Group-based Program Research Articles

AYA-UNITE: Lessons Learned on Intervention Development Promoting Social and Physical Health of Adolescent/Young Adult Cancer Survivors.

Adolescent/young adult cancer survivors (AYACS) struggle with poor psychosocial health related to social disruptions due to cancer diagnosis, impacting long-term goal achievement and overall health. In particular, social health promotion is overlooked in AYACS' care. AYA-UNITE, a sociobehavioral exercise intervention pilot for AYACS 15-21 years of age at cancer diagnosis, was designed to foster AYACS' social and physical health. AYA-UNITE was a 12-week group-based virtual exercise program incorporating strength training and aerobic activity. In this brief report, we account AYA-UNITE's conceptual design, lessons learned through AYA-UNITE intervention development, and opportunities for improvement in implementing effective AYACS psychosocial interventions (NCT03778658).

Rural libraries implementing walking groups or walking groups plus civic engagement for walkability in rural communities: a comparative effectiveness trial study protocol

BackgroundRural residents generally lack adequate physical activity to benefit health and reduce disparities in chronic diseases, such as cardiovascular disease and certain cancers. The Socioecological Model describes physical activity as involving a dynamic and reciprocal interaction between individual, social, and community factors. Community group-based walking programs and civic engagement interventions aimed at enhancing physical activity have been successful in rural communities but have not targeted all three socioecological levels. Public libraries can act as innovative public health partners in rural communities. However, challenges remain because rural libraries often lack the capacity to implement evidence-based health promotion programming. The goals of this study are (1) build the capacity for rural libraries to implement evidence-based health promotion programs, (2) compare changes in physical activity between a group-based walking program and a combined group-based walking and civic engagement program with rural residents, and (3) conduct an implementation evaluation.MethodsWe will conduct a comparative effectiveness study of a group-based walking (standard approach) versus a group-based walking plus civic engagement program (combined approach) aimed at enhancing walkability to increase physical activity among rural adults. Key mediators between the program effects and change in outcomes will also be identified. Finally, we will evaluate program implementation, conduct a cost effectiveness evaluation, and use a positive deviance analysis to understand experiences of high and low changers on key outcomes. Twenty towns will be matched and randomized to one of the two conditions and our aim is to enroll a total of 350–400 rural residents (15–20 per town). Study outcomes will be assessed at baseline, and 6, 12, and 24 months.DiscussionThis study will build the capacity of rural libraries to implement evidence-based walking programs as well as other health promotion programs in their communities. The study results will answer questions regarding the relative effectiveness and cost effectiveness of two multilevel physical activity interventions targeting rural communities. We will learn what works and how these multilevel interventions can be implemented in rural populations.Trial RegistrationClinicalTrials.gov Identifier: NCT05677906.

Evaluating Feasibility of a Secondary Stroke Prevention Program.

Healthy lifestyles including exercise and diet can reduce stroke risk, but stroke survivors often lack guidance to modify their lifestyles after hospital discharge. We evaluated the implementation of a new, secondary stroke prevention program involving supervised exercise, multidisciplinary education and coaching to address modifiable risk factors. The group-based program involved face-to-face and telehealth sessions. The primary outcomes were feasibility, examined via service information (referrals, uptake, participant demographics and costs), and participant acceptability (satisfaction and attendance). Secondary outcomes examined self-reported changes in lifestyle factors and pre-post scores on standardized clinical tests (e.g., waist circumference and 6-Minute Walk (6MWT)). We ran seven programs in 12 months, and 37 people participated. Attendance for education sessions was 79%, and 30/37 participants completed the full program. No adverse events occurred. Participant satisfaction was high for 'relevance' (100%), 'felt safe to exercise' (96%) and 'intend to continue' (96%). Most participants (88%) changed (on average) 2.5 lifestyle factors (diet, exercise, smoking and alcohol). Changes in clinical outcomes seemed promising, with some being statistically significant, e.g., 6MWT (MD 59 m, 95% CI 38 m to 80,159 m, p < 0.001) and waist circumference (MD -2.1 cm, 95%CI -3.9 cm to -1.4 cm, p < 0.001). The program was feasible to deliver, acceptable to participants and seemed beneficial for health. Access to similar programs may assist in secondary stroke prevention.

An Observational Study of Outcomes Associated with Virtual Pain Management Programmes Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic.

In response to COVID-19, virtual, group-based interdisciplinary pain management programmes (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low intensity and pre-neuromodulation PMPs based on Acceptance and Commitment Therapy (ACT) as part of routine care during the pandemic. Depending on patients' needs, participants completed a virtual high- or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 and 2019 for in-person residential (n=561), outpatient (n=123), and pre-neuromodulation (n=207) PMPs were also examined to provide an historical benchmark of performance. The virtual high-intensity PMP (n=294) showed significant improvements on all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP (n=129). No statistically significant improvements were observed for the virtual low intensity PMP (n=90). The improvements associated with pre-pandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic. These data provide preliminary support for the potential benefits of high, but not low, intensity virtual ACT-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.

Problem Çözme Eğitimi Grup Yaşantısının Kadın Hükümlülerin Sosyal Problem Çözme Becerilerine Etkisinin İncelenmesi

This study aims to examine the effectiveness of the psycho-education group-based program aimed at improving the social problem-solving skills of female prisoners. The applied program is adopted by Çekici &amp; Güçray (2012) based on the five-stage approach model in social problem-solving (D'zurilla &amp; Nezu, 2007; Nezu et al., 2007). The research is in the semi-experimental design, and one of the types of the experimental design, "real experimental model with pretest-posttest control group" was used. The implementation was carried out with 36 convicts in Karataş Prison in Adana province in the Women's Open Penal Institution. Since the sample did not show a normal distribution, it was evaluated by the Wilcoxon Signed Rows Test, one of the non-parametric analysis methods used to compare the difference between the scores of the two sets of measurements. As a result of the analysis, it was found that the use of a positive orientation-rational problem-solving style to the problem, which is a positive coping style, increased social problem-solving skills in female convicts who participated in social problem-solving group practices, and their use of inattentive and avoidant styles, which are negative orientation to the problem and negative coping styles, decreased. This did not change in the results of the monitoring measurement in which the persistence of the effect was evaluated. The findings were interpreted in light of the literature data.

A Pilot Randomised Controlled Trial to Improve Social Problem-Solving Skills of Kunjing Children without Sufficient Parental Care

Abstract Social problem-solving skills (SPS) are essential to child development, especially for kunjing children without sufficient parental care (KCw/oSPC). This study aimed to design and implement a group-based pilot intervention programme to improve KCw/oSPC’s SPS and assessed its effectiveness. This pilot intervention was a randomised controlled trial, fifty-seven KCw/oSPC at seventh grade (aged twelve to thirteen years) were recruited and randomly assigned into experimental (n = 24) and waiting (n = 33) groups. All participants in the experimental group received SPS training, whilst the waiting group did not receive any services at the research stage. Both pre- and post-test data about participants’ SPS from both groups were analysed with Mann–Whitney–Wilcoxon and Wilcoxon signed-rank tests, respectively. Results indicated that KCw/oSPC’s SPS in the experimental group improved significantly, with large effect size (Cohen’s d = 1.15). This pilot study, although with limitations, contributed to informing future social work intervention studies and practice to promote KCw/oSPC’s SPS in Mainland China and worldwide.

Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review

Objective To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients. Data sources A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews. Methods The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized. Results The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies. Conclusions This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.

How COVID-19 Ceases All Older Adult Services &amp; the Way Out for Community-Dwelling Older Adults with Chronic Pain

The COVID-19 pandemic started at the beginning of 2020. It significantly impacted the older adults in Hong Kong, with most of the community centers and elderly centers being closed down under various restrictive measures. Thus, community-based health promotion activities were temporarily paused, which decreased older adults’ health-promoting behaviors and motivation to stay active. This research aimed to improve the quality of life and the health of older adults with chronic pain through the pain management program. This study was conducted face-to-face on the campus of Hong Kong Metropolitan University. This dyadic pain management program (DPM) was an 8-week group-based program. The DPM comprised 4 weeks of campus-based activities and 4 weeks of digital-based activities delivered via a WhatsApp group. An 80% participation rate in the campus-based activities was regarded as completing the DPM. The control group only received lesson leaflets. Pain intensity, pain self-efficacy, psychological health of pain victims, caregiver burden inventory, and a semi-structured interview were evaluated at week 1 (T0), week 8 (T1), and week 12 (T2) after randomization. The IBM-SPSS version 22 was used to perform statistical analyses. Using non-pharmacological methods and regular exercise for 12 weeks improved physical health in terms of pain intensity, pain self-efficacy, and psychological health in anxiety, depression, and stress. For caregivers, their burden decreased after the pain management program. These findings indicated that Pender’s Health Promotion Model is helpful to empower the participants and their caregivers with knowledge, skills, and power to manage their chronic pain situations. Utilizing this model as a framework, Researchers can design more effective non-pharmacological interventions for older adults to increase their engagement in health-promoting activities in the community.

O.1.2-2 Delivering enjoyable group-based physical activity programmes to older adults: a qualitative exploration of the views of exercise instructors

Abstract Purpose Enjoyable group-based physical activity programmes provide an engaging opportunity for older adults to experience healthy ageing promotion. To understand the programme delivery context, we explored how exercise instructors seek to make their existing sessions enjoyable. Methods A semi-structured interview guide was used to qualitatively investigate how exercise instructors create the conditions to promote an enjoyable experience. Exercise instructors (n = 9) who were experienced in delivering group-based exercise programmes to community-dwelling older adults were interviewed. The mean interview length was 50 minutes. Results Reflexive thematic analysis generated three main themes: 1) Identifying individual expectations and motives for engagement. Exercise instructors recognised that safety was a foundational aspect of the exercise programme, so that older adults could enjoy exercising confidently. 2) Adopting a tailored approach to meet the needs of older adults. Exercise instructors ensured that the exercises were inclusive of all abilities so that older adults could enjoy exercising collectively. 3) Encouraging collective participation through the development of social support networks. Exercise instructors created a relaxed social atmosphere, facilitating social support, so that older adults could enjoy being part of the group and experience belonging. Conclusions In summary, exercise instructors reported that tailoring sessions to meet the identified needs of older adults and encouraging the group to foster social support can create the conditions to promote an enjoyable experience. The findings can inform the promotion of enjoyment and engagement into existing programs. Findings can be used by exercise instructors, policy makers, researchers, and civil society organisations to ensure that opportunities for healthy ageing are sustainable. Longer-term group-based physical activity opportunities are required to ensure that older adults can experience belonging in a group they enjoy being active in, and which encourages the development of external social networks they may not otherwise have. For the purpose of the presentation, the primary focus is on how exercise instructors can incorporate the social elements of enjoyment in group-based physical activity programmes for older adults, across the dynamic progression of group identity. Support/Funding Source This study was funded by a Postgraduate Studentship from the Department for the Economy (DfE) in Northern Ireland.

A qualitative stakeholder analysis of beliefs, facilitators, and barriers for a feasible prehabilitation program before lung cancer surgery.

In order to develop a feasible prehabilitation program before surgery of NSCLC, this study aimed to gain insight into beliefs, facilitators, and barriers of (1) healthcare professionals to refer patients to a prehabilitation program, (2) patients to participate in and adhere to a prehabilitation program, and (3) informal caregivers to support their loved ones. Semi-structured interviews were conducted with healthcare professionals, patients who underwent surgery for NSCLC, and their informal caregivers. The capability, opportunity, and motivation for behavior-model (COM-B) guided the development of the interview questions. Results were analyzed thematically. The interviews were conducted with twelve healthcare professionals, seventeen patients, and sixteen informal caregivers. Four main themes were identified: (1) content of prehabilitation and referral, (2) organizational factors, (3) personal factors for participation, and (4) environmental factors. Healthcare professionals mentioned that multiple professionals should facilitate the referral of patients to prehabilitation within primary and secondary healthcare involved in prehabilitation, considering the short preoperative period. Patients did not know that a better preoperative physical fitness and nutritional status would make a difference in the risk of postoperative complications. Patients indicated that they want to receive information about the aim and possibilities of prehabilitation. Most patients preferred a group-based physical exercise training program organized in their living context in primary care. Informal caregivers could support their loved one when prehabilitation takes place by doing exercises together. A prehabilitation program should be started as soon as possible after the diagnosis of lung cancer. Receiving information about the purpose and effects of prehabilitation in a consult with a physician seems crucial to patients and informal caregivers to be involved in prehabilitation. Support of loved ones in the patient's own living context is essential for adherence to a prehabilitation program.

Microfinance Impact on Household Poverty Levels

Purpose: The aim of the study was to investigate Microfinance Impact on Household Poverty Levels&#x0D; Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.&#x0D; Findings: The study's findings highlighted that microfinance has a mixed impact on household poverty levels. While treated households experienced increased income, consumption, and investment, overall poverty reduction remained modest. Notably, the positive effects were more pronounced for households with pre-existing entrepreneurial skills. The relationship between microfinance and women's empowerment was complex, as these programs had varying impacts on income generation and decision-making among women. Furthermore, group-based microcredit programs led to improved household welfare for both genders, with females experiencing more significant poverty reductions.&#x0D; Unique Contribution to Theory, Practice and Policy: Financial Inclusion Theory and Social Capital Theory may be used to anchor future studies on Microfinance impact on household poverty levels. Offer financial literacy training and business development support to borrowers. Enforce policies that protect borrowers from predatory lending practices, ensuring transparency in loan terms and preventing coercive debt collection tactics

Optimising Anxiety Treatment for Autistic Children: a Narrative Review

AbstractAnxiety disorders occurs at a high rate amongst autistic children. Cognitive behaviour therapy (CBT) is a reasonably well-established multi-component intervention used to reduce anxiety in this population. Whilst there are known effective intervention components in CBT for treating anxiety among autistic children, there are few guidelines for how to weight these intervention components to maximise positive outcomes. The objective of this study is to evaluate whether CBT is an effective intervention for autistic children, and if so, what the key components of effective CBT programs are for autistic children. A review of studies using manualised group-based CBT programs with family involvement was completed. The key finding was that the exposure-focused CBT (EF-CBT) studies reviewed showed a greater improvement in anxiety symptoms compared with CBT studies with fewer or no exposure-focused sessions. Compared to CBT without an exposure focus, EF-CBT may better fit the profiles of autistic children, potentially resulting in greater client and family engagement, and possibly greater intervention efficacy.

The effects of a group-based intervention through physical activities and dietary changes in young patients with severe psychiatric disorders: a pilot study.

The present study aims to investigate the effect of the 4-F (Fit, Fun, Feel, and Food) group-based program on physical, clinical, and biological outcomes in young patients suffering from severe psychiatric disorders. A pilot study with a naturalistic design was conducted to investigate the effect of a group-based intervention on young patients. A descriptive analysis revealed that out of the 61 outpatients initially enrolled in the program, with a mean age of 26.9 years old (±6.1, 60% men), 71% were overweight or obese. Paired T-tests for the difference between T0 and T1 were used to evaluate the evolution of the outcomes. The 24 patients who completed the full program showed no significant decrease in weight or body composition. Despite the limitations, the main findings of this study were the significant improvement in muscular endurance and coordination (from T0 (M = 13.65, SD = ±1.93) compared to T1 (M = 12.49, SD = ±1.81), [t(20) = 3.072, p < 0.05] and the general increase in mental well-being from baseline to the end of the program according to the type of psychopathology [F(3,10) = 4.25, p < .05]. A slight modification in eating behavior, with a tendency towards a decrease in TFEQ hunger levels, was also noticed. The ANCOVA showed no difference in outcomes between the groups based on diagnosis. Despite its limitations and the small sample size, this pilot study provides valuable insights, demonstrating the feasibility of the program and its positive impact on physical well-being and improved mental health in young patients with psychiatric disorders, sedentary behavior, and unhealthy lifestyles. These encouraging results warrant further research in controlled, larger population samples to deepen our understanding of the potential effects of such interventions.

Significant reduction in diabetes distress and improvements in psychosocial outcomes: A pilot test of an intervention to reduce diabetes distress in adults with type 1 diabetes and moderate-to-severe diabetes distress (REDUCE).

To pilot-test an intervention, co-designed with people with type 1 diabetes (T1DM) and diabetes specialist nurses, to reduce diabetes distress (DD) in adults with T1DM and moderate-to-severe DD. A group-based programme to reduce DD in people with T1DM and moderate-to-severe DD (REDUCE) was pilot-tested in four groups with five bi-weekly two and a half-hour meetings facilitated by two trained diabetes specialist nurses. Data collection included baseline and post-intervention questionnaires measuring DD and psychosocial outcomes and semi-structured interviews with participants post-intervention (n = 18). Data were analysed using descriptive statistics and systematic text condensation. Twenty-five adults with T1DM participated in the study. The median age and diabetes duration of participants were 50 (IQR: 32;57.5) years and 26 (IQR: 18;45) years, respectively. Seventeen (68%) were women. The pilot study showed a significant reduction in DD (measured by Type 1 Diabetes Distress Scale) between baseline and post-intervention from 2.6 ± 0.7 to 1.9 ± 0.6 (mean ± SD) (p < 0.001). The largest reductions were seen on the subscales: powerlessness 1.2 ± 1.1, eating distress 0.9 ± 1.2 and fear of hypoglycaemia 0.8 ± 1.0 (mean ± SD). Significant improvements were also seen for quality of life, diabetes empowerment and emotion regulation. Qualitative data showed that REDUCE supported participants in verbalizing emotions and seeing worries in a more constructive perspective. Acknowledgement of negative diabetes experiences eased negative self-judgments. Sharing experiences among peers increased relatedness and reduced loneliness. Participation in REDUCE was associated with significant reduction in DD and significant increase in quality of life. Larger scale studies are planned to determine sustained effectiveness of REDUCE.

How a group-based occupational therapy program works in woman with fibromyalgia: A process evaluation of the ADAPT program

Background The ADAPT Program have improved activities of daily living (ADL) in women with fibromyalgia. To understand the functioning of the program, it is relevant to evaluate how program theory components are linked to outcomes (mechanisms) and how the randomised controlled trial (RCT) context, influenced delivery and outcomes Objective To evaluate ADAPT in terms of dose, mechanisms of change and contextual factors. Material/Methods Dose was recorded on the n = 21 participants receiving ADAPT in the IMPROvE trial (NCT01352052). A subsample of n = 16 attended one of three 2-hour focusgroups, evaluating mechanisms of change and contextual factors. Interview questions explored participants’ interaction with four program components, i.e. how the ‘client-centred approach’, ‘group-based peer-exchange format’, ‘teaching-learning strategies’ and ‘long-term program format’ triggered mechanisms facilitating/hindering outcomes. Moreover, how randomisation procedures influenced delivery and outcomes. Results Attending a long-term educational peer-exchange program, in which participants experienced met by a health professional that legitimised difficulties, facilitated participants knowledge, insights and motivation for changing habits. With time and support, participants experienced increased acceptance of their situation and began to implement more effective ways to perform ADL tasks. Conclusions/Significance Results support previous findings of improved ADL ability post-ADAPT and provide initial evidence to support the ADAPT Program theory.

The GLA:D® Canada program for knee and hip osteoarthritis: A comprehensive profile of program participants from 2017 to 2022.

The Good Life with osteoArthritis in Denmark (GLA:D®) program was implemented in Canada in 2017 with the aim of making treatment guideline-recommended care available to the 4 million Canadians with knee and hip osteoarthritis (OA). This report describes the GLA:D® Canada program, registry and data collection procedures, and summarizes the sociodemographic and clinical profile of participants with knee and hip OA to inform the scientific research community of the availability of these data for future investigations and collaborations. The GLA:D® program consists of three standardized components: a training course for health care providers, a group-based patient education and exercise therapy program, and a participant data registry. Patients seeking care for knee or hip OA symptoms and enrolling in GLA:D® are given the option to provide data to the GLA:D® Canada registry. Participants agreeing to provide data complete a pre-program survey and are followed up after 3-, and 12-months. Data collected on the pre-program and follow-up surveys include sociodemographic factors, clinical characteristics, health status measures, and objective physical function tests. These variables were selected to capture information across relevant health constructs and for future research investigations. At 2022 year-end, a total of 15,193 (11,228 knee; 3,965 hip) participants were included in the GLA:D® Canada registry with 7,527 (knee; 67.0%) and 2,798 (hip; 70.6%) providing pre-program data. Participants were 66 years of age on average, predominately female, and overweight or obese. Typically, participants had knee or hip problems for multiple years prior to initiating GLA:D®, multiple symptomatic knee and hip joints, and at least one medical comorbidity. Before starting the program, the average pain intensity was 5 out of 10, with approximately 2 out of 3 participants using pain medication and 1 in 3 participants reporting a desire to have joint surgery. Likewise, 9 out 10 participants report having previously been given a diagnosis of OA, with 9 out 10 also reporting having had a radiograph, of which approximately 87% reported the radiograph showed signs of OA. We have described the GLA:D® Canada program, registry and data collection procedures, and provided a detailed summary to date of the profiles of participants with knee and hip OA. These individual participant data have the potential to be linked with local health administrative data registries and comparatively assessed with other international GLA:D® registries. Researchers are invited to make use of these rich datasets and participate in collaborative endeavours to tackle questions of Canadian and global importance for a large and growing clinical population of individuals with hip and knee OA.

Sex-Related Differences in Functional Fitness Outcomes in Older Adults.

Sex-related differences in changes in functional fitness over time were longitudinally assessed in older adults participating in a group-based multimodal exercise program. From a database, functional fitness scores were obtained for 89 older adults (71.6 ± 6.5years old) who had completed two assessments, 5-8years apart. Lower body strength, upper body strength, aerobic endurance, flexibility, and change of direction performances were compared over time and with normative values. Females (p = .02), but not males, had an improvement in upper body strength over time. Females were also more flexible than males at both assessments (p ≤ .02). Of those who had five consecutive assessments, females were more flexible than males (p ≤ .05) and had a faster change of direction ability (p < .001). When compared with normative values, our results indicate that typical time-related functional fitness loss can be attenuated with group exercise. Our results further support the need to tailor exercise prescription according to the individual.

Effects of the Multicomponent Cognitive Training Program BrainProtect in Cognitively Healthy Adults: A Randomized Controlled Trial.

Cognitive integrity is a fundamental driver of health. The exact structure of strategies against cognitive impairment is still under debate. To compare the short-term effects of a multicomponent cognitive training (BrainProtect) with those of general health counseling (GHC) on cognitive abilities and health-related quality of life (HRQoL) in healthy adults in Germany. In this parallel randomized controlled trial (RCT), 132 eligible cognitively healthy adults (age ≥50 years, Beck Depression Inventory ≤9/63; Montreal Cognitive Assessment ≥26/30) were randomized to either GHC (N = 72) or to intervention with BrainProtect (intervention group, IG; N = 60). IG participants received 8 weekly sessions of 90 min of the group-based BrainProtect program focusing on executive functions, concentration, learning, perception, and imagination, plus nutritional and physical exercise units. Before and after intervention, all participants underwent neuropsychological testing and HRQoL evaluation, blinded for pretest. No significant training effect was observed for the primary endpoint of global cognition as assessed by CERAD-Plus-z Total Score (p = 0.113; ηp2 = 0.023). Improvements in several cognitive subtests were shown in the IG (N = 53) compared to the GHC (N = 62) without adverse events. Differences reached significance for verbal fluency (p = 0.021), visual memory (p = 0.013), visuo-constructive functions (p = 0.034), and HRQoL (p = 0.009). Significance was lost after adjustment, though several changes were clinically relevant. BrainProtect did not significantly impact global cognition in this RCT. Nevertheless, the results of some outcomes indicate clinically meaningful changes, so that a strengthening of the cognitive performance by BrainProtect cannot be excluded. Further studies with larger sample size are needed to confirm these findings.

The association of adolescents' smoking with the physical activity levels of their friends

BackgroundSmoking is inversely related to people's Physical Activity Level (PAL). As the behavior of friends may affect the choices and behavior of adolescents, having friends with a high PAL may potentially protect against adolescent smoking. This study aims to assess whether adolescents' smoking is associated with the PAL of their friends. MethodsSILNE-R survey data of 11.918 adolescents from 55 different schools in 7 European cities was used to determine weekly smoking, individual PAL, PAL of friends, school PAL, and smoking of friends. Multilevel, multivariable logistic regression analysis were used to assess the association between the PAL of friends and weekly smoking. Several socio-demographic variables were included as covariates in the analysis. ResultsOur results indicated that 10.8% of the respondents was smoking weekly. Weekly smoking was most common among adolescents whose friends had a PAL of 0–42.0 min per day (14.5%). Respondents were significantly more likely to be smoking weekly if their friends were on average 0–42 min vs. 80–180 min physically active (OR 1.27 [95% CI 1.04–1.55]). This association existed independently of the individual PAL of respondents. Stratification for smoking of friends yielded equal results, although the association appeared to be somewhat stronger for those with smoking friends (OR 1.38 [95% CI 1.06–1.82]). ConclusionAdolescents are less likely to smoke weekly if they associate with friends who spend >80 min per day on physical activity. Initiatives aimed at the prevention of smoking among adolescents may benefit from organizing group-based physical activity programs.

“To be myself again”: Perceived benefits of group-based exercise for colorectal cancer patients

PurposeTo explore the perceived benefits of a group-based exercise program for patients with colorectal cancer (CRC) undergoing chemotherapy treatment. MethodsIn-depth semi-structured interviews were conducted with all participants (n = 27) at the end of the exercise program (patients, relatives and healthcare professionals). The exercise instructor in charge of the exercise program with CRC patients also collected observational field notes throughout a research diary. ResultsThree main themes related to exercise as a coping strategy were obtained: (a) physical recovery; (b) psychosocial well-being, and (c) reconnection with their embodied selves and normal lives. Physical recovery included a perceived increase in fitness and a reduction in physical side-effects. Psychosocial well-being included perceived benefits in self-confidence, sense of control, reduced fear, feeling of being useful, sense of achievement, positive thinking and avoiding depression. All the physical and psychosocial benefits helped patients reconnect with their embodied selves, engage in activities practised before the diagnoses, improve their body image, avoid stigma, and increase their social life beyond cancer diagnoses. In this sense, some patients held on to their past selves, trying to keep or recover normality in their lives, while others acknowledged that they might not be the same person anymore, with exercise being part of this new identity. ConclusionsThis study shows that exercise is a coping strategy that benefitted CRC patients in several ways related to their physical and psychosocial quality of life.