Psychosocial outcomes of an exercise maintenance intervention after phase II cardiac rehabilitation.

PURPOSE: Maintenance of exercise after completing phase II cardiac rehabilitation (CR) is challenging for many patients. We offered a telephone-based maintenance intervention and found improvement in exercise participation in the intervention group at 12 months post-CR discharge. We examined the effects of the intervention on psychosocial outcomes. METHODS: The effects of a home-based exercise maintenance intervention on psychosocial outcomes among patients who had completed phase II CR versus contact control were evaluated in a randomized controlled trial. Data were collected in 2005 to 2010 and analyzed in 2011. One hundred thirty patients (mean age = 63.6 [SD = 9.7] years, 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n = 64) or contact control (Contact Control group, n = 66). Maintenance Counseling group participants received exercise counseling (based on the transtheoretical model and social-cognitive theory) delivered via telephone for 6 months, as well as print materials and feedback reports. Assessments of depression, quality of life, and mental health were conducted at baseline, 6 months, and 12 months. RESULTS: The Maintenance Counseling group reported statistically significant higher quality of life than the Contact Control group at 6 months (b = 0.29, SE = 0.08, P < .001) and 12 months (b = 0.27, SE = 0.09, P = .002). Intervention effects on depressive symptoms were significant at 12 months (b = -6.42, SE = 2.43, P = .009). Effects on overall mental health were nonsignificant at both followups. No significant moderators of treatment effects were found. CONCLUSION: A telephone-based intervention that helped maintain exercise showed statistically significant improvements in quality of life and reduced depressive symptoms in this patient population.

Home-based physical activity intervention for colorectal cancer survivors.

BACKGROUND: The efficacy of a home-based physical activity (PA) intervention for colorectal cancer patients versus contact control was evaluated in a randomized controlled trial. METHODS: Forty-six patients (mean age = 57.3 years [SD = 9.7], 57% female, mean = 2.99 years post-diagnosis [SD = 1.64]) who had completed treatment for stages 1-3 colorectal cancer were randomized to telephone counseling to support PA (PA group, n = 20) or contact control (control group, n = 26). PA group participants received 3 months of PA counseling (based on the transtheoretical model and the social cognitive theory) delivered via telephone, as well as weekly PA tip sheets. Assessments of PA (Seven-day Physical Activity Recall [7-day PAR] and Community Healthy Activities Model Program for Seniors [CHAMPS]), submaximal aerobic fitness (Treadwalk test), motivational readiness for PA, and psychosocial outcomes were conducted at baseline, 3, 6, and 12 months post-baseline. Objective accelerometer data were collected at the same time points. RESULTS: The PA group reported significant increases in minutes of PA at 3 months (7-day PAR) and caloric expenditure (CHAMPS) compared with the control group, but the group differences were attenuated over time. The PA group showed significant improvements in fitness at 3, 6, and 12 months versus the control group. Improvements in motivational readiness for PA were reported in the PA group only at 3 months. No significant group differences were found for fatigue, self-reported physical functioning, and quality of life at 3, 6, and 12 months. CONCLUSION: A home-based intervention improved survivors' PA and motivational readiness at 3 months and increased submaximal aerobic fitness at 3, 6, and 12 months.

Maintenance of exercise after phase II cardiac rehabilitation: a randomized controlled trial.

BACKGROUND: Patients who have completed Phase II cardiac rehabilitation have low rates of maintenance of exercise after program completion, despite the importance of sustaining regular exercise to prevent future cardiac events. PURPOSE: The efficacy of a home-based intervention to support exercise maintenance among patients who had completed Phase II cardiac rehabilitation versus contact control was evaluated. DESIGN: An RCT was used to evaluate the intervention. Data were collected in 2005-2010 and analyzed in 2010. SETTING/PARTICIPANTS: One hundred thirty patients (mean age=63.6 years [SD=9.7], 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n=64) or contact control (Contact Control group, n=66). INTERVENTION: Maintenance Counseling group participants received a 6-month program of exercise counseling (based on the transtheoretical model and social cognitive theory) delivered via telephone, as well as print materials and feedback reports. MAIN OUTCOME MEASURES: Assessments of physical activity (7-Day Physical Activity Recall), motivational readiness for exercise, lipids, and physical functioning were conducted at baseline, 6 months, and 12 months. Objective accelerometer data were collected at the same time points. Fitness was assessed via maximal exercise stress tests at baseline and 6 months. RESULTS: The Maintenance Counseling group reported significantly higher exercise participation than the Contact Control group at 12 months (difference of 80 minutes, 95% CI=22, 137). Group differences in exercise at 6 months were nonsignificant. The intervention significantly increased the probability of participants' exercising at or above physical activity guidelines and attenuated regression in motivational readiness versus the Contact Control Group at 6 and 12 months. Self-reported physical functioning was significantly higher in the Maintenance Counseling group at 12 months. No group differences were seen in fitness at 6 months or lipid measures at 6 and 12 months. CONCLUSIONS: A telephone-based intervention can help maintain exercise, prevent regression in motivational readiness for exercise, and improve physical functioning in this patient population.

When, why and for whom there is a relationship between physical activity and menopause symptoms.

OBJECTIVES: The relationship between enhanced physical activity and decreased menopause symptoms is equivocal. In this study we sought to better understand this relationship by examining the association of physical activity to different symptom domains and by examining mediating and moderating variables. STUDY DESIGN: Women participating in a randomized control trial on physical activity were given a menopause symptom measure (MENQOL) at follow-up. Of the 280 women participating, 113 (mean age=52) reported having symptoms they attributed to menopause. Regression analyses were run to examine if change in physical activity predicted fewer symptoms. Exercise self-efficacy was examined as a mediator and depressive symptoms as a moderator. RESULTS: An increase in physical activity from baseline was found to be related to reporting fewer total menopause symptoms (beta=-0.22, p=.02). When the total menopause symptoms score was examined by domain, increased physical activity was found to be related to reporting fewer general symptoms attributed to menopause (psychosocial (beta=-0.18, p=.05) and physical (beta=-0.23, p=.01)), but had no effect on specific symptoms of menopause (vasomotor and sexual). Exercise self-efficacy was found to mediate the relationship between increased physical activity and total, physical and psychosocial menopause symptoms. Finally, for individuals with high depressive symptoms, those who increased physical activity the most reported fewer sexual symptoms of menopause. CONCLUSION: This study suggests that physical activity participation is associated with lower general symptom reporting as opposed to specifically impacting menopause symptoms. Further, exercise self-efficacy mediates the relationship between physical activity and general menopause symptoms, suggesting a psychological pathway.

A population-based study on substance abuse treatment for adults with disabilities: access, utilization, and treatment outcomes.

AIMS: To examine potential disparities in access to substance abuse treatment services for Medicaid-eligible adults with disabilities, and compare utilization rates and outcomes in outpatient programs. DESIGN: Population-based multi-year cross-sectional study. SETTING: State-wide examination of substance-abuse treatment, particularly outpatient. PARTICIPANTS: Medicaid enrollees aged 18-64. MEASURES: Treatment access and utilization; outcome measures of retention, completion, readmission, and abstinence derived from state treatment and Medicaid databases. FINDINGS: Access and utilization rates for adults with disabilities were about half others' rates; treatment outcomes were generally equivalent across groups. CONCLUSIONS: Adults with disabilities are underutilizing substance abuse treatment, suggesting barriers to accessing treatment.

Access barriers to substance abuse treatment for persons with disabilities: an exploratory study.

Research in substance abuse (SA) treatment has demonstrated that persons with disabilities (PWDs) are at substantially higher risk for SA than persons without disabilities. Despite their higher risk, PWDs access SA treatment at a much lower rate than persons without disabilities. Using the Behavioral Model for Vulnerable Populations as a research framework, we identified reasons for differences in access to SA treatment for Medicaid-eligible adults with disabilities in Oregon through a multiphase study. Analyses of demographic and referral source data, along with interviews with key state agency representatives, adults with disabilities, and treatment program personnel, helped identify barriers to SA treatment access. These barriers are reflected as attributes of PWDs, contextual variables that enable or impede access, recognition of the need for SA treatment, and characteristics of treatment services. The findings suggest needed policy and practice changes to increase access rates for PWDs. They provide direction for future research.

Outcomes from the women's wellness project: a community-focused physical activity trial for women.

BACKGROUND: Given the low rates of physical activity participation, innovative intervention approaches are needed to make a public health impact. METHODS: The study was conducted at the Miriam Hospital/Brown Medical School in Providence, RI, and in communities of Southeastern Massachusetts from 2002 to 2005. Previously sedentary women (n = 280; mean age = 47.1; 94.6% Caucasian) were randomly assigned to one of three conditions: (1) Choose to Move, a self-help printed booklet (n = 93), (2) Jumpstart, a motivationally tailored, print based intervention (n = 95); or (3) Wellness, women's health materials (n = 92). Face-to-face contact at months 3 (M3) and 12 (M12) occurred within participants' communities in local libraries. RESULTS: At M3, participants in the Jumpstart condition reported significantly more minutes of physical activity per week (M = 140.4, SE = 14.82) than participants in the Wellness condition (M = 98.1, SE = 15.09), (t(275) = 2.00, p < 0.05). The Jumpstart arm showed a trend towards significance (t(275) = 1.93, p = 0.054) when compared with the CTM arm (M = 99.5, SE = 15.11); there was no significant difference between the CTM and Wellness arms (t(275) = 0.07, p = NS). At M12, there were no significant differences (F(2,275) = 0.147, p = NS) between any of the treatment arms. CONCLUSIONS: Results suggest that print-based programs for physical activity may be efficacious short-term, but more research is needed to find approaches that are effective long-term. It is possible to deliver print-based programs through existing community infrastructures, however these approaches need further evaluation to examine maintenance effects apart from the demand characteristics of a research study.

Lifestyle and coronary heart disease prevention.

To conclude, promoting lifestyle changes in the primary care setting has received considerable attention. Efficacy data are most promising for encouraging smoking cessation; the evidence supporting increased physical activity and dietary changes among healthy adults is not conclusive. Nonetheless, the role of behavioral strategies for changing individual and multiple risk behaviors has been recognized. A simple framework for brief counseling by primary care clinicians is presented in the form of the 5A's.