Exercise Counseling Research Articles

Results From a National Survey of Asthma Provider Beliefs and Practices Regarding Exercise and Asthma: A Work Group Report of the AAAAI Committee on Sports, Exercise, and Fitness

National Heart, Lung, and Blood Institute guidelines recommend regular physical activity (PA) for patients with asthma. Health care provider (HCP) counseling represents an effective approach to optimizing patient PA. However, current exercise rates among asthma patients are suboptimal, which suggests that counseling may be improved. To understand PA counseling behaviors among HCPs who manage asthma. A voluntary 36-item survey assessing self-reported awareness of PA recommendations and current clinical practices was sent to 979 randomly selected HCP members of the American Academy of Allergy, Asthma & Immunology (AAAAI). The overall response rate was 9.3% (91 of 979). Respondents were physicians (100%) and allergists/immunologists (96%) who reported an average of 18.1 ± 12.3 years in independent practice. Over half (58%) reported personally engaging in 150 min/wk or more of moderate to strenuous PA. Eighty percent of participants were unaware of specific PA guidelines for patients with asthma, yet 66% acknowledged evidence for improved asthma outcomes with moderate exercise. A large majority of respondents believed that patients with asthma (97%) and severe asthma (84%) should pursue exercise. Whereas 90% of respondents support incorporating exercise counseling into asthma care, only 69% regularly counsel asthma patients about PA. Barriers cited included limited time, lack of knowledge regarding how and where to refer patients for exercise, and other medical priorities. Potential facilitators of PA included increasing practitioner education and patient-directed posters in waiting areas. Health care providers recognized PA as an important component of asthma care but were often unaware of specific guidelines. Promoting PA counseling may require using a time-efficient approach to implement counseling at each asthma patient encounter.

Exercise in lung Cancer, the healthcare providers opinion (E.C.H.O.): Results of the EORTC lung cancer Group (LCG) survey

ObjectivesExercise has been reported to alleviate disease as well as treatment impact in patients with lung cancer. Nevertheless, there is limited information available regarding the perception of lung cancer dedicated healthcare professionals’ and their advice on exercise. Materials and MethodsAn online survey exploring healthcare professionals’ practice patterns, perceptions, barriers, and facilitators of exercise in patients with lung cancer was conducted within members of the EORTC Lung Cancer Group (LCG). ResultsOne hundred forty-one healthcare providers completed the survey, mainly medical and radiation oncologists. Overall, 63% of the study participants declared that they frequently assessed exercise level in their patients, and 43% of them reinforced the importance of exercise. However, only 10% referred patients to an exercise program or specialist. Although the majority of the respondents had a positive perception regarding the benefits and safety of exercise (even in patients with advanced disease and/or bone metastasis), two-thirds of clinicians reported not having adequate training about exercise counselling. Moreover, 53% reported to lack of knowledge of guidelines referring to exercise in patients with cancer. Several obstacles and facilitators to improve exercise promotion in lung cancer care were identified. ConclusionHealthcare providers recognize the relevance and feasibility of exercise as part of cancer treatment intervention, but specific pathways to do the referral are frequently missing. Future structured and well-designed strategies and initiatives are needed to support an effective referral in order to implement exercise interventions routinely in clinical practice.

A nutritionally focused program for community-living older adults resulted in improved health and well-being

Among older adults, malnutrition is common and is associated with increased risk for impaired health and functionality, conditions further associated with poorer quality of life. In this study of community-living older adults, our objective was to quantify outcome changes following identification and treatment of malnutrition or its risk. Our intervention was a nutritional quality improvement program (QIP). The nutritional QIP included: (i) education of participants about the importance of complete and balanced macro- and micronutrient intake plus physical exercise, (ii) nutritional intervention with dietary counseling; and (iii) provision of oral nutritional supplements (ONS) for daily intake over 60 days. Follow-up measurements took place 30 days after ONS treatment ended, i.e., 90 days after start of intervention. We recruited 618 transitional-care, chronically ill, older adults (>60 years) with malnutrition/risk (per Mini Nutrition Assessment-Short Form, MNA-SF) from the outpatient clinic of Hospital Universitario San Ignacio, in Bogotá, Colombia. For pre-post comparisons, we examined cognition (Mini-Mental State Exam, MMSE), physical abilities (Barthel Activities of Daily Living, ADL; Short Physical Performance Battery, SPPB), affective disorder status (Global Depression Scale, GDS), and quality of life (QoL; EuroQoL-5D-3L, EQ-5D-3L; EuroQoL-Visual Analog Scale, EQ-VAS). Participants were mean age 74.1±8.7y, female majority (69.4%), and had an average of 2.6 comorbidities with cardiovascular and respiratory diseases predominant (28.5%). QIP-based nutritional intervention led to significant improvements in cognitive (MMSE) and physical functions (ADL and SPPB), affective disorder status (GDS), and health-related quality of life (EQ-VAS); all differences (P<0.001). Self-reported QoL (EQ-5D-3L) also improved. Over 90 days, the nutritional QIP led to improvements in all measured outcomes, thus highlighting the importance of addressing malnutrition or its risk among community-living older adults. From a patient's perspective, maintaining mental and physical function are important and further linked with quality of life. For older, community-living adults, nutrition care can improve health and well-being outcomes. Care includes screening for malnutrition risk, dietary and exercise counseling, and daily nutritional supplements when needed. NCT04042987.

Return to Work, Fatigue and Cancer Rehabilitation after Curative Radiotherapy and Radiochemotherapy for Pelvic Gynecologic Cancer

Simple SummaryRehabilitation from cancer treatment and therapy-induced toxicity requires individualized and specialized expertise. Beyond the resolution of treatment-related morbidity, socio-economic and psychological factors must be considered, and lifestyle or household characteristics can have a notable impact on the gradual return to normality and return-to-work rates following cancer therapy. A better identification of patients at a higher risk of prolonged impairment, and a more in-depth understanding of the impacts of treatment is needed to optimize post-therapy recovery. We aim to add to a limited body of literature exploring the posttreatment rehabilitative factors for women following curative radiotherapy for primary gynecologic malignancies. Herein we observed therapy-induced pain and fatigue were significantly more likely to interfere with return-to-work rates. Social support services and post-treatment inpatient cancer rehabilitation programs were helpful in keeping patients connected to their professional lives. Mental issues and the development of depression during follow-up remains an issue particularly for younger patients.Pain, fatigue, and depression are a common cluster of symptoms among cancer patients that impair quality of life and daily activities. We aimed to evaluate the burden of cancer rehabilitation and return-to-work (RTW) rates. Tumor characteristics, lifestyle and household details, treatment data, the use of in-house social services and post-treatment inpatient rehabilitation, and RTW were assessed for 424 women, diagnosed with cervical, uterine, or vaginal/vulvar cancer, receiving curative radio(chemo)therapy. Progression-free RTW rate at 3 months was 32.3%, and increased to 58.1% and 63.2% at 12 and 18 months, respectively. Patients with advanced FIGO stages and intensified treatments significantly suffered more from acute pain and fatigue. A higher Charlson-Comorbidity-Index reliably predicted patients associated with a higher risk of acute fatigue during RT. Aside from the presence of children, no other household or lifestyle factor was correlated with increased fatigue rates. Women aged ≤ 45 years had a significantly higher risk of developing depression requiring treatment during follow-up. Post-treatment inpatient cancer rehabilitation, including exercise and nutrition counseling, significantly relieved fatigue symptoms. The burdens for recovery from cancer therapy remain multi-factorial. Special focus needs to be placed on identifying high-risk groups experiencing fatigue or pain. Specialized post-treatment inpatient cancer rehabilitation can improve RTW rates.

Physical activity and exercise recommendations for people receiving dialysis: A scoping review.

Remaining physically active is important to patients undertaking dialysis, however, clinical recommendations regarding exercise type, timing, intensity, and safety precautions vary. The purpose of this scoping review was to analyse and summarise recommendations for physical activity and exercise for people undertaking dialysis and identify areas that require further research or clarification. A scoping review of literature from five bibliographic databases (Medline, Scopus, Web of Science, CINAHL, and SPORTDiscus) was conducted. Eligible articles included consensus guidelines, position statements, reviews, or clinical practice guidelines that included specific physical activity and exercise recommendations for people undertaking dialysis. Key search terms included "kidney disease" OR "kidney failure" OR "chronic kidney disease" OR "end stage kidney disease" AND guideline* OR consensus OR "position statement" OR prescription OR statement AND exercise OR "physical activity". Hand searching for relevant articles in all first twenty quartile 1 journals listed on SCImago under 'medicine-nephrology' and 'physical therapy, sports therapy and rehabilitation' using the terms 'exercise and dialysis' was undertaken. Finally, home pages of key societies and professional organisations in the field of sports medicine and nephrology were searched. The systematic search strategy identified 19 articles met the inclusion criteria. Two were specific to pediatric dialysis and three to peritoneal dialysis. Whilst many publications provided recommendations on aerobic exercise, progressive resistance training and flexibility, few provided explicit guidance. Recommendations for the intensity, duration and frequency of aerobic and resistance training varied. Discrepancies or gaps in guidance about precautions, contraindications, termination criteria, progression, and access site precautions were also apparent. Future guidelines should include specific guidance regarding physical activity, safety precautions, and timing and intensity of exercise for individuals who undertake dialysis. Collaborative multidisciplinary guideline development and appropriate exercise counselling may lead to increased participation in physical activity and exercise and facilitate better patient outcomes.

Effectiveness of Individual Exercise and Sport Counseling Based on Motives and Goals: A Randomized Controlled Trial.

This study tested the effectiveness of individual exercise and sport counseling in a nonclinical setting. The COunseling based on Motives and goals in Exercise and sporT (COMET) approach focuses on individual motives and goals and aims to identify suitable activities. Participants experience different exercise and sport activities and reflect on them with a counselor, who applies motivational interviewing. A stratified randomized controlled design with 129 people was used. The intervention group took part in a counseling event, which included feedback on motives and goals, trial exercise and sport sessions, and structured reflection. Four weeks later, members of the group got a telephone booster. The control group received minimal intervention as written information. Results show that the counseling promoted motivational competence (η2 = .16), physical activity-specific self-control (η2 = .08), and the weekly volume of exercise and sport (η2 = .15), whereas it did not influence self-concordance. Further studies can investigate whether the COMET approach is also effective in other settings.

Physically active primary care doctors are more likely to offer exercise counselling to patients with cardiovascular diseases: a cross-sectional study

BackgroundRegular physical activity had been shown to reduce morbidity and mortality from chronic diseases such as cardiovascular diseases, hypertension, type 2 diabetes mellitus, dyslipidaemia, obesity/metabolic syndrome, osteoarthritis, osteoporosis, bronchial asthma and chronic obstructive pulmonary disease. Research had shown that physically active doctors were more likely to offer exercise counselling to patients. However, few studies looked into this association with counselling practices to patients with specific chronic diseases. This study aims to determine the association between physical activity levels of primary care doctors (PCDs) in Malaysian private practice with physical activity counselling to patients with chronic diseases.MethodologyA cross-sectional study involving PCDs in private practice in 3 states was done. Participants were recruited from members of the Malaysian Academy of Family Physicians and attendees of a conference. A self-administered questionnaire obtained information on sociodemography, initiation of exercise counselling to patients with chronic diseases as well as physical activity levels using the International Physical Activity Questionnaire (IPAQ).ResultsThe response rate was 32.3% (272/842). 47.1% of the respondents were post-graduate holders. 50% of participants had a moderate level of physical activity and 24.3% a high level. Most respondents answered ‘always’ or ‘often’ for initiation of exercise counselling to patients with cardiovascular diseases (59.9%), hypertension (72.8%), type 2 diabetes mellitus (78.6%), obesity/metabolic syndrome (86.4%), dyslipidaemia (81.6%), osteoarthritis/osteoporosis (41.9%) and bronchial asthma/COPD (29.5%). PCDs being physically active and non-smokers were associated with a higher initiation of exercise counselling to patients with cardiovascular diseases. Doctors with post-graduate degrees were more likely to offer exercise counselling to hypertensive patients.ConclusionThe association between PCDs’ physical activity levels and their physical activity counselling varies between different types of chronic diseases. Primary care doctors with higher physical activity levels were more likely to initiate physical activity counselling in patients with cardiovascular disease during chronic disease follow up visits.

Effectiveness of Nutrition and Exercise Counseling Combination on Desirable Dietary Pattern and Weight Loss

Effectiveness of Nutrition and Exercise Counseling Combination on Desirable Dietary Pattern and Weight Loss

Fall prevention in hospitals and nursing homes: Clinical practice guideline.

BackgroundFalls and their consequences are particularly common in older adults in hospitals and long‐term care (LTC) facilities.AimTo avoid falls and their consequences, and provide nurses with an overview of all relevant research literature on fall prevention, and a practice guideline on fall prevention in older adults was developed.MethodsThe development process included a systematic literature review to identify systematic reviews and primary studies on the topic of fall prevention, an assessment of the study quality, the preparation of meta‐analyses to summarize the results, and the application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to grade the scientific literature. The guideline panel and an external multidisciplinary team graded the recommendations using the Delphi method. In addition, the panel and team formulated expert opinions.ResultsA total of 79 randomized controlled trials on fall prevention were identified, which formed the basis of the recommendations. Strongly recommended measures for both settings included multifactorial interventions, professionally supported body exercise interventions, and education and counselling interventions. The panel and team did not recommend the use of a specific assessment tool for fall risk assessment, low‐floor beds in hospitals, or body exercise interventions in frail residents.Linking Evidence to ActionDuring the development of this guideline, particular attention was paid to collecting evidence‐based knowledge relevant to practice. By applying the recommendations, the outlined nursing care is justified, enabling healthcare personnel to achieve the overriding goal of providing optimal care to persons at risk of falling. Evidence for several fall prevention interventions was graded as very low. Sound intervention studies are necessary to strengthen the confidence in the evidence for low‐floor beds, alarm sensor systems, medication review, and staff education in hospitals.

A phase III randomized trial of weight loss to reduce cancer-related fatigue among overweight and obese breast cancer patients: MEDEA Study design

BackgroundElevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CRF). Weight loss interventions are feasible and safe in cancer survivors, leading to improved cardio-metabolic and quality of life (QOL) outcomes and modulating inflammatory biomarkers. Randomized data are lacking showing that a lifestyle intervention aimed at weight loss, combining improved diet, exercise, and motivational counseling, reduces CRF. Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (MEDEA) is a multi-center, randomized controlled trial evaluating the impact of weight loss on CRF in overweight or obese survivors of breast cancer. Herein, we described the MEDEA methodology.Methods Patients (N = 220) with stage I–III breast cancer and BMI ≥ 25 kg/m2, within 12 months of primary treatment, and able to walk ≥ 400 m are eligible to enroll. Participants are randomized 1:1 to health education alone vs. a personalized telephone-based weight loss intervention plus health education. Both arms receive a health education program focusing on healthy living. Patients in the intervention arm are paired with an individual lifestyle coach, who delivers the intervention through 24 semi-structured telephone calls over 1 year. Intervention goals include weight loss ≥ 10% of baseline, caloric restriction of 500–1000 Kcal/day, and increased physical activity (PA) to 150 (initial phase) and 225–300 min/week (maintenance phase). The intervention is based on the social cognitive theory and is adapted from the Breast Cancer Weight Loss trial (BWEL, A011401). The primary endpoint is the difference in self-reported CRF (EORTC QLQ-C30) between arms. Secondary endpoints include the following: QOL (EORTC QLQ-C30, -BR45, -FA12), anxiety, and depression (HADS); weight and BMI, dietary habits and quality, PA, and sleep; health care costs (hospital-admissions, all-drug consumption, sick leaves) and cost-effectiveness (cost per quality-adjusted life-year); and patient motivation and satisfaction. The primary analysis of MEDEA will compare self-reported CRF at 12 months post-randomization between arms, with 80.0% power (two-sided α = 0.05) to detect a standardized effect size of 0.40.DiscussionMEDEA will test the impact of a weight loss intervention on CRF among overweight or obese BC survivors, potentially providing additional management strategies and contributing to establish weight loss support as a new standard of clinical care.Trial registrationClinicalTrials.govNCT04304924

Psychological Assistance in Managing Anxiety Among Jambi SMEs

The pandemic caused by Covid-19 virus has brought various impacts to the Indonesian people, including the people of Jambi, especially in the economic and social fields. The PPKM (Enforcement of Restriction on Community Activities) that was implemented made adversity to Jambi residents, especially Jambi SMEs (Small to Medium Enterprises) who feel the impact. Their income has decreased. The spread of the Covid-19 virus caused some participant to experience anxiety, from mild to severe. This activity was intended to provide special psychological assistance to Jambi SMEs participants who experience anxiety. There were 4 participants who experienced anxiety. Implementation methods include psychoeducation, relaxation technique exercise and group counseling with Cognitive Behavior Therapy – Recovery Oriented (CT-R) approach. The results of psychoeducation showed an increase in the score from pretest to posttest by 22.5%. Relaxation exercises succeeded in reducing anxiety levels in most of the participants. In group counseling activities with the CT-R approach, each participant managed to find his adaptive ability again.

Attitudes and behavioral intentions of aortic dissection survivors towards exercise: an application of the health action process approach framework.

Exercise can help patients with aortic dissection (AD) control blood pressure, prevent further progression of AD, promote mental health, improve the prognosis of cardiovascular disease, and improve their overall quality of life. However, it is not clear what the attitudes and behavioral intentions of AD survivors are towards exercise. This exploratory qualitative research was based on the Health Action Process Approach (HAPA) theory to explore the cognition, attitude, motivational factors, behavior intention, barriers and facilitators of exercise in patients with AD. Face-to-face and telephone semi-structured interviews were conducted in 24 AD patients from the Department of Cardio-Vascular Surgery of third-grade Class A hospitals in Wuhan, China from April 2021 to June 2021. The patient's current stage of behavior was evaluated according to the Patient-Centered Assessment and Counseling for Exercise (PACE) questionnaire. Among the 24 participants interviewed, 9 (37.5%) were in the pre-intention stage, 8 (33.3%) were in the intention stage, and 7 (29.2%) were in the action stage. The three groups were significantly different in terms of their history of previous cardiac surgery (Fisher's exact test, p = 0.043) and in the type of interview conducted (Fisher's exact test, p < 0.001). In-patients with a history of cardiac surgery were more likely to be in the pre-intention stage (post-hoc test, p < 0.05). Patients from different stages had different structures. AD patients in the pre-intention stage were more likely to express risk perception and negative results for exercise. The self-efficacy of this group was often low, and lacked exercise intention and clear action plans (post-hoc test, p < 0.05). More attention should be paid to in-patients with a history of cardiac surgery, including health advice on exercise after discharge and promotion of changes in their health behavior. Guidelines based on the available exercise data in AD patients should be established to provide recommendations for individualized exercise programs. This should provide a basis for promoting patient rehabilitation and improving postoperative quality of life.

General practitioners do not counsel more physical activity after a public health campaign

A physical activity (PA) promotional campaign was launched in June 2018 to raise awareness of the health benefits of PA in patients with chronic diseases in Luxembourg. This study aimed to evaluate the behavior of general practitioners (GPs) regarding PA counselling before and after the campaign. The campaign consisted of advertisement broadcasts on national TV/radio in June and July 2018 and comprised a toolkit (flyers and a PA evaluation tool) sent in September 2018 to all medical doctors registered in Luxembourg. PA counselling behaviors were evaluated in 59 and 53 GPs who answered a standardized questionnaire before and after the campaign, respectively. Interviewed GPs declared having advised only a small proportion of their patients regarding PA participation before and after the campaign (29% and 24%, respectively; p&lt;0.001). The campaign had no impact on the GPs’ awareness (21%) about the national program offering PA for patients with chronic diseases. Lack of time and knowledge were identified as the main barriers to engaging in PA counselling. Overall, GPs encouraged only a small proportion of their patients to engage more in PA, and the awareness campaign failed to change their PA counselling behavior, at least in the short term. Barriers to PA promotion within primary healthcare should be addressed before implementing new awareness campaigns targeting healthcare professionals. Key Words: Medical Doctors, Primary Healthcare, Exercise Counselling, Health Promotion

Cancer survivors' exercise beliefs, knowledge, and behaviors: An Australian National Survey.

This study aimed to (1) explore the perceptions of people living with cancer about exercise in general and exercise as an adjunct form of cancer care, (2) explore their perceptions regarding exercise counselling needs and preferences, and (3) investigate how these perceptions of exercise as an adjunct form of cancer care shape survivors exercise levels postcancer diagnosis. A cross-sectional design and online survey were used to recruit cancer survivors via cancer-related networks throughout Australia. Two factor analyses were conducted to examine the structure and reduce the number of variables pertaining to exercise during and after the cancer treatment. Extracted components were used in one-way analysis of variance to compare differences in physical activity levels postcancer diagnosis. Participants (N=288) had very positive perceptions of exercise, yet only 50% of participants would prefer to receive exercise counselling. Those who were more active postcancer diagnosis had higher exercise beliefs than those who were similarly active (p=0.04, r=0.27) and less active (p=0.03, r=0.24) postdiagnosis. Those who were less active also had lower exercise knowledge than those who were similarly active (p=0.01, r=0.31) and more active (p=0.03, r=0.26). Safety beliefs did not significantly differ between cancer survivors' activity levels (p=0.16) CONCLUSION: This survey highlights the potential benefits of a concentrated effort in connecting survivors to relevant services and resources, and utilizing cancer clinicians to communicate with survivors about the role of exercise in cancer care.

A Multimodal Intervention to Improve Cognition in Community-dwelling Older Adults

To examine the effects of a multimodal intervention composed of cognitive training, physical exercise, and group counseling on cognitive function in community-dwelling older adults. A four-armed, quasi-experimental intervention study. Community-dwelling adults aged 60 years and older (n=153). Participants were allocated into multimodal intervention, cognitive training plus Taichi exercise, cognitive training, or control group. The multimodal intervention included 18 sessions of cognitive training, 18 sessions of Taichi, and 6 sessions of group reminiscence over six weeks. Cognitive function, depressive symptoms, and psychological well-being were assessed at the baseline, postintervention, and three-month follow-up. The primary outcome was the change in overall cognition measured by the Montreal Cognitive Assessment (MoCA) and a composite cognitive score derived from a battery of neuropsychological tests. For MoCA, there was no significant difference between any of the three intervention groups and controls. For composite cognition, all three intervention groups showed improvements at the three-month follow-up, with a large effect size in the cognitive training plus Taichi group (change difference 0.37, 95% CI 0.18-0.56, Hedge's g=0.92), and medium effect sizes in the multimodal intervention group (change difference 0.23, 95% CI 0.0 -0.42, g=0.58) and cognitive training group (change difference 0.22, 95% CI 0.03-0.42, g=0.55). Multimodal intervention, cognitive training plus Taichi, and cognitive training could foster cognitive function in community-dwelling older adults. The combination of cognitive training and Taichi showed greater efficacy than the other two interventions.

25-hydroxyvitamin D levels are inversely related to metabolic syndrome risk profile in northern Chinese subjects without vitamin D supplementation

BackgroundThe comparatively low 25 hydroxyvitamin D [25(OH)D] levels have been reported in patients with metabolic syndrome (MetS). Herein we investigated the cross-sectional and longitudinal relationships between serum 25(OH)D levels and MetS risk profile in northern middle-aged Chinese subjects without vitamin D supplementation.MethodsA cohort of 211 participants including 151 MetS patients and 60 controls at 20–69 years of age were enrolled from suburban Beijing, China. The recruited MetS patients were subjected to diet and exercise counselling for 1-year. All subjects at baseline and MetS patients after intervention underwent clinical evaluations.ResultsSerum 25(OH)D levels were significantly decreased in MetS patients. 25(OH)D levels were inversely related to MetS score, fasting blood glucose (FBG) and triglyceride-glucose index (TyG) after adjusting for cofounders (all P < 0.05). Participants in the lowest tertile of 25(OH)D levels had increased odds for MetS (P = 0.045), elevated FBG (P = 0.004) in all subjects, and one MetS score gain in MetS patients (P = 0.005). Longitudinally, the metabolic statuses as well as 25(OH)D levels of MetS patients were significantly improved (all P < 0.05), and the increase of 25(OH)D levels were inversely related to MetS scores, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), FBG, and TyG, while positively related to high-density lipoprotein cholesterol (HDL-C) after adjusting for confounders.Conclusions25(OH)D levels were significantly decreased in MetS patients, and it was negatively associated with metabolic dysfunctions at baseline and 1-year after. Metabolic aberrations of MetS patients were significantly ameliorated with 1-year follow-up counselling accompanying by notably elevated 25(OH)D levels.

Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy

BackgroundThe Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in all fitness dimensions at the correct dose. To implement the PAR within EGs, they were translated into a new EG concept with five key activities: (a) training for supervising physiotherapists (PTs), (b) correctly dosed exercises in all fitness dimensions, (c) exercise counselling, (d) bi-annual fitness assessments, and (e) individual exercise training, in addition to EG. All these activities were realized in close coordination with SVMB management.ObjectivesTo analyse the implementation success by evaluating adherence/fidelity, feasibility, and satisfaction at the patient, PTs, and organisational level.MethodsThe five key activities of the new EG concept were developed, executed, and assessed after 6 months. The primary outcomes for implementation success were adherence of patients to the recommended exercise behaviour, self-reported by electronic diary; fidelity of PTs to the new concept, self-reported by diary; SVMB organisational changes. Secondary outcomes were feasibility and satisfaction with the new EG concept at all three levels. The tertiary outcome, to evaluate the effectiveness of PAR, was patient fitness, assessed through fitness assessments.Results30 patients with axSpA (ten women, mean age 58 ± 9 years) and four PTs (three women, mean age 46 ± 9 years) participated. The patients' self-reporting of adherence to the PAR was insufficient (43%), possibly due to technical problems with the electronic dairy. The PTs' fidelity to the new EG concept was satisfactory. On all levels, the new concept was generally perceived as feasible and useful for supporting personalised exercise.The frequency of exercise counselling and the fitness assessments was found by patients and PTs to be too high and rigid. Patients' cardiorespiratory fitness [ES 1.21 (95%CI 0.59, 1.89)] and core strength [ES 0.61 (95%CI 0.18, 1.06)] improved over the 6 months.ConclusionsThe pilot implementation of PAR showed acceptance and satisfaction to be sufficient, thus confirming the need for evidence-based EGs, provided by a patient organisation in order to support active PA behaviour. However, adaptations are necessary to increase its feasibility for nationwide implementation.Trial Registration: SNCTP, SNCTP000002880. Registered 31 May 2018, https://www.kofam.ch/en/snctp-portal/search/0/study/42491.

Effectiveness of Pharmacological and Nonpharmacological Interventions for Managing the Fatigue-Sleep Disturbance-Depression Symptom Cluster in Breast Cancer Patients Undergoing Chemotherapy: A Systematic Review.

The symptom cluster of cancer-related fatigue-sleep disturbance-depression (F-S-D) is common among breast cancer (BC) patients undergoing chemotherapy. Given the coexisting nature and synergistic effect of this symptom cluster, interventions for managing it are expected to benefit patient outcomes. The aims of this study were to examine the effectiveness and identify the essential components of interventions used to manage the F-S-D and quality of life (QOL) in BC patients undergoing chemotherapy. A systematic review was performed in March 2020 through 7 electronic databases. Relevant studies were assessed using the inclusion criteria. The level of evidence was assessed using the Cochrane risk-of-bias tool. The results were summarized and synthesized in narrative forms. Sixteen randomized controlled trials were included. Results showed that bright light therapy, acupressure, and psychological nursing interventions were useful in managing F-S-D in BC patients. Exercise and diet counseling alleviated F-D, whereas stress management and a health promotion program alleviated S-D. Bright light therapy, exercise, diet counseling, and psychological nursing interventions enhanced the QOL of these patients. Interventions that could alleviate F-S, F-D, S-D, and F-S-D in BC patients and enhance their QOL were identified. Future studies should investigate the effects of evidence-based multimodal interventions that integrate psychological support, education on the management of chemotherapy side effects, and diet counseling and exercise on F-S-D in and reduced QOL of BC patients undergoing chemotherapy. Nurses act as patient advocates, and the development of evidence-based interventions for managing F-S-D and QOL is significant to nursing practice.

Health Care Disparities in the Utilization of Type 2 Diabetes Prevention Services Among Ambulatory Care Patients in the United States

Background: Exercise routines, diet management, education and Medication Therapy Management (MTM) have shown to improve glycemic control, lower blood pressure and body weight. While the majority of patients are on some form of weight management, many do not receive professional guidance to create their diet plan. Objective: The aim of this study was to determine if the utilization of type 2 diabetes mellitus prevention services were impacted by patient and physician characteristics in visits to ambulatory providers in the United States. Findings: A total of 1,932 patients with a primary diagnosis of Type 2 Diabetes Mellitus were extracted from the 2017 National Ambulatory Medical Care Survey database, collected by the National Center of Health Statistics. The patients’ age, sex, race, gender, region, insurance and physician characteristics were among the demographic variables studied. The prevalence of lifestyle preventive services, including exercise therapy, nutrition therapy, patient education or counseling, were analyzed. Patients older than 61 years and white patients were offered more exercise therapy than their comparable demographics. The southern region of the U.S. and patients with Medicaid or state insured plans were offered and utilized the most exercise therapy, nutrition therapy and education. Family practice physicians and internists defined as primary care physicians offered the most exercise therapy, nutrition therapy and education services. Majority of the studied population were not offered exercise therapy, nutrition therapy, or education services, indicating the need for more preventative lifestyle services. Conclusions: Overall, the findings of this study revealed that there was a significant difference in the utilization and offering of preventive resources amongst various demographic groups and physician characteristics. This confirms the prevalence of disparities in the U.S. Healthcare System and calls for the need to narrow this gap both at the policy and community level.

Women’s views and experiences of a perinatal exercise counselling intervention: a qualitative study

ABSTRACT Current guidelines support that physical activity during the perinatal period is beneficial for the mother and the foetus. However, women during their pregnancy and postpartum limit or discontinue their exercise routine. The aim of this study was to illustrate perinatal women’s views and experiences derived from an Exercise Counselling (EC) intervention and evaluate the intervention’s acceptability. A qualitative study with semi-structured interviews was conducted with eight adult women of reproductive age recruited from obstetric care practices. Participants had just completed an EC intervention regarding the effectiveness of exercise on perinatal depressive symptoms, implemented in the context of a Randomised Control Trial. The analysis resulted in three overarching themes: main obstacles to engagement with the EC intervention, factors that enabled participation in the EC intervention and participants’ suggestions to improve the EC intervention. One of the main obstacles to engagement with the EC intervention was socio-cultural factors, such as the post-birth forty-day home stay, which negatively impacted women’s participation in the intervention. By contrast, obstetricians’ support and the positive effect of exercise on mental well-being were enabling factors. Finally, among recommendations to improve the EC intervention, women cited the partner’s involvement and engagement in the EC earlier in pregnancy. In conclusion, designing and implementing culturally sensitive interventions targeting expectant parents as a dyad is fundamental for researchers and obstetricians. Future research should focus on identifying effective strategies to educate obstetricians about perinatal exercise and to develop protocols that could support the implementation of perinatal exercise counselling sessions in public health policy.