Step Program Research Articles

Bench stepping with incremental heights improves muscle volume, strength and functional performance in older women.

Task-specific exercises such as bench stepping can improve functional ability and reduce falling incidents in older adults. However, such exercises are often not optimized to improve muscle volume and force-velocity characteristics. This study determined the effects of a 12-week stepping program using incremental step heights (STEEP), on muscle volume, strength, power, functional ability and balance performance in older women. Forty-five community-dwelling women (69y ± 4) were randomly assigned to the STEEP group or a non-training CONTROL group. Training intensity was primarily determined by step height, while training volume remained equal. Thigh muscle volume (CT-scan), force-velocity characteristics of the knee extensors (Biodex dynamometer) and functional ability (Short Physical Performance Battery, timed stair ascent, 10-m walk test and countermovement jump height) were determined pre- and post-intervention. In addition, 3D trunk accelerations were recorded at the lower back to assess balance during the Short Physical Performance Battery balance tests. Two-way ANOVA showed that the STEEP program increased thigh muscle volume, knee extensor isometric peak torque, dynamic peak power, unloaded rate of velocity development and improved performance on all functional tests to a greater extent than CONTROL (p < .05), except the countermovement jump. No improvements were found for peak velocity and balance performance (p > .05). Our results indicate that bench step training with incremental step heights simultaneously improves functional ability, thigh muscle volume and force-velocity characteristics of the knee extensors in older women.

Recumbent stepping aerobic exercise in amyotrophic lateral sclerosis: a pilot study

Aerobic exercise can promote neuroplastic responses in the healthy and injured brain. Although the role of exercise in amyotrophic lateral sclerosis (ALS) is debated, new evidence suggests that exercise may reduce disease progression. While common exercise modalities such as the treadmill and cycle ergometer have been explored in ALS, the safety and feasibility of a total body recumbent stepper have not been investigated. Additionally, the functional and neurophysiological effects of recumbent stepping in ALS are still unknown. Here, we investigated the safety and feasibility of a 4-week recumbent stepping program to slow disease progression in ALS and possibly facilitate neuroplasticity. Nine individuals with ALS performed moderate intensity recumbent stepping for four weeks. Outcomes included participation satisfaction questionnaire, ALS Functional Rating Scale Revised (ALSFRS-R), clinical tests of walking and endurance, fatigue severity scale, Beck depression inventory, SF-12, and transcranial magnetic stimulation-induced motor evoked potentials (MEPs). All measurements were collected at baseline, post-intervention, and at the 1-month follow-up. Eight participants completed the study without any adverse events. The ALSFRS-R scores were similar at the end of the study and at follow-up. No significant differences were noted for any of the clinical outcomes. MEPs were present only in two participants and changes in corticomotor excitability after exercise were minimal. Results from this preliminary study support the safety and feasibility of 12 sessions of total body recumbent stepping in individuals with ALS.

Cost-effectiveness analysis of collaborative treatment of late-life depression in primary care (GermanIMPACT)

BackgroundLate-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective. MethodsThis study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed. ResultsIn total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively. ConclusionEvidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.

The Effects of Pilates, Step and Zumba Exercises on Self-esteem, Happiness and Communication Skill Levels

The aim of this study is to examine the self-esteem, happiness and communication skills of women who participated in pilates, step and zumba exercise programs. A total of 54 women participated in the study. Pilates, step and zumba exercise program was applied three days a week for a total of 12 weeks. As a data col lection tool in research; personal information form, Rosenberg self-esteem scale consisting of 10 items, which was adapted to Turkish by Cuhadaroğlu (1986) the scale of communication skills created by Korkut-Owen and Bugay (2014) consisting of 25 items, and the scale of happiness created by Demirci (2017) composed of 6 items. When the self-esteem, happiness level and communication skills scale scores of the participants in the pilates exercise program are examined, there is a statistically significant difference between the pre-posttest values (p&lt;0.05). When the self-esteem scale scores of the participants in step and zumba exercise program were examined, there was no statistically significant difference between the pre-posttest values (p&gt;0.05). When the happiness level and communication skills scale scores of the participants in step and zumba exercise program were examined, statistically significant difference was observed between the pre-posttest (p&lt;0.05). Pilates exercise program positively affects self-esteem, happiness and communication skills. Step and zumba exercise programs have no effect on self-esteem. Step and zumba exercise program positively affect the level of happiness and communication skills. It is recommended that women participate in exercise programs such as pilates, step and zumba.

Le soutien des pairs souffrant de psychose : l’expérience du programme « Passer l’espoir au suivant »

For people with a mental health disorder, peer support (peer in the sense of people having recovered from such a disorder) is a great therapeutic value. Alcoholics Anonymous (AA) were the first to show this therapeutic value. Their approach has several elements of which, aside from the "meetings" and the program of the "12 steps," a major element is the sponsorship of an individual by a peer. Since then, appeared organizations based on peer groups, and this new profession of "peer support helper." In the context of a treatment center for people with severe psychotic disorders for which hope is a key ingredient of recovery. Objectives The paper present a young new program inspired by the AA 12 steps programme based mainly on sponsorship of a client by a peer for person suffering of a psychotic type of disorder. Methods A review of literature about the positive effects of sponsorship by a peer in the AA experience, and a description of the new program, its "meetings," and in particular the ethic code of the participants and its twelves specific steps. Differences between the peer sponsor and the new professional "peer support helper" are presented. Results The program that, since its introduction, starts to give some anecdotic results. A change or organisational responsibility has led to a pause for a research programme. Conclusion For the recovery of a severe psychotic condition, there is no unique way to help and this program is one among others.

Development and use of an index for measuring implementation of a weight management program in children in primary care clinics in Texas

BackgroundThe Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The primary care clinic component included the American Academy of Pediatrics’ Next Steps weight management counseling materials that support brief healthy lifestyle-focused visits. The current study describes the methodology and assesses the implementation of the Next Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention.MethodsThe study used a serial cross-sectional study design to collect data from 11 primary care clinics in Houston (n = 5) and Austin (n = 6), Texas, in 2013–2014. Responses of primary care providers on 42 self-reported survey questions assessing acceptability, adoption, appropriateness, and feasibility of the program were utilized to create a mean standardized clinic implementation index score. Provider scores were aggregated to represent Next Steps implementation scores at the clinic level. A mixed effects logistic regression test was conducted to determine the association between program implementation and the enrollment of children in the secondary prevention.ResultsMean implementation index score was lower at Year 2 of implementation (2014) than Year 1 (2013) although the decrease was not significant [63.2% (12.2%) in 2013 vs. 55.3% (16.5%) in 2014]. There were no significant associations between levels of implementation of Next Steps and enrollment into TX CORD secondary prevention study.ConclusionsThe development of an index using process evaluation measures can be used to assess the implementation and evaluation of provider-based obesity prevention tools in primary care clinics.

Baby Steps \u2013 a structured group education programme with accompanying mobile web application designed to promote physical activity in women with a history of gestational diabetes: study protocol for a randomised controlled trial

BackgroundA diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of GDM. Lifestyle interventions have been shown to reduce the risk of incident T2D in adults with impaired glucose tolerance, including in women with a history of GDM. The aim of this study is to establish whether a group self-management education programme, supported by a mobile web application, can improve levels of physical activity at 12 months in women who have had GDM.MethodsThe study is a randomised controlled trial with follow-up at 6 and 12 months. Primary outcome is change in objectively measured average daily physical activity at 12 months. Secondary outcomes include lipid profile, blood pressure, glycated haemoglobin, obesity, smoking and alcohol status, self-reported physical activity, anxiety, depression and quality of life. Participants are recruited from maternity and diabetes departments in hospital trusts in two sites in the UK. Women aged > 18 years, with a diagnosis of GDM during any pregnancy in the previous 60 months are eligible. Participants need to have a good understanding of written and verbal English, be able to give informed consent and have access to a smart-phone. Women who are pregnant or have type 1 or type 2 diabetes are not eligible. In total, 290 participants will be recruited and randomly assigned, with stratification for age and ethnicity, to either the control group, receiving usual care, or the intervention group who are invited to participate in the Baby Steps programme. This comprises a group education programme and access to a mobile web application which provides an education component and interacts with a wrist-worn activity monitor providing automated messages, setting challenges and encouraging motivation.DiscussionIf effective, the Baby Steps programme could be translated into a primary care-based intervention that women with GDM are referred to in the postnatal period. This could help them make lifestyle changes that could reduce their future risk of T2D.Trial registrationISRCTN, ISRCTN17299860. Registered on 5 April 2017.

A systematic review of the Second Step program

This article presents findings from a meta-analysis of 24 primary research studies on the Second Step social emotional learning program. Program content knowledge, outcomes related to prosociality, and outcomes related to antisociality are examined as outcome categories in randomized controlled trials, quasi-experimental studies and, separately, single-group repeated measures design studies. Students participating in Second Step demonstrated increased knowledge of program content and increased prosocial outcomes. Participation in the program was not associated with significant changes in antisocial outcomes. Evidence suggests the possibility of publication bias in studies reporting knowledge outcomes but no evidence of publication bias in studies reporting prosocial and antisocial outcomes. This study complements broader meta-analyses on SEL programs and aims to inform local decision making by providing an estimate of the overall effects of the Second Step program on a variety of student outcomes.

"Homo Caloricus": The epistemological construction of lipophobic stigma in public health media discourses

The case of obesity in Mexico constitutes an emblematic example of how, in the messages emitted by public health television campaigns, strong beliefs regarding the issue of body weight prevail. The main objective is to reflect on certain epistemological effects that abound in biomedical media narratives related to obesity. To do so, aspects of the rhetoric employed in two initiatives of the Ministry of Public Health - Muévete y Métete en Cintura [Move Around and Slim Down] in 2008 and the 5 Steps Program in 2011 - are analyzed, as is the discourse surrounding the tax measure introduced by the Mexican tax service in 2017. This study also looks at other similar practices that, although taking place outside of Mexico, stoke the fires of lipophobism, such as the "Cormillot industry" in Argentina. As a result, a strong discursive influx stemming from a reductionist vision of bodily diversity has been identified, supported by the pathologization of fat bodies through moral prejudices and biased generalizations.

小学校における「満足型」学級づくりへの試み―Q-Uアンケート結果の共有と問題解決支援を中心に―

小学校における「満足型」学級づくりへの試み―Q-Uアンケート結果の共有と問題解決支援を中心に―

Qualitative Exploration of the Feasibility and Acceptability of Workplace-Based Microgrants to Improve Physical Activity: The 10,000 Steps Pedometer Microgrant Scheme.

Despite the benefits associated with workplace health programs, many organizations are unable to offer them due to financial constraints. To address this barrier, the existing 10,000 Steps program trialed the 10,000 Steps Pedometer Microgrant Scheme. This study assessed the feasibility and acceptability of the Microgrant Scheme. Semi-structured interviews with employee representatives (n = 19) were used to explore perceptions of the Microgrant Scheme. Thematic inductive analysis was conducted. Three main themes emerged: 1) the need for workplace initiatives to address health promotion issues (The Need); 2) the factors associated with the application and implementation process (The Process); and 3) employee and employer benefits associated with the Microgrant Scheme (The Outcomes). These findings highlight the potential utility of a Microgrant Scheme to extend the reach and long-term sustainability of workplace health promotion activities.

Implementation of Perception Communication Construct of Sound and Rhythm in Children with Hearing Impairment: Case Study in Pre-School and Kindergarten

Communication is very important in the life. The children that were born with hearing impairment get less access to speech acoustic information for detecting and discriminating among speech sounds. Therefore, some program is needed to develop the remaining hearing. Perception Communication Construct of Sound and Rhythm (Bina Komunikasi Persepsi Bunyi dan Irama/BKPBI) is a program that aims to develop the potential for hearing to communicate. The aim of this study wa to know the implementation of BKPBI at TK-LB Santi Rama in Jakarta. This study used qualitative method by collecting observation data from classroom and BKPBI program, and interviewing the principal and teachers in the school. The results showed that the school implemented BKPBI program in the big class, private class, and in BKPBI room. The school implemented three step program such as assessment, implementation and evaluation. Besides, There is individual and classical program for hearing and articulation program.

Physiotherapy in the management of patients with peritoneal carcinomatosis receiving cytoreductive surgery

The development of multidisciplinary work around patients receiving cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) with thoracic epidural analgesia led us to articulate our reciprocal skills in a care program. Since 2012, a preoperative consultation of physiotherapy has been set up for these patients. Between 2009 and 2013, 124 patient's files have been analysed, comparing “Patient controlled epidural analgesia (PCEA) with physiotherapy” (67 patients) and “PCEA without physiotherapy” (57 patients). The reduction of the patient's apprehension of physiotherapy and mobilization contributed to the reduction of the length of stay in intensive care unit (on average 5 days instead of 7) and an early out of bed mobilization (one day gained). After 4 years of operation, we conducted a retrospective study of patient's files in order to evaluate the efficiency of this first step programme about the role of physiotherapy in this patient's care pathway. We estimated the length of stay and the way to go back home. Three hundred and sixty-six files had been analysed. Patient’ pathway had been systematically organized including this physiotherapy consultation during the month before surgery. The content of the consultation has been adapted including 3 parts leading to a real therapeutic educational program; –information on the physiotherapy that will begin the day after the surgery: respiratory mechanics, interest of early mobilization to warn the postoperative complications; –education of the patient with teaching of techniques of respiratory physiotherapy; –a notebook containing advice for improving the physical condition is given to the patient by adjusting the dosage and the intensity according to his basic state. Physiotherapy included in preoperative management is part of improving the quality of care provided to patients, allowing them a better participation in the postoperative care. This preoperative consultation had been adapted to better support the patient and his family.

Friends’ Company Affected My Life: A Case Study

Drug addiction leads to lack of control over behavior and compulsion of behavior in taking drugs despite of adverse consequences. The withdrawal symptoms of drug addiction disorder can be managed by medication and various psychological strategies such as Psycho-education, deep breathing, Progressive muscle relaxation (PMR), Positive coping statement, Distraction techniques, motivation enhancement therapy, assertive training, Costbenefit analysis, Relapse prevention, Anger management and12 step program.

The Effect ofa Web-based Physical Activity Promotion Program on Sedentary Behavior

Time spent engaging in sedentary behavior represents a growing public health concern, with many national physical activity guidelines now also including recommendations on reducing sedentary time. Sedentary behavior contributes to a range of poor health outcomes. Web-based interventions are increasingly used in health promotion given their broad reach and ability to engage participants through Web 2.0 technologies. The WALK 2.0 intervention (a Web 2.0-based physical activity intervention) has demonstrated effectiveness in increasing physical activity, yet its impact on sedentary behaviour is unknown. PURPOSE: To investigate the effectiveness of the WALK 2.0 intervention on sedentary behaviour. METHODS: Participants were 504 (328 female and 176 male, mean age 50.8±13.1 years) adults randomised to one of two web-based interventions or a paper-based Logbook group. Those in the Web 1.0 group participated in the existing 10,000 Steps program and those in the Web 2.0 group participated in a Web 2.0-enabled physical activity intervention that included social networking capabilities. Sedentary behaviour was assessed using ActiGraph GT3X activity monitors and was recorded in terms of total minutes of sedentary time per day and number of bouts (> 10 minutes) of sedentary time per day. RESULTS: For total daily minutes of sedentary behaviour, repeated measures analysis showed no significant group x time interactions in either the unadjusted model (p=0.46) or the model adjusted for gender, age at baseline, BMI, education, and accelerometer wear time (p=0.58). No significant group x time interactions were shown for daily bouts of sedentary time in either the unadjusted (p=0.21) or adjusted (p=0.21) models. There were no significant changes in total minutes or number of bouts of sedentary behaviour within groups or across time. CONCLUSIONS: The WALK 2.0 intervention is not effective in reducing sedentary behavior. Specific behavior strategies targeting both sedentary behaviour and physical activity are necessary and their implementation requires careful consideration in the design phase.

Clinical outcomes of a stepped care program for borderline personality disorder.

This study examines the clinical outcomes of two clinics for borderline personality disorder (BPD) in a naturalistic setting, offering a stepped care model with both short-term (ST) treatment lasting 12weeks and extended care (EC) up to 24months. A total of 479 patients attending the ST clinic and 145 attending the EC clinic were assessed on depression, impulsivity, self-esteem, emotion dysregulation, substance abuse, self-harm and suicidality. There were significant reductions in all symptoms in both clinics with the exception that substance abuse was only reduced in the EC clinic. On all symptoms, no significant differences in magnitude of changes were observed between patients who stayed in EC clinic for 6-12months in comparison to those who stayed for 18-24months. These results support the concept that for the majority of patients with BPD, brief treatment can be effective. While some patients still need longer treatment, the results are encouraging for brief treatment as a first step for the majority of patients with BPD. While this study adds to the weight of evidence to support ST interventions for patients with BPD, further research using a control group is needed. Copyright © 2018 John Wiley & Sons, Ltd.

Friends’ Company Affected My Life: A Case Study

Drug addiction leads to lack of control over behavior and compulsion of behavior in taking drugs despite of adverse consequences. The withdrawal symptoms of drug addiction disorder can be managed by medication and various psychological strategies such as Psycho-education, deep breathing, Progressive muscle relaxation (PMR), Positive coping statement, Distraction techniques, motivation enhancement therapy, assertive training, Costbenefit analysis, Relapse prevention, Anger management and12 step program.

Longitudinal predictors of caregiver burden in amyotrophic lateral sclerosis: a population-based cohort of patient-caregiver dyads.

Caregiver burden is a recognised consequence of caring for a patient with neurodegeneration. Amyotrophic lateral sclerosis (ALS) differs from other neurodegenerations by its rapid progression and impairment of motor, cognitive, and behavioural function, which contribute to caregiver burden. However, longitudinal factors that determine the extent of caregiver burden, and in particular the impact of psychological distress among caregivers, have not been fully established. Patients with ALS (n=85) and their primary caregivers (n=85) completed three serial evaluations. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). The Edinburgh Cognitive-Behavioural ALS Screen (ECAS) was used to determine cognitive function in patients. The ALS Functional Rating Scale (ALSFRS-R) measured disease progression. Using the ZBI, caregivers were categorised as high or low burden. In the low burden group, anxiety scores from the HADS predicted caregiver burden (r=0.410, F=3.73, p=0.033), whereas the depression sub-score from the HADS was predictive of caregiver burden in the high burden group (r=0.501, F=5.87, p=0.006) for cross-sectional analyses. Longitudinally, an elevated score on the HADS at Time 1 was the largest predictor of caregiver burden across serial assessments. In a patient cohort with relatively preserved cognitive function (65%), anxiety and depression at Time 1, as measured by the HADS, were the best predictors of caregiver burden at Time 3. This observation provides a mechanism by which caregiver burden can be identified by health-care professionals and a stepped care programme of intervention initiated.

\u201cHappy feet\u201d: evaluating the benefits of a 100-day 10,000 step challenge on mental health and wellbeing

BackgroundAn increased awareness of the health benefits of walking has emerged with the development and refinement of accelerometer equipment. Evidence is beginning to highlight the value of promoting walking, particularly focusing on the Japanese mark of obtaining 10,000 steps per day. Workplace based step challenges have become popular to engage large cohorts in increasing their daily physical activity in a sustainable and enjoyable way. Findings are now highlighting the positive health effects of these medium-term programs (typically conducted over a few months) in terms of cardiovascular health, reducing diabetes risk and improving lifestyle factors such as weight and blood pressure. As yet, research has not focused on whether similar improvements in psychological health and wellbeing are present.MethodsThis study investigated the impact of a 100-day, 10,000 step program on signs of depression, anxiety and stress as well as general wellbeing using standardised psychological scales.ResultsThe results indicated a small but consistent effect on all of these measures of mental health over the term of the program. This effect appeared irrespective of whether a person reached the 10,000 step mark.ConclusionsThese results highlight improved mental health and wellbeing in people undertaking this 100-day 10,000 step program and indicates the efficacy and potential of these programs for a modest, yet important improvement in mental health. Notably, targets reached may be less important than participation itself.

The Progression of End-of-Life Wishes and Concordance with End-of-Life Care.

Since 2013, Kaiser Permanente Northern California has engaged in a systematic effort to elicit, document, and honor the care preferences of patients as they near the end of life. This is done through its Advanced Steps program, in which selected patients discuss their preferences for future medical care with their healthcare agent during a structured conversation with a trained advance care planning facilitator. The facilitator then translates the patient's wishes into an actionable medical order set using a Physician's Order for Life-Sustaining Treatment (POLST) form. We wanted to know whether these patients' recorded wishes were concordant with care received at the end of life. To evaluate, we conducted an in-depth chart review of 300 patients who died in 2015 and had participated in the program. We determined that 290 patients received concordant care, whereas three patients received care discordant with their wishes before death. Seven patients did not have sufficient information in their record to determine concordance. Interestingly, we found care preferences often changed over time; ∼20% of patients revised their end-of-life preferences after having the facilitated conversation, with most of those patients opting for less intensive care. Most changes to preferences were made verbally in the final setting of care. While advance care planning and the POLST form provide invaluable tools for recording patients' wishes, our study highlights a need to track patients' wishes as they evolve over time and a need for ongoing, real-time conversations about goals of care, even after a POLST is completed.