Feasibility and acceptability of a televideo physical activity and nutrition program for recent kidney transplant recipients.

BACKGROUND: Post-transplant weight gain affects 50-90% of kidney transplant recipients adversely affecting survival, quality of life, and risk for diabetes and cardiovascular disease. Diet modification and physical activity may help prevent post-transplant weight gain. Methods for effective implementation of these lifestyle modifications are needed. The objective of this study is to assess the feasibility and acceptability of a remotely delivered nutrition and physical activity intervention among kidney transplant recipients. Secondary aims were to estimate the effectiveness of the intervention in producing changes in physical activity, qualify of life, fruit and vegetable intake, and consumption of whole grains and water from baseline to 6 months. METHODS: A randomized controlled study for stable kidney transplant recipients between 6 and 12 months post-transplantation was conducted. Participants were randomly assigned 1:1 to a technology-based, lifestyle modification program (intervention) or to enhanced usual care (control). RESULTS: The first 10 kidney transplant recipients screened were eligible and randomized into the intervention and control groups with no significant between-group differences at baseline. Health coaching attendance (78%) and adherence to reporting healthy behaviors (86%) were high. All participants returned for final assessments. The weight in controls remained stable, while the intervention arm showed weight gain at 3 and 6 months. Improvements were found for physical activity, quality of life, and fruit and vegetable intake in both groups. All participants would recommend the program to other transplant recipients. CONCLUSIONS: Our data suggest that a remotely delivered televideo nutrition and physical activity intervention is feasible and valued by patients. These findings will aid in the development of a larger, more prescriptive, randomized trial to address weight gain prevention. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT03697317. Retrospectively registered on October 5, 2018.

Physical activity across the curriculum (PAAC3): Testing the application of technology delivered classroom physical activity breaks.

Only 43% of children in the U.S., ages 6-11 yrs., meet current physical activity (PA) guidelines. To satisfy the MVPA requirement, schools have begun incorporating MVPA in the form of activity breaks or MVPA academic lessons. We completed two, 3 academic-yr. cluster randomized trials (DK61489, DK85317) called "Physical Activity Across the Curriculum" (PAAC) which involved increasing MVPA in the classroom. Across 3-yrs. teachers in PAAC schools delivered ~60 min/wk. (12 min/day) of MVPA. Although short of our MVPA goal (20 min/d), the PAAC approach substantially increased in-school MVPA. Teacher reluctance to devote additional time to develop and integrate PA lessons into their curriculum was the overwhelming barrier to meeting the MVPA goal. Therefore, to reduce barriers to delivery of classroom PA we developed a 3-academic yr. cluster randomized trial (2 yrs. active intervention, 1 yr. follow-up) to compare the effectiveness and sustainability of technology delivered (PAAC-R) and classroom teacher delivered (PAAC-T) activity breaks for increasing classroom MVPA in elementary school students in grades 2 and 3 at baseline who will progress to grades 4-5. NCT registration: NCT03493139.

Remote delivery of weight management for adults with intellectual and developmental disabilities: Rationale and design for a 24 month randomized trial.

Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0-6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.

Remote Exercise for Adults with Down Syndrome.

PURPOSE: Adults with Down syndrome are less physically active than their typically developed peers. The purpose of this study was to assess the feasibility of delivering moderate-to- vigorous exercise sessions, led by a trained health educator using real-time video conferencing, to groups of young adults with Down syndrome in their homes. METHODS: Participants were randomized to 30-minute group exercise sessions either 1 or 2 times a week delivered on an iPad mini tablet computer using the Zoom video conferencing application, and were asked to attend individual support/education sessions once a week using FaceTime® on the iPad, for 12 weeks. Minutes of MVPA during all group sessions were assessed using a Fitbit Charge HR activity/heart rate monitor. Participants were also asked to complete weekly homework assignments involving MVPA. RESULTS: Twenty-seven participants (n = 14,1 session·wk-1, n =13, 2 sessions·wk-1), mean age 27.9 ± 7.1 yrs., ~ 41% female, enrolled in and completed the 12-wk. intervention. Attendance at group exercise and individual support/education sessions did not differ significantly between those randomized to 1 (exercise sessions =89.9 ± 8.8%, support/education sessions = 81.2 ±18.7%) or 2 sessions·wk-1 (exercise sessions = 88.8 ± 7.7%; p=0.79, support/education sessions= 86.0 ± 20.9%; p=0.87). Participants averaged 27.7 ± 5.7 mins·session-1 of MVPA with no significant difference between the 1 (26.6 ± 3.0 mins·session-1) and 2 session·wk-1 groups (28.8 ± 7.7 mins·session-1, p=0.16). The completion rate for homework assignments did not differ significantly between the 1 (21.4 ± 26.3%) and 2 session·wk-1 groups (37.7 ± 21.7%, p=0.28). CONCLUSION: Exercise delivered by group video conferencing may be a feasible and potentially effective approach for increasing MVPA in adults with Down syndrome.

Changes in cognitive function after a 12-week exercise intervention in adults with Down syndrome.

BACKGROUND: Between 250,000 and 400,000 individuals in the United States are diagnosed with Down syndrome (DS). Nearly all adults with DS will develop Alzheimer's disease pathology starting in their thirties. Recent studies suggest that increased physical activity (PA) may be important for maintaining components of cognition, including memory. OBJECTIVE: The purpose of this study was to evaluate changes in cognitive function after completion of a 12-week exercise intervention in adults with DS. METHODS: Participants were randomized to attend 30-minute group exercise sessions 1 or 2 times a week for 12 weeks. The exercise sessions were delivered via video conferencing on a tablet computer to groups of 5-8 participants. Sessions consisted of aerobic based exercises such as walking and jogging to music, dancing, as well as strength based exercises such as vertical jumps, bicep curls, and squats. Cognitive function was measured at baseline and end of study using the Cantab Dementia Battery for iPads, which assessed the cognitive domains of memory, attention, and reaction time. RESULTS: Twenty-seven participants (27.9 ±â€¯7.1 years of age, 40.7% female) enrolled and completed the 12-week intervention. Participants randomized to 1 session/week averaged 26.6 ±â€¯3.0 min/week of PA from the group exercise session. Participants randomized to 2 sessions/week averaged 57.7 ±â€¯15.3 min/week of PA from the group exercise sessions. Participants improved their performance on the two memory variables (p = 0.048 and p = 0.069). CONCLUSION: Increased exercise may have positive changes on memory and other cognitive functions.

The Feasibility of Group Video Conferencing for Promotion of Physical Activity in Adolescents With Intellectual and Developmental Disabilities.

Physical activity (PA) rates of adolescents with intellectual and developmental disabilities (IDD) are low and effective strategies for increasing PA are limited. The purpose of this study was to assess the feasibility of a group-based PA intervention that was delivered remotely to adolescents with IDD. Participants attended 30-min group PA sessions 3 times a week. PA sessions were delivered in their homes by video conferencing on a tablet computer. Thirty-one participants enrolled and 29 completed the 12-week intervention. Participants attended 77.2% ± 20.8% of scheduled sessions and averaged 26.7 ± 2.8 min of PA/session, with 11.8 ± 4.8 min at moderate- to vigorous intensity. Group-based PA delivered remotely may be a feasible approach for the promotion of PA in adolescents with IDD.

Physical activity across the curriculum: year one process evaluation results.

BACKGROUND: Physical Activity Across the Curriculum (PAAC) is a 3-year elementary school-based intervention to determine if increased amounts of moderate intensity physical activity performed in the classroom will diminish gains in body mass index (BMI). It is a cluster-randomized, controlled trial, involving 4905 children (2505 intervention, 2400 control). METHODS: We collected both qualitative and quantitative process evaluation data from 24 schools (14 intervention and 10 control), which included tracking teacher training issues, challenges and barriers to effective implementation of PAAC lessons, initial and continual use of program specified activities, and potential competing factors, which might contaminate or lessen program effects. RESULTS: Overall teacher attendance at training sessions showed exceptional reach. Teachers incorporated active lessons on most days, resulting in significantly greater student physical activity levels compared to controls (p < 0.0001). Enjoyment ratings for classroom-based lessons were also higher for intervention students. Competing factors, which might influence program results, were not carried out at intervention or control schools or were judged to be minimal. CONCLUSION: In the first year of the PAAC intervention, process evaluation results were instrumental in identifying successes and challenges faced by teachers when trying to modify existing academic lessons to incorporate physical activity.