Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial

BACKGROUND/AIMS: The relation between heart rate variability (HRV) as non-invasive biomarkers of autonomic function and cognitive behavior therapy (CBT) as non-pharmacological treatments has rarely been examined in patients with constipation-predominant irritable bowel syndrome (IBS-C). The purpose of this study is to evaluate the efficacy of an 8-week CBT intervention on HRV and IBS symptoms, and the correlation of changes in HRV with changes in IBS symptoms among young female nursing students with IBS-C. METHODS: This study consisted of an exploratory subgroup analysis of 43 participants with IBS-C who had been randomly assigned to receive either 8 weeks of CBT (n = 23) or general medical information (control, n = 20). At baseline and 8, 16, and 24 weeks, participants completed a questionnaire assessing their gastrointestinal (GI) symptoms, anxiety, depression, and stress, and their HRV was measured via electrocardiography. RESULTS: At the 8-week follow-up, the high-frequency (HF) power was significantly higher, and the low-frequency (LF)/HF ratio was lower in the CBT group than in the control group (P < 0.001 for both), and the severity of GI symptoms (P = 0.003), anxiety (P < 0.001), depression (P < 0.001), and stress (P < 0.001) was significantly lower in the CBT group than in the control group. Changes in the HF power were significantly and inversely associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from −0.37 to −0.68). Changes in the LF/HF ratio were also significantly and positively associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from 0.38 to 0.60). CONCLUSIONS: CBT was effective in managing symptoms in young IBS-C patients and the improvement of symptoms was sustained at 24 weeks following the completion of CBT. Furthermore, indirect measurement of autonomic function using HRV may be a useful objective parameter for assessing response to CBT in young IBS-C patients.

Validity and Reliability of the Modified Thai Adolescent’s Physical Activity Questionnaire

This study sought to determine the validity and reliability of a self-report instrument, the Modified Thai Adolescent’s Physical Activity Questionnaire (MTAPAQ). Concurrent validity was assessed using 40 secondary school Thai adolescents (17 males and 23 females), who wore an ActiGraph accelerometer, during their waking hours for seven consecutive days. The students completed the MTAPAQ upon completion of the recording period. Reliability was evaluated using 30 secondary school Thai adolescents (12 males and 18 females) who completed the MTAPAQ by recalling their physical activities during the previous seven days, on two separate occasions that were three days apart.A significant correlation was found between the Metabolic Equivalent of Tasks (MET-mins), as determined by the MTAPAQ, and log (10) transformed activity counts, as determined by the ActiGraph accelerometer. The test-retest reliability, of the two administrations of the MTAPAQ, was found to be significant. The findings provide evidence of an acceptable level of concurrent validity and test-retest reliability of the MTAPAQ for use with Thai adolescents.

Development of a Family and School Collaborative (FASC) Program to Promote Healthy Eating and Physical Activity among School-age Children

Childhood obesity, a serious public health concern, has a high prevalence with long-term negative physical and mental health consequences. Prevention and treatment of obesity are considered a priority among pediatric health care providers. This participatory action research, using empowerment strategies with 110 school stakeholders, aimed to develop a family and school collaborative program for promoting healthy eating and physical activity for school-age children. Quantitative data were analyzed using descriptive statistics, while qualitative data were subjected to content analysis. The study findings revealed the program had five core components including: situational analysis, family and school collaboration, exploration of effective interventions, implementation of planned activities, and monitoring and evaluation. Methods of program implementation included: group discussions; brainstorming and mind mapping; group meetings; and, participatory workshops. The impact of program implementation was evident, with family and school collaboration, in: initiating school policy, developing practical guidelines and implementing obesity prevention activities. Activities created a supportive environment by disallowing sale of sodas and unhealthy snacks; developing a curriculum for enhancing the capacity of student leaders; promoting physical activity; providing a healthy school lunch and snack menu; providing obesity prevention education; conducting child nutrition status surveillance; and, developing a database for tracking children’s status over time. The program could be used as a guideline for nurses and health care personnel to enhance partnerships, between families and schools, in order to promote healthy eating and physical activity in school-age children.