Acceptance and commitment therapy improves exercise tolerance in sedentary women

PURPOSE

To test the efficacy of an acute intervention derived from acceptance and commitment therapy (ACT) for increasing high-intensity constant work rate (CWR) cycle exercise tolerance in a group of low-active women age 18-45 yr. The secondary goals were to examine whether ACT would reduce perceived effort and improve in-task affect during exercise and increase postexercise enjoyment.

METHODS

In a randomized controlled trial, 39 women were randomized to either the experimental (using ACT-based cognitive techniques and listening to music during the CWR exercise tests) or a control group (listening to music during the CWR exercise tests). Before (CWR-1) and after the intervention (CWR-2), participants completed a CWR cycle exercise test at 80% of maximal incremental work rate (Wmax) until volitional exhaustion.

RESULTS

On average, ACT (n = 18) and control (n = 21) groups were matched for age, body mass index, weekly leisure activity scores, and Wmax (all P > 0.05). Exercise tolerance time (ETT) increased by 15% from CWR-1 to CWR-2 for the ACT group (392.05 ± 146.4 vs 459.39 ± 209.3 s; mean ± SD) and decreased by 8% (384.71 ± 120.1 vs 353.86 ± 127.9 s) for the control group (P = 0.008). RPE were lower (e.g., by 1.5 Borg 6-20 scale units at 55% of ETT, P ≤ 0.01) during CWR-2 in the ACT versus that in the control group. By contrast, ACT had no effect on in-task affect. Exercise enjoyment was higher after CWR-2 in the ACT group versus that in the control group (P < 0.001).

CONCLUSIONS

An acute ACT intervention increased high-intensity ETT and postexercise enjoyment and reduced perceived effort in low-active women. Further investigations of ACT as an effective intervention for enhancing the established health benefits of high-intensity exercise need to be provided.

Dynamics of vitamin D in patients with mild or inactive inflammatory bowel disease and their families

BACKGROUND

25(OH) vitamin D levels may be low in patients with moderately or severely active inflammatory bowel diseases (IBD: Crohn's disease and Idiopathic Ulcerative Colitis) but this is less clear in patients with mild or inactive IBD. Furthermore there is limited information of any family influence on 25(OH) vitamin D levels in IBD. As a possible risk factor we hypothesize that vitamin D levels may also be low in families of IBD patients.

OBJECTIVES

To evaluate 25[OH] vitamin D levels in patients with IBD in remission or with mild activity. A second objective is to evaluate whether there are relationships within IBD family units of 25[OH] vitamin D and what are the influences associated with these levels.

METHODS

Participants underwent medical history, physical examination and a 114 item diet questionnaire. Serum 25[OH] vitamin D was measured, using a radioimmunoassay kit, (replete ≥ 75, insufficient 50-74, deficient < 25-50, or severely deficient < 25 nmol/L). Associations between 25[OH] vitamin D and twenty variables were evaluated using univariate regression. Multivariable analysis was also applied and intrafamilial dynamics were assessed.

RESULTS

55 patients and 48 controls with their respective families participated (N206). 25[OH] vitamin D levels between patients and controls were similar (71.2 ± 32.8 vs. 68.3 ±26.2 nmol/L). Vitamin D supplements significantly increased intake but correlation with serum 25[OH] vitamin D was significant only during non sunny months among patients. Within family units, patients' families had mean replete levels (82.3 ± 34.2 nmol/L) and a modest correlation emerged during sunny months between patients and family (r2 =0.209 p = 0.032). These relationships were less robust and non significant in controls and their families.

CONCLUSIONS

In patients with mild or inactive IBD 25[OH] vitamin D levels are less than ideal but are similar to controls. Taken together collectively, the results of this study suggest that patient family dynamics may be different in IBD units from that in control family units. However contrary to the hypothesis, intra familial vitamin D dynamics do not pose additional risks for development of IBD.

Impact of sleep extension and restriction on children's emotional lability and impulsivity

OBJECTIVE

To examine the impact of moderate sleep extension and restriction on child behavior in school.

METHODS

We conducted a randomized parallel group study to determine the impact of an experimental sleep extension (addition of 1 hour of sleep relative to baseline habitual sleep duration on weekdays) and experimental sleep restriction (elimination of 1 hour of sleep relative to baseline habitual sleep duration on weekdays) on child behavior in school. The primary outcome measures were scores on the Conners' Global Index Scale, as determined by teachers blinded to sleep status of the participants. A sample of 34 typically developing children aged 7 to 11 years with no reported sleep problems and no behavioral, medical, or academic issues participated in the study.

RESULTS

Our main findings were that (1) a cumulative extension of sleep duration of 27.36 minutes was associated with detectable improvement in Conners' Global Index-derived emotional lability and restless-impulsive behavior scores of children in school and a significant reduction in reported daytime sleepiness; and (2) a cumulative restriction of sleep of 54.04 minutes was associated with detectable deterioration on such measures.

CONCLUSIONS

A modest extension in sleep duration was associated with significant improvement in alertness and emotional regulation, whereas a modest sleep restriction had opposite effects.

Sleep patterns and the risk for ADHD: a review

Attention-deficit/hyperactivity disorder (ADHD) is often associated with comorbid sleep disturbances. Sleep disturbances may be a risk factor for development of the disorder, a symptom of the disorder, or a comorbid condition affected by a similar psychopathology. Various studies have examined the impact of sleep deprivation on the presence/exacerbation of ADHD symptomology, as well as longitudinal and concurrent associations between different sleep disturbances and ADHD, yet the notion of sleep disturbances as a predecessor to ADHD remains unclear. As such, this review examines the evidence for sleep disturbances as a risk factor for the development of ADHD, as well as the mechanisms underlying the association between sleep patterns and ADHD. Additionally, clinical implications regarding the comorbid nature of sleep disturbances and ADHD will be considered.

Sleep patterns and the risk for unipolar depression: a review

Psychological disorders, particularly mood disorders, such as unipolar depression, are often accompanied by comorbid sleep disturbances, such as insomnia, restless sleep, and restricted sleep duration. The nature of the relationship between unipolar depression and these sleep disturbances remains unclear, as sleep disturbance may be a risk factor for development, an initial manifestation of the disorder, or a comorbid condition affected by similar mechanisms. Various studies have examined the impact of sleep deprivation on the presence of (or exacerbation of) depressive symptoms, and have examined longitudinal and concurrent associations between different sleep disturbances and unipolar depression. This review examines the evidence for sleep disturbances as a risk factor for the development and presence of depression, as well as examining common underlying mechanisms. Clinical implications pertaining to the comorbid nature of various sleep patterns and depression are considered.

Sleep health education in pediatric community settings: rationale and practical suggestions for incorporating healthy sleep education into pediatric practice

This article offers practical ways to incorporate healthy sleep education into pediatric practice and discusses key questions, barriers, and strategies associated with such efforts. The rationale for incorporating healthy sleep education in pediatric practice settings is presented, and desirable features of sleep education programs that may be implemented in pediatric practice are identified. Potential barriers are reviewed and strategies offered to overcome these barriers, such as developing resources applicable to healthy sleep education and practical information for pediatricians. Key factors regarding effectiveness of such interventional programs and key points relevant to successful healthy sleep education in pediatric practice are highlighted.

Sleep and academic success: mechanisms, empirical evidence, and interventional strategies

Mounting evidence indicates that sleep is beneficial for learning, memory, attention, and academic success. However, the importance of sleep in these contexts has rarely been addressed in programs aimed at optimizing academic performance. This review aims to describe the role that sleep plays in processes pertaining to academic achievement. We first describe the basic sleep processes and their role with respect to cognitive and behavioral/emotional systems important for academic performance. We next review studies conducted to assess the association between sleep and academic performance, concluding by describing interventional programs being used to optimize sleep in the context of academic success.

Ultrasonographically indeterminate renal parapelvic masses

Ultrasonography is excellent in the evaluation of renal masses. Simple cysts can be distinguished from more complex or solid renal masses. Rarely, sonographic examination cannot be used to categorize renal masses, particularly those that are small and in a parapelvic location. We report six patients having sonographically indeterminate parapelvic masses. Subsequent computed tomographic examination demonstrated each of these masses to be a parapelvic cyst. Failure to make an ultrasonographic diagnosis was thought to be due to their parapelvic location. Complex interactions between cyst and normal renal sinus structures caused alteration and distortion of the anatomy of both, making exact diagnosis difficult. Computed tomography can be used to define the anatomy precisely and provide the correct diagnosis.

Ultrasound findings in small bowel infarction

A patient with small bowel infarction was studied using grey-scale ultrasound. The appearance was that of a lobulated abdominal mass consisting of smaller masses with a central sonolucent area and a peripheral echogenic rind. This is the reverse of what has been described in intramural intestinal hematoma, intussusception, and inflammatory and neoplastic bowel masses.

Comparative accuracy and complementary use of 67Ga-citrate imaging and ultrasound in the diagnosis of abdominal abscesses

Ultrasound and 67Ga-citrate imaging were used simultaneously for the evaluation of 26 suspected cases of abdominal abscess. Scintiscanning and ultrasonography identified respectively 92% and 69% of the abscesses. Jointly, both modalities detected all 13 abscesses and we suggest an integrated approach in the evaluation of such cases.

Grey-scale ultrasonography for assessment of gynecologic pelvic masses

In a retrospective study the grey-scale ultrasonographic appearance of pelvic masses was correlated with the surgical findings in 93 patients. Of the masses found at the time of laparotomy 95% had been detected preoperatively. In most instances useful information about size, consistency and location of the mass was provided by ultrasonography. Certain pathologic entities produce a characteristic sonographic appearance, but there is a wide overlap for others. Data obtained by history-taking and physical examination must be integrated with the sonographic findings for a correct diagnosis.