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Health-related quality of life and intensity-specific physical activity in high-risk adults attending a behavior change service within primary care.
Blom, EE, Aadland, E, Skrove, GK, Solbraa, AK, Oldervoll, LM
PloS one. 2019;(12):e0226613
Abstract
OBJECTIVES Health-related quality of life (HRQoL) is an important outcome for health interventions, such as physical activity (PA) promotion among high-risk populations. The aim of this study was to investigate levels of PA and HRQoL, and associations between PA and HRQoL, in participants attending a behavior change service within primary care in Norway. METHODS Adult participants (≥ 18 years) from 32 Healthy Life Centers (HLCs) in four regions of Norway, who provided valid data on HRQoL (SF-36) and PA (ActiGraph accelerometer) were included (N = 835). HRQoL scores were compared to normative data by independent sample t-tests. Associations between eight dimensions of HRQoL and time spent sedentary (SED), in light PA (LPA) or in moderate to vigorous PA (MVPA) were determined using general linear models adjusted for relevant confounders. RESULTS Nineteen percent of the participants (mean age 50; body mass index 32) met PA recommendations of > 150 min MVPA per week. SF-36 scores were 10 to 28 points lower than the norm (all p < 0.001). Positive associations were found between MVPA and the SF-36 dimensions physical functioning, role physical, general health and vitality, (all p < 0.045). LPA was positively associated with physical functioning, role physical, general health, vitality and role emotional (all p < 0.046). Time spent SED was negatively associated with physical functioning, general health, vitality, social functioning and mental health (all p < 0.030). CONCLUSIONS Individuals attending a Norwegian behavior change service within primary care had low PA level and low HRQoL compared to the general population. Our study suggest there is a positive dose-response relationship between PA and HRQoL, and a negative relationship between SED and HRQoL. Furthermore, that specific PA intensities and SED are related to different dimensions of HRQoL.
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Mind-body medicine and lifestyle modification in supportive cancer care: A cohort study on a day care clinic program for cancer patients.
Jeitler, M, Jaspers, J, von Scheidt, C, Koch, B, Michalsen, A, Steckhan, N, Kessler, CS
Psycho-oncology. 2017;(12):2127-2134
Abstract
OBJECTIVE We developed an integrative day care clinic program for cancer patients focusing on mind-body techniques and health-promoting lifestyle modification (7-hour once-per-week group sessions over 12 weeks). METHODS A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning, at the end of the active program, and at a 6-month follow-up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT-G, FACT-B/C, WHO-5), fatigue (FACIT-F), depression/anxiety (HADS), and mood states (ASTS). A per protocol analysis using mixed linear models was performed. RESULTS One hundred patients were screened on-site for eligibility. Eighty-six cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer) were included into the study. Sixty-two patients were allocated to the intervention group and 24 patients, to the waiting group (mean waiting time 5 ± 1 weeks). Sixty-six data sets were included in the final analysis. Significant improvements were observed in favor of the intervention group after 12 weeks compared with the waiting group at the end of the waiting period for quality of life, anxiety/depression, and fatigue. Results from the 6-month follow-up for the whole study population showed lasting improvement of quality of life. CONCLUSIONS The program can be considered as an effective means to improve quality of life, fatigue, and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials.
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Recovery in Young Children with Weight Faltering: Child and Household Risk Factors.
Black, MM, Tilton, N, Bento, S, Cureton, P, Feigelman, S
The Journal of pediatrics. 2016;:301-6
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Abstract
OBJECTIVE To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors. STUDY DESIGN Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6-36 months with weight/age RESULTS Enrolled 286 children (mean age 18.8 months, SD 6.8). Significant weight/age recovery occurred regardless of risk index or age. Mean weight/age z-score change was significantly greater among younger compared with older age (0.29 vs 0.17, P = .03); top household risk quartile compared with reference (0.34 vs 0.22, P = .046); and marginally greater among top child risk quartile compared with reference (0.37 vs 0.25, P = .058). Mean weight/age z-score change was not associated with single risk factors or interactions; greatest weight gain occurred in most underweight children. CONCLUSIONS Weight recovery over 6 months was statistically significant, although modest, and greater among younger children and among children with multiple child and household risk factors. Findings support differential susceptibility theory, whereby some children with multiple risk factors are differentially responsive to intervention. Future investigations should evaluate components of the mealtime behavior intervention.
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Improvements in Functional Exercise Capacity after a Residential Behavioural Change, Diet and Fitness Program for Obese Adults.
Errickson, SP, Kolotkin, RL, Skidmore, MS, Endress, G, Østbye, T, Crosby, R, Eisenson, H
Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2016;(2):84-90
Abstract
BACKGROUND AND PURPOSE Obese adults are at an increased risk for mobility-related problems. National guidelines recommend calorie restrictions and exercise for obese adults as a means to improve functional fitness capacity and to increase mobility. Yet, lifestyle weight loss interventions often fail to measure fitness changes. The aim of this study was to assess whether a 1-month, intensive behavioural change, diet and fitness intervention for overweight and obese adults would result in statistically significant and clinically meaningful changes in functional exercise. METHODS A pre-post test design was used in this study. Seventy-two participants (40 women, 32 men; mean baseline body mass index (BMI) = 42.6 + 9.0; mean age = 45.8 + 16.8) completed a modified 6-minute walk test (6MWT), performed on a treadmill, at baseline and at end of treatment. RESULTS Significant improvements included decreased BMI (2.7 + 1.7 kg m(-2) , p < 0.001) and increased 6MWT distance (66.4 + 73.0 m, p < 0.001). The 6MWT improved by 66 m on average, a reported clinically meaningful difference. Greater improvements in the 6MWT were significantly correlated with greater weight loss and BMI reduction. DISCUSSION Our findings suggest that rehabilitation beyond weight loss may be derived from participation in a brief, intensive behavioural change, diet and fitness programme. Physiotherapists are in a prime position to address the physical and motivational challenges participants face while living with severe obesity: targeting functional exercise capacity is one key strategy for addressing immobility associated with obesity. Copyright © 2015 John Wiley & Sons, Ltd.
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Primary care weight loss maintenance with behavioral nutrition: An observational study.
Lenoir, L, Maillot, M, Guilbot, A, Ritz, P
Obesity (Silver Spring, Md.). 2015;(9):1771-7
Abstract
OBJECTIVE To evaluate the rate of weight loss maintenance, defined as a 10% loss of initial weight maintained beyond 1 year, among patients with BMI > 25 kg/m(2) who had been managed by primary care physicians practicing behavioral nutrition (moderately high-protein diet, carbohydrate restriction, and behavioral therapy). METHODS Restrospective analysis of anthropometric characteristics, weight loss, and its determinants was conducted in 14,256 patients. RESULTS 26.7% of subjects met the success criterion (successful maintenance group; SM), 25.7% did not maintain their weight loss (unsuccessful maintenance group; UM), and 47.6% did not lose 10% of their initial weight (failure group; F). At inclusion, patients in the SM group had a greater BMI and fat mass percentage (40.5% in SM, 38.5% in UM, and 37.0% in F). These patients lost more weight (-14.1% vs. -4.59%) and fat mass (-24.7% vs. -8.21%) than patients in the UM group, and contribution of adiposity to their weight loss was 75.1%. Follow-up of patients in the SM group was characterized by a greater frequency of consultations. CONCLUSIONS Management by primary care providers with behavioral nutrition facilitates weight loss maintenance in patients with overweight and obesity. The determinants of success are frequency of consultations, initial BMI, and initial weight loss.
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Patterns of weight change in black Americans: pooled analysis from three behavioral weight loss trials.
Morales, KH, Kumanyika, SK, Fassbender, JE, Good, J, Localio, AR, Wadden, TA
Obesity (Silver Spring, Md.). 2014;(12):2632-40
Abstract
OBJECTIVE Differentiating trajectories of weight change and identifying associated baseline predictors can provide insights for improving behavioral obesity treatment outcomes. METHODS Secondary, observational analyses using growth mixture models were conducted in pooled data for 604 black American, primarily female adults in three completed clinical trials. Covariates of identified patterns were evaluated. RESULTS The best fitting model identified three patterns over 2 years: 1) mean weight loss of approximately 2 kg (n = 519); 2) mean weight loss of approximately 3 kg at 1 year, followed by ∼4 kg regain (n = 61); and 3) mean weight loss of ∼20 kg at 1 year followed by ∼4 kg regain (n = 24, with 23 from one study). In final multivariate analyses, higher BMI predicted having pattern 2 (OR [95% CI]) 1.10 [1.03, 1.17]) or 3 (OR [95% CI] 1.42 [1.25, 1.63]), and higher dietary fat score was predictive of a lower odds of having patterns 2 (OR [95% CI] 0.37[0.15, 0.94]) or 3 (OR [95% CI] 0.23 [0.07, 0.79]). CONCLUSIONS Findings were consistent with moderate, clinically non-significant weight loss as the predominant pattern across all studies. Results underscore the need to develop novel and more carefully targeted and tailored approaches to facilitating weight loss in black American adults.