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Choi YA, Lee JS, Kim YH. Associated Factors of Time Spent Walking for Community-Dwelling Stroke Survivors. J Phys Act Health 2024; 21:222-228. [PMID: 37597844 DOI: 10.1123/jpah.2022-0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/21/2023] [Accepted: 07/15/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND This study aimed to investigate the factors associated with the time that community-dwelling stroke survivors spent walking. METHODS We analyzed the cross-sectional data of 1534 community-dwelling stroke survivors from the Korean National Health and Nutrition Examination Survey. Complex-sample logistic regression analyses were performed to determine the factors associated with insufficient walking time (<90 min/wk). The mean time spent walking was examined according to age, sex, resistance exercise level, and self-reported disability using complex-sample general linear models. RESULTS Women (odds ratio [OR] 1.5; 95% confidence interval [CI], 1.0-2.3), current smokers (OR 1.7; 95% CI, 1.1-2.8), insufficient resistance exercise (OR 2.3; 95% CI, 1.5-3.5), and those with rural residences (OR 1.4; 95% CI, 1.0-1.9) were independently associated with insufficient walking time. The mean time spent walking was significantly lower in older adults aged ≥65 years than in young adults aged <65 years (200.0 ± 42.0 min/wk vs 287.2 ± 36.6 min/wk, P = .002), in women than in men (200.9 ± 44.9 vs 286.2 ± 37.7 min/wk, P = .027), and in individuals engaging in insufficient resistance exercise compared with those engaging in sufficient resistance exercise (203.2 ± 36.2 vs 283.9 ± 43.0 min/wk, P = .008). The mean walking time did not vary according to the presence of self-reported disabilities. CONCLUSIONS Environmental and personal factors are associated with insufficient walking time in community-dwelling stroke survivors.
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Affiliation(s)
- Young-Ah Choi
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul,Republic of Korea
| | - Jung Soo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul,Republic of Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul,Republic of Korea
- Department of Rehabilitation Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do,Republic of Korea
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Uhlig-Reche H, Ontiveros D, Syzdek R, Mathews P, Dalal L, Amaro A, Wunnava N, Housammy Z, Schmitt B, Sharrief A, Gonzales NR. Description of Baseline Nutrition and Physical Activity Knowledge and Behavior in Acute Stroke/TIA Patients Enrolled in the Health Education on Information Retention and Behavior Change in Stroke (HERBS) Pilot Trial. Nutrients 2023; 15:3761. [PMID: 37686793 PMCID: PMC10490333 DOI: 10.3390/nu15173761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Lifestyle modifications after stroke are associated with better risk factor control and lower mortality. The primary objective of this study was to describe the knowledge of American Heart Association (AHA) recommendations for diet and exercise in survivors of stroke and transient ischemic attack (TIA). The secondary objectives were to describe their diet and exercise behaviors, self-efficacy (SE), behavioral intent (BI), stage of change, and barriers to change. Data are described from participants enrolled in a prospective educational intervention in mild stroke/TIA survivors. A multiple-choice questionnaire ascertained knowledge of AHA recommendations for diet and exercise, nutrition and physical activity behavior, SE, BI, stage of change, and barriers to change. Twenty-eight stroke/TIA survivors, with a mean age of 61.7 ± 11.8 years, completed questionnaires during their acute hospitalization. Participants underestimated the recommended intake of fruits, vegetables, whole grains, and participation in aerobic exercise and overestimated the recommended intake of sugar and salt. SE demonstrated a significant positive association with combined behavior scores (rs = 0.36, p = 0.043). Greater knowledge of the AHA recommendations was not associated with healthier behavior, greater SE, higher BI, or more advanced stage of change. The gaps between AHA recommendations and stroke/TIA patient knowledge identifies an area for potential intervention in stroke prevention and recovery.
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Affiliation(s)
- Hannah Uhlig-Reche
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Diana Ontiveros
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA
| | - Riley Syzdek
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA (L.D.); (Z.H.)
| | - Patenne Mathews
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Leanne Dalal
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA (L.D.); (Z.H.)
| | - Andrea Amaro
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Nidhi Wunnava
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Zina Housammy
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA (L.D.); (Z.H.)
| | - Barrie Schmitt
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO 80045, USA (N.R.G.)
| | - Anjail Sharrief
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Nicole R. Gonzales
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO 80045, USA (N.R.G.)
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Rosignoli da Conceição A, da Silva A, Marcadenti A, Bersch-Ferreira ÂC, Weber B, Bressan J. Consumption of unprocessed or minimally processed foods and their association with cardiovascular events and cardiometabolic risk factors in Brazilians with established cardiovascular events. Int J Food Sci Nutr 2023; 74:107-119. [PMID: 36625034 DOI: 10.1080/09637486.2023.2164922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Consumption of food in its natural form has an inverse relationship with cardiometabolic risk factors; however, the relationship between consumption of unprocessed or minimally processed foods and the presence of cardiovascular diseases (CVD) remains unclear in individuals receiving secondary care for CVD. Thus, we aimed to evaluate the association between the consumption of unprocessed or minimally processed foods and the presence of CVD and cardiometabolic risk factors in individuals with established CVD. Baseline data from 2357 participants in a Brazilian multicentre study showed that the consumption of unprocessed or minimally processed foods corresponded to most of the daily caloric intake (69.3%). Furthermore, regression analyses showed that higher consumption of unprocessed or minimally processed foods (>78.0% of caloric intake) was associated with a lower prevalence of elevated waist circumference (WC1; PR: 0.889; CI: 0.822-0.961; WC2; PR: 0.914; CI: 0.873-0.957) and overweight (PR: 0.930; CI: 0.870-0.994), but also was associated with simultaneous occurrence of coronary and peripheral artery disease and stroke (OR: 2.802; CI: 1.241-6.325) when compared with a lower intake (<62.8% of caloric intake). These findings reinforce the importance of nutritional guidance that considers the profile of the target population and the composition and quality of the meals consumed.
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Affiliation(s)
| | - Alessandra da Silva
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Aline Marcadenti
- Hcor Research Institute, HCor (IP-Hcor), São Paulo, Brazil.,Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul (IC/FUC), Porto Alegre, Brazil
| | | | | | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
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Nguyen LH, Tran PTM, Dam TA, Forse RJ, Codlin AJ, Huynh HB, Dong TTT, Nguyen GH, Truong VV, Dang HTM, Nguyen TD, Nguyen HB, Nguyen NV, Khan A, Creswell J, Vo LNQ. Assessing private provider perceptions and the acceptability of video observed treatment technology for tuberculosis treatment adherence in three cities across Viet Nam. PLoS One 2021; 16:e0250644. [PMID: 33961645 PMCID: PMC8104441 DOI: 10.1371/journal.pone.0250644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization recently recommended Video Observed Therapy (VOT) as one option for monitoring tuberculosis (TB) treatment adherence. There is evidence that private sector TB treatment has substandard treatment follow-up, which could be improved using VOT. However, acceptability of VOT in the private sector has not yet been evaluated. Methods We conducted a cross-sectional survey employing a theoretical framework for healthcare intervention acceptability to measure private provider perceptions of VOT across seven constructs in three cities of Viet Nam: Ha Noi, Ho Chi Minh City, and Hai Phong. We investigated the differences in private providers’ attitudes and perceptions of VOT using mixed ordinal models to test for significant differences in responses between groups of providers stratified by their willingness to use VOT. Results A total of 79 private providers completed the survey. Sixty-two providers (75%) indicated they would use VOT if given the opportunity. Between private providers who would and would not use VOT, there were statistically significant differences (p≤0.001) in the providers’ beliefs that VOT would help identify side effects faster and in their confidence to monitor treatment and provide differentiated care with VOT. There were also significant differences in providers’ beliefs that VOT would save them time and money, address problems faced by their patients, benefit their practice and patients, and be relevant for all their patients. Conclusion Private providers who completed the survey have positive views towards using VOT and specific subpopulations acknowledge the value of integrating VOT into their practice. Future VOT implementation in the private sector should focus on emphasizing the benefits and relevance of VOT during recruitment and provide programmatic support for implementing differentiated care with the technology.
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Affiliation(s)
| | | | - Thu Anh Dam
- Friends for International TB Relief, Hanoi, Viet Nam
| | | | | | - Huy Ba Huynh
- Friends for International TB Relief, Hanoi, Viet Nam
| | | | | | | | | | | | | | | | - Amera Khan
- Stop TB Partnership, Geneva, Switzerland
| | | | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Hanoi, Viet Nam
- IRD VN, Hanoi, Viet Nam
- * E-mail:
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Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094666. [PMID: 33925718 PMCID: PMC8124907 DOI: 10.3390/ijerph18094666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men.
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Bailey RR, Singleton JR, Majersik JJ. Association of obesity and diabetes with physical activity and fruit and vegetable consumption in stroke survivors. Fam Pract 2021; 38:56-61. [PMID: 32968806 PMCID: PMC8427731 DOI: 10.1093/fampra/cmaa101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Engaging in unhealthy behaviours [poor diet, insufficient physical activity (PA)] increases risk for recurrent stroke and can be compounded by obesity and diabetes, but the association of obesity and diabetes with poor diet and insufficient PA in stroke survivors is unknown. OBJECTIVE The purpose of this study was to compare prevalences of low fruit and vegetable consumption (low FV consumption, <1 fruit and <1 vegetable daily) and low physical activity (low PA, <150 minutes of weekly moderate-intensity PA) in stroke survivors, stratified by obesity-diabetes status (neither condition, obesity only, diabetes only, both conditions). METHODS Cross-sectional data from 32 876 non-institutionalized, US stroke survivors aged ≥45 years from the 2015 and 2017 Behavioral Risk Factor Surveillance System were examined. Weighted, age-adjusted prevalence estimates and adjusted odds ratios (AORs) of the investigated unhealthy behaviours (adjusted for sex, age, race, income, education and marital status) and 95% confidence intervals (CIs) were calculated. RESULTS Prevalences of low FV consumption and low PA exceeded 50% across all obesity-diabetes categories. Compared with respondents with neither obesity nor diabetes, AORs for low PA were increased for respondents with both obesity and diabetes (2.02, 95% CI: 1.72-2.37) and respondents with obesity only (1.31, 1.13-1.53); AORs for low FV consumption did not differ across obesity-diabetes categories. CONCLUSIONS Results indicated a joint effect of obesity and diabetes with low PA among stroke survivors. Regardless of obesity-diabetes status, however, prevalence of low FV consumption and low PA exceeded 50%. Targeted interventions that modify these unhealthy behaviours among stroke survivors should be explored.
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Affiliation(s)
- Ryan R Bailey
- Department of Occupational and Recreational Therapies, Salt Lake City, UT, USA
| | | | - Jennifer J Majersik
- Vascular Neurology Division, Department of Neurology, University of Utah, Salt Lake City, UT, USA
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Does Exercise-Based Conventional Training Improve Reactive Balance Control among People with Chronic Stroke? Brain Sci 2020; 11:brainsci11010002. [PMID: 33374957 PMCID: PMC7821930 DOI: 10.3390/brainsci11010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Exercise-based conventional training has predominantly benefited fall-associated volitional balance control domain; however, the effect on reactive balance control is under-examined. Therefore, the purpose of this study was to examine the effect of exercise-based conventional training on reactive balance control. Methods: Eleven people with chronic stroke (PwCS) underwent multi-component training for six weeks (20 sessions) in a tapering manner. Training focused on four constructs-stretching, functional strengthening, balance, and endurance. Volitional balance was measured via movement velocity on the Limits of Stability (LOS) test and reactive balance via center of mass (COM) state stability on the Stance Perturbation Test (SPT). Additionally, behavioral outcomes (fall incidence and/or number of steps taken) were recorded. Results: Movement velocity significantly increased on the LOS test (p < 0.05) post-intervention with a significant decrease in fall incidence (p < 0.05). However, no significant changes were observed in the COM state stability, fall incidence and number of recovery steps on the SPT post-intervention. Conclusion: Although volitional and reactive balance control may share some neurophysiological and biomechanical components, training based on volitional movements might not significantly improve reactive balance control for recovery from large-magnitude perturbations due to its task-specificity.
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Taryana AA, Krishnasamy R, Bohm C, Palmer SC, Wiebe N, Boudville N, MacRae J, Coombes JS, Hawley C, Isbel N, Thompson S. Physical activity for people with chronic kidney disease: an international survey of nephrologist practice patterns and research priorities. BMJ Open 2019; 9:e032322. [PMID: 31857307 PMCID: PMC6936996 DOI: 10.1136/bmjopen-2019-032322] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES People with chronic kidney diseases (CKD) have identified exercise as a research priority. To inform the research agenda, we surveyed nephrologists on their practice patterns, available resources and research priorities for exercise and physical activity (PA) in CKD. DESIGN Cross-sectional international survey. SETTING AND PARTICIPANTS 19-item electronic survey was administered to practising nephrologists with publicly available email addresses in Canada (n=354) and Australia and New Zealand (ANZ) and via newsletters for the Australian and New Zealand Society of Nephrology (n=598). OUTCOMES Frequency and predictors of exercise and PA counselling in practice and research priorities. RESULTS 189 respondents (20% response) completed the survey. Eighty-one per cent of ANZ and 42% of Canadian respondents reported that their renal programmes did not have any exercise programmes or resources. The most frequently reported barrier for exercise programme implementation was a lack of funding (77%). Ninety per cent of respondents thought regular exercise provides 'health benefits' for all CKD stages; 59% reported that exercise counselling was within the nephrologists' scope of practice and 47% reported 'frequently' or 'always' counselling patients. In multivariable analysis, female gender (OR 2.31; 95% CI 1.16 to 4.58) and older age (OR 1.94 per age category increase; 95% CI 1.15 to 3.26) were associated with exercise counselling. Out of 194 research priorities, 65 (34%) were clinical outcomes (cardiovascular parameters) and 30% were patient-reported outcomes (quality of life). CONCLUSIONS Most nephrologists consider exercise and PA counselling as within their scope of practice and beneficial but, due to competing priorities, do not regularly counsel patients. This suggests a need for the evaluation of effective and efficient counselling strategies and a role for the routine involvement of exercise specialists in kidney care. Cardiovascular parameters and quality of life were identified as important outcomes for future exercise trials.
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Affiliation(s)
| | - Rathika Krishnasamy
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Clara Bohm
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Jennifer MacRae
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff Scott Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, South Brisbane, Queensland, Australia
| | - Nicole Isbel
- Department of Nephrology, Princess Alexandra Hospital, South Brisbane, Queensland, Australia
| | - Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Srivastava P, Verma A, Geronimo C, Button TM. Behavior stages of a physician- and coach-supported cloud-based diabetes prevention program for people with prediabetes. SAGE Open Med 2019; 7:2050312119841986. [PMID: 31105938 PMCID: PMC6509979 DOI: 10.1177/2050312119841986] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction: Centers for Disease Control and Prevention Diabetes Prevention Program recognition requires successful program completion by a cohort of at least five people with prediabetes. Such programs have generally been “in-person” and provided by a qualified coach from a recognized program. A cohort of 10 patients with prediabetes was enrolled in a physician’s office to use the cloud-based Type II Diabetes Prevention Module in an effort to achieve recognition. Module use was supported by the physician and a qualified coach. The purpose of this article is to evaluate Module performance relative to behavior stages associated with long-term behavior modification. Methods: The Module employs a web application supporting diabetes prevention education and a mobile application that is an electronic diary and virtual coach. A dashboard allows an efficient review of user performance and the ability to send users notifications of support from the user’s coach or physician. The cohort of 10 patients with prediabetes was offered Module use upon diagnosis of prediabetes. Results: All 10 patients with prediabetes offered Module use agreed participation. Six have completed educational sessions, made diary entries, and have met the 5% Centers for Disease Control and Prevention Diabetes Prevention Program weight loss target prior to 6 months of Module use. This high success rate (60%) is contrary to behavior stages often associated with long-term behavior modification. Conclusion: The strength of the physician–patient relationship appears to allow patients with prediabetes to skip or advance rapidly through behavioral stages in the process of lifestyle modification.
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Affiliation(s)
| | - Ashish Verma
- Evidence Based Medical Apps LLC, Middle Island, NY, USA
| | | | - Terry M Button
- Evidence Based Medical Apps LLC, Middle Island, NY, USA.,Department of Radiology, Stony Brook University, Stony Brook, NY, USA
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Prevalence of five lifestyle risk factors among U.S. adults with and without stroke. Disabil Health J 2018; 12:323-327. [PMID: 30448248 DOI: 10.1016/j.dhjo.2018.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/23/2018] [Accepted: 11/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND History of stroke increases cardiometabolic risk, which can be exacerbated by the presence of unhealthy lifestyle factors. Population-based estimates of lifestyle risk factors in people with stroke are lacking but could be used to inform research, policy, and healthcare practice. OBJECTIVE To compare population-based estimates of the prevalence of five lifestyle risk factors-low fruit and vegetable consumption, insufficient physical activity, smoking, heavy alcohol consumption, and overweight/obesity-among U.S. adults with and without stroke. METHODS Representative data from noninstitutionalized adults aged ≥18 years (stroke, n = 37,225; no stroke, n = 851,607) from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate prevalence of individual and total number of risk factors. Logistic regression models were used to determine the odds of lifestyle risk factors in adults with stroke, adjusting for sex, age, ethnicity, marital status, education, income, and disability. RESULTS Prevalence and adjusted odds ratios (AOR) were higher in individuals with stroke compared to those without stroke for insufficient physical activity (56.5% vs. 49.5%, AOR: 1.14) and smoking (30.1% vs. 16.6%, AOR: 1.16), but lower for heavy alcohol consumption (5.4% vs. 6.1%, AOR: 0.76). Prevalence for low fruit and vegetable consumption (51.7% vs. 46.0%) and overweight/obesity (70.2% vs. 64.5%) was higher among adults with stroke, but differences were attenuated by demographic characteristics. Additionally, clustering of 4-5 lifestyle risk factors was higher in adults with stroke (9.0% vs. 5.3%, AOR: 1.12). CONCLUSION Additional research and healthcare interventions are needed to improve lifestyle risk factors in adults with stroke.
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van de Port I, Punt M, Meijer JW. Walking activity and its determinants in free-living ambulatory people in a chronic phase after stroke: a cross-sectional study. Disabil Rehabil 2018; 42:636-641. [PMID: 30326756 DOI: 10.1080/09638288.2018.1504327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Free-living walking activity and its contributing factors in ambulatory people with stroke is poorly investigated.Objective: Evaluating free-living walking activity and identifying factors associated with free-living walking activity.Methods: In this cross-sectional study, participants wore an accelerometer to measure their level of walking activity. They also completed the Berg Balance Scale (BBS) and the Timed Up and Go test for functional balance, the Falls Efficacy Scale, the 10-Metre Walk Test and the Geriatric Depression Scale to investigate the relation between the performance tests and walking activity.Results: The 38 analyzed participants were on average 62 (±11.4) years old and 66 (IQR 64.8) months post stroke. They took an average of 3048.3 ± 1983.1 steps, had 123.3 ± 61.3 walking bouts a day and walked for 32.5 ± 18.2 min a day. Their average speed was 90.3 ± 13.8 steps a minute. The multivariate linear analysis showed that the BBS was the only determinant that was significantly related to all outcomes, except walking bouts.Conclusion: Free-living walking activity levels in ambulatory people with chronic stroke are low. The BBS is an independent significant predictor of free-living walking activity.Implications for rehabilitationFree-living walking activity can be expressed in different outcomes measured by accelerometry.Free-living walking activity levels in ambulatory people with chronic stroke are low, therefore support to sustain walking in the own environment should be part of the rehabilitation program after stroke.Balance is an important related factor to free-living walking activity which needs attention during rehabilitation after stroke.
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Affiliation(s)
| | - Michiel Punt
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, The Netherlands
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Bardach SH, Schoenberg NE. The Role of Primary Care Providers in Encouraging Older Patients to Change Their Lifestyle Behaviors. Clin Gerontol 2018; 41:326-334. [PMID: 29221431 PMCID: PMC5893434 DOI: 10.1080/07317115.2017.1376029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study sought to identify older patients' perceptions of primary care providers' influence on their likelihood of improving diet and physical activity. METHODS 104 adults ages 65 and older were interviewed immediately following a routine primary care visit about their plans and motivations for behavior change and how their clinic visit would influence their likelihood of making lifestyle changes. All interviews were recorded, transcribed and analyzed using a constant comparison approach. RESULTS Participants reported that their providers influence their health behaviors by developing strong relationships, addressing concerns and encouraging change, and providing concrete instruction. When providers did not discuss diet or physical activity, or mentioned these topics only briefly, participants often perceived the message that they should continue their current behaviors. CONCLUSIONS Whether and how diet and physical activity are discussed in primary care influences the likelihood that older adults will make changes in these behaviors. CLINICAL IMPLICATIONS These findings highlight the need for a patient-centered counseling approach and caution providers to think twice before omitting discussion of the need for lifestyle change.
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Affiliation(s)
- Shoshana H Bardach
- a University of Kentucky, Graduate Center of Gerontology, College of Public Health and Sanders-Brown Center on Aging , Lexington , Kentucky , USA
| | - Nancy E Schoenberg
- b University of Kentucky, College of Public Health and Behavioral Science, College of Medicine , Lexington , Kentucky , USA
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13
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Bailey RR. Lifestyle Modification for Secondary Stroke Prevention. Am J Lifestyle Med 2018; 12:140-147. [PMID: 30202386 PMCID: PMC6124986 DOI: 10.1177/1559827616633683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 12/27/2022] Open
Abstract
Of nearly 800 000 strokes that occur annually, 23% are recurrent events. Risk for disability and mortality is higher following a recurrent stroke than following a first-time stroke, which makes secondary stroke prevention a priority. Many risk factors for stroke are modifiable and amenable to improvement through lifestyle modification. Lifestyle modification can be difficult for people with stroke, however, in part because of stroke-related physical and cognitive deficits. Despite these challenges, risk factor management through lifestyle modification is important. This article reviews the multiple cardiovascular and metabolic benefits associated with the modification of several lifestyle behaviors: diet, physical activity, smoking cessation, and alcohol consumption. Health behavior theories and existing lifestyle intervention programs are also reviewed to identify important behavioral and cognitive skills that can be used to facilitate modification of health behaviors, and practical skills and suggestions for health care providers are provided.
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Affiliation(s)
- Ryan R. Bailey
- Advanced Fellowship in Geriatrics, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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Self-Reported Exercise Prevalence and Determinants in the Long Term After Stroke: The North East Melbourne Stroke Incidence Study. J Stroke Cerebrovasc Dis 2017; 26:2855-2863. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/15/2017] [Accepted: 07/10/2017] [Indexed: 11/18/2022] Open
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Fruit consumption and physical activity in relation to all-cause and cardiovascular mortality among 70,000 Chinese adults with pre-existing vascular disease. PLoS One 2017; 12:e0173054. [PMID: 28403155 PMCID: PMC5389797 DOI: 10.1371/journal.pone.0173054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/14/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess the associations of fresh fruit consumption and total physical activity with all-cause and cardiovascular mortality among Chinese adults who have been diagnosed with cardiovascular disease (CVD) or hypertension. Methods During 2004–08, the China Kadoorie Biobank study recruited 70,047 adults, aged 30–79 years, with physician-diagnosed stroke or transient ischaemic attack, ischemic heart disease, or hypertension. Information on diet and physical activity was collected using an interviewer-administered electronic questionnaire. Cox regression was used to yield hazard ratios (HRs) for the independent and joint associations of fresh fruit consumption and total physical activity with mortality. Results At baseline, 32.9% of participants consumed fresh fruit regularly (i.e. >3 days/week) and the mean total physical activity were 15.8 (SD = 11.8) MET-hr/day. During ~7-years follow-up, 6569 deaths occurred with 3563 from CVD. Compared to participants with <1 day/week fruit consumption, regular consumers had HR (95% CI) of 0.84 (0.79–0.89) for all-cause mortality and 0.79 (0.73–0.86) for CVD mortality. The HRs for the top vs bottom tertile of physical activity were 0.68 (0.64–0.72) and 0.65 (0.60–0.71), respectively, with no clear evidence of reverse causality. After correcting for regression dilution, each 100 g/day usual consumption of fresh fruit or 10 MET-hr/day usual levels of physical activity was associated with 23–29% lower mortality. The combination of regular fruit consumption with top 3rd of physical activity (>16.53 MET-hr/day) was associated with about 40% lower mortality. Conclusion Among Chinese adults with pre-existing vascular disease, higher physical activity and fruit consumption were both independently and jointly associated with lower mortality.
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Tsujiguchi H, Hori D, Kambayashi Y, Hamagishi T, Asakura H, Mitoma J, Kitaoka M, Olando AE, Thao NTT, Yamada Y, Hayashi K, Konoshita T, Sagara T, Shibata A, Nakamura H. Sex- and Age-Specific Associations of Social Status and Health-Related Behaviors with Health Check Attendance: Findings from the Cross-Sectional Kanazawa Study. Health (London) 2017. [DOI: 10.4236/health.2017.99093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Case J, Willoughby D, Haley-Zitlin V, Maybee P. Preventing Type 2 Diabetes After Gestational Diabetes. DIABETES EDUCATOR 2016; 32:877-86. [PMID: 17102155 DOI: 10.1177/0145721706294263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purposes of this article are to examine the epidemiology of gestational diabetes mellitus (GDM) and subsequent type 2 diabetes, identify risk factors for the development of GDM and subsequent type 2 diabetes, discuss protocols for postpartum screening, and recommend evidence-based interventions to delay or prevent type 2 diabetes after GDM. Methods A review of the research literature from 1995 to 2005 concerning gestational diabetes was done using MEDLINE, CINAHL, National Institutes of Health, and American Diabetes Association internet resources. The criteria set for selection included the following: the research explored risk factors for and epidemiology of gestational diabetes, the relationship of gestational diabetes and the subsequent development of type 2 diabetes, and/or the prevention of type 2 diabetes after GDM. Results Women with pregnancies complicated by GDM are at increased risk for subsequent development of type 2 diabetes. Research suggests that modification of lifestyle-based risk factors including obesity, poor nutrition, and lack of exercise can delay or prevent the onset of type 2 diabetes in these women. However, there is evidence that recommended postpartum screening protocols for women with GDM are not being followed; hence, those women at high risk for type 2 diabetes are not identified, and no intervention is undertaken to reduce their risks. Conclusions Diabetes educators must play an integral role in increasing awareness of the need for postpartum screening and intervention for women with gestational diabetes. Only with early identification and intensive intervention can the devastating toll of diabetes be averted for many of these women.
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Affiliation(s)
- Jayne Case
- The Department of Nursing, Spartanburg Community College, Spartanburg, South Carolina (Ms Case)
| | | | | | - Pat Maybee
- Clemson University, Clemson, South Carolina; and Mountain View Family Practice, Greer, South Carolina (Dr Maybee)
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Abstract
As Rippe, Angelopoulos, and Zuckley pointed out, coronary heart disease “represents the quintessential lifestyle disease of developed countries,” offering both opportunities and challenges for the routine practice of lifestyle medicine. Although the empirical evidence provides a compelling rationale for the modification of preventable cardiovascular risks, their review prompts discussion of the continuing tendency for practice to lag behind knowledge, the persisting challenges to narrowing this knowledge-practice divide, and the emerging trends that may further advance cardiovascularrisk reduction efforts.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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Wright N, Akhtar A, Tosh GE, Clifton AV. HIV prevention advice for people with serious mental illness. Cochrane Database Syst Rev 2016; 9:CD009639. [PMID: 27609030 PMCID: PMC6457823 DOI: 10.1002/14651858.cd009639.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. OBJECTIVES To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (24 January 2012; 4 July 2016). SELECTION CRITERIA We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review's criteria. MAIN RESULTS We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. AUTHORS' CONCLUSIONS Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV infection. It is entirely feasible that this could be within the context of a well-designed simple large randomised study.
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Affiliation(s)
- Nicola Wright
- University of NottinghamSchool of Health SciencesInstitute of Mental HealthTriumph RoadNottinghamUKNG7 2TU
| | - Athfah Akhtar
- University of NottinghamSchool of Sociology and Social PolicyInstitute of Mental HealthTriumph RoadNottinghamUKNG7 2TU
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
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Khokhar MA, Khokhar WA, Clifton AV, Tosh GE. Oral health education (advice and training) for people with serious mental illness. Cochrane Database Syst Rev 2016; 9:CD008802. [PMID: 27606629 PMCID: PMC6457656 DOI: 10.1002/14651858.cd008802.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND People with serious mental illness not only experience an erosion of functioning in day-to-day life over a protracted period of time, but evidence also suggests that they have a greater risk of experiencing oral disease and greater oral treatment needs than the general population. Poor oral hygiene has been linked to coronary heart disease, diabetes, and respiratory disease and impacts on quality of life, affecting everyday functioning such as eating, comfort, appearance, social acceptance, and self esteem. Oral health, however, is often not seen as a priority in people suffering with serious mental illness. OBJECTIVES To review the effects of oral health education (advice and training) with or without monitoring for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (5 November 2015), which is based on regular searches of MEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA All randomised clinical trials focusing on oral health education (advice and training) with or without monitoring for people with serious mental illness. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS We included three randomised controlled trials (RCTs) involving 1358 participants. None of the studies provided useable data for the key outcomes of not having seen a dentist in the past year, not brushing teeth twice a day, chronic pain, clinically important adverse events, and service use. Data for leaving the study early and change in plaque index scores were provided. Oral health education compared with standard careWhen 'oral health education' was compared with 'standard care', there was no clear difference between the groups for numbers leaving the study early (1 RCT, n = 50, RR 1.67, 95% CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may have implications regarding improvement in oral hygiene. Motivational interview + oral health education compared with oral health educationSimilarly, when 'motivational interview + oral health education' was compared with 'oral health education', there was no clear difference for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60 95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding improvement in oral hygiene. Monitoring compared with no monitoringFor this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring the 'no monitoring' group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection of the acceptability of the monitoring to patients. For this comparison, no data were available for 'no clinically important change in plaque index'. AUTHORS' CONCLUSIONS We found no evidence from trials that oral health advice helps people with serious mental illness in terms of clinically meaningful outcomes. It makes sense to follow guidelines and recommendations such as those put forward by the British Society for Disability and Oral Health working group until better evidence is generated. Pioneering trialists have shown that evaluative studies relevant to oral health advice for people with serious mental illness are possible.
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Affiliation(s)
- Mariam A Khokhar
- University of SheffieldOral Health and Development15 Askham CourtGamston Radcliffe RoadNottinghamUKNG2 6NR
| | - Waqqas Ahmad Khokhar
- Leicestershire Partnership NHS TrustDepartment of PsychiatryLeicesterLeicestershireUK
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
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The Effects of “Physical Activity on Prescription” in Persons With Transient Ischemic Attack: A Randomized Controlled Study. J Neurol Phys Ther 2016; 40:176-83. [DOI: 10.1097/npt.0000000000000134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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An R, Yang Y. Diabetes Diagnosis and Screen-Based Sedentary Behavior Among US Adults. Am J Lifestyle Med 2016; 12:252-262. [PMID: 30202395 DOI: 10.1177/1559827616650416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/19/2016] [Accepted: 04/27/2016] [Indexed: 12/18/2022] Open
Abstract
Diabetes threatens a patient's health and quality of life, whereas disease diagnosis itself could potentially serve as a teachable moment for initiating behavior change. This study assessed diabetes diagnosis as a possible teachable moment for screen-based sedentary behavior among US adults. The nationally representative sample (n = 3690) came from the 2005-2006 and 2011-2012 National Health and Nutrition Examination Survey. Self-reported hours spent on screen-based sedentary behavior (television/video watching, computer/digital device use) were measured by the Global Physical Activity Questionnaire. Diabetes/prediabetes was identified by fasting plasma glucose and the glycated hemoglobin test. Logistic regressions were conducted to examine the relationship between diabetes diagnosis and screen-based sedentary behavior, adjusting for individual characteristics and sampling design. Compared with those with undiagnosed diabetes, the adjusted values for prevalence of daily television/video watching ≥2 hours (77.45% vs 65.14%), computer/digital device use ≥1 hour (43.20% vs 36.52%), and total screen time (ie, television/video watching plus computer/digital device use) ≥3 hours (66.75% vs 45.78%) were all noticeably higher among adults with diagnosed diabetes, although only the difference in the prevalence of daily total screen time was significant at P < .05. No evidence was found regarding diabetes diagnosis as a teachable moment in reducing screen-based sedentary behavior in US adults.
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Affiliation(s)
- Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Yan Yang
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois
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Facilitating Community-Based Exercise for People With Stroke: Cross-Sectional e-Survey of Physical Therapist Practice and Perceived Needs. Phys Ther 2016; 96:469-78. [PMID: 26294684 PMCID: PMC4817209 DOI: 10.2522/ptj.20150117] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Educating people with stroke about community-based exercise programs (CBEPs) is a recommended practice that physical therapists are well positioned to implement. OBJECTIVE The aim of this study was to evaluate the provision of education about CBEPs to people with stroke, barriers to providing education, and preferences for resources to facilitate education among physical therapists in neurological practice. DESIGN A cross-sectional e-survey of physical therapists treating adults with stroke in Ontario, Canada, was conducted. METHODS A link to the questionnaire was emailed to physical therapists in a provincial stroke network, a provincial physical therapy association, and on hospital and previous research lists. RESULTS Responses from 186 physical therapists were analyzed. The percentage of respondents who reported providing CBEP education was 84.4%. Only 36.6% reported typically providing education to ≥7 out of 10 patients with stroke. Physical (90.5%) and preventative (84.6%) health benefits of exercise were most frequently discussed. Therapists reported most commonly delivering education at discharge (73.7%). Most frequently cited barriers to educating patients were a perceived lack of suitable programs (53.2%) and a lack of awareness of local CBEPs (23.8%). Lists of CBEPs (94.1%) or brochures (94.1%) were considered to be facilitators. The percentage of physical therapists providing CBEP education varied across acute, rehabilitation, and public outpatient settings. LIMITATIONS The percentage of physical therapists providing education may have been overestimated if respondents who deliver CBEP education were more likely to participate and if participants answered in a socially desirable way. CONCLUSIONS Even though a high proportion of physical therapists provide CBEP education, education is not consistently delivered to the majority of patients poststroke. Although a CBEP list or brochure would facilitate education regarding existing CBEPs, efforts to implement CBEPs are needed to help overcome the lack of suitable programs.
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Abstract
BACKGROUND People with a serious mental illness are more likely to smoke more and to be more dependent smokers than the general population. This may be due to a wide range of factors that could include a common aetiology to both smoking and the illness, self medication, smoking to alleviate adverse effects of medications, boredom in the existing environment, or a combination of these factors. It is important to undertake this review to facilitate improvements in both the health and safety of people with serious mental illness who smoke, and to reduce the overall burden of costs (both financial and health) to the smoker and, eventually, to the taxpayer. OBJECTIVES To review the effects of smoking cessation advice for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group Specialized Trials Register up to 2 April 2015, which is based on regular searches of CENTRAL, BIOSIS, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and trial registries. We also undertook unsystematic searches of a sample of the component databases (BNI, CINHAL, EMBASE, MEDLINE, and PsycINFO), up to 2 April 2015, and searched references of all identified studies SELECTION CRITERIA We planned to include all randomised controlled trials (RCTs) that focussed on smoking cessation advice versus standard care or comparing smoking cessation advice with other more focussed methods of delivering care or information. DATA COLLECTION AND ANALYSIS The review authors (PK, AC, and DB) independently screened search results but did not identify any trials that fulfilled the inclusion criteria of this review. MAIN RESULTS We did not identify any RCTs that evaluated advice regarding smoking cessation for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to smokers with serious mental illness is possible. AUTHORS' CONCLUSIONS People with serious mental illness are more likely to smoke than the general population. Yet we could not find any high quality evidence to guide the smoking cessation advice healthcare professionals pass onto service users. This is an area where trials are possible and needed.
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Affiliation(s)
- Priya Khanna
- Northumberland, Tyne and Wear NHS Foundation TrustRehabilitation and Recovery, Adult PsychiatryNewcastleUK
| | - Andrew V Clifton
- University of HuddersfieldSchool of Human and Health SciencesQueensgateHuddersfieldSouth West YorkshireUKHD1 3DH
| | - David Banks
- Queen Margaret UniversitySchool of Health SciencesQueen Margaret DriveMusselburghEdinburghUKEH21 6UU
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
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Ball L, Leveritt M, Cass S, Chaboyer W. Effect of nutrition care provided by primary health professionals on adults' dietary behaviours: a systematic review. Fam Pract 2015; 32:605-17. [PMID: 26289046 DOI: 10.1093/fampra/cmv067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND 'Nutrition care' refers to any practice conducted by a health professional to support a patient to improve their dietary behaviours. Better understanding about the effectiveness of nutrition care is required to identify ways to enhance success of future interventions. OBJECTIVE Systematically review literature that investigated the effect of nutrition care provided by primary health professionals on adult patients' dietary behaviours. METHODS The systematic review included all studies published between January 2000 and January 2015 that involved nutrition care by one or more primary health professionals to adult patients and incorporated at least one quantified food-related outcome measure (e.g. daily intake of vegetables in grams, weekly servings of lean meats). After data extraction, the methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. RESULTS Twenty-one studies, totalling 12497 participants were included. The design, intensity, theoretical underpinning and follow-up period of interventions were diverse. Twelve studies found significant improvements in participants' dietary behaviours, such as increased daily consumption of fruit, vegetables, high-fibre bread and fish. However, seven studies did not identify any improvement in dietary behaviours; one observed equal improvements among participants in the intervention and control groups and one found a reduction in participants' daily fruit and vegetable intake. CONCLUSION Interventions involving nutrition care provided by primary health professionals have the potential to improve patients' dietary behaviours. However, the consistency and clinical significance of intervention outcomes are unclear. Further consideration of factors that may influence the effectiveness of interventions, but not traditionally measured, are required.
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Affiliation(s)
- Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland and
| | - Michael Leveritt
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Cass
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland and
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland and
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Abstract
OBJECTIVE To assess the role of diabetes diagnosis as a potential teachable moment in nutrition facts label use among US adults. DESIGN Logistic regression analyses were conducted to examine the relationship between diabetes diagnosis status (diagnosed diabetes, undiagnosed diabetes, diagnosed prediabetes, undiagnosed prediabetes, no diabetes or prediabetes) and self-reported nutrition facts label use, adjusted by individual characteristics and survey design. SETTING Study sample came from the National Health and Nutrition Examination Survey 2005-2010 waves. SUBJECTS A total of 5110 US adults aged 20 years and older were included in the analyses. Diabetes/prediabetes was identified by fasting plasma glucose and glycated Hb testing. RESULTS People with diagnosed diabetes/prediabetes were substantially more likely to report nutrition facts label use when making daily food purchase decisions compared with those with undiagnosed diabetes/prediabetes, whereas the prevalence of nutrition facts label use was similar between people with undiagnosed diabetes/prediabetes and those without diabetes/prediabetes. The adjusted prevalence (95 % CI) of any and regular nutrition facts label use was 85·93 (82·91, 88·95) % and 55·60 (50·04, 61·16) % among those with diagnosed diabetes, respectively, in comparison to 71·50 (59·64, 83·37) % and 32·88 (19·11, 46·65) % among those with undiagnosed diabetes. Analogously, the adjusted prevalence (95 % CI) of any and regular nutrition facts label use was 81·16 (75·27, 87·06) % and 45·28 (37·28, 53·29) % among those with diagnosed prediabetes, respectively, in comparison to 72·83 (68·06, 77·59) % and 39·95 (34·02, 45·89) % among those with undiagnosed prediabetes. CONCLUSIONS As a potential teachable moment, diabetes diagnosis may positively impact nutrition facts label use and motivate diabetic patients to manage their condition through making healthier food choices.
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Profil des patients post-AVC volontaires à un programme d’éducation thérapeutique à l’activité physique : étude descriptive. Sci Sports 2015. [DOI: 10.1016/j.scispo.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Patient Understanding of Body Mass Index (BMI) in Primary Care Practices: A Two-State Practice-based Research (PBR) Collaboration. J Am Board Fam Med 2015; 28:475-80. [PMID: 26152438 PMCID: PMC4612633 DOI: 10.3122/jabfm.2015.04.140279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The concept of body mass index (BMI) may not be well understood by patients. The purpose of this study was to evaluate patients' knowledge of BMI in the primary care setting. METHODS Adult patients seen in 18 practices in West Virginia and New Jersey were invited to complete a voluntary survey. The survey assessed the patient's baseline knowledge of BMI as well as demographic information and whether the patient had known chronic conditions associated with increased BMI, including hypertension, hyperlipidemia, diabetes mellitus, and sleep apnea. RESULTS While the majority (59.9%) of primary care patients knew the meaning of BMI and that it is related to obesity, there was little knowledge of BMI cutoff values; more than 80% of responses were incorrect when asked to define specific BMI levels and their meaning. Self-awareness of obesity was limited as well, with only 16.4% aware of their own personal BMI. Furthermore, nearly 70% of patients could not recall having discussed BMI with their physician. CONCLUSION Findings indicate low comprehension of the term BMI. Increasing awareness of BMI may help patients address this key risk factor and significantly affect public health.
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Mansfield A, Aqui A, Centen A, Danells CJ, DePaul VG, Knorr S, Schinkel-Ivy A, Brooks D, Inness EL, McIlroy WE, Mochizuki G. Perturbation training to promote safe independent mobility post-stroke: study protocol for a randomized controlled trial. BMC Neurol 2015; 15:87. [PMID: 26048054 PMCID: PMC4456796 DOI: 10.1186/s12883-015-0347-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/29/2015] [Indexed: 11/10/2022] Open
Abstract
Background Falls are one of the most common medical complications post-stroke. Physical exercise, particularly exercise that challenges balance, reduces the risk of falls among healthy and frail older adults. However, exercise has not proven effective for preventing falls post-stroke. Falls ultimately occur when an individual fails to recover from a loss of balance. Thus, training to specifically improve reactive balance control could prevent falls. Perturbation training aims to improve reactive balance control by repeatedly exposing participants to postural perturbations. There is emerging evidence that perturbation training reduces fall rates among individuals with neurological conditions, such as Parkinson disease. The primary aim of this work is to determine if perturbation-based balance training can reduce occurrence of falls in daily life among individuals with chronic stroke. Secondary objectives are to determine the effect of perturbation training on balance confidence and activity restriction, and functional balance and mobility. Methods/design Individuals with chronic stroke will be recruited. Participants will be randomly assigned to one of two groups: 1) perturbation training, or 2) ‘traditional’ balance training. Perturbation training will involve both manual perturbations (e.g., a push or pull from a physiotherapist), and rapid voluntary movements to cause a loss of balance. Training will occur twice per week for 6 weeks. Participants will record falls and activity for 12 months following completion of the training program. Standardized clinical tools will be used to assess functional balance and mobility, and balance confidence before and after training. Discussion Falls are a significant problem for those with stroke. Despite the large body of work demonstrating effective interventions, such as exercise, for preventing falls in other populations, there is little evidence for interventions that prevent falls post-stroke. The proposed study will investigate a novel and promising intervention: perturbation training. If effective, this training has the potential to not only prevent falls, but to also improve safe independent mobility and engagement in daily activities for those with stroke. Trial registration Current Controlled Trials: ISRCTN05434601.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Anthony Aqui
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Andrew Centen
- Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Vincent G DePaul
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada. .,St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | - Svetlana Knorr
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Alison Schinkel-Ivy
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Dina Brooks
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - William E McIlroy
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada. .,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
| | - George Mochizuki
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
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Grady A, Carey M, Oldmeadow C, Bryant J, Mazza D, Sanson-Fisher R. GP detection of health risk factors among general practice patients at risk of primary and secondary stroke. Fam Pract 2015; 32:336-42. [PMID: 25900676 DOI: 10.1093/fampra/cmv024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People with a history of stroke or heart disease are at increased risk of future stroke; therefore, identification of risk factors by GPs is critical. OBJECTIVES To compare the following among general practice patients with and without a history of stroke or heart disease: (i) self-reported prevalence rates of lifestyle risk factors; (ii) accuracy of GP detection of patient-reported risk factors and (iii) average proportion of patient-reported risk factors detected by GPs. METHODS Consecutive patients attending a participating general practice clinic were invited to participate in a cross-sectional touchscreen survey assessing lifestyle risk factors in 2010-11. The GP of each consenting patient completed a corresponding survey assessing the patient's risk factors. Demographic characteristics of patients and GPs were obtained. RESULTS Data from 51 GPs and 564 patients were analysed. Patients without a history of stroke or heart disease reported significantly higher rates of smoking (12%) and risky alcohol consumption (56%) than patients with a history of stroke or heart disease (6% and 36%, respectively). Low sensitivity of GP detection of risk factors was found for all risk factors for all patients. Patients with a history of stroke or heart disease have a significantly higher mean proportion of risk factors detected by their GP compared to patients without a history of stroke or heart disease (P = 0.00). CONCLUSION Given low sensitivity and specificity of GP detection of risk factors among patients, alternate methods of identification are needed. Research is required to determine strategies to facilitate secondary care of patients with a history of stroke or heart disease by GPs.
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Affiliation(s)
- Alice Grady
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305 and
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305 and
| | | | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305 and
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria 3168, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305 and
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Berning J. The role of physicians in promoting weight loss. ECONOMICS AND HUMAN BIOLOGY 2015; 17:104-115. [PMID: 25795471 DOI: 10.1016/j.ehb.2014.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/04/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
Abstract
There are numerous costs resulting from being overweight or obese. A relevant question is how to effectively reduce rates of obesity. I examine the effect of advice from a physician or heath care provider to lose weight on individual weight outcomes using survey data. I account for selection bias using a control function approach and rely on data restrictions to control for simultaneity. I find robust results indicating that advice has a significant effect on weight loss. Several studies suggest physicians may not adequately advise their patients about weight loss. The results of this paper highlight an important opportunity for physicians to advise at-risk patients.
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Affiliation(s)
- Joshua Berning
- University of Georgia, Agricultural and Applied Economics, Conner Hall, Athens, GA 30602, United States.
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Denby F, Harvey RL. An Educational Intervention for Stroke Rehabilitation Patients and Their Families: Healthy Living After Stroke. Top Stroke Rehabil 2015; 9:34-45. [PMID: 14523698 DOI: 10.1310/wpf9-k8jv-1bmy-vavd] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The education of stroke patients and their families on prevention of recurrent stroke is a rehabilitation challenge. The principal objective of this article is to share a process for creating a stroke education program that improves patient and caregiver knowledge of secondary prevention, stroke signs and symptoms, modifiable risk factors, and maintenance of functional independence. During stroke recovery, patient education is a continuous journey. The education program needs to take into consideration the individual's readiness to learn, unique learning styles, and timing of sessions. In our educational program, Healthy Living After Stroke, we used the stroke team to develop different venues of learning.
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Pool AC, Kraschnewski JL, Cover LA, Lehman EB, Stuckey HL, Hwang KO, Pollak KI, Sciamanna CN. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract 2015; 8:e131-9. [PMID: 24743008 DOI: 10.1016/j.orcp.2013.03.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/01/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
PROBLEM The increasing prevalence of overweight and obesity in the United States and worldwide is at epidemic levels. Physicians may play a vital role in addressing this epidemic. We aimed to examine the association of a physician's discussion of patients’ weight status with self-reported weight loss. We hypothesized that physician discussion of patients’ being overweight is associated with increased weight loss in patients with overweight and obesity. METHODS Data analysis of participants (n = 5054) in the National Health and Nutritional Examination Survey (NHANES) in 2005-2008. The main outcome was rates of self-reported weight loss and the association with physicians’ discussion of their patients’ weight status. RESULTS Overweight and obese participants were significantly more likely to report a 5% weight loss in the past year if their doctor had told them they were overweight (adjusted OR (AOR) 1.88; 95% CI 1.45-2.44; AOR 1.79; 95% CI 1.30-2.46, respectively). CONCLUSIONS Physicians’ direct discussion of their patients’ weight status is associated with clinically significant patient weight loss and may be a targetable intervention. Further studies are needed to determine if increasing physician discussion of patients’ weight status leads to significant weight loss.
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Affiliation(s)
- Andrew C Pool
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Lindsay A Cover
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Heather L Stuckey
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Kevin O Hwang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Kathryn I Pollak
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Christopher N Sciamanna
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
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Abstract
BACKGROUND People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. OBJECTIVES To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (24 January, 2012), which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review's criteria. MAIN RESULTS We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. AUTHORS' CONCLUSIONS Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV infection. It is entirely feasible that this could be within the context of a well-designed simple large randomised study.
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Affiliation(s)
- Nicola Wright
- School of Health Sciences, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, UK.
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Alexandrino GM, Damásio J, Canhão P, Geraldes R, Melo TP, Correia C, Ferro JM. Stroke in sports: a case series. J Neurol 2014; 261:1570-4. [PMID: 24888314 DOI: 10.1007/s00415-014-7383-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 11/25/2022]
Abstract
Regular physical activity decreases vascular risk. However, vascular events, including stroke, can occur while practicing physical activities. Stroke associated with sports is a rare clinical entity, whose risk factors and mechanisms are not fully understood. We report a case series of sports-related stroke, from tertiary care institutions. From the stroke registries of two University Neurology services and Stroke Units we retrieved all cases of stroke which occurred in temporal association with the practice of sports. Investigators had to fill a simple case report form, describing the demographic, clinical characteristics of the patients and the sport associated with the stroke. We included ten patients aged between 27 and 65 years, 8 being male. Only three subjects had vascular risk factors. Trauma to the head and/or neck was reported in two patients only. Cervicocerebral arterial dissection was the main cause of stroke, occurring in six of the ten cases. No patient died, but three were left disabled (modified Rankin Scale 3-5). This case series confirms that stroke associated with sport is very rare. The majority of the victims did not have vascular risk factors. Dissection was the most common cause of sport-associated stroke. Strokes were often disabling.
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Affiliation(s)
- Gonçalo M Alexandrino
- Serviço de Neurologia, Department of Neurosciences, Hospital de Santa Maria, Universidade de Lisboa, Lisbon, Portugal
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Tosh G, Clifton AV, Xia J, White MM. General physical health advice for people with serious mental illness. Cochrane Database Syst Rev 2014; 2014:CD008567. [PMID: 24676557 PMCID: PMC10731645 DOI: 10.1002/14651858.cd008567.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is currently much focus on provision of general physical health advice to people with serious mental illness and there has been increasing pressure for services to take responsibility for providing this. OBJECTIVES To review the effects of general physical healthcare advice for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (last update search October 2012) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO and registries of Clinical Trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA All randomised clinical trials focusing on general physical health advice for people with serious mental illness.. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS Seven studies are now included in this review. For the comparison of physical healthcare advice versus standard care we identified six studies (total n = 964) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.20, CI -0.47 to 0.87, very low quality of evidence) but another two did for the Quality of Life Medical Outcomes Scale - mental component (n = 487, 2 RCTs, MD 3.70, CI 1.76 to 5.64). There was no difference between groups for the outcome of death (n = 487, 2 RCTs, RR 0.98, CI 0.27 to 3.56, low quality of evidence). For service use two studies presented favourable results for health advice, uptake of ill-health prevention services was significantly greater in the advice group (n = 363, 1 RCT, MD 36.90, CI 33.07 to 40.73) and service use: one or more primary care visit was significantly higher in the advice group (n = 80, 1 RCT, RR 1.77, CI 1.09 to 2.85). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 964, 6 RCTs, RR 1.11, CI 0.92 to 1.35). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal. AUTHORS' CONCLUSIONS General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer-term benefits such as reduced mortality or morbidity. On the other hand, it is possible clinicians are expending much effort, time and financial resources on giving ineffective advice. The main results in this review are based on low or very low quality data. There is some limited and poor quality evidence that the provision of general physical healthcare advice can improve health-related quality of life in the mental component but not the physical component, but this evidence is based on data from one study only. This is an important area for good research reporting outcome of interest to carers and people with serious illnesses as well as researchers and fundholders.
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Affiliation(s)
- Graeme Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)Early Intervention in Psychosis and Community TherapiesSwallownest CourtAughton RoadSwallownestUKS26 4TH
| | - Andrew V Clifton
- University of HuddersfieldSchool of Human and Health SciencesQueensgateHuddersfieldSouth West YorkshireUKHD1 3DH
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
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Li J, Luan X, Clark JC, Rafols JA, Ding Y. Neuroprotection against transient cerebral ischemia by exercise pre-conditioning in rats. Neurol Res 2013; 26:404-8. [PMID: 15198867 DOI: 10.1179/016164104225016038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
There is increasing evidence that physical activity is associated with decreased stroke risk and incidence. The purpose of this study was to determine whether increased levels of physical activity could reduce brain damage in rats subjected to transient or permanent middle cerebral artery (MCA) occlusion. Adult male Sprague-Dawley rats (three months old, n=36) exercised on a treadmill, which required repetitive locomotor movement, for 30 min each day for three weeks. Then, using an intraluminal filament, stroke was induced by either 2-h MCA occlusion followed by two days of reperfusion or by MCA occlusion for two days without reperfusion. Brain damage was determined by evaluating neurologic deficits and brain infarction. In rat with transient MCA occlusion, pre-ischemic motor activity significantly (p<0.01) reduced neurologic deficits and infarct volume in the frontoparietal cortex and the dorsolateral striatum. In contrast, the same exercise procedure did not produce neuroprotection in the permanently MCA-occluded stroke. In addition to decreasing stroke risk and incidence, physical activity also reduces brain damage after stroke. Although we cannot completely rule out a neuroprotective effect on ischemic episode, our study suggests that a major neuroprotection is conferred during reperfusion for rats that have undergone exercise pre-conditioning. This exercise-induced endogenous neuroprotection may be an effective strategy to ameliorate ischemia/reperfusion brain injury from stroke.
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Affiliation(s)
- Jie Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Phillips EM, Kennedy MA. The exercise prescription: a tool to improve physical activity. PM R 2013; 4:818-25. [PMID: 23174544 DOI: 10.1016/j.pmrj.2012.09.582] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
The current epidemic of sedentary behavior is a serious public health issue that requires the attention of the medical community. Although the benefits of physical activity are well established, research indicates that Americans are not heeding the message, and new strategies are warranted to bring about change in this arena. The health care community can and should play a key role in this movement. Patients respect their physicians as credible sources of information and look to them for health-related guidance. Unfortunately, many physicians are not talking to their patients about physical activity and are missing a unique opportunity to raise awareness about its benefits. Exercise needs to be discussed as a serious form of treatment, similar to medication, and should be thoughtfully prescribed to every patient. Physicians need to be familiar with the level of exercise necessary to achieve health benefits as defined by the Physical Activity Guidelines for Americans. Furthermore, they should be competent in their ability to identify a patient's level of risk for starting or increasing exercise and provide guidance on the frequency, intensity, time, and type of activity necessary to safely elicit maximal health benefits. These basic competencies can be easily understood by physicians and incorporated into their practices. Resources have been established to help support physicians in this process. Physiatrists are uniquely positioned to lead the effort for change in this area because they are well-established proponents of exercise and are trained to prescribe therapeutic exercise to address the complex medical issues of their patients. This skill-set should be used for every patient in an effort to reduce the widespread prevalence of the "chronic disease" physical inactivity.
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Affiliation(s)
- Edward M Phillips
- Harvard Medical School Department of Physical Medicine and Rehabilitation, Boston, MA, USA.
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Josyula L, Lyle R. Health Care Provider Physical Activity Prescription Intervention. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2013.779903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lakshmi Josyula
- a Indian Institute of Public Health , Hyderabad
- b Purdue University
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Daviet JC, Bonan I, Caire J, Colle F, Damamme L, Froger J, Leblond C, Leger A, Muller F, Simon O, Thiebaut M, Yelnik A. Therapeutic patient education for stroke survivors: Non-pharmacological management. A literature review. Ann Phys Rehabil Med 2012; 55:641-56. [DOI: 10.1016/j.rehab.2012.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 11/17/2022]
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Franken DL, Olinto MTA, Paniz VMV, Henn RL, Junqueira LD, da Silveira FG, Roman VR, Manenti ERF, Dias da Costa JS. Behavioral changes after cardiovascular events: A cohort study. Int J Cardiol 2012; 161:115-7. [DOI: 10.1016/j.ijcard.2012.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 06/09/2012] [Indexed: 10/28/2022]
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Khanna P, Clifton A, Banks D, Tosh G. Smoking cessation advice for people with serious mental illness. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wright N, Akhtar A, Tosh G, Clifton A. HIV prevention advice for people with serious mental illness. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Braun A, Herber V, Michaelsen SM. Relação entre nível de atividade física, equilíbrio e qualidade de vida em indivíduos com hemiparesia. REV BRAS MED ESPORTE 2012. [DOI: 10.1590/s1517-86922012000100006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A atividade física proporciona benefícios sobre o sistema neurológico, em particular, sobre as deficiências motoras e de equilíbrio, sendo estes déficits importantes em indivíduos com sequelas após acidente vascular encefálico (AVE). OBJETIVO: Avaliar a relação existente entre o equilíbrio e nível de confiança no equilíbrio com o nível de atividade física e com a qualidade de vida (QV) de indivíduos com hemiparesia após AVE. Método: Participaram 19 indivíduos (57,8 ± 14,1 anos) com hemiparesia crônica (44,1 ± 37,9 meses). Avaliou-se o perfil de atividade humana (PAH), o nível de confiança no equilíbrio (ABC), o equilíbrio funcional (BERG) e a QV (EQVEAVE). Os dados foram submetidos ao teste de coeficiente de correlação de Spearman. RESULTADOS: O PAH ajustado apresentou uma correlação positiva forte para o BERG (ρ = 0,73) e uma correlação positiva moderada para o ABC (ρ = 0,64). A QV (total) e os domínios de papéis familiares e mobilidade da EQVE-AVE apresentaram correlações moderadas para BERG e ABC (ρ entre 0,53 e 0,67). O PAH total e ajustado apresentaram correlação positiva moderada com os domínios mobilidade (respectivamente, ρ = 0,48 e ρ = 0,71), autocuidado (ρ = 0,48 e ρ = 0,65), função do membro superior (ρ = 0,56 para ambos) e visão (ρ = 0,49 e ρ = 0,69). CONCLUSÃO: Sugere-se que quanto mais ativo o indivíduo se apresenta melhor será seu equilíbrio e sua confiança no equilibrar-se, tanto na realização das atividades de vida diária (AVDs) como também nas atividades físicas, com um impacto positivo na sua QV. Diante disto, é de extrema importância o desenvolvimento de programas de atividade física voltados para indivíduos com hemiparesia após AVE.
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Affiliation(s)
- Aline Braun
- Universidade do Estado de Santa Catarina, Brasil
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Abstract
BACKGROUND People with serious mental illness experience an erosion of functioning in day-to-day life over a protracted period of time. There is also evidence to suggest that people with serious mental illness have a greater risk of experiencing oral disease and have greater oral treatment needs than the general population. However, oral health has never been seen as a priority in people suffering with serious mental illness. Poor oral health has a serious impact on quality of life, everyday functioning, social inclusion and self-esteem. We feel that oral healthcare advice could have a positive impact on this disadvantaged population. OBJECTIVES To assess the effectiveness of oral health advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (October 2009) which is based on regular searches of CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO. SELECTION CRITERIA We planned to include all randomised clinical trials focusing on oral health advice versus standard care or comparing oral health advice with other more focused methods of delivering care or information. DATA COLLECTION AND ANALYSIS The review authors (GT, AC, WK) independently screened search results and did not identify any studies that fulfilled the review's criteria. MAIN RESULTS We did not identify any studies that met our inclusion criteria. AUTHORS' CONCLUSIONS Healthcare professionals should be more proactive in liaising with oral health professionals in developing novel ways to cater for the needs of people with serious mental illness.
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Affiliation(s)
- Waqqas Ahmad Khokhar
- Bradgate Mental Health Unit, Glenfield General Hospital, Leicestershire Partnership Trust, Leicester, UK.
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Kang KA, Seong H, Jin HB, Park J, Lee J, Jeon JY, Kim YJ. [The effect of treadmill exercise on ischemic neuronal injury in the stroke animal model: potentiation of cerebral vascular integrity]. J Korean Acad Nurs 2011; 41:197-203. [PMID: 21551991 DOI: 10.4040/jkan.2011.41.2.197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to identify whether pre-conditioning exercise has neuroprotective effects against cerebral ischemia, through enhance brain microvascular integrity. METHODS Adult male Sprague-Dawley rats were randomly divided into four groups: 1) Normal (n=10); 2) Exercise (n=10); 3) Middle cerebral artery occlusion (MCAo), n=10); 4) Exercise+MCAo (n=10). Both exercise groups ran on a treadmill at a speed of 15 m/min, 30 min/day for 4 weeks, then, MCAo was performed for 90 min. Brain infarction was measured by Nissl staining. Examination of the remaining neuronal cell after MCAo, and microvascular protein expression on the motor cortex, showed the expression of Neuronal Nuclei (NeuN), Vascular endothelial growth factor (VEGF) & laminin. RESULTS After 48 hr of MCAo, the infarct volume was significantly reduced in the Ex+MCAo group (15.6±2.7%) compared to the MCAo group (44.9±3.8%) (p<.05), and many neuronal cells were detected in the Ex+MCAo group (70.8±3.9%) compared to the MCAo group (43.4±5.1%) (p<.05). The immunoreactivity of laminin, as a marker of microvessels and Vascular endothelial growth factor (VEGF) were intensively increased in the Ex+MCAo group compared to the MCAo group. CONCLUSION These findings suggest that the neuroprotective effects of exercise pre-conditioning reduce ischemic brain injury through strengthening the microvascular integrity after cerebral ischemia.
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Affiliation(s)
- Kyoung Ah Kang
- Department of Nursing, Mokpo Catholic University, Mokpo, Korea
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Simpson LA, Eng JJ, Tawashy AE. Exercise perceptions among people with stroke: Barriers and facilitators to participation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011; 18:520-530. [PMID: 23255881 PMCID: PMC3524261 DOI: 10.12968/ijtr.2011.18.9.520] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
BACKGROUND/AIMS: People with stroke continue to lead sedentary lives despite the multiple benefits of exercise. Knowledge regarding stroke survivors' conception of exercise, which is essential for a thorough understanding of the barriers and facilitators to exercise, is lacking. This study aims to explore the perceptions of exercise among stroke survivors, including their concepts and definitions of exercise, as well as their perceptions of barriers and facilitators to exercise. METHODS: This study utilized a qualitative exploratory design. Focus groups were conducted with 11 community dwelling participants with stroke (mean 8 ± 3 years post stroke). Data was analysed using content analysis methods. FINDINGS: Six themes that provided information regarding participants' perceptions of exercise were identified: mobility, balance, self-efficacy, outcomes, support, and exercise as part of an active or healthy lifestyle. Although participants internalized specific benefits of exercise, they did not demonstrate an internalized link between exercise and stroke risk. Low self-efficacy was identified as a barrier to participating in exercise, whereas, support to exercise (e.g., external encouragement, qualified personnel) was identified as a facilitator. CONCLUSION: These findings may provide insight when developing exercise interventions which optimize adherence for people with stroke.
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Affiliation(s)
- Lisa A Simpson
- Graduate program of Rehabilitation Sciences at the University of British Columbia, Vancouver, British Columbia, Canada
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Buppert C. Where Do Nurse Practitioners Stand With Health Care? J Nurse Pract 2011. [DOI: 10.1016/j.nurpra.2011.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jurkiewicz MT, Marzolini S, Oh P. Adherence to a home-based exercise program for individuals after stroke. Top Stroke Rehabil 2011; 18:277-84. [PMID: 21642065 DOI: 10.1310/tsr1803-277] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although aerobic training (AT) and resistance training (RT) have been shown to improve functional abilities in patients post stroke, few patients participate, with many doing so for only a short duration. PURPOSE To retrospectively identify factors that affect adherence to a home-based exercise program adapted for stroke patients in a cardiac rehabilitation program during and after program completion. METHODS Fourteen participants (age 63 ± 3 years, 37 ± 34 months post stroke) attended the rehabilitation center on a weekly (24 weeks) and then monthly (2 months) basis. Patients were required to complete 4 AT and 1 to 2 RT sessions away from the center each week. A 16-item survey exploring adherence to home-based workouts was administered. RESULTS Seven patients were currently participating (mean time in program, 19.4 ± 8 weeks) and 7 had graduated (mean of 32.8 ± 28 weeks post graduation) from the program. Current participants had higher adherence than graduated participants to AT (100% vs 76%; P < .01) and RT (100% vs 55%; P < .01). The most common factors motivating participants were to improve overall health, improve functional abilities, and enhance confidence and to reduce musculoskeletal issues. The most common factors preventing workouts were lack of motivation, musculoskeletal issues, and fatigue. There was a negative correlation between age and adherence to AT in the graduated group. CONCLUSION Adherence to home-based exercise is superior during participation in an organized group program, with decline after graduation.
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Affiliation(s)
- Michael T Jurkiewicz
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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