Exercise Plus Research Articles

Fifty‐ two—Week Treatment With Diet and Exercise Plus Transdermal Testosterone Reverses the Metabolic Syndrome and Improves Glycemic Control in Men With Newly Diagnosed Type 2 Diabetes and Subnormal Plasma Testosterone

Men with the metabolic syndrome (MetS) and type 2 diabetes (T2D) often have low testosterone levels. Elevating low testosterone levels may improve features of the MetS and glycemic control. In a single blind, 52-week randomized clinical trial, the effects of supervised diet and exercise (D&E) with or without transdermal testosterone administration on components of the MetS in hypogonadal men with the MetS and newly diagnosed T2D were assessed. A total of 32 hypogonadal men (total testosterone <12.0 nmol/L) with newly diagnosed T2D and with the MetS as defined by the Adult Treatment Panel III and the International Diabetes Federation received supervised D&E, but 16 received it in combination with testosterone gel (50 mg) once daily (n = 16). No glucose-lowering agents were administered prior to or during the study period. Outcome measures were components of the MetS as defined by the Adult Treatment Panel III and the International Diabetes Federation. Serum testosterone, glycosylated hemoglobin (HbA(1c)), fasting plasma glucose, high-density lipoprotein cholesterol, triglyceride concentrations, and the waist circumference improved in both treatment groups after 52 weeks of treatment. Addition of testosterone significantly further improved these measures compared with D&E alone. All D&E plus testosterone patients reached the HbA(1c) goal of less than 7.0%; 87.5% of them reached an HbA(1c) of less than 6.5%. Based on Adult Treatment Panel III guidelines, 81.3% of the patients randomized to D&E plus testosterone no longer matched the criteria of the MetS, whereas 31.3% of the D&E alone participants did. Additionally, testosterone treatment improved insulin sensitivity, adiponectin, and high-sensitivity C-reactive protein. Addition of testosterone to supervised D&E results in greater therapeutic improvements of glycemic control and reverses the MetS after 52 weeks of treatment in hypogonadal patients with the MetS and newly diagnosed T2D.

Measuring Physical Activity in Older Adults

The purpose of this study was to use data from three Behavior Change Consortium intervention studies to consider the practicality of use of two surveys of physical activity (PA) relevant for older adults, provide support for the validity of these surveys, and provide guidance to researchers for decisions on use of one survey as opposed to the other. The samples included 218 participants in the Community Health Advice by Telephone Study, 150 participants in the Study of Exercise and Nutrition in Older Rhode Islanders, and 150 participants from the Testing the Effectiveness of the Exercise Plus Program. PA surveys included the Yale PA Survey and the Community Health Activities Model Program for Seniors PA Questionnaire. Older adults were able to complete either survey, although for frailer participants, an interview format is recommended. The Community Health Activities Model Program for Seniors PA Questionnaire was more likely to elicit information about moderate-intensity physical activities and was more likely to be related to vitality. Conversely, the Yale PA Survey may more comprehensively describe overall PA and provide information about moderate-intensity physical activity.

Testing the effectiveness of the exercise plus program in older women post-hip fracture

Exercise is an important strategy with potential to improve recovery in older adults following a hip fracture. The purpose of this study was to test the impact of a self-efficacy based intervention, the Exercise Plus Program, and the different components of the intervention, on self-efficacy, outcome expectations, and exercise behavior among older women post-hip fracture. Participants were randomized to one of four groups: exercise plus, exercise only, plus only (i.e., motivation), or routine care. Data collection was done at baseline (within 22 days of fracture), 2, 6, and 12 months post-hip fracture. A total of 209 women were recruited with an average age of 81.0 years (SD=6.9). The majority was White (97.1%), was widowed (57.2%), and had a high school education (66.7%). Generalized Estimating Equations were used to perform repeated measures analyses. No differences in trajectories of recovery were observed for self-efficacy or outcome expectations. A statistically significant difference in the overall trajectory of time in exercise was seen (p<.001), with more time spent exercising in all three treatment groups. The study demonstrated that it was possible to engage these women in a home-based exercise program and that the plus only, exercise only, and the exercise plus groups all increased exercise.

Factors that influence exercise activity among women post hip fracture participating in the Exercise Plus Program

Factors that influence exercise activity among women post hip fracture participating in the Exercise Plus Program

The Exercise Plus Program for Older Women Post Hip Fracture: Participant Perspectives

The purpose of this study was to explore the experiences of older women post hip fracture who were exposed to a motivational intervention, the Exercise Plus Program, intended to increase adherence to exercise. This study used a naturalistic inquiry. We interviewed a total of 70 older women, 12 months post hip fracture, using an interview guide asking about issues related to willingness to exercise. All interviews were tape recorded and transcribed verbatim. Analysis of the semi-structured interviews revealed 44 codes that were categorized and reduced to 14 major themes. Eleven of these themes focused on components that facilitated participation in exercise and included: (a) real and expected benefits; (b) visual cues and knowing what to do; (c) simplicity; (d) individualized care; (e) verbal encouragement to exercise; (f) regular schedule; (g) confidence (i.e., self-efficacy); (h) determination; (i) social support; (j) reciprocity; and (k) goal identification. The remaining three themes reflected what decreased the participants' willingness to exercise: (a) unpleasant sensations; (b) constraints to exercise; and (c) getting back to baseline. The findings provide some support for the benefit of the Exercise Plus Program. Lessons learned in the Exercise Plus Program can be translated to the development of other motivational interventions to help engage older adults in exercise, particularly those individuals who recently experienced an acute event, such as a hip fracture.

Treatment Fidelity in Behavior Change Research

Treatment fidelity refers to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Assuring optimal treatment fidelity also may decrease the costs of a study and help the research team explain findings. The Behavioral Change Consortium developed a comprehensive model of treatment fidelity that incorporates 5 areas: (a) study design, (b) training providers, (c) delivery of treatment, (d) receipt of treatment, and (e) enactment of treatment skills. The definitions of these areas and a case example (Testing the Effectiveness of the Exercise Plus Program) are provided. There was evidence of treatment fidelity related to delivery based on careful monitoring of the study implementation. A comprehensive plan for training of the interventionists was provided, although evidence of treatment fidelity to training was not quantified. There were evidence based on observations of treatment sessions of delivery and receipt of the intervention and evidence of enactments based on evaluation of exercise calendars. The development and implementation of a treatment fidelity plan requires a careful conceptualization of what is relevant to treatment fidelity in any given study. Monitoring of treatment fidelity ideally requires direct or indirect observations of sessions, which can be built into the study design so that costs are minimal in terms of time and resources. Monitoring treatment fidelity allows research teams to truly test interventions and to develop and implement interventions that ultimately improve the overall health and well-being of individuals.

Coronary Risk Incidence of Obese Adolescents: Reduction by Exercise Plus Diet Intervention

The incidence of coronary heart disease risk factors and the effects of 20 weeks of diet and exercise were studied in 36 obese adolescents. Values for the following risk factors were determined: serum triglyceride level, high-density lipoprotein-cholesterol level, total cholesterol level, systolic and diastolic BP, maximum work capacity, obesity, and presence of coronary heart disease in the family history. Of the subjects, 97% had four or more risk factors. Two subjects possessed all eight risk factors. The adolescents were randomly assigned to either a control, diet therapy and behavior change, or exercise, diet therapy, and behavior change group. From pre- to posttreatment, a 14.8% and 41.4% reduction in multiple risk was noted for the latter two groups, respectively. No significant difference between the control group and the diet and behavior change group was found. In contrast, the exercise-diet-behavior change group reduced multiple risk (P less than .01) more than either of the other groups. It was concluded that obese adolescents are at high risk for the development of coronary heart disease and that exercise in addition to moderate dietary restriction can result in the reduction of multiple coronary heart disease risk.