Procedures used to standardize data collected by RT3 triaxial accelerometers in a large-scale weight-loss trial.

BACKGROUND: Accelerometers measure intensity, frequency, and duration of physical activity. However, the scarcity of reports on data reduction makes comparing accelerometer results across studies difficult. METHODS: Participants were asked to wear a triaxial accelerometer (RT3) for ?10 hours for at least 4 days, including one weekend day. We summarize our data-cleaning procedures and assess the impact of defining a usable day of measurements as at least 6, 8, or 10 hours of wear time, and of standardizing data to a 12-hour day. RESULTS: Eighty-two percent of participants met wear time requirements; 93% met requirements when we defined a day as 8-or-more hours of wear time. Normalization of data to a 12-hour day had little impact on estimates of daily moderate-to-vigorous physical activity (MVPA; 16.9 vs. 17.1 minutes); restricting MVPA to activities occurring in bouts of 10 minutes or longer had greater impact (16.9 vs. 6.3 minutes per day). CONCLUSION: Our account of accelerometry quality-control and data-cleaning procedures documents the small impact of variations in daily wear time requirements on MVPA estimates, and the larger impact of evaluating total MVPA vs. MVPA occurring in extended bouts. This paper should allow other researchers to duplicate or revise our methods as needed.

Patterns of physical activity among overweight and obese adults.

INTRODUCTION: Little is known about patterns of physical activity in overweight and obese adults, although they are at high risk for chronic disease and can benefit from physical activity. We describe patterns of moderate-to-vigorous physical activity (MVPA) and MVPA in bouts of 10 minutes or longer in overweight and obese adults. METHODS: Overweight and obese participants (n = 1,648) who were screened for the multicenter Weight Loss Maintenance Trial wore RT3 accelerometers for at least 3 weekdays and 1 weekend day. We determined minutes spent in moderate physical activity, vigorous physical activity, and MVPA overall, by weekday vs weekend, and by time of day. We also measured bouts of at least 10 minutes of sustained MVPA. RESULTS: Participants were active for an average of 15.8 minutes per day. Among those who engaged in bouts of MVPA, the average bout was 33.3 minutes long. Participants who were younger than 50 years, male, non-African American, or overweight were more active than were those who were older than 50, female, African American, or obese. Participants were more active on weekends than on weekdays and in the morning than in the afternoon or evening. Only 2% of participants were active for 60 or more minutes per day. CONCLUSION: We found differences in physical activity patterns by demographic characteristics, day, and time of day. Weekend mornings may be an opportune time to promote additional physical activity.

Weight loss during the intensive intervention phase of the weight-loss maintenance trial.

BACKGROUND: To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I). METHODS: Eligible adults were aged > or =25, overweight or obese (BMI=25-45 kg/m2), and on medications for hypertension and/or dyslipidemia. Anthropomorphic, demographic, and psychosocial measures were collected at baseline and 6 months. Participants (n=1685) attended 20 weekly group sessions to encourage calorie restriction, moderate-intensity physical activity, and the DASH (dietary approaches to stop hypertension) dietary pattern. Weight-loss predictors with missing data were replaced by multiple imputation. RESULTS: Participants were 44% African American and 67% women; 79% were obese (BMI> or =30), 87% were taking anti-hypertensive medications, and 38% were taking antidyslipidemia medications. Participants attended an average of 72% of 20 group sessions. They self-reported 117 minutes of moderate-intensity physical activity per week, kept 3.7 daily food records per week, and consumed 2.9 servings of fruits and vegetables per day. The Phase-I follow-up rate was 92%. Mean (SD) weight change was -5.8 kg (4.4), and 69% lost at least 4 kg. All race-gender subgroups lost substantial weight: African-American men (-5.4 kg +/- 7.7); African-American women (-4.1 kg +/- 2.9); non-African-American men (-8.5 kg +/- 12.9); and non-African-American women (-5.8 kg +/- 6.1). Behavioral measures (e.g., diet records and physical activity) accounted for most of the weight-loss variation, although the association between behavioral measures and weight loss differed by race and gender groups. CONCLUSIONS: The WLM behavioral intervention successfully achieved clinically significant short-term weight loss in a diverse population of high-risk patients.

Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial.

CONTEXT: Behavioral weight loss interventions achieve short-term success, but re-gain is common. OBJECTIVE: To compare 2 weight loss maintenance interventions with a self-directed control group. DESIGN, SETTING, AND PARTICIPANTS: Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2). Enrollment at 4 academic centers occurred August 2003-July 2004 and randomization, February-December 2004. Data collection was completed in June 2007. INTERVENTIONS: After the phase 1 weight-loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology-based intervention, or self-directed control. Main Outcome Changes in weight from randomization. RESULTS: Mean entry weight was 96.7 kg. During the initial 6-month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal-contact group regained less weight (4.0 kg) than those in the self-directed group (5.5 kg; mean difference at 30 months, -1.5 kg; 95% confidence interval [CI], -2.4 to -0.6 kg; P = .001). At 30 months, weight regain did not differ between the interactive technology-based (5.2 kg) and self-directed groups (5.5 kg; mean difference -0.3 kg; 95% CI, -1.2 to 0.6 kg; P = .51); however, weight regain was lower in the interactive technology-based than in the self-directed group at 18 months (mean difference, -1.1 kg; 95% CI, -1.9 to -0.4 kg; P = .003) and at 24 months (mean difference, -0.9 kg; 95% CI, -1.7 to -0.02 kg; P = .04). At 30 months, the difference between the personal-contact and interactive technology-based group was -1.2 kg (95% CI -2.1 to -0.3; P = .008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight. CONCLUSIONS: The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive technology-based intervention provided early but transient benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00054925.

A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures.

Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting.