Can Nurses Self-Assess Fatigue?: Implications for Nurse Leaders.

OBJECTIVE: The aims of this study were to describe nurses' self-perceptions of fatigue and to examine nurses' acceptance of specific fatigue countermeasures. BACKGROUND: The work of nurses places them at a high risk of fatigue. Evidence suggests 75% to 80% of nurses in the United States experience high levels of fatigue. METHODS: This descriptive, cross-sectional correlational study surveyed 279 nurses. RESULTS: Results suggest that almost half of nurses (46%) are not able to accurately self-assess fatigue. Nurses expressed acceptance of several workplace fatigue reduction strategies. CONCLUSIONS: It may be unrealistic to expect nurses to self-assess fatigue levels and make decisions about their ability to safely provide patient care. Reliable methods for assessing fatigue in the workplace are needed. Several strategies exist that may be used to alleviate fatigue, and many were acceptable to nurses. Nurse leaders are well positioned to implement changes that impact the occurrence of nurse fatigue and thereby the quality of patient care.

The effect of physical activity on cognition relative to APOE genotype (PAAD-2): study protocol for a phase II randomized control trial.

BACKGROUND: By 2050, the prevalence of Alzheimer's disease (AD) in the United States is predicted to reach 13.8 million. Despite worldwide research efforts, a cure for AD has not been identified. Thus, it is critical to identify preventive strategies that can reduce the risk of or delay the onset of AD. Physical activity (PA) has potential in this regard. This randomized clinical trial aims to (a) test the causal relationship between PA and AD-associated cognitive function for persons with a family history of AD (FH+), (b) determine the moderating role of apolipoprotein epsilon 4 (APOE4) carrier status on cognition, and (c) assess cerebral structure, cerebral function, and putative biomarkers as mediators of the effects of PA on cognition. METHODS: We are recruiting cognitively normal, middle aged (40-65 years) sedentary adults with FH+. Participants are randomly assigned to a 12-month PA intervention for 3 days/week or to a control group maintaining their normal lifestyle. Saliva samples are taken at pre-test to determine APOE genotype. At pre-, mid-, and post-tests, participants complete a series of cognitive tests to assess information-processing speed, verbal and visual episodic memory, constructional praxis, mnemonic discrimination, and higher-order executive functions. At pre- and post-tests, brain imaging and blood biomarkers are assessed. DISCUSSION: We hypothesize that 1) the PA group will demonstrate improved cognition compared with controls; 2) PA-derived cognitive changes will be moderated by APOE4 status; and 3) PA-induced changes in neural and blood biomarkers will contribute to cognitive changes and differ as a function of APOE4 status. Our results may provide important insights into the potential of PA to preserve neurocognitive function in people with a heightened risk of AD due to FH+ and as moderated by APOE4 status. By using sophisticated analytic techniques to assess APOE as a moderator and neurobiological mechanisms as mediators across trajectories of cognitive change in response to PA, we will advance our understanding of the potential of PA in protecting against AD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03876314. Registered March 15, 2019.

The Physical Activity and Alzheimer's Disease (PAAD) Study: Cognitive outcomes.

Background: Alzheimer's disease is a progressive disease that degrades cognitive functioning and ultimately results in death. Currently, there is no cure for Alzheimer's disease and, hence, the identification of preventative strategies is important. Physical activity (PA) is a behavioral intervention that holds promise with respect to delaying the onset of Alzheimer's disease. Purpose: The purpose of this study was to explore the differential cognitive benefits achieved in response to PA as a function of a person's genetic risk for AD. Methods: Older cognitively normal adults (50-65 years) with a family history of AD (FHxAD) participated in an 8-month PA program. Cognitive performance was measured at baseline, pretest, midtest, and posttest and changes over time were assessed as a function of apolipoprotein E (APOE) status (carriers: 1-2 copies of the ɛ4 allele; noncarriers: 0 copies of the ɛ4 allele). Results: Improvements in memory were associated with PA participation irrespective of APOE ɛ4 carrier status. Conclusions: Future experimental studies are needed to confirm that PA causes improvements to cognitive performance in older cognitively normal adults with a FHxAD and that these improvements are equivalent for cognitively normal APOE ɛ4 carriers and noncarriers.

Motivating Mature Adults to be Physically Active.

As a population, middle-aged and older adults are not meeting national guidelines for exercise. The purpose of this study was to describe factors associated with exercise adherence in an 8-month program offered as part of a research study testing the effects of exercise on cognitive performance for persons with a family history of Alzheimer's disease (AD). After completion of the program, participants provided open-ended responses indicating their reasons for adhering to the exercise program, and they completed the Motives for Physical Activities Measure-Revised. Results indicated that adherence was tied to an interest in contributing to our understanding of AD, the opportunity to join an exercise program, perceived exercise benefits, and social support. In addition, participants reported high levels of extrinsic (fitness-related) and intrinsic (interest/enjoyment) motivation. Other possible motivating factors which emerged from day-to-day observations in the program were identified. Findings suggest directions for exercise professionals with respect to exercise adherence.

Effects of exercise, patient education, and resource support on women with fibromyalgia: An extended long-term study.

This research examined whether a long-term, multi-component program positively affected physical fitness, pain and fatigue in seven women with fibromyalgia syndrome. These women lived independently in the community. They attended a university-based program 3 days per week, 1 hour per session, year-around for many years. They were evaluated periodically with a fitness test and rating scale regarding pain and fatigue. Results from when they began the program versus most recently are provided. All of these women showed various positive results from participation in the program.

Fibromyalgia, Fibro Fog, and Exercise.

Fibro fog causes serious problems for those with fibromyalgia syndrome. The mechanisms that cause it have not been well identified. Since prescription medication and other conventional medical interventions have proven less than satisfactory, and while waiting for more investigational information, research suggests that exercise might be helpful.

Innovative Research Design Exploring the Effects of Physical Activity and Genetics on Cognitive Performance in Community-Based Older Adults.

Physical activity is predictive of better cognitive performance and lower risk of Alzheimer's disease (AD). The apolipoprotein E gene (APOE) is a susceptibility gene for AD with the e4 allele being associated with a greater risk of AD. Cross-sectional and prospective research shows that physical activity is predictive of better cognitive performance for those at greater genetic risk for AD. However, the moderating role of APOE on the effects of a physical activity intervention on cognitive performance has not been examined. The purpose of this manuscript is to justify the need for such research and to describe the design, methods, and recruitment tactics used in the conductance of a study designed to provide insight as to the extent to which cognitive benefits resulting from an 8-month physical activity program are differentiated by APOE e4 status. The effectiveness of the recruitment strategies and the feasibility of recruiting APOE e4 carriers are discussed.

Exercise effects on two men with fibromyalgia syndrome: an update.

In 2007, an article was published in this journal about the effects of exercise on two older men with fibromyalgia syndrome (FMS). This new article is an update on how exercise has affected them during a 4-year period since 2007. Results suggest that both these men still function at approximately the same levels (physically and psychosocially) as reported in 2007. This is viewed as a positive finding, because even with all of their FMS symptoms, these two men managed to maintain their functional capacity. It is hard for most older people without FMS to remain motivated enough to accomplish this. Because it is difficult to find specifically published data on men (vs. women) with FMS, this long-term information on these two men is important for professionals who are involved in exercise programming for men with FMS and for those interested in studying exercise effects on men with FMS.

Intestinal permeability, moderate exercise, and older adult health.

This article proposes that inflammation leading to intestinal permeability (a leaky gut) may be responsible for numerous physical and mental abnormalities and associated functional decline. This may be especially true for elderly people, particularly involving the development of autoimmune disorders. In this regard, engagement in appropriate moderate exercise/physical activity can produce an anti-inflammatory effect and may have a powerful role to play as part of a holistic treatment for this potential problem. This is important information for nurses who are interested in integrative and nonpharmacologic care.

Exercise, fibromyalgia, and fibrofog: a pilot study.

BACKGROUND: This pilot study was designed to test the efficacy of a physical activity program for improving psychological variables and fibromyalgia syndrome (FMS) symptoms and to provide preliminary evidence regarding the effects on perceived cognitive symptoms and objectively measured cognitive performance by FMS patients. METHODS: Sixteen women diagnosed with FMS were randomly assigned to an 18-week physical activity program or to a control condition. Psychological measures, FMS symptoms, perceived cognitive function, objective measures of cognition, and walking capacity were assessed at baseline and posttest. RESULTS: At posttest, there were significant differences in fatigue (effect size, ES=1.86), depression (ES=1.27), FMS symptoms (ES=1.56), self-reported cognitive symptoms (ES=1.19), and delayed recall performance (ES=1.16) between the physically active group and the control group, indicating that the FMS patients benefited from physical activity. Beneficial effects were also observed for 6 of the 7 objective measures of cognition and ranged from small to large (ESs=0.26 to 1.06). CONCLUSIONS: Given that all FMS patients do not respond well to conventional treatments, these beneficial effects of physical activity are important. Future studies with larger samples are warranted to test the reliability of the findings for the objective measures of cognition.

The holistic effects of long-term exercise, health education, and resource assistance on one woman with multiple debilitating medical problems: a case report.

This interventional case study describes the effects of a 3-component program on one woman with multiple, serious medical problems. The program was anchored with exercise accompanied by health education and resource help, and it lasted from fall 1998 until spring 2007. The patient was diagnosed with fibromyalgia, multiple sclerosis, Crohn's disease, and depression. The program was conducted 3, and for a period of time, 5 days per week for approximately 60 minutes per session. Results from fitness testing, psychosocial measurements, and the subject's feedback suggest that the exercise, health education, and resource help combined to produce a positive effect on selected fitness variables, psychosocial factors, and everyday functioning. Most important, the program impact appears to have had a holistic effect on numerous symptoms related to this patient's medical problems as well as functional improvement.

Fibromyalgia, cognitive problems and independence: physical activity may be useful in home health care.

Home health care providers often deal with older clients who have cognitive deficits. Cognitive problems have a negative impact on independence. Certain chronic pain conditions present with cognitive dysfunction as a co-morbidity. Fibromyalgia syndrome is one such condition. Home health care providers need to know that mild-moderate exercise may positively affect fibromyalgia-related cognitive deficits at very low cost. All of the above is discussed in this paper along with advice concerning the provision of exercise for older, home bound people.

Exercise effects on two men with fibromyalgia syndrome.

The primary purpose of this study was to examine the effects of an exercise program on physical fitness, psychosocial factors, and symptoms in two men with fibromyalgia syndrome (FMS). An interventional case study research design was used to collect data on physical fitness, psychosocial factors, and symptoms at intervals throughout a 14-month period. Raw scores and raw score averages, devoid of statistical manipulation, are presented to display real individual results. The secondary purpose of the study was to discuss how these two men tolerated the program in comparison to women in a similar program. This is important because data on men with FMS appear to be unavailable, because the greater majority of participants in FMS programs are women. Results support that these two men benefited from the program and that differences between men and women with FMS should be considered relative to the conduct of exercise programs for these groups.

Fibromyalgia syndrome: the beneficial effects of exercise.

This article highlights positive outcomes for a convenience sample of six women (49-64 years of age) with fibromyalgia syndrome (FMS) who participated in an exercise program over 5 years. This group showed improvement with various FMS symptoms,fitness, and psychosocial factors early in the program, then showed further improvement as a result of adding new exercises to the protocol during the fourth and fifth years. Data suggest that certain people with FMS can improve their functional capacity with exercise over time, and move to even higher levels of physical function while aging and coping with FMS. Practical advice is provided for rehabilitation nurses regarding exercise and FMS.

Exercise effects on interstitial cystitis: two case reports.

Interstitial cystitis (IC) is a painful bladder condition. Because of a reported link between exercise and pain reduction, a case study analysis was conducted to explore exercise effects on IC. Exercise was provided 3 days per week for 6 months. Two subjects appeared to have benefitted from the program. Implications for future research are dis-.

A successful, long-term exercise program for women with fibromyalgia syndrome and chronic fatigue and immune dysfunction syndrome.

This article describes an ongoing, long-term clinical exercise program for women with fibromyalgia syndrome (FMS), some of whom also have chronic fatigue and immune dysfunction syndrome (CFIDS). The recorded outcomes from the most recent year of the program also are reported. Participants engaged in sessions lasting 50-70 minutes, 5 days per week; each session involved aerobic activity, resistance training, and other dynamic exercise. One group was in the program for 3 years and another group was in the program for 2 years. Program outcomes for the year (comparing beginning and end-of-year results) are presented for both groups on physical fitness, psychosocial, and FMS/CFIDS symptoms. The outcomes support that all of the women appear to have benefited from the program in numerous ways, suggesting that the program works. Also, those outcomes are in agreement with past research reported in this journal. Implications for clinical nurse specialists working with FMS/CFIDS patients are discussed.