), Telemedicine group, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - Wim Hullegie
- Fysiotherapie Hullegie & Richter, Geessinkbrink 7, 7544 CW, Enschede, the Netherlands
| | | | - J Bart Staal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| |
Collapse
|
13
|
Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J. Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence 2016; 10:1547-59. [PMID: 27574404 PMCID: PMC4990387 DOI: 10.2147/ppa.s103649] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adhering to weight loss interventions is difficult for many people. The majority of those who are overweight or obese and attempt to lose weight are simply not successful. The objectives of this study were 1) to quantify overall adherence rates for various weight loss interventions and 2) to provide pooled estimates for factors associated with improved adherence to weight loss interventions. METHODS We performed a systematic literature review and meta-analysis of all studies published between January 2004 and August 2015 that reviewed weight loss intervention adherence. RESULTS After applying inclusion and exclusion criteria and checking the methodological quality, 27 studies were included in the meta-analysis. The overall adherence rate was 60.5% (95% confidence interval [CI] 53.6-67.2). The following three main variables were found to impact adherence: 1) supervised attendance programs had higher adherence rates than those with no supervision (rate ratio [RR] 1.65; 95% CI 1.54-1.77); 2) interventions that offered social support had higher adherence than those without social support (RR 1.29; 95% CI 1.24-1.34); and 3) dietary intervention alone had higher adherence than exercise programs alone (RR 1.27; 95% CI 1.19-1.35). CONCLUSION A substantial proportion of people do not adhere to weight loss interventions. Programs supervising attendance, offering social support, and focusing on dietary modification have better adherence than interventions not supervising attendance, not offering social support, and focusing exclusively on exercise.
Collapse
Affiliation(s)
| | | | | | - Marla Rogers
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | |
Collapse
|
14
|
Stone RC, Baker J. Painful Choices: A Qualitative Exploration of Facilitators and Barriers to Active Lifestyles Among Adults With Osteoarthritis. J Appl Gerontol 2015; 36:1091-1116. [PMID: 26316267 DOI: 10.1177/0733464815602114] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Research has indicated physical activity and exercise can effectively attenuate biopsychosocial osteoarthritis-related symptoms in adults, more so than other management strategies; however, both leisure and structured physical activity are scarcely recommended by health care providers, and remain rarely adopted and adhered to in this patient population. Using qualitative interviews, the present study investigated potential facilitators and barriers to physical activity for adults with osteoarthritis. Fifteen participants (30-85 years of age) with osteoarthritis engaged in semi-structured interviews, which focused on experiences with physical activity/exercise, daily osteoarthritis management, and experiences with health professionals' recommendations. Analysis of the interview transcripts revealed that pain relief, clear health-related communication, and social support facilitated physical activity. Physical pain, psychological distress, and inadequate medical support were the most frequently expressed barriers. The present study supports the biopsychosocial nature of osteoarthritis, which may have important implications for advancing exercise as an effective and long-term intervention strategy in aging adults with osteoarthritis.
Collapse
|
15
|
Ahlgren C, Hammarström A, Sandberg S, Lindahl B, Olsson T, Larsson C, Fjellman-Wiklund A. Engagement in New Dietary Habits—Obese Women’s Experiences from Participating in a 2-Year Diet Intervention. Int J Behav Med 2015; 23:84-93. [DOI: 10.1007/s12529-015-9495-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
16
|
Feathers A, Aycinena AC, Lovasi GS, Rundle A, Gaffney AO, Richardson J, Hershman D, Koch P, Contento I, Greenlee H. Food environments are relevant to recruitment and adherence in dietary modification trials. Nutr Res 2015; 35:480-8. [PMID: 25981966 PMCID: PMC4767277 DOI: 10.1016/j.nutres.2015.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 11/25/2022]
Abstract
Few studies have examined the built environment's role in recruitment to and adherence in dietary intervention trials. Using data from a randomized dietary modification trial of urban Latina breast cancer survivors, we tested the hypotheses that neighborhood produce access could act as a potential barrier and/or facilitator to recruitment, and that a participant's produce availability would be associated with increased fruit/vegetable intake, one of the intervention's targets. Eligible women who lived within a higher produce environment had a non-significant trend towards being more likely to enroll in the trial. Among enrollees, women who had better neighborhood access to produce had a non-significant trend toward increasing fruit/vegetable consumption. As these were not a priori hypotheses to test, we consider these analyses to be hypothesis generating and not confirmatory. Results suggest that participants' food environment should be considered when recruiting to and assessing the adherence of dietary intervention studies.
Collapse
Affiliation(s)
- Alexandra Feathers
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ana C Aycinena
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Gina S Lovasi
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | | | - John Richardson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dawn Hershman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Pam Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Isobel Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| |
Collapse
|
17
|
Liu YL, Lu CW, Shi L, Liou YM, Lee LT, Huang KC. Low intensive lifestyle modification in young adults with metabolic syndrome a community-based interventional study in Taiwan. Medicine (Baltimore) 2015; 94:e916. [PMID: 26039125 PMCID: PMC4616347 DOI: 10.1097/md.0000000000000916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The study aims to find whether a low intensity lifestyle modification (LILM) program was effective to achieve weight reduction and improves metabolic syndrome in young adults. Our study prospectively enrolled young adults aged 30 to 45 years with metabolic syndrome in northeastern Taiwan from June 1, 2008 to December 31, 2009. The participants in the intervention group attended a LILM program for 6 months, which included 4 interactive group discussion sessions and weekly phone contact with volunteer counselors. Participants in the comparison group, however, attended only 1 noninteractive session on diet and physical activity. The main outcomes measured the weight reduction and prevalence of metabolic syndrome in intervention and comparison groups. Generalized estimating equation modeling was used to analyze the effects at baseline, during the study, and postcompletion of the program. Compared with comparison group, the intervention group showed significantly greater reductions in body weight (-2.95 ± 3.52 vs -0.76 ± 2.76 kg, P < 0.0001) and body mass index (-1.03 ± 1.25 vs -0.30 ± 1.16 kg/m(2), P < 0.0001). After adjustment for potential confounders, a modest decrease in body weight resulted in a statistically significant 43.32% resolution in the prevalence of metabolic syndrome in the intervention group compared with 33.64% in the comparison group (P < 0.01).The 6-month LILM program is not only effective in weight reduction but also an efficient intervention tool of metabolic syndrome in a community setting. The program with restricted manpower and limited medical resources can be practically transferred into primary care in rural area.
Collapse
Affiliation(s)
- Yi-Lien Liu
- From the Department of Family Medicine, National Taiwan University Hospital (Y-LL, C-WL, L-TL, K-CH); Department of Family Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan (Y-LL); Department of Health Policy and Management, Johns Hopkins School of Public Health, MD, USA (LS); Institute of Clinical and Community Health Nursing, and Laboratory of Physical Activity & Obesity Prevention, National Yang-Ming University Taipei (Y-ML); and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan (K-CH)
| | | | | | | | | | | |
Collapse
|
18
|
Khoja SS, Susko AM, Josbeno DA, Piva SR, Fitzgerald GK. Comparing physical activity programs for managing osteoarthritis in overweight or obese patients. J Comp Eff Res 2015; 3:283-99. [PMID: 24969155 DOI: 10.2217/cer.14.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Obesity is a well-known modifiable risk factor for osteoarthritis (OA) in weight-bearing joints, and is present in approximately 35% of individuals with OA. Obesity adds significant burden to individuals with OA and is associated with poorer functional status and greater disability. In addition to tackling OA-related impairments, such as pain and functional limitations, interventions in this population need to address bodyweight reduction, as well as promotion of active lifestyle behaviors. While exercise and regular physical activity participation are both recommended and beneficial for OA and obese populations, our current understanding of optimal strategies to improve function and health status in those who have both OA and obesity is limited. This review will summarize the current available evidence related to effectiveness of various physical activity interventions to reduce pain, improve function and overall health-related quality of life in overweight or obese individuals with OA.
Collapse
Affiliation(s)
- Samannaaz S Khoja
- Department of Physical Therapy, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | |
Collapse
|
19
|
Piva SR, Susko AM, Khoja SS, Josbeno DA, Fitzgerald GK, Toledo FGS. Links between osteoarthritis and diabetes: implications for management from a physical activity perspective. Clin Geriatr Med 2015; 31:67-87, viii. [PMID: 25453302 PMCID: PMC4254543 DOI: 10.1016/j.cger.2014.08.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Osteoarthritis (OA) and type 2 diabetes mellitus (T2DM) often coexist in older adults. Those with T2DM are more susceptible to developing arthritis, which has been traditionally attributed to common risk factors, namely, age and obesity. Alterations in lipid metabolism and hyperglycemia might directly impact cartilage health and subchondral bone, contributing to the development/progression of OA. Adequate management of older persons with both conditions benefits from a comprehensive understanding of the associated risk factors. We discuss common risk factors and emerging links between OA and T2DM, emphasizing the importance of physical activity and the implications of safe and effective physical activity.
Collapse
Affiliation(s)
- Sara R Piva
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA.
| | - Allyn M Susko
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA
| | - Samannaaz S Khoja
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA
| | - Deborah A Josbeno
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA
| | - Frederico G S Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, 200 Lothrop Street, BST E1140, Pittsburgh, PA 15261, USA
| |
Collapse
|
20
|
Desai PM, Hughes SL, Peters KE, Mermelstein RJ. Impact of telephone reinforcement and negotiated contracts on behavioral predictors of exercise maintenance in older adults with osteoarthritis. Am J Health Behav 2014; 38:465-77. [PMID: 25181766 DOI: 10.5993/ajhb.38.3.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the impact of telephone reinforcement (TR) on predictors of physical activity (PA) maintenance in older adults with osteoarthritis. METHODS Mixed effects modeling was conducted of data from a randomized PA trial that used negotiated maintenance contracts, supplemented by TR, to test impact of TR on barriers, decisional balance, and stage of change at multiple points in time. RESULTS Participants who were referred to a PA program and received TR improved the most in barriers and decisional balance. Participants who negotiated a tailored maintenance contract but did not receive TR improved the most in stage. CONCLUSIONS TR appears to positively affect perceptions around engagement, whereas negotiation positively impacts PA behavior. Further research should examine the effectiveness of specific PA maintenance strategies.
Collapse
|
21
|
Messier SP, Mihalko SL, Beavers DP, Nicklas BJ, DeVita P, Carr JJ, Hunter DJ, Williamson JD, Bennell KL, Guermazi A, Lyles M, Loeser RF. Strength Training for Arthritis Trial (START): design and rationale. BMC Musculoskelet Disord 2013; 14:208. [PMID: 23855596 PMCID: PMC3722013 DOI: 10.1186/1471-2474-14-208] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/11/2013] [Indexed: 12/12/2022] Open
Abstract
Background Muscle loss and fat gain contribute to the disability, pain, and morbidity associated with knee osteoarthritis (OA), and thigh muscle weakness is an independent and modifiable risk factor for it. However, while all published treatment guidelines recommend muscle strengthening exercise to combat loss of muscle mass and strength in knee OA patients, previous strength training studies either used intensities or loads below recommended levels for healthy adults or were generally short, lasting only 6 to 24 weeks. The efficacy of high-intensity strength training in improving OA symptoms, slowing progression, and affecting the underlying mechanisms has not been examined due to the unsubstantiated belief that it might exacerbate symptoms. We hypothesize that in addition to short-term clinical benefits, combining greater duration with high-intensity strength training will alter thigh composition sufficiently to attain long-term reductions in knee-joint forces, lower pain levels, decrease inflammatory cytokines, and slow OA progression. Methods/Design This is an assessor-blind, randomized controlled trial. The study population consists of 372 older (age ≥ 55 yrs) ambulatory, community-dwelling persons with: (1) mild-to-moderate medial tibiofemoral OA (Kellgren-Lawrence (KL) = 2 or 3); (2) knee neutral or varus aligned knee ( -2° valgus ≤ angle ≤ 10° varus); (3) 20 kg.m-2 ≥ BMI ≤ 45 kg.m-2; and (3) no participation in a formal strength-training program for more than 30 minutes per week within the past 6 months. Participants are randomized to one of 3 groups: high-intensity strength training (75-90% 1Repetition Maximum (1RM)); low-intensity strength training (30-40%1RM); or healthy living education. The primary clinical aim is to compare the interventions’ effects on knee pain, and the primary mechanistic aim is to compare their effects on knee-joint compressive forces during walking, a mechanism that affects the OA disease pathway. Secondary aims will compare the interventions’ effects on additional clinical measures of disease severity (e.g., function, mobility); disease progression measured by x-ray; thigh muscle and fat volume, measured by computed tomography (CT); components of thigh muscle function, including hip abductor strength and quadriceps strength, and power; additional measures of knee-joint loading; inflammatory and OA biomarkers; and health-related quality of life. Discussion Test-retest reliability for the thigh CT scan was: total thigh volume, intra-class correlation coefficients (ICC) = 0.99; total fat volume, ICC = 0.99, and total muscle volume, ICC = 0.99. ICC for both isokinetic concentric knee flexion and extension strength was 0.93, and for hip-abductor concentric strength was 0.99. The reliability of our 1RM testing was: leg press, ICC = 0.95; leg curl, ICC = 0.99; and leg extension, ICC = 0.98. Results of this trial will provide critically needed guidance for clinicians in a variety of health professions who prescribe and oversee treatment and prevention of OA-related complications. Given the prevalence and impact of OA and the widespread availability of this intervention, assessing the efficacy of optimal strength training has the potential for immediate and vital clinical impact. Trial registration ClinicalTrials.gov, NCT01489462
Collapse
|
22
|
Lemacks J, Wells BA, Ilich JZ, Ralston PA. Interventions for improving nutrition and physical activity behaviors in adult African American populations: a systematic review, January 2000 through December 2011. Prev Chronic Dis 2013; 10:E99. [PMID: 23786910 PMCID: PMC3690829 DOI: 10.5888/pcd10.120256] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The incidence of preventable chronic diseases is disproportionally high among African Americans and could be reduced through diet and physical activity interventions. Our objective was to systematically review the literature on clinical outcomes of diet and physical activity interventions conducted among adult African American populations in the United States. Methods We used the Preferred Reporting Items for Systematic Review and Meta Analysis construct in our review. We searched Medline (PubMed and Ovid), Cochrane, and DARE databases and restricted our search to articles published in English from January 2000 through December 2011. We included studies of educational interventions with clinically relevant outcomes and excluded studies that dealt with nonadult populations or populations with pre-existing catabolic or other complicated disorders, that did not focus on African Americans, that provided no quantitative baseline or follow-up data, or that included no diet or physical activity education or intervention. We report retention and attendance rates, study setting, program sustainability, behavior theory, and education components. Results Nineteen studies were eligible for closer analysis. These studies described interventions for improving diet or physical activity as indicators of health promotion and disease prevention and that reported significant improvement in clinical outcomes. Conclusion Our review suggests that nutrition and physical activity educational interventions can be successful in improving clinically relevant outcomes among African Americans in the United States. Further research is needed to study the cost and sustainability of lifestyle interventions. Further studies should also include serum biochemical parameters to substantiate more specifically the effect of interventions on preventing chronic disease and reducing its incidence and prevalence.
Collapse
|
23
|
Desroches S, Lapointe A, Ratté S, Gravel K, Légaré F, Turcotte S. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database Syst Rev 2013:CD008722. [PMID: 23450587 PMCID: PMC4900876 DOI: 10.1002/14651858.cd008722.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients, and greater adherence to dietary advice is a critical component in preventing and managing chronic diseases. OBJECTIVES To assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. SEARCH METHODS We searched the following electronic databases up to 29 September 2010: The Cochrane Library (issue 9 2010), PubMed, EMBASE (Embase.com), CINAHL (Ebsco) and PsycINFO (PsycNET) with no language restrictions. We also reviewed: a) recent years of relevant conferences, symposium and colloquium proceedings and abstracts; b) web-based registries of clinical trials; and c) the bibliographies of included studies. SELECTION CRITERIA We included randomized controlled trials that evaluated interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Studies were eligible if the primary outcome was the client's adherence to dietary advice. We defined 'client' as an adult participating in a chronic disease prevention or chronic disease management study involving dietary advice. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the studies. They also assessed the risk of bias and extracted data using a modified version of the Cochrane Consumers and Communication Review Group data extraction template. Any discrepancies in judgement were resolved by discussion and consensus, or with a third review author. Because the studies differed widely with respect to interventions, measures of diet adherence, dietary advice, nature of the chronic diseases and duration of interventions and follow-up, we conducted a qualitative analysis. We classified included studies according to the function of the intervention and present results in a narrative table using vote counting for each category of intervention. MAIN RESULTS We included 38 studies involving 9445 participants. Among studies that measured diet adherence outcomes between an intervention group and a control/usual care group, 32 out of 123 diet adherence outcomes favoured the intervention group, 4 favoured the control group whereas 62 had no significant difference between groups (assessment was impossible for 25 diet adherence outcomes since data and/or statistical analyses needed for comparison between groups were not provided). Interventions shown to improve at least one diet adherence outcome are: telephone follow-up, video, contract, feedback, nutritional tools and more complex interventions including multiple interventions. However, these interventions also shown no difference in some diet adherence outcomes compared to a control/usual care group making inconclusive results about the most effective intervention to enhance dietary advice. The majority of studies reporting a diet adherence outcome favouring the intervention group compared to the control/usual care group in the short-term also reported no significant effect at later time points. Studies investigating interventions such as a group session, individual session, reminders, restriction and behaviour change techniques reported no diet adherence outcome showing a statistically significant difference favouring the intervention group. Finally, studies were generally of short duration and low quality, and adherence measures varied widely. AUTHORS' CONCLUSIONS There is a need for further, long-term, good-quality studies using more standardized and validated measures of adherence to identify the interventions that should be used in practice to enhance adherence to dietary advice in the context of a variety of chronic diseases.
Collapse
Affiliation(s)
- Sophie Desroches
- Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), St-François d’Assise Hôpital, Québec, Canada.
| | | | | | | | | | | |
Collapse
|
24
|
Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, Maetzel A, Huijbregts M, McCullough C, De Angelis G, Coyle D. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Aerobic Walking Programs in the Management of Osteoarthritis. Arch Phys Med Rehabil 2012; 93:1269-85. [PMID: 22421624 DOI: 10.1016/j.apmr.2012.01.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 12/26/2011] [Accepted: 01/03/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Laurianne Loew
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Stevenson JD, Roach R. The benefits and barriers to physical activity and lifestyle interventions for osteoarthritis affecting the adult knee. J Orthop Surg Res 2012; 7:15. [PMID: 22462601 PMCID: PMC3353175 DOI: 10.1186/1749-799x-7-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 03/31/2012] [Indexed: 12/02/2022] Open
Abstract
Osteoarthritis prevalence is increasing, placing greater demands on healthcare and future socioeconomic costing models. Exercise and non-pharmacological methods should be employed to manage this common and disabling disease. Expectations at all stages of disease are increasing with a desire to remain active and independent. Three key areas have been reviewed; the evidence for physical activity, lifestyle changes and motivational techniques concerning knee osteoarthritis and the barriers to instituting such changes. Promotion of activity in primary care is discussed and evidence for compliance has been reviewed. This article reviews a subject that is integral to all professionals involved with osteoarthritis care.
Collapse
Affiliation(s)
- Jonathan Daniel Stevenson
- Department of Trauma & Orthopaedics, Princess Royal Hospital, Apley Castle, Telford, Shropshire TF1 6TF, UK
- 6 Beaumont House, Old Stafford Road, Cross Green, Staffordshire WV10 7EP, UK
| | - Richard Roach
- Department of Trauma & Orthopaedics, Princess Royal Hospital, Apley Castle, Telford, Shropshire TF1 6TF, UK
| |
Collapse
|
26
|
Physical activity intervention in older adults: does a participating partner make a difference? Eur J Ageing 2011; 8:211. [PMID: 28798651 DOI: 10.1007/s10433-011-0193-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Social integration and social support are expected to facilitate the adoption and maintenance of physical activity. In the context of a physical activity intervention, we distinguished three partner status groups, serving as an indicator of social integration. It was hypothesized that individuals whose partner also participated in the intervention, as opposed to individuals whose partners did not participate, or individuals without an intimate partner, would benefit more in terms of their physical activity. In a second step, a differential prediction pattern of social support on physical activity for each of the three partner status groups was investigated. The study involved 302 men and women (aged 60-95 years) and included two measurement points in time: A baseline assessment with a leaflet intervention to foster physical activity, and a 4-week follow-up assessment. In participants whose partners took part in the intervention, physical activity increased substantially over time, whereas it did not change in those individuals whose partners were not involved in the intervention, and it did not change in singles. Social support was positively related to physical activity when couples participated together in the intervention, but it was negatively related in singles or when partners did not participate. Social support appeared to be beneficial for physical activity in older adults when both partners participate in the intervention, which might reflect joint exercise or reciprocal exercise support. Singles or those with nonparticipating partners are not only less active, they might also be impeded by misguided support that could be perceived as social control.
Collapse
|
27
|
Ottawa Panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight. Phys Ther 2011; 91:843-61. [PMID: 21493746 DOI: 10.2522/ptj.20100104] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The objective of this review was to construct an updated evidence-based clinical practice guideline on the use of physical activity and diet for the management of osteoarthritis (OA) in adults (>18 years of age) who are obese or overweight (body mass index ≥25 kg/m(2)). DATA SOURCES Articles were extracted from the following databases: MEDLINE, EMBASE (Current Contents), SPORTDiscus, SUM, Scopus, CINAHL, AMED, BIOMED, PubMed, ERIC, the Cochrane Controlled Trials, and PEDro. STUDY SELECTION The Ottawa Panel and research assistance team strictly applied the inclusion and exclusion criteria from previous Ottawa Panel publications. DATA EXTRACTION An a priori literature search was conducted for articles related to obesity and OA of the lower extremities that were published from January 1, 1966, to November 30, 2010. Inclusion criteria and the methods to grade the recommendations were created by the Ottawa Panel. RECOMMENDATIONS were graded based on the strength of evidence (A, B, C, C+, D, D+, or D-) as well as experimental design (I for randomized controlled trials and II for nonrandomized studies). In agreement with previous Ottawa Panel methods, Cochrane Collaboration methods were utilized for statistical analysis. Clinical significance was established by an improvement of ≥15% in the experimental group compared with the control group. There were a total of 79 recommendations from 9 articles. From these recommendations, there were 36 positive recommendations: 21 grade A and 15 grade C+. There were no grade B recommendations, and all recommendations were of clinical benefit. LIMITATIONS Further research is needed, as more than half of the trials were of low methodological quality. CONCLUSIONS This review suggests that physical activity and diet programs are beneficial, specifically for pain relief (9 grade A recommendations) and improved functional status (6 grade A and 7 grade C+ recommendations), for adults with OA who are obese or overweight. The Ottawa Panel was able to demonstrate that when comparing physical activity alone, diet alone, physical activity combined with diet, and control groups, the intervention including physical activity and diet produced the most beneficial results.
Collapse
|
28
|
|
29
|
Sevick MA, Miller GD, Loeser RF, Williamson JD, Messier SP. Cost-effectiveness of exercise and diet in overweight and obese adults with knee osteoarthritis. Med Sci Sports Exerc 2010; 41:1167-74. [PMID: 19461553 DOI: 10.1249/mss.0b013e318197ece7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to compare the cost-effectiveness of dietary and exercise interventions in overweight or obese elderly patients with knee osteoarthritis (OA) enrolled in the Arthritis, Diet, and Physical Activity Promotion Trial (ADAPT). METHODS ADAPT was a single-blinded, controlled trial of 316 adults with knee OA, randomized to one of four groups: Healthy Lifestyle Control group, Diet group, Exercise group, or Exercise and Diet group. A cost analysis was performed from a payer perspective, incorporating those costs and benefits that would be realized by a managed care organization interested in maintaining the health and satisfaction of its enrollees while reducing unnecessary utilization of health care services. RESULTS The Diet intervention was most cost-effective for reducing weight, at $35 for each percentage point reduction in baseline body weight. The Exercise intervention was most cost-effective for improving mobility, costing $10 for each percentage point improvement in a 6-min walking distance and $9 for each percentage point improvement in the timed stair climbing task. The Exercise and Diet intervention was most cost-effective for improving self-reported function and symptoms of arthritis, costing $24 for each percentage point improvement in subjective function, $20 for each percentage point improvement in self-reported pain, and $56 for each percentage point improvement in self-reported stiffness. CONCLUSIONS The Exercise and Diet intervention consistently yielded the greatest improvements in weight, physical performance, and symptoms of knee OA. However, it was also the most expensive and was the most cost-effective approach only for the subjective outcomes of knee OA (self-reported function, pain, and stiffness). Perceived function and symptoms of knee OA are likely to be stronger drivers of downstream health service utilization than weight, or objective performance measures and may be the most cost-effective in the long term.
Collapse
Affiliation(s)
- Mary A Sevick
- 1Center for Health Equity Research and Promotion of the VA Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA.
| | | | | | | | | |
Collapse
|
30
|
Acharya SD, Elci OU, Sereika SM, Music E, Styn MA, Turk MW, Burke LE. Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers. Patient Prefer Adherence 2009; 3:151-60. [PMID: 19936157 PMCID: PMC2778406 DOI: 10.2147/ppa.s5802] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To describe participants' adherence to multiple components (attendance, energy intake, fat gram, exercise goals, and self-monitoring eating and exercise behaviors) of a standard behavioral treatment program (SBT) for weight loss and how adherence to these components may influence weight loss and biomarkers (triglycerides, low density lipoproteins [LDL], high density lipoprotein, and insulin) during the intensive and less-intensive intervention phases. METHODS A secondary analysis of a randomized clinical trial consisting of a SBT with either fat-restricted standard or lacto-ovo vegetarian diet. The 12-month intervention was delivered in 33 group sessions. The first six months reflected the intensive phase; the second six months, the less-intensive intervention phase. We conducted the analysis without regard to treatment assignment. Eligible participants included overweight/obese adults (N = 176; mean body mass index = 34.0 kg/m(2)). The sample was 86.9% female, 70.5% White, and 44.4 +/- 8.6 years old. The outcome measures included weight and biomarkers. RESULTS There was a significant decline in adherence to each treatment component over time (P < 0.0001). In the first six months, adherence to attendance, self-monitoring and the energy goal were significantly associated with greater weight loss (P < 0.05). Adherence to attendance and exercise remained significantly associated with weight loss in the second six months (P < 0.05). Adherence to attendance, self-monitoring and exercise had indirect effects through weight loss on LDL, triglycerides, and insulin (P < 0.05). CONCLUSIONS We observed a decline in adherence to each treatment component as the intervention intensity was reduced. Adherence to multiple treatment components was associated with greater weight loss and improvements in biomarkers. Future research needs to focus on improving and maintaining adherence to all components of the treatment protocol to promote weight loss and maintenance.
Collapse
Affiliation(s)
| | - Okan U Elci
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan M Sereika
- Department of Biostatistics, Graduate School of Public Health
- Department of Epidemiology, Graduate School of Public Health
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edvin Music
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mindi A Styn
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lora E Burke
- Department of Epidemiology, Graduate School of Public Health
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
- Correspondence: Lora E Burke, Professor, School of Nursing, Department of Epidemiology, Graduate School of Public Health, 3500 Victoria St., 415, Victoria Bldg, University of Pittsburgh, Pittsburgh, PA 15261, USA, Tel +1 412 624 2305, Fax +1 412 383 7293, Email
| |
Collapse
|
31
|
van Stralen MM, De Vries H, Mudde AN, Bolman C, Lechner L. Determinants of initiation and maintenance of physical activity among older adults: a literature review. Health Psychol Rev 2009. [DOI: 10.1080/17437190903229462] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Ogbuanu IU, Zhang H, Karmaus W. Can we apply the Mendelian randomization methodology without considering epigenetic effects? Emerg Themes Epidemiol 2009; 6:3. [PMID: 19432981 PMCID: PMC2698894 DOI: 10.1186/1742-7622-6-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 05/11/2009] [Indexed: 12/03/2022] Open
Abstract
Introduction Instrumental variable (IV) methods have been used in econometrics for several decades now, but have only recently been introduced into the epidemiologic research frameworks. Similarly, Mendelian randomization studies, which use the IV methodology for analysis and inference in epidemiology, were introduced into the epidemiologist's toolbox only in the last decade. Analysis Mendelian randomization studies using instrumental variables (IVs) have the potential to avoid some of the limitations of observational epidemiology (confounding, reverse causality, regression dilution bias) for making causal inferences. Certain limitations of randomized controlled trials, such as problems with generalizability, feasibility and ethics for some exposures, and high costs, also make the use of Mendelian randomization in observational studies attractive. Unlike conventional randomized controlled trials (RCTs), Mendelian randomization studies can be conducted in a representative sample without imposing any exclusion criteria or requiring volunteers to be amenable to random treatment allocation. Within the last decade, epigenetics has gained recognition as an independent field of study, and appears to be the new direction for future research into the genetics of complex diseases. Although previous articles have addressed some of the limitations of Mendelian randomization (such as the lack of suitable genetic variants, unreliable associations, population stratification, linkage disequilibrium (LD), pleiotropy, developmental canalization, the need for large sample sizes and some potential problems with binary outcomes), none has directly characterized the impact of epigenetics on Mendelian randomization. The possibility of epigenetic effects (non-Mendelian, heritable changes in gene expression not accompanied by alterations in DNA sequence) could alter the core instrumental variable assumptions of Mendelian randomization. This paper applies conceptual considerations, algebraic derivations and data simulations to question the appropriateness of Mendelian randomization methods when epigenetic modifications are present. Conclusion Given an inheritance of gene expression from parents, Mendelian randomization studies not only need to assume a random distribution of alleles in the offspring, but also a random distribution of epigenetic changes (e.g. gene expression) at conception, in order for the core assumptions of the Mendelian randomization methodology to remain valid. As an increasing number of epidemiologists employ Mendelian randomization methods in their research, caution is therefore needed in drawing conclusions from these studies if these assumptions are not met.
Collapse
Affiliation(s)
- Ikechukwu U Ogbuanu
- Department of Epidemiology and Biostatistics, Norman J Arnold School of Public Health, University of South Carolina, SC, USA.
| | | | | |
Collapse
|
33
|
Pettman TL, Misan GM, Owen K, Warren K, Coates AM, Buckley JD, Howe PR. Self-management for obesity and cardio-metabolic fitness: description and evaluation of the lifestyle modification program of a randomised controlled trial. Int J Behav Nutr Phys Act 2008; 5:53. [PMID: 18954466 PMCID: PMC2582031 DOI: 10.1186/1479-5868-5-53] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 10/27/2008] [Indexed: 11/22/2022] Open
Abstract
Background Sustainable lifestyle modification strategies are needed to address obesity and cardiovascular risk factors. Intensive, individualised programs have been successful, but are limited by time and resources. We have formulated a group-based lifestyle education program based upon national diet and physical activity (PA) recommendations to manage obesity and cardio-metabolic risk factors. This article describes the content and delivery of this program, with information on compliance and acceptability. Methods Overweight/obese adults (n = 153) with metabolic syndrome were recruited from the community and randomly allocated to intervention (INT) or control (CON). Written copies of Australian national dietary and PA guidelines were provided to all participants. INT took part in a 16-week lifestyle program which provided a curriculum and practical strategies on 1) dietary and PA information based on national guidelines, 2) behavioural self-management tools, 3) food-label reading, supermarkets tour and cooking, 4) exercise sessions, and 5) peer-group support. Compliance was assessed using attendance records and weekly food/PA logs. Participants' motivations, perceived benefits and goals were assessed through facilitated discussion. Program acceptability feedback was collected through structured focus groups. Results Although completion of weekly food/PA records was poor, attendance at information/education sessions (77% overall) and exercise participation (66% overall) was high, and compared with CON, multiple markers of body composition and cardio-metabolic health improved in INT. Participants reported that the most useful program components included food-label reading, cooking sessions, and learning new and different physical exercises, including home-based options. Participants also reported finding self-management techniques helpful, namely problem solving and short-term goal setting. The use of a group setting and supportive 'peer' leaders were found to be supportive. More frequent clinical assessment was suggested for future programs. Conclusion This group-based lifestyle program achieved improvements in body composition and cardio-metabolic and physical fitness similar to individualised interventions which are more resource intensive to deliver. It confirmed that active training in lifestyle modification is more effective than passive provision of guidelines. Such programs should include social support and self-management techniques. Continued clinical follow up may be required for long-term maintenance in individuals attempting lifestyle behaviour change. Program facilitation by peers may help and should be further investigated in a community-based model.
Collapse
Affiliation(s)
- Tahna L Pettman
- Australian Technology Network (ATN) Centre for Metabolic Fitness and Nutritional Physiology Research Centre, School of Health Sciences, University of South Australia, Adelaide 5000, South Australia, Australia.
| | | | | | | | | | | | | |
Collapse
|
34
|
McIlvane JM, Baker TA, Mingo CA, Haley WE. Are behavioral interventions for arthritis effective with minorities? Addressing racial and ethnic diversity in disability and rehabilitation. ACTA ACUST UNITED AC 2008; 59:1512-8. [DOI: 10.1002/art.24117] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
35
|
Colberg SR. ENHANCING INSULIN ACTION WITH PHYSICAL ACTIVITY TO PREVENT AND CONTROL DIABETES. ACSMS HEALTH & FITNESS JOURNAL 2008. [DOI: 10.1249/01.fit.0000312407.09637.1d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2007; 66:433-9. [PMID: 17204567 PMCID: PMC1856062 DOI: 10.1136/ard.2006.065904] [Citation(s) in RCA: 398] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This review aims to assess by meta-analysis of randomised controlled trials (RCTs) changes in pain and function when overweight patients with knee osteoarthritis (OA) achieve a weight loss. Systematic searches were performed and reference lists from the retrieved trials were searched. RCTs were enclosed in the systematic review if they explicitly stated diagnosis of knee OA and reported a weight change as the only difference in intervention from the control group. Outcome Measures for Arthritis Clinical Trials III outcome variables were considered for analysis. Effect size (ES) was calculated using RevMan, and meta-regression analyses were performed using weighted estimates from the random effects analyses. Among 35 potential trials identified, four RCTs including five intervention/control groups met our inclusion criteria and provided data from 454 patients. Pooled ES for pain and physical disability were 0.20 (95% CI 0 to 0.39) and 0.23 (0.04 to 0.42) at a weight reduction of 6.1 kg (4.7 to 7.6 kg). Meta-regression analysis showed that disability could be significantly improved when weight was reduced over 5.1%, or at the rate of >0.24% reduction per week. Clinical efficacy on pain reduction was present, although not predictable after weight loss. Meta-regression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime. The analysis supported that a weight loss of >5% should be achieved within a 20-week period--that is, 0.25% per week.
Collapse
Affiliation(s)
- Robin Christensen
- The Parker Institute, H:S Frederiksberg Hospital, DK-2000 Frederiksberg, and Copenhagen University Library, Denmark
| | | | | | | |
Collapse
|