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Abstract
Age-associated cardiovascular (CV) dysfunction increases the risk for CV diseases. Aerobic exercise training can improve CV function, but only a minority of adults meet aerobic exercise guidelines. High-resistance inspiratory muscle strength training is a time-efficient lifestyle intervention that may promote adherence and improve CV function. However, further investigation is needed to translate inspiratory muscle strength training into the public health domain.
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Affiliation(s)
- Daniel H. Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Kaitlin A. Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Grace S. Maurer
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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Loeb SJ, Murphy JL, Kitt-Lewis E, Wion RK, Jerrod T, Myers VH. Inmates Care: Computer-Based Training for Geriatric and End-of-Life Care in Prisons. J Correct Health Care 2021; 27:132-144. [PMID: 34232784 DOI: 10.1089/jchc.20.03.0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The growing aged and dying incarcerated population increases demands on corrections health care. People who are incarcerated can assist in care delivery; however, currently, their training is typically face-to-face, home grown, and variable in content and duration. Six focus groups conducted with peer caregivers (PCs) (n = 12) and staff (n = 15) identified priority training topics. Three prototype modules (Standard Precautions; Loss and Grief; and Role of the Inmate Caregiver in the Final Hours) were developed in consultation with an advisory board. Face-to-face usability testing with (n = 20) PCs and staff confirmed contextual relevance and feasibility of the Inmates Care training. The mean system usability score for all participant segments was 86.5. Inmates Care holds promise to complement nurse-led training with a standardized e-training package.
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Affiliation(s)
- Susan J Loeb
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Julie L Murphy
- Nursing, King's College, Wilkes Barre, Pennsylvania, USA
| | - Erin Kitt-Lewis
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Rachel K Wion
- Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Tiffany Jerrod
- Department of Public Health, Denver Health, Denver, Colorado, USA
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Midgett A, Doumas DM, Myers VH, Moody S, Doud A. Technology-Based Bullying Intervention for Rural Schools: Perspectives on Needs, Challenges, and Design. ACTA ACUST UNITED AC 2021; 45:14-30. [PMID: 33777286 DOI: 10.1037/rmh0000151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bullying is a significant problem in the United States, with 26.7% of middle school students reporting bullying victimization. The majority of bullying programs are comprehensive, school-wide interventions that require significant resources for implementation, creating barriers and challenges for schools in rural and low-income communities. To increase access for these schools, we propose to translate a brief, bystander bullying intervention (STAC) into a technology-based format. Using consensual qualitative research (CQR), we aimed to understand the needs of school personnel and perceived challenges to program implementation to provide information on how to best serve middle schools in rural and low-income communities. We conducted interviews and focus groups with key school personnel at three middle schools in rural, low-income communities (N = 15). Participants indicated a strong interest in a technology-based bullying intervention and reported positive conditions for implementation including administrative support and technology-readiness. Participants identified program efficacy, flexibility of delivery, and parental involvement as important components of bullying prevention and identified implementation challenges, which included time, financial resources, and teacher buy-in. Perceived strengths of the STAC intervention included providing a clear definition of bullying, skills training and practice, and a certificate of completion. Feedback related to translating the intervention to a technology-based format included the use of virtual interaction and a hybrid virtual/in-person program, particularly for booster-sessions. Findings from this study support the need for the proposed technology-based STAC intervention and provide feedback on both the needs and challenges that need to be addressed for successful implementation in middle schools in rural and low-income communities.
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Kitt-Lewis E, Loeb SJ, Wion RK, Myers VH, Jerrod T, Strickfaden S. Developing Computer-Based Learning on Care of Aged and Dying Incarcerated People. J Forensic Nurs 2020; 16:36-46. [PMID: 31299671 PMCID: PMC6949422 DOI: 10.1097/jfn.0000000000000248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Corrections agencies are exploring ways to securely and cost-effectively increase access to high-quality, evidence-based educational programs for personnel. Technology-based instructional tools hold strong potential for continuing education. The Institute for Healthcare Improvement's Framework for Going to Full Scale was employed to guide a systematic approach. PURPOSE The purpose of this article is to outline and describe the design and development of a media-rich interactive computer-based learning product, Enhancing Care for Aged and Dying in Prison, which addresses geriatric and end-of-life care issues in corrections. METHOD Through an iterative process, the research team developed the computer-based educational program that included program and module-specific objectives in alignment with goals and priorities of the end users, detailed evidence-based content that was engaging and visually appealing, and assessments aimed at testing the user's knowledge. RESULTS The Enhancing Care for Aged and Dying in Prison contains six modules, created under the careful guidance of the research team and the two advisory boards. Contents, including images and testimonials, were selected purposefully and strategically. Module objectives were developed in alignment with the goals and priorities of each module, and assessments tested user knowledge level pre/post module exposure. Completion of the training product advances the research and development necessary to further the goal of full-scale dissemination of the computer-based education. DISCUSSION/CONCLUSIONS The goal of this program is to enhance care and improve quality of life for aged and dying inmates. Evidence-based training products are critical in preparing not only forensic nurses who work in corrections but also the broader group of correctional personnel in how to better meet the care needs of incarcerated persons.
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Affiliation(s)
| | - Susan J. Loeb
- 201 Nursing Sciences Building, The Pennsylvania State University, University Park, PA 16802
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5
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Glynn NW, Gmelin T, Santanasto AJ, Lovato LC, Lange-Maia BS, Nicklas BJ, Fielding RA, Manini TM, Myers VH, de Rekeneire N, Spring BJ, Pahor M, King AC, Rejeski WJ, Newman AB. Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability. J Am Geriatr Soc 2019; 68:619-624. [PMID: 31867713 DOI: 10.1111/jgs.16274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study. DESIGN Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years. SETTING LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD. PARTICIPANTS Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment. MEASUREMENTS Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual-paced 400-m walk every 6 months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates. RESULTS Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD = .71; 95% confidence interval [CI] = .57-.90; P = .004) and PMMD (HR = .60; 95% CI = .44-.82; P = .001). For those with lower baseline fatigue, no group differences in MMD (P = .36) or PMMD (P = .82) were found. Results of baseline fatigue by intervention interaction was MMD (P = .18) and PMMD (P = .05). CONCLUSION A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue. J Am Geriatr Soc 68:619-624, 2020.
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Affiliation(s)
- Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J Santanasto
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura C Lovato
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Brittney S Lange-Maia
- Department of Preventive Medicine and Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Barbara J Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roger A Fielding
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Todd M Manini
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | | | | | - Bonnie J Spring
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Marco Pahor
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Abby C King
- Department of Health Research & Policy, and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Anne B Newman
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Kitt-Lewis E, Loeb SJ, Myers VH, Wion RK, Baney B, Strickfaden S. Developing educational modules to enhance care of aged and dying inmates: Set-up phase. Public Health Nurs 2019; 36:401-410. [PMID: 30734363 PMCID: PMC6595484 DOI: 10.1111/phn.12583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/05/2018] [Accepted: 12/15/2018] [Indexed: 11/28/2022]
Abstract
The purpose of this article is to explain the strategies used in the "Set-up" phase of developing computer-based education on the care and management of incarcerated people who are older and/or dying. Public health nurses have an opportunity to support efforts in educating corrections staff to enhance health care for older and dying inmates. Such endeavors can promote social justice through inmates receiving evidence-based care that parallels that received by the community at large. "Set-up" is the first of four phases in the Institute for Healthcare Improvement's Framework for Going to Full Scale. Our design approach was threefold and included an environmental scan, a modified Delphi survey, and a usability study. An expert advisory board was consulted throughout the Set-up Phase. Participants for the Delphi Survey had expertise in geriatrics and corrections health care. Usability testing was conducted at two State Correctional Institutions. The Delphi Survey consisted of three Qualtrics surveys. Usability testing examined navigability; detected problems; observed time spent solving problems; identified problem severity; and developed recovery strategies. The Set-up established proof of concept, three prototype modules, and a specifications document to guide future programming. In addition, a Technology Niche Analyses® provided a preliminary commercialization plan (NIH, 2017). The Set-up phase has been instrumental in exposing the available infrastructure for dissemination of an educational product within corrections and may be a first step in addressing public health concerns on issues in aging. Commercial feasibility of the program and the need for continued research for Developing the Scalable Unit were established.
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Affiliation(s)
- Erin Kitt-Lewis
- The Pennsylvania State University, College of Nursing, 210H Nursing Sciences Building, University Park, PA
| | - Susan J. Loeb
- The Pennsylvania State University, College of Nursing, 201 Nursing Sciences Building, University Park, PA
| | | | - Rachel K. Wion
- The Pennsylvania State University, College of Nursing, 201 Nursing Sciences Building, University Park, PA
| | - Brenda Baney
- The Methodology Center, 406 Health and Human Development Building, The Pennsylvania State University, University Park, PA
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Loeb SJ, Penrod J, Myers VH, Baney BL, Strickfaden SM, Kitt-Lewis E, Wion RK. Enhancing Care of Aged and Dying Prisoners: Is e-Learning a Feasible Approach? J Forensic Nurs 2017; 13:178-185. [PMID: 28990989 PMCID: PMC5705445 DOI: 10.1097/jfn.0000000000000168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prisons and jails are facing sharply increased demands in caring for aged and dying inmates. Our Toolkit for Enhancing End-of-life Care in Prisons effectively addressed end-of-life (EOL) care; however, geriatric content was limited, and the product was not formatted for broad dissemination. Prior research adapted best practices in EOL care and aging; but, delivery methods lacked emerging technology-focused learning and interactivity. PURPOSES Our purposes were to uncover current training approaches and preferences and to ascertain the technological capacity of correctional settings to deliver computer-based and other e-learning training. METHODS An environmental scan was conducted with 11 participants from U.S. prisons and jails to ensure proper fit, in terms of content and technology capacity, between an envisioned computer-based training product and correctional settings. RESULTS Environmental scan findings focused on content of training, desirable qualities of training, prominence of "homegrown" products, and feasibility of commercial e-learning. CONCLUSIONS/IMPLICATIONS This study identified qualities of training programs to adopt and pitfalls to avoid and revealed technology-related issues to be mindful of when designing computer-based training for correctional settings, and participants spontaneously expressed an interest in geriatrics and EOL training using this learning modality as long as training allowed for tailoring of materials.
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Coughlin JW, Brantley PJ, Champagne CM, Vollmer WM, Stevens VJ, Funk K, Dalcin AT, Jerome GJ, Myers VH, Tyson C, Batch BC, Charleston J, Loria CM, Bauck A, Hollis JF, Svetkey LP, Appel LJ. The impact of continued intervention on weight: Five-year results from the weight loss maintenance trial. Obesity (Silver Spring) 2016; 24:1046-53. [PMID: 26991814 PMCID: PMC4896740 DOI: 10.1002/oby.21454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/16/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE In the Weight Loss Maintenance (WLM) Trial, a personal contact (PC) intervention sustained greater weight loss relative to a self-directed (SD) group over 30 months. This study investigated the effects of continued intervention over an additional 30 months and overall weight change across the entire WLM Trial. METHODS WLM had 3 phases. Phase 1 was a 6-month weight loss program. In Phase 2, those who lost ≥4 kg were randomized to a 30-month maintenance trial. In Phase 3, PC participants (n = 196, three sites) were re-randomized to no further intervention (PC-Control) or continued intervention (PC-Active) for 30 more months; 218 SD participants were also followed. RESULTS During Phase 3, weight increased 1.0 kg in PC-Active and 0.5 kg in PC-Control (mean difference 0.6 kg; 95% CI:-1.4 to 2.7; P = 0.54). Mean weight change over the entire study was -3.2 kg in those originally assigned to PC (PC-Combined) and -1.6 kg in SD (mean difference -1.6 kg; 95% CI:-3.0 to -0.1; P = 0.04). CONCLUSIONS After 30 months of the PC maintenance intervention, continuation for another 30 months provided no additional benefit. However, across the entire study, weight loss was slightly greater in those originally assigned to PC.
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Affiliation(s)
- Janelle W. Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Phillip J. Brantley
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Catherine M. Champagne
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - William M. Vollmer
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Victor J. Stevens
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Kristine Funk
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Arlene T. Dalcin
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gerald J. Jerome
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Kinesiology, Towson University, Towson, Maryland, USA
| | | | - Crystal Tyson
- Division of Nephrology/Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Bryan C. Batch
- Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeanne Charleston
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Alan Bauck
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Jack F. Hollis
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Laura P. Svetkey
- Division of Nephrology/Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Beach WA, Dozier DM, Buller MK, Gutzmer K, Fluharty L, Myers VH, Buller DB. The Conversations About Cancer (CAC) Project-Phase II: National findings from viewing When Cancer Calls…and implications for Entertainment-Education (E-E). Patient Educ Couns 2016; 99:393-399. [PMID: 26547304 PMCID: PMC4779378 DOI: 10.1016/j.pec.2015.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/05/2015] [Accepted: 10/11/2015] [Indexed: 05/15/2023]
Abstract
OBJECTIVE We address cancer communication by creating and assessing the impacts of a theatrical production, When Cancer Calls…(WCC…), anchored in conversations from the first natural history of a patient and family members talking through cancer on the telephone. METHODS A national study was conducted using a multi-site and randomized controlled trial. An 80-minute video was produced to assess viewing impacts across cancer patients, survivors, and family members. Comparisons were made with a control video on cancer nutrition and diet. Pretest-posttest sample size was 1006, and 669 participants completed a 30-day follow-up impacts assessment. RESULTS All five family and communication indices increased significantly for WCC…. When compared to the placebo, average pretest-posttest change scores were higher for self-efficacy (775%), family fabric (665%), outside support (189%), and family communication (97%). One month following viewings, WCC…participants reported 30% more conversations about cancer among patients and family members about cancer. CONCLUSION A new genre of Entertainment-Education (E-E) was created that triggers positive reactions from audience members. Managing delicate and often complex communication about the trials, tribulations, hopes, and triumphs of cancer journeys is fundamentally important for everyday living. PRACTICE IMPLICATIONS Unique opportunities exist to make WCC… available to national and global audiences, create tailored curricula, and integrate these viewings into educational programs for patients, family members, and care-provider teams across diverse health, corporate, and governmental systems.
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Affiliation(s)
- Wayne A Beach
- Department of Surgery, Member, Moores Cancer Center, University of California, UCSD/SDSU Joint Doctoral Program on Public Health, San Diego, United States.
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Jerome GJ, Myers VH, Young DR, Matthews-Ewald MR, Coughlin JW, Wingo BC, Ard JD, Champagne CM, Funk KL, Stevens VJ, Brantley PJ. Psychosocial predictors of weight loss by race and sex. Clin Obes 2015; 5:342-8. [PMID: 26486256 PMCID: PMC4715521 DOI: 10.1111/cob.12120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/28/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022]
Abstract
This paper examined the psychosocial predictors of weight loss among race and sex subgroups. Analyses included overweight and obese participants from the PREMIER study, a previously published randomized trial that examined the effects of two multi-component lifestyle interventions on blood pressure among pre-hypertensive and stage 1 hypertensive adults. Both intervention conditions received behavioural recommendations for weight loss and group sessions. Weight and psychosocial measures of self-efficacy and social support for diet and exercise were assessed at baseline and at 6 months. There were 157 African-American (AA) women, 46 AA men, 203 non-AA women and 182 non-AA men with an average age of 50 years and average body mass index of 34 at baseline. Multiple predictor regression models were performed individually by race and sex subgroup. Among AA women, increases in diet self-efficacy were associated with weight loss. Among AA men, increases in diet-related social support and self-efficacy, along with increases in family support to exercise, were associated with weight loss (all Ps <0.05). Among non-AA women, increases in friends' support to exercise and exercise-related self-efficacy were associated with weight loss, and among non-AA men only increases in diet self-efficacy were associated with weight loss (all Ps <0.05). These results emphasize the need for targeted interventions based on race and sex to optimize the impact of lifestyle-based weight loss programmes.
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Affiliation(s)
- G J Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V H Myers
- Klein Buendel, Inc., Golden, CO, USA
| | - D R Young
- Kaiser Permanente Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - J W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B C Wingo
- Department of Occupational Therapy, University of Alabama, Birmingham, AL, USA
| | - J D Ard
- Wake Forest School of Medicine, Department of Epidemiology and Prevention, Medical Center Blvd, Winston Salem, NC, USA
| | - C M Champagne
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - K L Funk
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - V J Stevens
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - P J Brantley
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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11
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Brantley PJ, Waldo K, Matthews-Ewald MR, Brock R, Champagne CM, Church T, Harris MN, McKnight T, McKnight M, Myers VH, Ryan DH. Why patients seek bariatric surgery: does insurance coverage matter? Obes Surg 2015; 24:961-4. [PMID: 24671622 DOI: 10.1007/s11695-014-1237-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite increasing prevalence of bariatric surgery, little is known about why patients seek out this treatment option. Heads Up is an observational study sponsored by a large benefits management group that examines surgical and nonsurgical approaches to weight management in obese adults. This study examined patients' reasons for choosing surgery. The sample included 360 adult obese patients seeking bariatric surgery who were invited to volunteer for a surgical or a medical weight loss program by their insurer. Participants rank ordered their top three reasons as a deciding factor for choosing to consider surgery. The top three reasons were concerns regarding health (52%), current obesity-related medical conditions (28%), and improved physical fitness (5%). Overall, 13% endorsed insurance coverage as one of their top three choices. When insurance coverage is assured, health and functionality issues were the major reasons reported for obese adults choosing to undergo bariatric surgery.
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Affiliation(s)
- Phillip J Brantley
- Behavioral Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808-4124, USA,
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Vaz Fragoso CA, Miller ME, King AC, Kritchevsky SB, Liu CK, Myers VH, Nadkarni NK, Pahor M, Spring BJ, Gill TM. Effect of Structured Physical Activity on Sleep-Wake Behaviors in Sedentary Elderly Adults with Mobility Limitations. J Am Geriatr Soc 2015; 63:1381-90. [PMID: 26115386 PMCID: PMC4892176 DOI: 10.1111/jgs.13509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the effect of structured physical activity on sleep-wake behaviors in sedentary community-dwelling elderly adults with mobility limitations. DESIGN Multicenter, randomized trial of moderate-intensity physical activity versus health education, with sleep-wake behaviors prespecified as a tertiary outcome over a planned intervention period ranging from 24 to 30 months. SETTING Lifestyle Interventions and Independence for Elders Study. PARTICIPANTS Community-dwelling persons aged 70 to 89 who were initially sedentary and had a Short Physical Performance Battery score less than 10 (N = 1,635). MEASUREMENTS Sleep-wake behaviors were evaluated using the Insomnia Severity Index (ISI) (≥8 defined insomnia), Epworth Sleepiness Scale (ESS) (≥10 defined daytime drowsiness), and Pittsburgh Sleep Quality Index (PSQI) (>5 defined poor sleep quality) administered at baseline and 6, 18, and 30 months. RESULTS The randomized groups were similar in terms of baseline demographic variables, including mean age (79) and sex (67% female). Structured physical activity resulted in a significantly lower likelihood of having poor sleep quality (adjusted odds ratios (aOR) for PSQI >5 = 0.80, 95% confidence interval (CI) = 0.68-0.94), including fewer new cases (aOR for PSQI >5 = 0.70, 95% CI = 0.54-0.89), than health education but not in resolution of prevalent cases (aOR for PSQI ≤5 = 1.13, 95% CI = 0.90-1.43). No significant intervention effects were observed for the ISI or ESS. CONCLUSION Structured physical activity resulted in a lower likelihood of developing poor sleep quality (PSQI >5) over the intervention period than health education but had no effect on prevalent cases of poor sleep quality or on sleep-wake behaviors evaluated using the ISI or ESS. These results suggest that the benefit of physical activity in this sample was preventive and limited to sleep-wake behaviors evaluated using the PSQI.
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Affiliation(s)
- Carlos A. Vaz Fragoso
- Clinical Epidemiology Research Center, VA Connecticut, West Haven, CT
- Yale School of Medicine, Department of Medicine, New Haven, CT
| | - Michael E. Miller
- Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC
| | - Abby C. King
- Stanford School of Medicine, Stanford Prevention Research Center, Department of Medicine, and Health Research and Policy Department, Stanford, CA
| | | | - Christine K. Liu
- Boston University School of Medicine, Department of Medicine, Boston, MA
| | - Valerie H. Myers
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA; Klein Buendel, Inc., Golden, CO
| | - Neelesh K. Nadkarni
- University of Pittsburgh, Department of Epidemiology and Medicine, Pittsburgh, PA
| | - Marco Pahor
- University of Florida, Department of Aging and Geriatric Research, Gainesville, FL
| | - Bonnie J. Spring
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Thomas M. Gill
- Yale School of Medicine, Department of Medicine, New Haven, CT
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Matthews-Ewald MR, Myers VH, Newton RL, Beyl R, Waldo K, Dufour CM, Donato SG, Champagne CM, Church T, Ryan DH, Brantley PJ. Predictors for selection of insurance-funded weight loss approaches in individuals with severe obesity. Obesity (Silver Spring) 2015; 23:1151-8. [PMID: 25959516 PMCID: PMC4536570 DOI: 10.1002/oby.21116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 03/13/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine whether there are differences in baseline psychological and behavioral characteristics between individuals with severe obesity who chose a surgical or nonsurgical intervention for weight loss. METHODS The current study utilized data from a larger study funded by a state insurance company and is unique in that the insurance company funded the weight loss interventions. Participants indicated their preferred method of weight loss, and completed several self-report psychological questionnaires, as well as demographic information. RESULTS Participants (N = 605) were 58.8% Caucasian and mostly (86%) female. Logistic regression results indicated that an increased number of weight loss attempts, and select other measures of eating behavior and quality of life may influence individuals' selection for either surgical or nonsurgical treatments for weight loss. CONCLUSIONS Practitioners should pay particular attention to these baseline characteristics that influence choice to examine potential characteristics that may influence the success of these weight loss treatments.
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Affiliation(s)
- Molly R. Matthews-Ewald
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | | | - Robert L. Newton
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Robbie Beyl
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Krystal Waldo
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Cody M. Dufour
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Sheletta G. Donato
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Catherine M. Champagne
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Timothy Church
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Donna H. Ryan
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
| | - Phillip J. Brantley
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral, Medicine Laboratory, Baton Rouge, LA
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Glynn NW, Lovato LC, Santanasto AJ, Lange-Maia B, Nicklas B, Fielding RA, Manini TM, Myers VH, de Rekeneire N, Spring BJ, Pahor M, King AC, Rejeski WJ. Role of Fatigue on the Effectiveness of a Physical Activity Intervention Aimed at Preventing Mobility Disability. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000476572.23791.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mcvay MA, Myers VH, Vollmer WM, Coughlin JW, Champagne CM, Dalcin AT, Funk KL, Hollis JF, Jerome GJ, Samuel-Hodge CD, Stevens VJ, Svetkey LP, Brantley PJ. Predictors of dietary change among those who successfully lost weight in phase I of the Weight Loss Maintenance Trial. Nutr Diet 2014; 71:144-151. [PMID: 26877708 DOI: 10.1111/1747-0080.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Dietary changes occurring during weight loss interventions can vary. The present study tested if pretreatment psychosocial, dietary and demographic factors were associated with changes in fat intake and fruit and vegetable intake during a weight loss intervention. METHODS This analysis includes participants who lost at least four kilograms during the initial six month weight loss phase (phase I) of the Weight Loss Maintenance Trial, a group format behavioural intervention emphasising a low-fat diet and increased physical activity. Multiple linear regression was used to determine associations between pretreatment psychosocial, dietary, physical activity, and demographic variables and changes from pretreatment to six months in fat intake and fruit and vegetable intake. RESULTS Participants (n = 1032) were 63.4% female, 62.4% non-African American, and had a mean age of 55.6 and BMI of 34.1 kg/m2. Being African American (P < 0.0001) and higher baseline kilojoule intake (P < 0.01) were associated with smaller reductions in fat intake. Being African American (p < 0.001) and older age (P = 0.02) were associated with smaller increases in fruit and vegetable intake, whereas a history of 10 or more past weight loss episodes of at least 10 lb (4.5 kg; P < 0.01) was associated with greater increases. CONCLUSIONS Few psychosocial factors examined contributed to variability in dietary change. Even when achieving meaningful weight losses during a behavioural weight loss intervention, African Americans may make fewer beneficial changes in fat and fruit and vegetable intake than non-African Americans.
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Affiliation(s)
- Megan A Mcvay
- Duke University Medical Center, Division of General Internal Medicine, Duke University, Durham; Department of Veteran Affairs, Center of Excellence for Health Services Research in Primary Care, Durham
| | | | | | | | - Catherine M Champagne
- Louisiana State University System, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Kristine L Funk
- Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jack F Hollis
- Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Carmen D Samuel-Hodge
- Gillings School of Public Health and School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Laura P Svetkey
- Sarah W. Stedman Nutrition and Metabolism Center, Durham; Duke Hypertension Center, Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham
| | - Phillip J Brantley
- Louisiana State University System, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Harris MN, Swift DL, Myers VH, Earnest CP, Johannsen NM, Champagne CM, Parker BD, Levy E, Cash KC, Church TS. Cancer survival through lifestyle change (CASTLE): a pilot study of weight loss. Int J Behav Med 2014; 20:403-12. [PMID: 22535636 DOI: 10.1007/s12529-012-9234-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Excess weight is a strong predictor of incident breast cancer (BC) and survivorship. A limited number of studies comparing strategies for promoting successful weight loss in women with remitted BC exist. PURPOSE CASTLE was a pilot study comparing the effectiveness/feasibility of in-person and telephonic behavioral-based lifestyle weight loss interventions in BC survivors. METHOD Fifty-two overweight/obese women (BMI = 25-45 kg/m(2)) with remitted BC (stages I-IIIa) who recently completed cancer treatment were assigned to either an in-person group (n = 24) or an individual telephone-based condition (n = 11). Both interventions focused on increasing physical activity and reducing caloric intake. The phase I intervention lasted 6 months. The in-person condition received 16 group-based sessions, and the telephone condition received intervention calls approximately weekly. Phase II lasted 6 months (e.g., months 6-12), and all participants received monthly intervention calls via telephone. RESULTS Participants were predominately Caucasian (80 %) with a mean age of 52.8 (8.0) years and BMI of 31.9 (5.4) kg/m(2). Mixed models ANOVAs showed significant within group weight loss after 6 months for both the in-person (-3.3 kg ± 4.4, p = 0.002) and the telephonic (-4.0 kg ± 6.0, p = 0.01) conditions with no between group differences. During phase II, the in-person group demonstrated significant weight regain (1.3 kg ± 1.7, p = 0.009). CONCLUSION Our pilot study findings demonstrated that telephone-based behavioral weight loss programs are effective and feasible in BC survivors and that telephonic programs may have advantages in promoting weight loss maintenance.
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Affiliation(s)
- Melissa Nauta Harris
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808-4124, USA
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Myers VH, McVay MA, Brashear MM, Johnson WD, Gupta AK, Brantley PJ, Ryan DH. Five-Year Medical and Pharmacy Costs after a Medically Supervised Intensive Treatment Program for Obesity. Am J Health Promot 2014; 28:364-71. [DOI: 10.4278/ajhp.120207-quan-80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose. The financial impact of intensive medical interventions for weight loss has not been fully studied. Design. A randomized pragmatic clinical trial. Setting. Seven primary care clinics and one research center in Louisiana. Subjects. Severely obese individuals (body mass index 40–60 kg/m2) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses. Intervention. Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies. Measures. Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs. Analysis. Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories. Results. Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197). Conclusion. An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.
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Brantley PJ, Stewart DW, Myers VH, Matthews-Ewald MR, Ard JD, Coughlin JW, Jerome GJ, Samuel-Hodge C, Lien LF, Gullion CM, Hollis JF, Svetkey LP, Stevens VJ. Psychosocial predictors of weight regain in the weight loss maintenance trial. J Behav Med 2014; 37:1155-68. [PMID: 24722826 DOI: 10.1007/s10865-014-9565-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
This study's purpose was to identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial, following a group-based weight loss program. Participants (N = 1025) were predominately women (63%) and 38% were Black (mean age = 55.6 years; SD = 8.7). At 12 months, higher SF-36 mental health composite scores were associated with less weight regain (p < .01). For Black participants, an interaction existed between race and friends' encouragement for exercise, where higher exercise encouragement was related to more weight regain (p < .05). At 30 months, friends' encouragement for healthy eating was associated with more weight regain (p < .05), whereas higher SF-36 mental health composite scores were related to less weight regain (p < .0001). Perceived stress and select health-related quality of life indices were associated with weight regain; this relationship varied across gender, race, and treatment conditions. Temporal changes in these variables should be investigated for their impact on weight maintenance.
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Affiliation(s)
- Phillip J Brantley
- Behavioral Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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Myers VH, McVay MA, Brashear MM, Johannsen NM, Swift DL, Kramer K, Harris MN, Johnson WD, Earnest CP, Church TS. Exercise training and quality of life in individuals with type 2 diabetes: a randomized controlled trial. Diabetes Care 2013; 36:1884-90. [PMID: 23404304 PMCID: PMC3687283 DOI: 10.2337/dc12-1153] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish whether exercise improves quality of life (QOL) in individuals with type 2 diabetes and which exercise modalities are involved. RESEARCH DESIGN AND METHODS Health Benefits of Aerobic and Resistance Training in individuals with type 2 Diabetes (HART-D; n = 262) was a 9-month exercise study comparing the effects of aerobic training, resistance training, or a combination of resistance and aerobic training versus a nonexercise control group on hemoglobin A1c (HbA1c) in sedentary individuals with type 2 diabetes. This study is an ancillary analysis that examined changes in QOL after exercise training using the Short Form-36 Health Survey questionnaire compared across treatment groups and with U.S. national norms. RESULTS The ancillary sample (n = 173) had high baseline QOL compared with U.S. national norms. The QOL physical component subscale (PCS) and the general health (GH) subscale were improved by all three exercise training conditions compared with the control group condition (resistance: PCS, P = 0.005; GH, P = 0.003; aerobic: PCS, P = 0.001; GH, P = 0.024; combined: PCS, P = 0.015; GH, P = 0.024). The resistance training group had the most beneficial changes in bodily pain (P = 0.026), whereas physical functioning was most improved in the aerobic and combined condition groups (P = 0.025 and P = 0.03, respectively). The changes in the mental component score did not differ between the control group and any of the exercise groups (all P > 0.05). The combined training condition group had greater gains than the aerobic training condition group in the mental component score (P = 0.004), vitality (P = 0.031), and mental health (P = 0.008) and greater gains in vitality compared with the control group (P = 0.021). CONCLUSIONS Exercise improves QOL in individuals with type 2 diabetes. Combined aerobic/resistance exercise produces greater benefit in some QOL domains.
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Affiliation(s)
- Valerie H Myers
- Pennington Biomedical Research Center, Baton Rouge, Lousiana, USA.
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Swift DL, Johannsen NM, Myers VH, Earnest CP, Smits JAJ, Blair SN, Church TS. The effect of exercise training modality on serum brain derived neurotrophic factor levels in individuals with type 2 diabetes. PLoS One 2012; 7:e42785. [PMID: 22880108 PMCID: PMC3412800 DOI: 10.1371/journal.pone.0042785] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/12/2012] [Indexed: 01/21/2023] Open
Abstract
Introduction Brain derived neurotrophic factor (BDNF) has been implicated in memory, learning, and neurodegenerative diseases. However, the relationship of BDNF with cardiometabolic risk factors is unclear, and the effect of exercise training on BDNF has not been previously explored in individuals with type 2 diabetes. Methods Men and women (N = 150) with type 2 diabetes were randomized to an aerobic exercise (aerobic), resistance exercise (resistance), or a combination of both (combination) for 9 months. Serum BDNF levels were evaluated at baseline and follow-up from archived blood samples. Results Baseline serum BDNF was not associated with fitness, body composition, anthropometry, glucose control, or strength measures (all, p>0.05). Similarly, no significant change in serum BDNF levels was observed following exercise training in the aerobic (−1649.4 pg/ml, CI: −4768.9 to 1470.2), resistance (−2351.2 pg/ml, CI:−5290.7 to 588.3), or combination groups (−827.4 pg/ml, CI: −3533.3 to1878.5) compared to the control group (−2320.0 pg/ml, CI: −5750.8 to 1110.8). However, reductions in waist circumference were directly associated with changes in serum BDNF following training (r = 0.25, p = 0.005). Conclusions Serum BDNF was not associated with fitness, body composition, anthropometry, glucose control, or strength measures at baseline. Likewise, serum BDNF measures were not altered by 9 months of aerobic, resistance, or combination training. However, reductions in waist circumference were associated with decreased serum BDNF levels. Future studies should investigate the relevance of BDNF with measures of cognitive function specifically in individuals with type-2 diabetes.
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Affiliation(s)
- Damon L Swift
- Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
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Champagne CM, Broyles S, Myers VH, Funk KL, Brantley P. What data suggests that protein may be effective for weight loss? FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.820.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Champagne CM, Broyles ST, Moran LD, Cash KC, Levy EJ, Lin PH, Batch BC, Lien LF, Funk KL, Dalcin A, Loria C, Myers VH. Dietary intakes associated with successful weight loss and maintenance during the Weight Loss Maintenance trial. J Am Diet Assoc 2011; 111:1826-35. [PMID: 22117658 PMCID: PMC3225890 DOI: 10.1016/j.jada.2011.09.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/05/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dietary components effective in weight maintenance efforts have not been adequately identified. OBJECTIVE To determine the effects of changes in dietary consumption on weight loss and maintenance during the Weight Loss Maintenance clinical trial. DESIGN Weight Loss Maintenance was a randomized controlled trial. Successful weight loss participants who completed Phase I of the trial and lost 4 kg were randomized to one of three maintenance intervention arms in Phase II and followed for an additional 30 months. PARTICIPANTS/SETTING The multicenter trial was conducted from 2003 through 2007. This substudy included 828 successful weight loss participants. METHODS The Block Food Frequency Questionnaire (FFQ) was used to assess nutrient intake levels and food group servings. Carbohydrates, proteins, fats, dietary fiber, fruit/vegetable, and dairy servings were utilized as predictor variables. The FFQ was collected on all participants at study entry (beginning of Phase I). Those randomized to Phase II completed the FFQ at three additional time points: randomization (beginning of Phase II), 12 months, and 30 months. INTERVENTION The main intervention focused on long-term maintenance of weight loss using the Dietary Approaches to Hypertension diet. This substudy examined if changes to specific dietary variables were associated with weight loss and maintenance. STATISTICAL ANALYSES PERFORMED Linear regression models that adjusted for change in total energy examined the relationship between changes in dietary intake and weight for each time period. Site, age, race, sex, and a race-sex interaction were included as covariates. RESULTS Participants who substituted protein for fat lost, on average, 0.33 kg per 6 months during Phase I (P<0.0001) and 0.07 kg per 6 months during Phase II (P<0.0001) per 1% increase in protein. Increased intake of fruits and vegetables was associated with weight loss in Phases I and II: 0.29 kg per 6 months (P<0.0001) and 0.04 kg per 6 months (P=0.0062), respectively, per 1-serving increase. Substitution of carbohydrates for fat and protein for carbohydrates were associated with weight loss during both phases. Increasing dairy intake was associated with significant weight loss during Phase II (-0.17 kg per 6 months per 1-serving increase, P=0.0002), but not during Phase I. Dietary fiber revealed no significant findings. CONCLUSIONS Increasing fruits, vegetables, and low-fat dairy may help achieve weight loss and maintenance.
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Affiliation(s)
- Catherine M. Champagne
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-2553, Fax: 225-763-3045,
| | - Stephanie T Broyles
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-2760, Fax: 225-763-3009,
| | - Laura D. Moran
- Baton Rouge Clinic, 7373 Perkins Road, Baton Rouge, LA 70808, Phone: 225-246-9413, Fax: 225-246-9159,
| | - Katherine C. Cash
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-3110 Fax: 225-763-3045,
| | - Erma J. Levy
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-3167, Fax: 225-763-3045,
| | - Pao-Hwa Lin
- Department of Medicine, Nephrology Division, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, Phone: 919-660-6685, Fax: 919-660-8802,
| | - Bryan C. Batch
- Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center Box 3031, Durham, NC 27710, Phone: 919-681-2168, Fax: 919-681-9846,
| | - Lillian F. Lien
- Division of Endocrinology, Metabolism, and Nutrition, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27710, Phone: 919-684-9036, Fax: 919-681-7796,
| | - Kristine L. Funk
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227-1110, Phone: 503-335-2443, Fax: 503-335-2428,
| | - Arlene Dalcin
- Johns Hopkins ProHealth, 1849 Gwynn Oak Avenue Suite 3, Baltimore, MD 21207, Phone: 410-265-1109, Fax: 410-281-1134,
| | - Catherine Loria
- National Heart, Lung and Blood Institute, National Institutes of Health, Division of Cardiovascular Services, 6701 Rockledge Drive, Ste. 10018, MSC 7936, Bethesda, MD 20892-7936, Phone: 301-435-0702, Fax: 301-480-5158,
| | - Valerie H. Myers
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-3085, Fax: 225-763-3045,
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Funk KL, Stevens VJ, Bauck A, Brantley PJ, Hornbrook M, Jerome GJ, Myers VH, Appel L. Development and Implementation of a Tailored Self-assessment Tool in an Internet-based Weight Loss Maintenance Program. Clin Pract Epidemiol Ment Health 2011; 7:67-73. [PMID: 21566735 PMCID: PMC3092445 DOI: 10.2174/1745017901107010067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 07/13/2010] [Accepted: 08/24/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Using the Internet to replicate client/counselor interactions provides a tremendous opportunity to disseminate interventions at relatively low cost per participant. However, there are substantial challenges with this approach. The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions: (1) a personal contact arm and (2) an Internet arm, to a third self-directed control arm. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. This paper describes a highly interactive self-assessment tool developed for use in the WLM trial Internet intervention arm. METHODS The Tailored Self-Assessment (TSA) website tool was an interactive resource for those WLM participants assigned to the Internet arm to review their personal weight-management progress and make choices about future weight-management actions. The TSA was highly tailored and ended with a suggested list of personalized action plans. While the participant could complete the TSA at any time, criteria-based reminder messages prompted participation. RESULTS The TSA was one of 27 interactive tools on the WLM website. Over the course of the 28 months, the TSA was completed 800 times by the 348 randomized participants. Fifty-three percent of the participants (185/348) used the TSA at least once (range: 0, 110) and 72% of the 185 participants who did complete the TSA at least once, completed it more than once. CONCLUSION The Internet has great potential to impact health behavior by attempting to replicate personal counseling. We learned that while development is complex and appears costly, tailored strategies based on client feedback are likely worthwhile and should be formally tested.
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Affiliation(s)
- Kristine L Funk
- Kaiser Permanente, Center for Health Research, Portland, OR, USA
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Adams CE, Myers VH, Barbera BL, Brantley PJ. The Role of Fear of Negative Evaluation in Predicting Depression and Quality of Life Four Years after Bariatric Surgery in Women. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/psych.2011.23024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Funk KL, Stevens VJ, Appel LJ, Bauck A, Brantley PJ, Champagne CM, Coughlin J, Dalcin AT, Harvey-Berino J, Hollis JF, Jerome GJ, Kennedy BM, Lien LF, Myers VH, Samuel-Hodge C, Svetkey LP, Vollmer WM. Associations of internet website use with weight change in a long-term weight loss maintenance program. J Med Internet Res 2010; 12:e29. [PMID: 20663751 PMCID: PMC2956327 DOI: 10.2196/jmir.1504] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/19/2010] [Accepted: 03/20/2010] [Indexed: 11/23/2022] Open
Abstract
Background The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions, a personal contact arm and an Internet arm, with a no-treatment control after an initial six-month Phase I weight loss program. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. There is limited information about patterns of website use and specific components of an interactive website that might help promote maintenance of weight loss. Objective This paper presents a secondary analysis of the subset of participants in the Internet arm and focuses on website use patterns and features associated with long-term weight maintenance. Methods Adults at risk for cardiovascular disease (CVD) who lost at least 4 kilograms in an initial 20-week group-based, behavioral weight-loss program were trained to use an interactive website for weight loss maintenance. Of the 348 participants, 37% were male and 38% were African American. Mean weight loss was 8.6 kilograms. Participants were encouraged to log in at least weekly and enter a current weight for the 30-month study period. The website contained features that encouraged setting short-term goals, creating action plans, and reinforcing self-management habits. The website also included motivational modules, daily tips, and tailored messages. Based on log-in and weight-entry frequency, we divided participants into three website use categories: consistent, some, and minimal. Results Participants in the consistent user group (n = 212) were more likely to be older (P = .002), other than African American (P = .02), and more educated (P = .01). While there was no significant difference between website use categories in the amount of Phase I change in body weight (P = .45) or income (P = .78), minimal website users (n = 75) were significantly more likely to have attended fewer Phase I sessions (P = .001) and had a higher initial body mass index (BMI) (P < .001). After adjusting for baseline characteristics including initial BMI, variables most associated with less weight regain included: number of log-ins (P = .001), minutes on the website (P < .001), number of weight entries (P = .002), number of exercise entries (P < .001), and sessions with additional use of website features after weight entry (P = .002). Conclusion Participants defined as consistent website users of an interactive behavioral website designed to promote maintenance of weight loss were more successful at maintaining long-term weight loss. Trial Registration NCT00054925; http://clinicaltrials.gov/ct2/show/NCT00054925 (Archived by WebCite at http://www.webcitation.org/5rC7523ue)
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Affiliation(s)
- Kristine L Funk
- Kaiser Permanente, Center for Health Research, Portland, USA.
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Ryan DH, Johnson WD, Myers VH, Prather TL, McGlone MM, Rood J, Brantley PJ, Bray GA, Gupta AK, Broussard AP, Barootes BG, Elkins BL, Gaudin DE, Savory RL, Brock RD, Datz G, Pothakamuri SR, McKnight GT, Stenlof K, Sjöström LV. Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study. ACTA ACUST UNITED AC 2010; 170:146-54. [PMID: 20101009 DOI: 10.1001/archinternmed.2009.508] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Effective primary care practice (PCP) treatments are needed for extreme obesity. The Louisiana Obese Subjects Study (LOSS) tested whether, with brief training, PCPs could effectively implement weight loss for individuals with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 40 to 60. METHODS The LOSS, a 2-year (July 5, 2005, through January 30, 2008) randomized, controlled, "pragmatic clinical trial" trained 7 PCPs and 1 research clinic in obesity management. Primary outcome measure was year-2 percentage change from baseline weight. Volunteers (597) were screened and randomized to intensive medical intervention (IMI) (n = 200) or usual care condition (UCC) (n = 190). The UCC group had instruction in an Internet weight management program. The IMI group recommendations included a 900-kcal liquid diet for 12 weeks or less, group behavioral counseling, structured diet, and choice of pharmacotherapy (sibutramine hydrochloride, orlistat, or diethylpropion hydrochloride) during months 3 to 7 and continued use of medications and maintenance strategies for months 8 to 24. RESULTS The mean age of participants was 47 years; 83% were women, and 75% were white. Retention rates were 51% for the IMI group and 46% for the UCC group (P = .30). After 2 years, the results were as follows: (1) among 390 randomized participants, 31% in the IMI group achieved a 5% or more weight loss and 7% achieved a 20% weight loss or more, compared with 9% and 1% of those in the UCC group. (2) The mean +/- SEM baseline observation carried forward analysis showed a weight loss of -4.9% +/- 0.8% in IMI and -0.2 +/- 0.3% in UCC. (3) Last observation carried forward analysis showed a weight loss of -8.3% +/- 0.79% for IMI, whereas UCC was -0.0% +/- 0.4%. (4) A total of 101 IMI completers lost -9.7% +/- 1.3% (-12.7 +/- 1.7 kg), whereas 89 UCC completers lost -0.4% +/- 0.7% (-0.5 +/- 0.9 kg); (P < .001 for all group differences). Many metabolic parameters improved. CONCLUSION Primary care practices can initiate effective medical management for extreme obesity; future efforts must target improving retention and weight loss maintenance. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00115063.
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Affiliation(s)
- Donna H Ryan
- Pennington Biomedical Research Center of Louisiana State University System, Baton Rouge, LA 70808, USA.
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Herbert JD, Gaudiano BA, Rheingold AA, Moitra E, Myers VH, Dalrymple KL, Brandsma LL. Cognitive behavior therapy for generalized social anxiety disorder in adolescents: a randomized controlled trial. J Anxiety Disord 2009; 23:167-77. [PMID: 18653310 PMCID: PMC4356535 DOI: 10.1016/j.janxdis.2008.06.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 06/12/2008] [Accepted: 06/13/2008] [Indexed: 11/18/2022]
Abstract
Early identification and treatment of social anxiety disorder (SAD) is critical to prevent development of a chronic course of symptoms, persistent functional impairment, and progressive psychiatric comorbidity. A small but growing literature supports the effectiveness of cognitive behavior therapy (CBT) for anxiety disorders, including SAD, in adolescence. The present randomized controlled trial evaluated the efficacy of group vs. individual CBT for adolescents with generalized SAD in relation to an educational/supportive psychotherapy that did not contain specific CBT elements. All three treatments were associated with significant reductions in symptoms and functional impairment, and in improved social skills. No differences between treatments emerged on measures of symptoms, but the CBT conditions demonstrated greater gains on behavioral measures. The implications of the findings are discussed.
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Affiliation(s)
- James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA 19102-1192, USA.
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Stevens VJ, Funk KL, Brantley PJ, Erlinger TP, Myers VH, Champagne CM, Bauck A, Samuel-Hodge CD, Hollis JF. Design and implementation of an interactive website to support long-term maintenance of weight loss. J Med Internet Res 2008; 10:e1. [PMID: 18244892 PMCID: PMC2483846 DOI: 10.2196/jmir.931] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 11/28/2007] [Accepted: 01/04/2008] [Indexed: 01/22/2023] Open
Abstract
Background For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. Objective This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. Methods The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. Results The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use. Conclusions Developing interactive websites is expensive, complex, and time consuming. We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient. Trial Registration clinicaltrials.gov NCT00054925
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Affiliation(s)
- Victor J Stevens
- Kaiser Permanente, Center for Health Research, Portland, OR 97227, USA
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Myers VH, Boyer BA, Herbert JD, Barakat LP, Scheiner G. Fear of Hypoglycemia and Self Reported Posttraumatic Stress in Adults with Type I Diabetes Treated by Intensive Regimens. J Clin Psychol Med Settings 2007. [DOI: 10.1007/s10880-007-9051-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Herbert JD, Gaudiano BA, Rheingold AA, Myers VH, Dalrymple K, Nolan EM. Social skills training augments the effectiveness of cognitive behavioral group therapy for social anxiety disorder. Behav Ther 2005. [DOI: 10.1016/s0005-7894(05)80061-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brantley PJ, Myers VH, Roy HJ. Environmental and lifestyle influences on obesity. J La State Med Soc 2005; 157 Spec No 1:S19-27. [PMID: 15751906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Obesity is an end result of the intricate interactions of biology, behavior, and environment. Recent hypotheses in the scientific community suggest the current obesity epidemic is being driven largely by environmental factors (e.g., high energy/high fat foods, fast food consumption, television watching, "super-sized" portions, etc.) rather than biological ones. Individuals are bombarded with images and offers of high fat, high calorie, highly palatable, convenient, and inexpensive foods. These foods are packaged in portion sizes that far exceed federal recommendations. Furthermore, the physical demands of our society have changed resulting in an imbalance in energy intake and expenditure. Today's stressful lifestyles compound the effects of environmental factors by impairing weight loss efforts and by promoting fat storage. Combating the obesity epidemic demands environmental and social policy changes, particularly in the areas of portion size, availability of healthful foods, and promotion of physical activity.
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Affiliation(s)
- Phillip J Brantley
- Behavioral Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Enelow AJ, Myers VH. The value of psychiatric courses for practicing physicians. Hosp Community Psychiatry 1968; 19:146-9. [PMID: 5644844 DOI: 10.1176/ps.19.5.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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