6-month Program Research Articles

A health-social service partnership programme for improving the health self-management of community-dwelling older adults: a hybrid effectiveness-implementation pilot study protocol

BackgroundThe ageing population requires seamless, integrated health and social care services in the community to promote the health of older adults. However, inadequate financial resources, a lack of clear operational guidelines, and various organisational work cultures may affect the implementation quality and sustainability of these services. As a unique approach, this study seeks to examine the preliminary effects of a health-social partnership programme on the health self-management of community-dwelling older adults in Hong Kong. Additionally, the study seeks to ascertain key insights into the mechanisms and processes required to implement and sustain a self-care management programme in broader practice in community settings.MethodsThis study will use a hybrid effectiveness-implementation design. During the 3-month programme, subjects in the intervention group will receive four Zoom video conference sessions and four telephone calls conducted by a health-social service team that will include a nurse case manager, community workers, general practitioners, a Chinese medicine practitioner, and social workers. Subjects in the control group will receive a monthly social telephone call from a trained research assistant to rule out the possible social effect of the intervention. The reach, effectiveness, adoption, implementation, and maintenance framework (i.e. RE-AIM framework) will be used to evaluate the implementation and effectiveness outcomes. Of the five dimensions included in the RE-AIM framework, only effectiveness and maintenance outcomes will be collected from both the intervention and control groups. The outcomes of the other three dimensions—reach, adoption, and implementation—will only be collected from subjects in the intervention group. Data will be collected pre-intervention, immediately post-intervention, and 3 months after the intervention is completed to evaluate the maintenance effect of the programme.DiscussionThis programme will aim to enhance health-promoting self-care management behaviours in older adults dwelling in the community. This will be the first study in Hong Kong to use the hybrid effectiveness-implementation design and involve key stakeholders in the evaluation and implementation of a health self-management programme using a health-social service partnership approach. The programme, which will be rooted in the community, may be used as a model, if proven successful, for similar types of services.Trial registrationClinicaltrials.gov, NCT04442867. Submitted 19 June 2020

Enhancing Intrinsic Capacity and Related Biomarkers in Community-Dwelling Multimorbid Older Adults Through Integrated Multidomain Interventions: Ancillary Findings From the Taiwan Integrated Geriatric (TIGER) Trial

ObjectiveThis study aimed to evaluate the efficacy of integrated multidomain interventions and primary health care on intrinsic capacity (IC) and related biomarkers. DesignAn ancillary analysis from the Taiwan Integrated Geriatric Care (TIGER) study: a randomized controlled trial. Setting and ParticipantsA total of 398 community-dwelling older adults aged ≥65 years with ≥3 chronic conditions. MethodsParticipants were randomized into the 12-month pragmatic multidomain intervention or usual care groups. The primary outcome was the change in IC and its subdomains (locomotion, cognition, vitality, psychological, and sensory) at baseline and 3-, 6-, 9-, and 12-month follow-ups. Generalized linear mixed models were used to evaluate the multidomain intervention effects on these changes. ResultsThe intervention arm had greater improvement in IC than the usual care arm (overall difference 1.5; 95% CI 0.5–2.5; P = .005), mainly from subdomains of locomotion (overall difference 1.4; 95% CI 0.5–2.4; P = .004) and cognition (2.9; 95% CI 2.1–3.7; P < .001). Changes in neutrophil-to-lymphocyte ratio (NLR −2.4; 95% CI −3.9 to −0.8, P = .003), serum levels of albumin (35.1; 95% CI 23.1–47.2; P < .001), dehydroepiandrosterone sulfate (DHEA-S 2.8; 95% CI 1.9–3.8; P < .001), free androgen index (FAI 1.5; 95% CI 1.1–1.9; P < .001), and vitamin D (4.0; 95% CI 2.0–6.1; P < .001) were associated with changes in IC over time. Conclusions and ImplicationsThe incorporation of multidomain interventions into primary health care significantly enhanced IC over the 12-month program. Changes in NLR, FAI, and serum levels of albumin, DHEA-S, vitamin D were associated with changes in IC over time. Trial registrationClinicalTrials.gov Identifier: NCT03528005.

Abstract 15443: An Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients

Background For patients with heart failure with reduced ejection fraction (HFrEF), suboptimal initiation and titration of guideline-directed medical therapy (GDMT) has resulted in preventable loss of life and function. The STRONG-HF trial reinforced this finding by demonstrating substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized heart failure (HF) patients who were randomized to intensive GDMT optimization compared to usual care. Research Question Whether an intensive GDMT optimization program would be cost-effective in HFrEF has yet to explored. Aim We performed an economic analysis of a hypothetical intensive GDMT optimization program over 6 months in patients hospitalized with HFrEF compared to usual care. Methods: Using a 2-state Markov model we evaluated the effect of an intensive GDMT optimization program on patients hospitalized with HFrEF. Two population models were created to simulate this intervention, the first, a “clinical trial” model, based off the participants in the STRONG-HF trial and the second, a “real world” model, based off the Get With The Guidelines-HF Registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive GDMT optimization program comprised of a HF physician, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both populations models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a United States healthcare perspective with a lifetime time horizon. Results: An intensive GDMT optimization program, resulted in an additional 1.04 and 0.59 life years in the clinical trial and real-world models, respectively. Both models showed the program would be highly cost-effective with incremental cost-effectiveness ratios &lt;$5000 and reductions in healthcare spending due to reduced hospitalizations in the 6 months after discharge. Conclusions: An intensive GDMT optimization program for patients hospitalized with HFrEF would be highly cost-effective and result in substantial gains in clinical outcomes. Clinicians, payers, and policy makers should prioritize creation of such programs.

Abstract 14936: Integrated Text Messaging for Patients Attending Cardiac and Pulmonary Rehabilitation: A Multicentre Randomised Controlled Trial

Introduction: People living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient. Hypothesis/Aims: Support via text message alongside cardiac and pulmonary rehabilitation (rehab) improves clinical, lifestyle and attendance. Aim was to test effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes among patients attending cardiac and pulmonary rehab and evaluate program acceptability and utility for patients. Methods: Multicentre randomised controlled trial (3:1, intervention:control) among patients attending cardiac and pulmonary rehab. Control received usual care. Intervention received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, medication adherence and rehab program attendance. Results: Of the 316 participants (mean age±standard deviation, 66.7±10.1years) randomised, 60% were male (190/327), 156 were recruited from cardiac rehab. At 6 months, 6MWD improved in both groups and was significantly greater among intervention than control participants (unadjusted mean difference [95% CI]: 43.4m [4.3 to 82.4];p=0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2m [-21.2 to 25.6];p=0·85), medication adherence or cardiovascular risk factors. At 6 months, intervention participants reported significantly lower depression scores (adjusted mean diff [95%CI] -1.3 [-2.2 to -0.3], p=0.012) and anxiety (adjusted mean diff [95%CI] -1.1 [-2.1 to 0.0], p=0.046). Sub-group analysis of cardiac rehab participants found a clinically meaningful increase in 6MWD at 6 months in the intervention compared to control group (mean diff 18.9m, 95% CI -29.2 to 67.1). The majority of participants found the messages easy to understand (99%) and useful (86%). Conclusion: An education and support-based text message program for cardiac and pulmonary rehab attendees improved anxiety and depression plus program attendance, was useful for patients and suitable for implementation.

Effectiveness of mixed-mode parenting training program during the COVID-19 pandemic: A quasi-experiment study in Hong Kong

This study examined the effectiveness of a mixed-mode parenting training program in Hong Kong during the COVID-19 pandemic with a quasi-experiment. Altogether 139 parents of preschoolers (ages 3–6) participated in this study and completed the survey on Family Emotional Expressiveness, Child Behavior, Authoritative & Responsive & Negative Parenting across three time points during the lockdowns. They were cluster randomly assigned to the intervention (N1 = 69) and control groups (N2 = 70). The intervention was a 3-month mixed-mode parental training program, including 12-session videos followed by phone calls and homework assignments. The control group did not receive any parental training during the same period. The repeated ANOVA results indicated that: (1) there was a significant main effect of Time (p =.012, ηp2 = 0.045) on parents physical coercion dimension (PCD) scores and also a significant interaction effect between Time and Group (p =.042, ηp2 = 0.032), with the experimental group improved more over time; (2) there was a significant main effect of time (p =.027, ηp2 = 0.036) on parents’ verbal hostility dimension (VHD) scores, but no significant Time*Group interaction effect; (3) there was no significant Time effect in parents’ score on Negative Submissive (NS), but there was a significant interaction effect between time and group (p =.004, ηp2 = 0.054), with the experimental group reduced more than the control group. These results further provided empirical evidence to support the effectiveness of a mixed-mode parental training program in reducing negative parenting, including the negative submissive emotional expressions at home, physical coercion, and verbal hostility in interacting with preschool children at home. Implications based on social-cultural contexts are also discussed.

Outcomes of a Pharmacy Internship Program at a Quaternary Care Hospital

ObjectiveTo design, implement, and evaluate a Hospital-based Pharmacy Internship Program that meets the educational requirements of pharmacy graduates to register as competent pharmacists in the United Arab Emirates. MethodThe Pharmacy Internship Program was designed as a 6-month, full-time, competency-based program. Intern performance was assessed through monthly continuous evaluations. Interns who successfully completed the program were eligible to take the Department of Health Licensing Examination. Pharmacy intern surveys were collected to assess their overall satisfaction with the program. ResultsOver the previous 5 years, the program has trained 53 interns. All interns completed the 6-month training program. Of the 53 graduates, 45 completed the post-internship survey. Interns reported a high level of satisfaction with the program structure and content. ConclusionsThe Pharmacy Internship Program structure was successful in its first 5 years of implementation and was both feasible and sustainable. The program was viewed as highly beneficial for the professional and personal growth of pharmacy interns and provided them with the necessary competencies and skills to successfully enter the workforce.

Creation and evaluation of oral anticancer agent (OAA) management resources for a thematic quality improvement program.

380 Background: The Hematology/Oncology Pharmacy Association (HOPA) supported a 6-month American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) for its members focused on oral anticancer agent (OAA) management. HOPA’s Oral Chemotherapy Collaborative (OCC) developed 3 resources for use – an OAA program/practice self-assessment, OAA self-reported adherence guide, and OAA dashboard reporting guide. The purpose of this study is to describe resource development and feedback provided by participants. Methods: Three resources were developed by HOPA OCC. The OAA program/practice self-assessment was created based on Michigan Oncology Quality Consortium (MOQC’s) pre-existing OAA self-assessment with the goal of helping practices assess gaps in care and focus area during quality improvement (QI). The OAA adherence guide focused on the clinic-based patient-facing assessment of OAA adherence that identified three recommended adherence surveys and guidance based on responses. Finally, the OAA dashboard guide was created to help sites track their workload and quality-based metrics and included 2 sections – Administrative and Outcome/Quality Metrics. Resources were provided to teams during the 6-month program and feedback related to their usefulness was requested following programming in June 2023. Results: The sample includes 9 respondents from 7 of 9 participating sites. The majority of respondents found the self-assessment to be useful and would recommend its use (Table). Participants ranked the 1-item adherence question as their top preference for self-reported adherence. Of the dashboard administrative metrics, OAA volume, prescription capture rate, and visits were most selected as useful. For the dashboard outcome/quality metrics, number of interventions, patient reported outcomes, time from OAA prescribed to dispense date, prescribed date to start date, prescribed date to 1st follow-up, percent patients receiving education, percent patients with follow-up within defined time period, and percent patients with OAA adherence assessed were most useful. Resources, priority, information technology, and time were most selected as barriers to implementation of the resources. 100% of survey respondents indicated they were likely to recommend participating in the HOPA-ASCO QTP programming. Conclusions: Overall, the thematic programming with resources from HOPA’s OCC was useful. Multiple barriers exist to incorporate best practice aspects of OAA program implementation.[Table: see text]

Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention.

Prolonged exposure (PE) is a first-line treatment for posttraumatic stress disorder (PTSD) available in specialty mental health. PE for primary care (PE-PC) is a brief version of PE adapted for primary care mental health integration, composed of four-eight, 30-min sessions. Using retrospective data of PE-PC training cases from 155 Veterans Health Administration (VHA) providers in 99 VHA clinics who participated in a 4- to 6-month PE-PC training and consultation program, we examined patients' PTSD and depression severity across sessions via mixed effects multilevel linear modeling. Additionally, hierarchical logistic regression analysis was conducted to assess predictors of treatment dropout. Among 737 veterans, medium-to-large reductions in PTSD (intent-to-treat, Cohen's d = 0.63; completers, Cohen's d = 0.79) and small-to-medium reductions in depression (intent-to-treat, Cohen's d = 0.40; completers, Cohen's d = 0.51) were observed. The modal number of PE-PC sessions was five (SD = 1.98). Providers previously trained in both PE and cognitive processing therapy (CPT) were more likely than providers who were not trained in either PE or CPT to have veterans complete PE-PC (OR = 1.54). Veterans with military sexual trauma were less likely to complete PE-PC than veterans with combat trauma (OR = 0.42). Asian American and Pacific Islander veterans were more likely than White veterans to complete treatment (OR = 2.93). Older veterans were more likely than younger veterans to complete treatment (OR = 1.11). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Outcomes of a digital health coaching program for individuals with acute myeloid and chronic lymphocytic leukemia.

496 Background: Chronic lymphocytic leukemia (CLL) accounts for ~19,000 and acute myeloid leukemia (AML) accounts for ~20,000 new cases a year, according to SEER data. Individual management and overall survival rates vary by cancer type, each with unique and potentially long-term care needs. Digital interventions continue to expand, connecting with individuals beyond the clinical setting to support health self-efficacy and address overall wellness needs. However, data related to their application for hematologic malignancies is limited. Methods: The aim of this randomized, longitudinal cohort study was to evaluate the effect of a 3-month digital health coaching program on health self-efficacy, measured by the Cancer Behavior Inventory (CBI), and other patient reported outcomes (PROs) among individuals with AML or CLL. We aimed to enroll 500 participants, 250 each with CLL and AML, randomized to either the digital intervention or usual care. PROs were collected at baseline and up to once per month for 3 months via REDCAp. Clinical outcomes were tracked via electronic health record. The change in CBI scores from baseline to 3 months was calculated with 95% confidence intervals. A 2-sample t-test was used to compare change between intervention and control arms. PRO trends over time were analyzed using linear mixed models (LMMs). Results: The study enrolled 147 individuals from July 2020 through December 2022. Thirty-seven were enrolled in the AML group (19 control), and 110 in the CLL group (55 control). The mean change in CBI from baseline to 3 months in the AML control arm was -3.57 (95% CI: -17.30 – 10.15) and in the AML intervention arm was 7.03 (95% CI: -2.67 – 16.74), with higher scores indicating greater efficacy for coping. While not significant, mean change in CBI in the CLL control arm was 1.43 (95% CI: -3.45 – 6.31; p=0.556) and in the CLL intervention arm was 3.46 (95% CI: -1.44 – 8.37; p=0.219). In the CLL group, self-efficacy was associated with improved quality of life (p &lt;0.001); For every unit increase in FACT-LEU-TOI, CBI increased on average by 0.81 units (95% CI: 0.62 – 1.00). Conclusions: Due to limited study enrollment during the COVID-19 pandemic, the study was not powered to detect a difference between groups. Data from the engaged cohort suggest a non-statistically significant trend over time in improvement in health self-efficacy for the participants engaged in digital health coaching. A recent meta-analysis suggests self-efficacy has a strong negative correlation with distress and positive correlation with quality of life and improved self-efficacy may mitigate negative effects of a cancer diagnosis and treatment. Data related to trends in PRO over time within and between AML and CLL cohorts provide further insights into physiologic and psychosocial outcomes for these populations. Clinical trial information: NCT04774744 .

Physical Activity and Its Prophylactic Effects on Cognition and Dementia

The dynamics of aging are not identical for all individuals, and certain lifestyle factors are likely to modulate its effects. Among these factors, the regular practice of physical activity is now the subject of increasing research. Many epidemiological, cross-sectional, and interventional studies present a convincing body of evidence in favor of the prophylactic effect of regular physical activity on brain and cognitive health in older adults. Various cognitive functions such as information processing speed, executive functions, or declarative memory appear to function more efficiently under the effect of a 6-month program combining 45 minutes of moderate-to-high-intensity aerobic physical exercise (sustained walking, jogging) and strength training three or more times a week.

Delivering the National Diabetes Prevention Program: Assessment of Outcomes in In-Person and Virtual Organizations.

The Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program (DPRP) has helped organizations deliver the National Diabetes Prevention Program (National DPP) lifestyle change program for over 10 years. Four delivery modes are now approved: in person, online (self-paced, asynchronous delivery), distance learning (remote, synchronous delivery), and combination (hybrid delivery using more than one delivery mode). We assessed outcomes using data from 333,715 participants who started the 12-month program between January 1, 2012, and December 31, 2018. The average number of sessions attended was highest for in-person participants (15.0), followed by online (12.9), distance learning (12.2), and combination (10.7). The average number of weeks in the program was highest for in-person participants (28.1), followed by distance learning (20.1), online (18.7), and combination (18.6). The average difference between the first and last reported weekly physical activity minutes reflected an increase for in person (42.0), distance learning (27.1), and combination (15.0), but a decrease for online (-19.8). Among participants retained through session 6 or longer, average weekly physical activity minutes exceeded the program goal of 150 for all delivery modes. Average weight loss (percent of body weight) was greater for in person (4.4%) and distance learning (4.7%) than for online (2.6%) or combination (2.9%). Average participant weight loss increased gradually by session for all delivery modes; among participants who remained in the program for 22 sessions, average weight loss exceeded the program goal of 5% for all delivery modes. In summary, if participants stay in the program, most have positive program outcomes regardless of delivery mode; they have some outcome improvement even if they leave early; and their outcomes improve more the longer they stay. This highlights the benefits of better retention and increased enrollment in the National DPP lifestyle change programs, as well as enhancements to online delivery.

Effects of exercise and training on plasma and blood volumes in Thoroughbreds and endurance horses

Abstract Exercise-and training-induced changes in plasma (PV) and blood volumes (BV) have been well documented in racehorses but not in endurance horses. We aimed to determine and compare the effects of training and exercise on BV and PV in Thoroughbred racehorses and endurance horses. Six endurance horses underwent a 4-month training program under saddle and 11 Thoroughbreds completed a racehorse-appropriate interval training program for 3-4 months on a racetrack. PV and BV were measured before and after training at rest and post-exercise using the indocyanine green dilution technique. For the Thoroughbreds, exercise consisted of a 1000 m breeze on a racetrack. The endurance horses completed rides of 10, 20 and 30 miles during training and 50 miles when fully trained. Data were analysed using the Wilcoxon signed rank test, Mann-Whitney test and paired t test, with significance set at . Although absolute PV and BV were greater in Thoroughbreds, mass-specific PV and BV were mostly greater in endurance horses. Untrained endurance horses had a greater mass-specific PV and BV at rest (PV: 65 ± 4.1 vs 54 ± 5.7 ml/kg, ; BV: 101 ± 8.0 vs 83 ± 8.8 ml/kg; ) and a greater PV (60 ± 3.8 vs 44 ± 4.8 ml/kg; ) but not BV (108 ± 2.0 vs 112 ± 14.3 ml/kg) after exercise. Training induced an increase in resting PV and BV to 73 ± 4.3 and 116 ± 14.1 ml/kg, respectively, in endurance horses (), and an increase in PV and BV after 30 miles endurance exercise (PV: 60 ± 3.8 vs 80 ± 15.8 ml/kg; ; BV: 108 ± 2.0 vs 139 ± 26.5 ml/kg; ). Resting and post-exercise PV and BV increased following training in the Thoroughbreds: resting PV = 57 ± 5.1 ml/kg (), resting BV = 89 ± 8.3 ml/kg (); post-exercise PV = 49 ± 4.8 ml/kg (), post-exercise BV = 112 ± 14.3 ml/kg (untrained) vs 124 ± 18.2 ml/kg (trained), ). PV increased in response to exercise in endurance horses but decreased in Thoroughbreds. Endurance horses had smaller absolute PV and BV but greater mass-specific resting PV and BV than Thoroughbreds.

Sustaining training effects through physical activity coaching (STEP): a randomized controlled trial

BackgroundPulmonary rehabilitation (PR) programs improve physical fitness, symptoms and quality of life (QoL) of patients with COPD. However, improved physical activity (PA) is not guaranteed after PR and the clinical benefits fade off after PR discharge. We aimed to investigate whether a 9 months PA-telecoaching program is able to improve PA of patients with COPD, after 3 months of PR and if this leads to maintenance of PR-acquired benefits.MethodsPatients with COPD enrolled in a 6-month PR program were randomized to a (semi-automated) PA-telecoaching program or usual care, 3 months after PR initiation. The intervention consisted of a smartphone application with individual targets and feedback (for 6 months) and self-monitoring with a step counter (for 9 months). Patients were followed up for 9 months after randomization. Primary outcome was PA (daily step count by accelerometery), secondary outcomes were exercise tolerance, quadriceps force, dyspnea and QoL.ResultsSeventy-three patients were included (mean ± SD: 65 ± 7 years, FEV1 49 ± 19%, 6MWD 506 ± 75 m, PA 5225 ± 2646 steps/day). The intervention group presented a significant improvement in steps/day at every visit compared to usual care (between-group differences mean ± SE: 1431 ± 555 steps/day at 9 months after randomization, p = 0.01). Secondary outcomes did not differ between the groups.ConclusionThe semi-automated PA-telecoaching program implemented after 3 months of PR was effective to improve the amount of PA (steps/day) during PR and after follow-up. However, this was not accompanied by the maintenance of other PR-acquired benefits.Trial registrationClinicalTrials.gov. Identifier: NCT02702791. Retrospectively registered on March 9, 2016. Start study October 2015. https://clinicaltrials.gov/ct2/show/NCT02702791?term=NCT02702791&draw=2&rank=1.

Behavioral Lifestyle Intervention Program Using Mobile Application Improves Diet Quality in Adults With Prediabetes (D’LITE Study): A Randomized Controlled Trial

BackgroundMobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. ObjectiveThe objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. DesignA secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) was conducted, with participants recruited from October 2017 to September 2019. Participants/settingCommunity-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. InterventionParticipants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. Main outcome measuresDietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. Statistical AnalysesBetween-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. ResultsThere was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8–8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, −0.8, −0.2; P < 0.001) and sodium by 726 mg/day (95% CI, −983, −468; P < .001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. ConclusionFor adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss.

Effects of 3-month Qigong exercise on heart rate variability and respiration in anxious college students.

This longitudinal study aimed to investigate the effects of Qigong on the anxiety state, heart rate variability (HRV), and breathing of anxious college students. A total of 37 individuals (18-25 years old) were randomly allocated to the control (n = 19) and intervention (n = 18) groups. Qigong interventions were conducted five times weekly for 12 weeks, with each session lasting 60 min. Hamilton Anxiety Scale, Fatigue Scale 14, Pittsburgh Sleep Quality Index, and 36-item Short Form Survey, HRV, and respiration data were collected before and after the 3-month intervention. Individuals who participated in the three-month Qigong exercise intervention showed a significant reduction in anxiety, particularly mental anxiety (p < 0.05). Subjects in the intervention group presented a decrease in skin temperature (p < 0.05) and an increase in blood volume pulsation (p < 0.05). Meanwhile, HRV exhibited a significant increase in the standard deviation of interbeat interval before and after comparisons (p < 0.05) and between the two groups (p = 0.039) and a reduction in the normalized low-frequency power after the intervention. Moreover, the intervention group experienced increased abdominal breathing depth and abdominal breathing per minute (p < 0.05). These findings indicate that Qigong is an effective mind-body exercise strategy for relieving anxiety. HRV and breathing were improved accordingly among college students after the completion of the 3-month Qigong program.

A - 35 The Relationship between Perceived Social Support and Everyday Cognition in Mild Cognitive Impairment: a Longitudinal Study.

Explore the relationship between perceived social support and changes in informant-rated cognitive ability in people with mild cognitive impairment (pwMCI) enrolled in a lifestyle intervention program. Based on prior literature, we hypothesized lower levels of social support would be associated with greater declines in executive functioning (EF) over time. Forty-nine pwMCI who enrolled in a 12-month comprehensive lifestyle program completed the Multidimensional Scale of Perceived Social Support (MSPSS), and their informants completed the Everyday Cognition Scale (ECog) pre- and post-program. Change scores were calculated for the ECog Total Score and EF subscale. MCI participants were classified into three groups based on ECog change: Declined (n = 17), Stable (n = 17), and Improved (n = 15). Pearson correlations were conducted between MSPSS, ECog, and EF change scores within each group. There was no significant difference in baseline ECog ratings between groups, F(2,46) = 0.36, p = 0.70 or baseline MSPSS F(2,46) = 1.23, p = 0.30. For the Declined group, a trend emerged suggesting higher MSPSS was associated with declines in EF (r = 0.27, p = 0.07). The relationship between MSPSS and ECog total scores was not significant (p = 0.16). No trends or associations were observed in the Stable or Improved groups. Findings were counter to initial hypotheses. Although further work is needed, this effect may relate to Reciprocity Theory which posits those who require more social support experience emotional distress due to feelings of unwanted dependence and a lack of perceived ability to reciprocate support. This experience may adversely affect EF through an increase in negative emotions and stress. Further exploration of moderators of this relationship is warranted.

The Effects of Pilates Exercise Training Combined with Walking on Cardiorespiratory Fitness, Functional Capacity, and Disease Activity in Patients with Non-Radiologically Confirmed Axial Spondylitis.

The objective of the study was to examine the effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondylitis (nr-axSpA). Thirty patients with nr-axSpA (seven women (90%), with a mean age of 46.07 ± 10.48 years old and C-reactive protein (CRP) 2.26 ± 2.14 mg/L) were randomly divided into two groups: A (n1 = 15 patients) and B (n2 = 15 patients). Group A followed a 6-month home-based Pilates exercise training program, while Group B remained untrained until the end of the study. A cardiopulmonary exercise test (CPET), timed up and go test (TUG), five times sit-to-stand test (5×STS), sit-and-reach test (SR), back scratch test for the right (BSR) and the left arm (BSL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were applied to all patients, both at the beginning and at the end of the study. After 6 months, Group A showed higher values in exercise time by 37.41% (p = 0.001), higher peak oxygen uptake (VO2peak) by 25.41% (p = 0.01), a higher ratio between oxygen uptake and maximum heart rate (VO2/HRmax) by 14.83% (p = 0.04), and higher SR by 18.70% (p = 0.007), while lower values were observed in TUG by 24.32% (p = 0.001), 5×STS by 12.13% (p = 0.001), BASDAI score by 20.00% (p = 0.04) and ASDAS score by 23.41% (p = 0.03), compared to Group B. Furthermore, linear regression analysis showed a positive correlation in Group A between BASDAI and 5×STS (r = 0.584, p = 0.02), BASDAI and TUG (r = 0.538, p = 0.03), and ASDAS and 5×STS (r = 0.538, p = 0.03), while a negative correlation was found between BASDAI and VO2peak (r = -0.782, p < 0.001), ASDAS and SR (r = -0.548, p = 0.03), and ASDAS and VO2peak (r = -0.659, p = 0.008). To sum up, cardiorespiratory fitness, functional capacity, and disease activity improved after a long-term Pilates exercise training program in patients with nr-axSpA.

Building musical lives: The impact of supporting musical play in the everyday lives of autistic children and their families

Musical spaces have been observed to be highly engaging for autistic children, ameliorating barriers often experienced in communication and interaction. Music interventions with this group are widespread and have frequently noted the importance of integrating caregivers. Yet beyond music therapy, there is limited research on how to support music-making in daily life for autistic children and their families. In particular, there is a lack of long-term ecological evidence with this group for how music can support everyday functioning, care routines, and wellbeing. In this study, 25 families participated in a 12-month program which supported the integration of music into everyday life. Families were interviewed at the end of the project regarding the effectiveness of music as a support for daily routines, play, and wellbeing. Qualitative thematic analysis highlighted how families implemented musical strategies in widespread ways as a medium to support communication, create valued opportunities for shared interaction, and as a way to scaffold everyday caring routines. Families’ uses of musical play strategies, as observed in this study, emphasize the importance of incorporating caregivers and home environments as part of arts programs for autistic children, and the effectiveness of empowering parents to use music as a tool to navigate everyday life.

Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial.

People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI -22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (β=1.62; P=.05), waist circumference (β=5.81; P=.01), waist-to-hip ratio (β=.03, P=.03), and quality of life (β=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123. RR2-10.1136/bmjopen-2020-040479.

Does physiotherapist-led treatment for FAI syndrome alter running biomechanics? A randomised controlled trial of two 6-month treatment programs

Does physiotherapist-led treatment for FAI syndrome alter running biomechanics? A randomised controlled trial of two 6-month treatment programs