Self-guided Exercise Research Articles

THE IMPACT OF A SENSOR BASED PLATFORM ON THE OUTCOME OF MEDIAL OFF-LOADER BRACING IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS: A PILOT RANDOMIZED CLINICAL TRIAL.

Determine the effectiveness of a medial off-loader brace with sensor monitoring capabilities and associated phone application in improving outcomes for individuals with knee osteoarthritis (OA). Randomized clinical trial of participants with knee OA, aged 40-75 with two groups: 1) brace-only 2) brace+sensor (sensor providing walking time, knee range of motion and 7-day activity streak). Both groups received a prefabricated custom-fitted medial off-loader brace and 12-week self-guided exercise therapy program. Baseline and post-intervention assessments included subjective and objective outcomes. 60 participants were recruited (n = 30/group). The brace+sensor group demonstrated higher study retention(88.89%) compared to the brace-only group(73.33%). Significant improvement in KOOS knee pain and other KOOS sub-scores compared to baseline was observed for both groups. However, only the brace+sensor group improved beyond the established minimal clinically important difference for KOOS pain(11.31+/-13.87). KOOS ADL was also significantly improved in the brace+sensor group compared to brace only group(p = 0.049). Both treatment groups had significant improvement in functional outcomes(10 m walk, 5x sit-to-stand, p < 0.05). Only the brace+sensor group had significant improvements in the 6-minute walk test(p = 0.02) and reduction in participant weight(p = 0.01) at 12 weeks. Incorporating wearable technology in standard bracing for individuals with knee OA has potential in improving clinical outcomes.

Abstract PO1-10-10: Leveraging technology to optimize symptom management and patient empowerment in routine breast cancer care: implementation of a remote patient monitoring (RPM) pathway across 24 hospitals in Europe

Abstract Background: In clinical trials, RPM has been proven to improve the quality of life and toxicity management for patients receiving systemic treatment and is recommended by international guidelines for routine clinical practice (Di Maio et al., Ann Oncol 2022). Resilience is an oncology-specific RPM system (CE marked, class IIa medical device - mobile application [app] or web interface) which prompts patients to complete a weekly survey including core symptoms from NCI’s PRO-CTCAE questionnaire. Severe or worsening symptoms trigger an alert notification sent to the patient’s care team. In addition to the RPM system, the mobile app offers a large pool of breast cancer-specific educational, self-management, and patient empowerment resources that are personalized according to symptoms reported, disease stage, and treatments received. Here we present the implementation of the Resilience RPM pathway in routine breast cancer care across 24 highly diverse cancer centers. Methods: The implementation process followed a phasic process of Exploration, Preparation, Implementation, and Sustainability that involved close collaboration with technology providers, hospital managers, and care teams at participating cancer centers to coordinate, train, provide technical assistance, and respond to site-specific needs. In addition, monthly webinars offered participating centers an opportunity to share best practices and ways to overcome implementation barriers. A dedicated platform with educational RPM resources for healthcare providers was also available. A process evaluation according to the RE-AIM framework was performed assessing the reach, adoption, implementation, and maintenance of the RPM pathway in routine care. The effectiveness of the pathway was assessed as the ability of the care team to timely respond to alerts. Aggregated system level metric of RPM was collected covering patients with breast cancer under active systemic treatment followed by Resilience from 01-11-2021 to 29-06-2023. Usage data of mobile app resources was tracked from 01-01-2023 to 29-06-2023. Qualitative assessments with focus groups complemented this evaluation. Results: 985 patients, 1% male, 99% female, with a median age of 57y (range: 21-95y; P25-75 38.5-64.5y), were registered across 24 cancer centers. In the last 6 months, the predominant RPM interface chosen by patients was the mobile app (64.1 vs 35.9% for the web platform). Adherence to weekly ePRO reporting was 89.4% in the mobile app and 86.6% in the web platform. The median time from prompt receipt to survey completion was 5.6 hours. The median time for the nurse navigator (NN) to process an alert was 3h50min. Most alerts (91%) were handled directly by NN with 9% requiring the support of a physician. The mean number of individual content consumed per patient was 13 (6744 resources/523 pts, 100% of app users accessed resources). Preferred formats of content delivery were written articles (66.5%), followed by videos (23.1%) and podcasts (10.4%). Most assessed contents referred to: symptom management advice (16%), followed by information about breast cancer disease characteristics (12.5%), supportive care strategies (11.5%), self-guided exercises of mindfulness-based stress reduction (9.4%), and breast cancer treatment journey (8.3%). Qualitative assessments of the app interface, educational content, and self-management programs revealed high levels of satisfaction. The RPM pathway is sustained in the 24 cancer centers and implementation is expanding to additional centers. Conclusion: The Resilience RPM pathway was successfully implemented in routine care across a diverse group of cancer centers with elevated levels of patient engagement and responsiveness from NN. In addition, patients accessed evidence-based educational and empowerment resources, adapted to their medical profile according to their preferences and learning style. Citation Format: Maria Alice Franzoi, Arlindo R Ferreira, Juliette Fanton d'Andon, Thomas Grellety, Eliane Ithurbide-Dachary, Laura Polastro, Laurence Caravella, Joseph Rodriguez, Nathanaelle Leprevier, Elsa Blanchard, Stéphane Remy, Belen d' Ythurbide, Romain Rivoirard, Raoudha Boughzala, Joana M Ribeiro, Ines Vaz Luis. Leveraging technology to optimize symptom management and patient empowerment in routine breast cancer care: implementation of a remote patient monitoring (RPM) pathway across 24 hospitals in Europe [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-10.

Effects of Peer-Supported and Self-Guided Exercise on Self-Reported Anxiety and Depression among Young Adults-A Pilot Study.

Mental health conditions such as anxiety and depression became heightened issues for college-aged young adults during the global pandemic. The main purpose of this study was to examine the effects of a peer-supported exercise intervention on young adults (vs. self-guided exercise) who reported elevated levels of anxiety and/or depression. A parallel group design was used where young adults (n = 27) were randomly assigned to either a peer-supported or self-guided exercise group which lasted for eight weeks. The generalized anxiety and depression subscales of the Counseling Center Assessment of Psychological Symptoms (CCAPS-34) were measured for a baseline and then at 4-week, 8-week, and 12-week follow-up. Analyses of covariance (ANCOVA) with repetitive measures show that peer-supported and self-guided exercise programs reduced participant anxiety and depression scores; however, intervention decay for the peer-supported exercise intervention was more severe than that for the self-guided group. Self-guided exercise had a longer-lasting effect than the peer-supported alternative and could be a cost-effective approach to combat anxiety and depression issues among young adults.

Implementation of supervised exercise therapy in a veteran population with symptomatic claudication.

Real-world implementation of supervised exercise therapy (SET) referral for symptomatic intermittent claudication has been limited by poor provider awareness around reimbursement and low patient adherence owing to factors including limited center availability and long travel distances to sites. In this study, 76 of 77 consecutive male veteran patients with intermittent claudication managed at a single-center vascular specialty clinic were referred to SET prior to revascularization. Pre- and post-SET submaximal exercise treadmill testing was performed for assessment of exercise capacity in metabolic equivalents (METs). In the 48.7% of subjects who completed 36 sessions of SET (n = 37), the average improvement in METs was 60.3%, reflecting improvement from baseline average of 3.4 METs to 5.5 METs after SET. Another 14 patients pursued self-guided exercise therapy and 25 patients declined any participation in exercise therapy. Reasons for declining participation in SET included inadequate transportation, cost of copayment, and interference with full-time work schedules. There was a nonsignificant numeric trend toward improved change in ankle-brachial index in the combined SET and self-guided exercise groups compared to those that declined exercise therapy (0.011 ± 0.124 vs -0.040 ± 0.105, p = 0.156). High acceptance of referral to SET is possible, despite the limitations to implementation. Incorporation of novel pre- and post-SET submaximal exercise treadmill testing allows for assessment of change in exercise capacity and aids in risk stratification and management of intermittent claudication symptoms.

Walking All over COVID-19: The Rapid Development of STRIDE in Your Room, an Innovative Approach to Enhance a Hospital-Based Walking Program during the Pandemic.

Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United States to implement STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans), a hospital-based walking program designed to mitigate the risks of immobility during hospitalization. However, the COVID-19 pandemic made in-person, or face-to-face, walking challenging due to social distancing recommendations and infection control concerns. In response, our team applied principles of implementation science, including stakeholder engagement, prototype development and refinement, and rapid dissemination and feedback, to create STRIDE in Your Room (SiYR). Consisting of self-guided exercises, light exercise equipment (e.g., TheraBands, stress ball, foam blocks, pedometer), the SiYR program provided safe alternative activities when face-to-face walking was not available during the pandemic. We describe the methods used in developing the SiYR program; present feedback from participating sites; and share initial implementation experiences, lessons learned, and future directions.

Book Review of Blank, E. A. (2020). Easy Marriage Counselling: 52 Self-Guided Exercises to Deepen Your Relationship. California: Rockridge Press.

Book Review of Blank, E. A. (2020). Easy Marriage Counselling: 52 Self-Guided Exercises to Deepen Your Relationship. California: Rockridge Press.

A moderate 200-m walk test estimates peak oxygen uptake in elderly outpatients with cardiovascular disease

A moderate 1-km treadmill walk test (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak) in outpatients with cardiovascular disease (CVD). The results obtained by the 1k-TWT predict survival and hospitalization in men and women with CVD. We aimed to examine whether shorter versions of the full 1k-TWT equally assess VO2peak in outpatients with CVD. One hundred eighteen outpatients with CVD, aged 70±9 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, heart rate, time to walk 100-m, 200-m, 300-m, and 400-m, and the full 1000-m, were entered into equations to estimate VO2peak. The minimal distance providing similar VO2peak results of the full 1k-TWT was 200-m: 23.0±5.3 mL/kg/min and 23.0±5.5 mL/kg/min, respectively. The concordance correlation coefficient between the two was 0.97 (95%CI 0.96 to 0.98, P<0.0001). The slope and the intercept of the relationship between the values obtained by the 200-m and the full 1k-TWT were not different from the line of identity. Bland-Altman analysis did not show systematic or proportional error. A moderate 200-m treadmill-walk is a reliable method for estimating VO2peak in elderly outpatients with CVD. A 200-m walk enables quick and easy cardiorespiratory fitness assessment, with low costs and low burden for health professionals and patients. These findings have practical implications for the transition of patients from clinically-based programs to fitness facilities or self-guided exercise programs.

Peak oxygen uptake estimation from a moderate 500-m treadmill walk in older women with cardiovascular disease

Low levels of cardiorespiratory fitness are associated with a high risk of cardiovascular disease (CVD) and all-cause mortality in women. The aim of this study was to determine the validity of a 500-m moderate treadmill-walking test for estimating peak oxygen uptake (VO2peak) in older women with CVD. Fifty-three women with stable CVD (age 70.4 ± 8.2 years) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patient completed a maximal cardiopulmonary exercise test, and a moderate and self-paced (11–13/20 on the Borg scale) 500-m treadmill-walking test. Treadmill walk time, age, weight, height, and heart rate during the test were entered into prediction equations previously validated for VO2peak estimation in male patients. Measured and estimated VO2peak values were not different (20.8 ± 4.3 vs 21.3 ± 4.6 mL/kg/min, P = 0.12). The comparison between measured and estimated VO2peak values yielded a correlation of R = 0.92 (SEE = 1.3 mL/kg/min, P < 0.0001), with the slope and the intercept that coincided with the line of identity (Passing and Bablok analysis, P = 0.65). Residuals were normally distributed with a mean value of − 0.5 mL/kg/min. Examination of the Bland–Altman analysis does not show systematic or proportional error. A moderate and self-regulated 500-m treadmill-walking test is a valid tool for VO2peak estimation in older women with CVD. These findings may have practical implications in the context of transitioning from clinically based programs to fitness facilities or self-guided exercise programs in older women with stable cardiovascular disease.

A moderate 500-m treadmill walk for estimating peak oxygen uptake in men with NYHA class I-II heart failure and reduced left ventricular ejection fraction

BackgroundMaximal cardiopulmonary exercise testing (CPX) is the gold-standard for cardiorespiratory fitness assessment in chronic heart failure (CHF) patients. However, high costs, required medical supervision, and safety concerns make maximal exercise testing impractical for evaluating mobility-impaired adults. Thus, several submaximal walking protocols have been developed and currently used to estimate peak oxygen consumption (VO2peak) in CHF patients. However, these tests have to be performed at close to maximum exercise intensity. The aim of this study was to examine the validity of a 500-m treadmill-walking test carried out at moderate intensity for estimating VO2peak in community-dwelling adult and elderly patients with CHF and reduced left ventricular ejection fraction (HFrEF).MethodsForty-three clinically stable men with HFrEF (age 67.7 ± 9.2 years, and left ventricular ejection fraction, LVEF 38% ± 6%) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patients completed a CPX, and a moderate and self-paced (11–13/20 on the Borg scale) 500-m treadmill-walking test. Age, weight, height, walk time, and heart rate during the 500-m test were entered into prediction equations previously validated for VO2peak estimation from a 1000-m walking test in patients with cardiovascular disease and preserved LVEF.ResultsDirectly measured and estimated VO2peak values were not different (21.6 ± 4.9 vs 21.7 ± 4.6 mL/kg/min). The comparison between measured and estimated VO2peak values yielded a correlation of R = 0.97 (SEE = 0.7 mL/kg/min, P < 0.0001). The slope and the intercept coincided with the line of identity (Passing and Bablock analysis, P = 0.50). Residuals were normally distributed, and the examination of the Bland-Altman analysis do not show systematic or proportional error.ConclusionsA moderate and self-regulated 500-m treadmill-walking test is a valid tool for VO2peak estimation in patients with HFrEF. These findings may have practical implications in the context of transitioning from clinically based programs to fitness facilities or self-guided exercise programs in adults and elderly men with HFrEF.

500-meter and 1000-meter moderate walks equally assess cardiorespiratory fitness in male outpatients with cardiovascular diseases.

The walking speed maintained during a moderate 1-km treadmill walk (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak), and to be inversely related to long-term survival and hospitalization in outpatients with cardiovascular disease (CVD). We aimed to examine whether 500-meters and 1-k moderate treadmill-walking tests equally estimate VO2peak in male outpatients with CVD. One hundred forty-two clinically stable male outpatients with CVD, aged 34-92 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, time to walk 500-meter and the entire 1000-meter, and the corresponding heart rates were entered into validated equations to estimate VO2peak. VO2peak estimated from the 500-meters test was not different from that estimated from the 1k test (25.2±5.1 vs. 25.1±5.2 mL/kg/min). The correlation coefficient between the two was 0.98. The slope and the intercept of the relationship between the 500-meter and 1k tests were not different from the line of identity. Bland-Altman analysis demonstrated that 96% of the data points were within two standard deviations (from -1.9 to 1.7 mL/kg/min). The 500-meter treadmill-walking test is a reliable method for estimating VO2peak in stable male outpatients with CVD. A shorter version of the test, 500-meter, provides similar information as that from the original 1k test, but is more time efficient. These findings have practical implications in the context of transitioning patients from clinically based and supervised programs to fitness facilities or self-guided exercise programs.

The 28th International Mammalian Genome Conference--meeting report.

The 28th International Mammalian Genome Conference (IMGC) was held October 26–29th, 2014 in scenic Bar Harbor, Maine. In addition to being the home of The Jackson Laboratory, Mount Desert Island is a popular summer vacation destination. More than 200 attendees of the conference enjoyed the last few days of the tourist season as the autumn leaves fell and the local residents prepared for winter. Darla Miller and Dasha Li Kappe organized the meeting, with the help of local organizers Ron Korstanje, Karen Svenson, Erin McDevitt, and Nancy Place. Scientists presented cutting-edge research in the fields of mammalian genetics and genomics that highlighted the importance of mammalian models for human genetics and disease research. The plenary presentations demonstrated the broad applicability of mammalian models to study a range of topics from gene evolution to rare human diseases. Meanwhile, the Verne Chapman lecture provided a historical account of mouse genetics research and encouraged a new, automated approach to forward genetics. Bioinformatics and Systems Genetics Workshops gave participants hands-on opportunities to become familiar with genetic and genomic tools. A student satellite symposium afforded budding scientists the chance to share their work and two poster sessions encouraged interaction among researchers. The meeting program and abstracts are available online at www.imgs.org/Archive/abstracts/2014Abstracts/IMGS2014Program.pdfwww.imgs.org. Online resources presented at the meeting are listed in Table 1. Table 1 Databases, resources, and tools Bioinformatics workshops Several workshops provided conference attendees with opportunities for hands-on guided tours of publicly available informatics resources relevant to IMGS members. The pre-conference Bioinformatics Workshop offered three mini-sessions: (1) a guide to genome annotations produced by the GENCODE consortium, and differences between annotation sets provided by popular databases (Laurens Wilming, Wellcome Trust Sanger Institute); (2) an overview of the International Knockout Mouse Consortium's pipeline and progress (Mark Thomas, Wellcome Trust Sanger Institute); and (3) a tour of the International Mouse Phenotyping Consortium's database of mutant mouse phenotypes (www.mousephenotype.org). An online link to these workshop powerpoint presentations can be found under the “History” tab on the IMGS home page (www.imgs.org). The System Genetics Workshops, led by Dan Gatti (The Jackson Laboratory), Marty Ferris (University of North Carolina at Chapel Hill), Gary Churchill (The Jackson Laboratory) along with Andrew Morgan and Fernando Pardo-Manuel de Villena (University of North Carolina at Chapel Hill) featured talks on the design and status of two important multiparental genetic reference populations, the Collaborative Cross (CC) and the Diversity Outbred (DO) mice. Didactic sessions were supplemented with small-group discussions on rational experimental designs using these populations and available online tools for analyses (www.csbio.unc.edu/CCstatus/index.py) were described by Leonard McMillan, Chen-Ping Fu, and Chia-yu Kao (University of North Carolina at Chapel Hill). This year's Mouse Genome Informatics(MGI) Workshops (www.informatics.jax.org) were led by Joanne Berghout and David Shaw (The Jackson Laboratory). The hands-on workshops included seminar-style demonstrations followed by the opportunity to navigate MGI using self-guided exercises. Participants were instructed on how to locate biological information by performing a variety of searches, and were also introduced to new tools such as the Human-Mouse: Disease Connection portal (www.informatics.jax.org/humanDisease.shtml), the Recombinase (Cre) Activity portal (www.informatics.jax.org/recombinase.shtml), and the MouseMine computational access platform (www.mousemine.org/mousemine/begin.do). In celebration of the 25th birthday of the MGI database, Janan Eppig (The Jackson Laboratory; O-30) tracked the history of the MGI from a pre-web version distributed on floppy disks to the MGI website (www.informatics.jax.org) that we know today. Janan emphasized the continued commitment of MGI to provide integrated genetic, genomic, and biological data for mouse and to provide increased access to translational data views to support discovery and hypothesis building for studies of human disease. Janan also recognized the contributions of many individuals who worked to develop MGI over the years and described future plans as MGI evolves to meet the growing needs of the scientific community.

Neuromuscular adaptations to long-term progressive resistance training translates to improved functional capacity for people with multiple sclerosis and is maintained at follow-up

Background: Progressive resistance training (PRT) is acknowledged to effectively improve muscle strength for people with multiple sclerosis (PwMS), but diverging results exist regarding whether such improvements translates to improved functional capacity, possibly relating to insufficient duration and/or intensity in some previous studies. Objective: The purpose of this study was to evaluate potential changes in functional capacity and neuromuscular function after 24 weeks of supervised PRT, and whether improvements are maintained after an additional 24 weeks of self-guided exercise. Methods: This study was a randomised controlled trial, with a training group and a waitlist group undergoing supervised PRT for 24 weeks initially or after 24 weeks of habitual lifestyle, respectively. Functional capacity, isometric muscle strength of knee extensors and flexors, neural drive and thigh muscle cross-sectional area was measured at baseline, after 24 and 48 weeks. Results: The training group significantly improved neuromuscular function of the knee extensors and flexors, which translated to improvements in functional capacity. Furthermore, the improved functional capacity was maintained after 24 weeks of self-guided physical activity. The waitlist group produced similar patterns of changes after PRT. Conclusion: Compelling evidence is provided, that PRT performed over sufficiently long periods, improves functional capacity, likely due to neuromuscular adaptations.

Morphological and health-related changes associated with a 12-week self-guided exercise programme in overweight adults: a pilot study

Over 12 weeks, supervised physical activity (PA) interventions have demonstrated improvements in morphological and health parameters, whereas community walking programmes have not. The present study piloted a self-guided programme for promoting PA and reducing sedentary behaviour in overweight individuals and measured its effect on a range of health outcomes. Six male and 16 female sedentary adults aged 48.5 ± 5.5 years with body mass index (BMI) 33.4 ± 6.3 kg m−2 were assessed for anthropometric variables, blood pressure, functional capacity, well-being and fatigue. After an exercise consultation, participants pursued their own activity and monitored PA points weekly. At baseline, mid-point and 12 weeks, eight participants wore activity monitors, and all participants undertook a 5-day food diary to monitor dietary intake. In 17 completers, mass, BMI, sit-to-stand, physical and general fatigue had improved by 6 weeks. By 12 weeks, waist, sagittal abdominal diameter (SAD), diastolic blood pressure, well-being and most fatigue dimensions had also improved. Throughout the intervention, PA was stable, energy intake and lying time decreased and standing time increased; thus, changes in both energy intake and expenditure explain the health-related outcomes. Observed changes in function, fatigue and quality of life are consistent with visceral fat loss and can occur at levels of weight loss which may not be considered clinically significant.

Morphological and functional changes associated with a 12-week self-guided exercise programme of overweight adults: a pilot study

Morphological and functional changes associated with a 12-week self-guided exercise programme of overweight adults: a pilot study

Effects of a Learning Trial on Self-Regulation of Exercise

Heart rate (HR) and ratings of perceived exertion (RPE) are common exercise intensity regulatory strategies, however, some individuals are unable to use these strategies effectively. Alternative or conjunctive strategies may aid in the transition to self-guided programs. The purpose of the present study was to examine the value of a brief, field-based exercise intensity learning trial on self-regulation of intensity during a weeklong exercise program. Forty-two males were randomly assigned to either a paced learning trial (P) or non-paced control (NP), and then one of three intensity feedback groups: HR, HR + RPE, or no feedback (CONT). The paced trial consisted of an 800-m trial at 75 % of maximal heart rate reserve (MHRR) on day one. Subjects then completed four 800-m trials each day for four days and received feedback on deviation from target HR (THR) after each 800-m trial. Four-way MANOVA (pacing x feedback x trials x days) was used to assess the influence of the learning trial on THR deviation scores across the week. The pacing x feedback x trials interaction was significant (Pillai's Trace = 0.36, approximately F (6,70) = 2.56, p = 0.03) and thus, the influence of the learning trial was assessed within feedback group. There were no significant differences in THR deviation scores for P vs. NP within the HR or HR + RPE feedback groups. However, P was significantly more accurate then NP (p < 0.05) within the CONT feedback groups during each trial averaged across the week (T (1) = - 2.6 vs. 5.3; T (2) = 2.6 vs. 14.2; T (3) = 4.6 vs. 16.2; T (4) = 5.3 vs. 20.5 beats . min (-1)). These results demonstrate that a brief intensity learning trial, in the absence of HR or HR+RPE feedback, provided for accurate self-regulation of vigorous exercise training. These results would support the efficacy of a brief intensity learning trial within the context of transitioning an individual to a self-guided exercise program.

Applying Active Learning Methods to the Design of Library Instruction for a Freshman Seminar

Active learning methods were employed in designing library instruction for an experimental freshman seminar at California State University-San Bernardino. Rather than rely on the traditional lecture/demonstration format, the centerpiece of the ninety-minute “one-shot” sessions was a small-group, self-guided exercise focusing on the library’s online system. As a prelude to the hands-on exercise, students participated in class discussions on the importance of information literacy. Opportunities for individual instruction also were provided. Student, librarian, and faculty evaluations of the sessions were favorable.