Physical Activity Assessment and Promotion in Clinical Settings in the United States: A Scoping Review.

OBJECTIVE: The purpose of this scoping review was to systematically examine interventions that focused on physical activity assessment and promotion in clinical settings in the United States. DATA SOURCES: A literature search was performed in 6 major databases to extract published peer-reviewed studies from 2008 to 2019. INCLUSION AND EXCLUSION CRITERIA: Interventions with practicing health professionals in the United States who performed physical activity assessment and promotion with adult patients 18 years of age and older. Studies were excluded if they were published in non-English, observational or case study designs, or gray literature. DATA EXTRACTION: Studies were screened and coded based on the population, intervention, comparison, outcomes and study setting for scoping reviews (PRISMA-ScR) framework. Of 654 studies that were identified and screened for eligibility, 78 met eligibility criteria and were independently coded by two coders. DATA SYNTHESIS: Data were synthesized using qualitative and descriptive methods. RESULTS: Forty-three of the included studies were randomized controlled trials with a majority being delivered by physicians and nurses in primary care settings. Fifty-six studies reported statistically significant findings in outcome measures such as anthropometrics and chronic disease risk factors, with 17 demonstrating improvements in physical activity levels as a result of the interventions. CONCLUSION: The assessment and promotion of physical activity in clinical settings appears to be effective but warrants continued research.

Usability testing of an electronic health application for patient activation on weight management.

BACKGROUND: Obesity is a leading public health concern in the United States. One promising method for enhancing patient activation to engage in health promoting behaviors is with technology in the primary care setting. The primary purpose of this study was to test the usability of a patient activation tool, called mWRAPPED, for weight management during primary care wait times. METHODS: A two-cycle approach to usability testing was followed by a pragmatic usability study in the primary care setting. The application was subsequently revised based on patient feedback. A convenience sample of patients completed usability testing in the clinical setting. Patients completed the System Usability Scale throughout all testing phases. RESULTS: First cycle patients provided an average score of 76.5 on the System Usability Scale. After revising mWRAPPED, the average patient System Usability Scale score increased to 80.5. mWRAPPED received an average System Usability Scale score of 77.9 when tested in the clinical setting. mWRAPPED demonstrated initial usability for primary care patients in an academic outpatient family medicine clinical setting. CONCLUSIONS: Results of the current study will help to support the use of this application in future studies as a novel approach to delivering guideline-based weight management information to patients.

Cerebral Cortical Microvascular Rarefaction in Metabolic Syndrome is Dependent on Insulin Resistance and Loss of Nitric Oxide Bioavailability.

OBJECTIVE: Chronic presentation of the MS is associated with an increased likelihood for stroke and poor stroke outcomes following occlusive cerebrovascular events. However, the physiological mechanisms contributing to compromised outcomes remain unclear, and the degree of cerebral cortical MVD may represent a central determinant of stroke outcomes. METHODS: This study used the OZR model of MS and clinically relevant, chronic interventions to determine the impact on cerebral cortical microvascular rarefaction via immunohistochemistry with a parallel determination of cerebrovascular function to identify putative mechanistic contributors. RESULTS: OZR exhibited a progressive rarefaction (to ~80% control MVD) of the cortical microvascular networks vs. lean Zucker rats. Chronic treatment with antihypertensive agents (captopril/hydralazine) had limited effectiveness in blunting rarefaction, although treatments improving glycemic control (metformin/rosiglitazone) were superior, maintaining ~94% control MVD. Chronic treatment with the antioxidant TEMPOL severely blunted rarefaction in OZR, although this ameliorative effect was prevented by concurrent NOS inhibition. CONCLUSIONS: Further analyses revealed that the maintenance of glycemic control and vascular NO bioavailability were stronger predictors of cerebral cortical MVD in OZR than was prevention of hypertension, and this may have implications for chronic treatment of CVD risk under stroke-prone conditions.