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In many kinesiology and health care science departments in the United States, there is a mismatch between the demographic composition of the student population and the faculty cohort. That is, although student populations are more diverse, the faculty cohort does not reflect this same diversity. The purpose of this paper is threefold: (a) Provide background information on the faculty–student mismatch, (b) discuss reactive strategies to increase diversity among a faculty cohort, and (c) discuss proactive strategies to increase diversity among a faculty cohort. Our approach is pragmatic and concise, which will give the reader various strategies they can incorporate to increase diversity in their faculty cohort. [ABSTRACT FROM AUTHOR]

Mobility declines in older adults can be determined through monitoring longitudinal changes in gait speed. We examined longitudinal changes [in] ankle proprioception among those with and without baseline lower extremity numbness to develop a better understanding of mobility declines in healthy older adults. Participants included 568 adults (52.8% women) aged 60–98 years from the Baltimore Longitudinal Study of Aging. Larger ankle proprioception decreases during plantar flexion were found in the participants with lower extremity numbness compared with those without numbness (p =.034). Among participants with lower extremity numbness, slower baseline speeds from both usual and fast pace gait were associated with performance decline in ankle proprioception measured during ankle dorsiflexion (p =.039 and p =.004, respectively). Assisting older adults, especially those with lower extremity numbness, to maintain and improve ankle proprioception may help prevent mobility declines that have previously been considered age related. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic created challenges for U. S. nursing home administrators (NHA) and staff. This study explored organizational and psychological factors associated with NHA stress, dissatisfaction, and turnover intent (TI) during the third year of the pandemic. Results from a nationwide, cross-sectional survey of 1139 NHAs were merged with Centers for Medicare and Medicaid Services nursing home survey deficiency, staffing, complaint, and other operations data. A hierarchical, generalized estimating equations model with ordered logit link found that NHAs with higher COVID stress (AOR = 1.65, 95% CI = 1.22, 2.23), higher use of agency/contract staff (AOR = 1.50, 95% CI = 1.08.2.09) and higher role conflict were more likely to indicate TI. NHAs with higher job satisfaction in workload, work content, and rewards were less likely to hold TI. Industry leaders should create strategies to reduce NHA's job stress and role conflicts and provide opportunities for improving staff recruitment and retention, reducing reliance on agency staffing. [ABSTRACT FROM AUTHOR]

Background: Obesity is a leading cause of preventable death among individuals with serious mental illness (SMI). A prior randomized controlled trial demonstrated the efficacy of a lifestyle style intervention tailored to this population; however, such interventions need to be adapted and tested for real‐world settings. Aims: This study evaluated implementation interventions to support community mental health program staff to deliver an evidence‐based lifestyle intervention to clients with obesity and SMI. Materials & Methods: In this cluster‐randomized pilot trial, the standard arm combined multimodal training with organizational strategy meetings and the enhanced arm included all standard strategies plus performance coaching. Staff‐coaches delivered a 6‐month group‐based lifestyle intervention to clients with SMI. Primary outcomes were changes in staff knowledge, self‐efficacy, and fidelity scores for lifestyle intervention delivery. Linear mixed‐effects modeling was used to analyze outcomes, addressing within‐site clustering and within‐participant longitudinal correlation of outcomes. Results: Three sites were in the standard arm (7 staff‐coaches); 5 sites in the enhanced arm (11 staff‐coaches). All sites delivered all 26 modules of the lifestyle intervention. Staff‐coaches highly rated the training strategy's acceptability, feasibility and appropriateness. Overall, mean knowledge score significantly increased pre‐post by 5.5 (95% CI: 3.9, 7.1) and self‐efficacy was unchanged; neither significantly differed between arms. Fidelity ratings remained stable over time and did not differ between arms. Clients with SMI achieved a mean 6‐month weight loss of 3.8 kg (95% CI: 1.6, 6.1). Conclusions: Mental health staff delivering a lifestyle intervention was feasible using multicomponent implementation interventions, and preliminary results show weight reduction among clients with SMI. The addition of performance coaching did not significantly change outcomes. Future studies are needed to definitively determine the effect on client health outcomes. [ABSTRACT FROM AUTHOR]

Background: Given the obesity's high prevalence among individuals with serious mental illness (SMI), translating weight‐loss interventions with demonstrated effectiveness is needed. This study describes the initial translation phase of such an intervention using the Enhanced Replicating Effective Programs (REP) Framework for delivery by mental health program staff. Methods: The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (Achieving Healthy Lifestyles in Psychiatric Rehabilitation) trial intervention was preliminarily adapted to create the ACHIEVE‐Dissemination (ACHIEVE‐D) curriculum. A treatment‐only study was conducted to rapidly evaluate the curriculum using a mixed‐methods approach including surveys and focus groups. A study coach delivered an abbreviated curriculum to individuals with SMI from a single psychiatric program. Among all participants with SMI (n = 17), outcomes were attendance and satisfaction; 14 participated in a focus group. The program staff observed curriculum delivery and participated in a focus group (n = 3). Results: Overall, 23 group sessions were delivered. Median attendance was 78.6% across participants with SMI; 92.9% would recommend ACHIEVE‐D to others. The staff found the curriculum acceptable, particularly its structured nature, inclusion of weight management and exercise, and integrated goal setting and tracking. These improvements recommended by participants and/or staff were to assess participant readiness‐to‐change prior to enrollment, change the frequency of weigh‐ins, and train staff coaches on anticipated challenges (e.g., exercise engagement, weight fluctuations). Conclusions: During this first REP phase, individuals with SMI and program staff were satisfied with ACHIEVE‐D. Additional refinements will aid future implementation and improve participant experience. [ABSTRACT FROM AUTHOR]

This randomized clinical trial investigates if an 18-month tobacco-smoking cessation intervention including weight management is effective in adults with serious mental illness who may not be ready to quit smoking right away. Key Points: Question: Is an 18-month, tobacco-smoking cessation intervention with pharmacologic and behavioral components, including weight management, effective in adults with serious mental illness who are not necessarily ready to quit smoking right away? Findings: In this randomized clinical trial enrolling 192 participants in community settings who reported interest in quitting smoking within 1 or 6 months, 26.4% of the intervention group and 5.7% of the control group achieved smoking abstinence at 18 months, without significant weight gain. Meaning: These findings support implementation of extended-duration tobacco cessation treatment to reduce smoking rates and cardiovascular risk in this population with elevated smoking and obesity prevalence. Importance: Tobacco smoking drives markedly elevated cardiovascular disease risk and preventable death in persons with serious mental illness, and these risks are compounded by the high prevalence of overweight/obesity that smoking cessation can exacerbate. Guideline-concordant combined pharmacotherapy and behavioral smoking cessation treatment improves abstinence but is not routinely offered in community settings, particularly to those not seeking to quit smoking immediately. Objective: To determine the effectiveness of an 18-month pharmacotherapy and behavioral smoking cessation intervention incorporating weight management and support for physical activity in adults with serious mental illness interested in quitting smoking within 1 or 6 months. Design, Setting, and Participants: This was a randomized clinical trial conducted from July 25, 2016, to March 20, 2020, at 4 community health programs. Adults with serious mental illness who smoked tobacco daily were included in the study. Participants were randomly assigned to intervention or control, stratified by willingness to try to quit immediately (within 1 month) or within 6 months. Assessors were masked to group assignment. Interventions: Pharmacotherapy, primarily varenicline, dual-form nicotine replacement, or their combination; tailored individual and group counseling for motivational enhancement; smoking cessation and relapse prevention; weight management counseling; and support for physical activity. Controls received quitline referrals. Main Outcome and Measures: The primary outcome was biochemically validated, 7-day point-prevalence tobacco abstinence at 18 months. Results: Of the 298 individuals screened for study inclusion, 192 enrolled (mean [SD] age, 49.6 [11.7] years; 97 women [50.5%]) and were randomly assigned to intervention (97 [50.5%]) or control (95 [49.5%]) groups. Participants self-identified with the following race and ethnicity categories: 93 Black or African American (48.4%), 6 Hispanic or Latino (3.1%), 90 White (46.9%), and 9 other (4.7%). A total of 82 participants (42.7%) had a schizophrenia spectrum disorder, 62 (32.3%) had bipolar disorder, and 48 (25.0%) had major depressive disorder; 119 participants (62%) reported interest in quitting immediately (within 1 month). Primary outcome data were collected in 183 participants (95.3%). At 18 months, 26.4% of participants (observed count, 27 of 97 [27.8%]) in the intervention group and 5.7% of participants (observed count, 6 of 95 [6.3%]) in the control group achieved abstinence (adjusted odds ratio [OR], 5.9; 95% CI, 2.3-15.4; P <.001). Readiness to quit within 1 month did not statistically significantly modify the intervention's effect on abstinence. The intervention group did not have significantly greater weight gain than the control group (mean weight change difference, 1.6 kg; 95% CI, −1.5 to 4.7 kg). Conclusions and Relevance: Findings of this randomized clinical trial showed that in persons with serious mental illness who are interested in quitting smoking within 6 months, an 18-month intervention with first-line pharmacotherapy and tailored behavioral support for smoking cessation and weight management increased tobacco abstinence without significant weight gain. Trial Registration: ClinicalTrials.gov Identifier: NCT02424188 [ABSTRACT FROM AUTHOR]

Obstacle crossing, such as stepping over a curb, exerts additional demands on balance control, and therefore the study of usualpace gait patterns associated with obstacle-crossing performance may provide additional insight into understanding falls and deterioration of gait in older adults. Participants included 432 adults aged 60-96 years (218 women). Participants who failed the obstacle-crossing task (n = 181) walked slower with smaller knee range of motion than participants who successfully completed the obstacle-crossing task (all ps < .001). Participants who failed the obstacle crossing reported a greater likelihood of falling in the previous year, more balance problems, lower walking ability, and needed longer time to complete 5 chair stands than those who passed the task (all ps < .05). Obstacle-crossing task may identify gait patterns in older adults who appear functionally intact, but who are nonetheless at risk of fall and balance problems. [ABSTRACT FROM AUTHOR]

Fewer than 1 in 4 adults achieves the recommended amount of physical activity, with lower activity levels reported among some groups. Addressing low levels of physical activity among underresourced groups provides a modifiable target with the potential to improve equity in cardiovascular health. This article (1) examines physical activity levels across strata of cardiovascular disease risk factors, individual level characteristics, and environmental factors; (2) reviews strategies for increasing physical activity in groups who are underresourced or at risk for poor cardiovascular health; and (3) provides practical suggestions for physical activity promotion to increase equity of risk reduction and to improve cardiovascular health. Physical activity levels are lower among those with elevated cardiovascular disease risk factors, among certain groups (eg, older age, female, Black race, lower socioeconomic status), and in some environments (eg, rural). There are strategies for physical activity promotion that can specifically support underresourced groups such as engaging the target community in designing and implementing interventions, developing culturally appropriate study materials, identifying culturally tailored physical activity options and leaders, building social support, and developing materials for those with low literacy. Although addressing low physical activity levels will not address the underlying structural inequities that deserve attention, promoting physical activity among adults, especially those with both low physical activity levels and poor cardiovascular health, is a promising and underused strategy to reduce cardiovascular health inequalities. [ABSTRACT FROM AUTHOR]

Achieving recommended levels of physical activity is important for optimal cardiovascular health and can help reduce cardiovascular disease risk. Emerging evidence suggests that physical activity fluctuates throughout the life course. Some life events and transitions are associated with reductions in physical activity and, potentially, increases in sedentary behavior. The aim of this scientific statement is to first provide an overview of the evidence suggesting changes in physical activity and sedentary behavior across life events and transitions. A second aim is to provide guidance for health care professionals or public health workers to identify changes and promote physical activity during life events and transitions. We offer a novel synthesis of existing data, including evidence suggesting that some subgroups are more likely to change physical activity behaviors in response to life events and transitions. We also review the evidence that sedentary behavior changes across life events and transitions. Tools for health care professionals to assess physical activity using simple questions or wearable devices are described. We provide strategies for health care professionals to express compassion as they ask about life transitions and initiate conversations about physical activity. Last, resources for life phase-specific, tailored physical activity support are included. Future research needs include a better characterization of physical activity and sedentary behavior across life events and transitions in higher-risk subgroups. Development and testing of interventions designed specifically to combat declines in physical activity or increases in sedentary behavior during life events and transitions is needed to establish or maintain healthy levels of these cardiovascular health-promoting behaviors. [ABSTRACT FROM AUTHOR]

Consideration of knee pain can be crucial for identifying fall-related gait patterns. While walking, gait parameters at usual speed were examined in persons with different falls and knee pain status. A total of 439 adults aged 60–92 years participated in this study. Persons with a history of falls had a wider stride width (p =.036) and longer double support time (p =.034) than nonfallers. In the absence of knee pain, fallers had longer double support time than nonfallers (p =.012), but no differences in double support time by history of falls were observed in participants with knee pain. With slower gait speed, fallers with knee pain have narrower stride width and larger hip range of motion (p =.027 and p =.001, respectively). Results suggest the importance of considering knee pain in fall studies for better understanding the fall-related differential gait mechanisms and for designing fall prevention intervention strategies. [ABSTRACT FROM AUTHOR]

• Balance related gait efficiency in older adults. • Functional leg muscle strength can be related with gait deficits in balance. • Examining the associations between leg muscle strength and gait performance under different balance conditions. • Comprehensive measurement of gait performance for early detection of gait issues in older adults. Balance-related gait patterns in older adults can be objectively discerned through the examination of gait parameters, maximum leg torques, and their interconnections. To investigate the correlation between leg muscle strength and balance during gait concerning functional performance in healthy older adults. Participants included 117 adults aged 60-95 years were recruited from the Baltimore Longitudinal Study of Aging (BLSA). They underwent evaluations of gait, balance, and maximum isometric leg torque (for both hamstrings and quadriceps). Analyses examined the association between leg torque and functional performance among those with higher and lower balances. Individuals with lower balance (n = 43) were older, more prone to experiencing a fear of falling, and exhibited lower functional performance (gait speeds and Generalized Gait Stability Scores (GGSS), ps < 0.001) compared to their counterparts with higher balance (n = 74). At a usual walking pace, the GGSS showed a positive association with concentric Quadriceps Maximum Torque (QMT) in participants with lower balance (p = 0.013). Conversely, it displayed a positive association with eccentric QMT in those with higher balance (p = 0.014). At a fast walking pace, only individuals with higher balance demonstrated a positive muscle torque association with both gait speed and GGSS, encompassing concentric and eccentric actions in both the quadriceps and hamstrings (ps < 0.050). Evaluating muscle strength capacity in both concentric and eccentric phases during dynamic high-effort events, along with investigating their associations with gait performance, can be beneficial for identifying subtle gait deficits. This comprehensive approach may assist in the early detection of gait deterioration among healthy older adults, given the intricate muscle activations involved in lower body functional performance. [ABSTRACT FROM AUTHOR]

People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical trials; however, the uptake of these interventions into real-life clinical settings remains limited. Implementation strategies, which constitute the "how to" component of changing healthcare practice, are critical to supporting the scale-up of evidence-based interventions that can improve the cardiovascular health of people with SMI. And yet, implementation strategies are often poorly described and rarely justified theoretically in the literature, limiting the ability of researchers and practitioners to tease apart why, what, how, and when implementation strategies lead to improvement. In this Perspective, we describe the implementation strategies that the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness is using to scale-up three evidenced-based interventions related to: (1) weight loss; (2) tobacco smoking cessation treatment; and (3) hypertension, dyslipidemia, and diabetes care for people with SMI. Building on concepts from the literature on complex health interventions, we focus on considerations related to the core function of an intervention (i.e., or basic purposes of the change process that the health intervention seeks to facilitate) vs. the form (i.e., implementation strategies or specific activities taken to carry out core functions that are customized to local contexts). By clearly delineating how implementation strategies are operationalized to support the interventions' core functions across these three studies, we aim to build and improve the future evidence base of how to adapt, implement, and evaluate interventions to improve the cardiovascular health of people with SMI. [ABSTRACT FROM AUTHOR]

Objective: This study investigates predictors of weight loss among individuals with serious mental illness participating in an 18-month behavioral weight loss intervention, using Lasso regression to select the most powerful predictors. Methods: Data were analyzed from the intervention group of the ACHIEVE trial, an 18-month behavioral weight loss intervention in adults with serious mental illness. Lasso regression was employed to identify predictors of at least five-pound weight loss across the intervention time span. Once predictors were identified, classification trees were created to show examples of how to classify participants into having likely outcomes based on characteristics at baseline and during the intervention. Results: The analyzed sample contained 137 participants. Seventy-one (51.8%) individuals had a net weight loss of at least five pounds from baseline to 18 months. The Lasso regression selected weight loss from baseline to 6 months as a primary predictor of at least five pound 18-month weight loss, with a standardized coefficient of 0.51 (95% CI: −0.37, 1.40). Three other variables were also selected in the regression but added minimal predictive ability. Conclusions: The analyses in this paper demonstrate the importance of tracking weight loss incrementally during an intervention as an indicator for overall weight loss, as well as the challenges in predicting long-term weight loss with other variables commonly available in clinical trials. The methods used in this paper also exemplify how to effectively analyze a clinical trial dataset containing many variables and identify factors related to desired outcomes. [ABSTRACT FROM AUTHOR]

Context: Higher levels of insulin-like growth factor-1 (IGF-1) are associated with increased risk of cancers and higher mortality. Therapies that reduce IGF-1 have considerable appeal as means to prevent recurrence. Design: Randomized, 3-parallel-arm controlled clinical trial. Interventions and Outcomes: Cancer survivors with overweight or obesity were randomized to (1) self-directed weight loss (comparison), (2) coach-directed weight loss, or (3) metformin treatment. Main outcomes were changes in IGF-1 and IGF-1:IGFBP3 molar ratio at 6 months. The trial duration was 12 months. Results: Of the 121 randomized participants, 79% were women, 46% were African Americans, and the mean age was 60 years. At baseline, the average body mass index was 35 kg/m2; mean IGF-1 was 72.9 (SD, 21.7) ng/mL; and mean IGF1:IGFBP3 molar ratio was 0.17 (SD, 0.05). At 6 months, weight changes were -1.0% (P = 0.07), -4.2% (P < 0.0001), and -2.8% (P < 0.0001) in self-directed, coach-directed, and metformin groups, respectively. Compared with the self-directed group, participants in metformin had significant decreases on IGF-1 (mean difference in change: -5.50 ng/mL, P = 0.02) and IGF1:IGFBP3 molar ratio (mean difference in change: -0.0119, P = 0.011) at 3 months. The significant decrease of IGF-1 remained in participants with obesity at 6 months (mean difference in change: -7.2 ng/mL; 95% CI: -13.3 to -1.1), but not in participants with overweight (P for interaction = 0.045). There were no significant differences in changes between the coach-directed and self-directed groups. There were no differences in outcomes at 12 months. Conclusions: In cancer survivors with obesity, metformin may have a short-term effect on IGF-1 reduction that wanes over time. [ABSTRACT FROM AUTHOR]

Background: Obesity is linked to poorer physical functioning in older adults, but impact of excess adiposity on loss of functional capacity in late midlife is unclear. This study examined associations between adiposity markers and 11-year change in maximal walking speed, a sensitive indicator of physical functioning, among adults aged 55 to 69 years. Method: Maximal walking speed over 6.1 m was assessed in 2000 and 2011 among Finnish men (n = 409) and women (n = 498) from the prospective Health 2000 Survey. Body mass index (BMI) and waist circumference were assessed in 2000. Generalized estimating equation models estimated changes in maximal walking speed by BMI and waist circumference, stratified by sex. Results: BMI greater than 30 kg/m2 was associated with accelerated decline in maximal walking speed particularly in women. Associations with waist circumference were nonsignificant. Conclusion: Late midlife obesity may speed up the decline in functional capacity as measured by maximal walking speed, especially in women. [ABSTRACT FROM AUTHOR]

Obesity presents an important public health problem that affects more than a third of the U.S. adult population and that is associated with increased morbidity, mortality, and costs. Previously, we documented that two primary care-based weight loss interventions were clinically effective. To encourage the implementation of and reimbursement for these interventions, we evaluated their relative cost-effectiveness. We performed a cost analysis of the Practice-based Opportunities for Weight Reduction (POWER) trial, a three-arm trial that enrolled 415 patients with obesity from six primary care practices. Trial participants were randomized to a control arm, an in-person support intervention, or a remote support intervention; in the two intervention arms, behavioral interventions were delivered over 24 months, in two phases. Weight loss was measured at 6, 12, and 24 months. Using timesheets and empirical data, we evaluated the cost of the in-person and remote support interventions from the perspective of a health care system delivering the interventions. A univariate sensitivity analysis was conducted to evaluate uncertainty around model assumptions. All comparisons were tested using independent t -tests. Cost of the in-person intervention was higher at 6 months ($113 per participant per month and $117 per kg lost) than the remote support intervention ($101 per participant per month and $99 per kg lost; p <.001). Costs were also higher for the in-person support intervention at 24 months ($73 per participant per month and $342 per kg lost) than for the remote support intervention ($53 per participant per month and $275 per kg lost; p <.001). In the sensitivity analyses, cost ranged from $274/kg lost to $456/kg lost for the in-person support intervention and from $218/kg to $367/kg lost for the remote support intervention. A primary care weight loss intervention administered remotely was relatively more cost-effective than an in-person intervention. Expanding the scope of reimbursable programs to include other cost-effective interventions could help ensure that a broader range of patients receive the type of support needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Overweight and obesity are significant concerns for first responders (firefighters and emergency medical service providers). OBJECTIVE: This pilot study examines the feasibility of a weight loss program for career first responders. METHODS: Participants were career first responders with BMI≥30 and interest in losing weight. Baseline height, weight, and body composition using dual x-ray absorptiometry, Pittsburgh Sleep Quality Index (PSQI), and a Functional Movement Screen (FMS) with follow-up weight and body composition were assessed. A 10-week weight loss program used evidence-based lifestyle goals (encouraged increasing activity levels, using tailored calorie goals, following the DASH diet, tracking with a phone app) and weekly in-person sessions with a student coach-in-training who reviewed weight and tracking information. RESULTS: Participants (N = 10) were 39.0±9.9 years old with a BMI of 35.6±4.7 kg/m2. There were significant reductions in weight –4.8±2.3 kg and percent body fat –3.9±1.7%. All participants had a PSQI score >5 indicating poor quality of sleep. Nine participants had FMS scores ≤14 indicating increased risk of injury. CONCLUSION: The use of commercially available apps with support from a student coach-in-training and evidence-based weight loss recommendations is a feasible approach to support career firefighters in their weight loss efforts. [ABSTRACT FROM AUTHOR]

Background: Accelerometers measure intensity, frequency, and duration of physical activity. However, the scarcity of reports on data reduction makes comparing accelerometer results across studies difficult. Methods: Participants were asked to wear a triaxial accelerometer (RT3) for ≥10 hours for at least 4 days, including one weekend day. We summarize our data-cleaning procedures and assess the impact of defining a usable day of measurements as at least 6, 8, or 10 hours of wear time, and of standardizing data to a 12-hour day. Results: Eighty-two percent of participants met wear time requirements; 93% met requirements when we defined a day as 8-or-more hours of wear time. Normalization of data to a 12-hour day had little impact on estimates of daily moderate-to-vigorous physical activity (MVPA; 16.9 vs. 17.1 minutes); restricting MVPA to activities occurring in bouts of 10 minutes or longer had greater impact (16.9 vs. 6.3 minutes per day). Conclusion: Our account of accelerometry quality-control and data-cleaning procedures documents the small impact of variations in daily wear time requirements on MVPA estimates, and the larger impact of evaluating total MVPA vs. MVPA occurring in extended bouts. This paper should allow other researchers to duplicate or revise our methods as needed. [ABSTRACT FROM AUTHOR]

Little research exists to identify optimal coaching behaviors and factors that influence the effectiveness of particular behaviors. The present study tested 484 athletes in order to determine sub-scales on the Coaching Behavior Questionnaire (CBQ). The CBQ measures athletes' perceptions of coaching behaviors and evaluates their effectiveness in helping athletes play better and maintain optimal mental states and focus. A confirmatory factor analysis (CFA) supported the two-factor model (negative activation, supportiveness/emotional composure) derived from an exploratory factor analysis (EFA). Correlational analyses indicated that athletes with higher anxiety and lower self-confidence and compatibility with the coach were more likely to negatively evaluate coaching behaviors. The results support and expand on Smoll and Smith's (1989) model of leadership behaviors in sport. [ABSTRACT FROM AUTHOR]

Objective: Given the high prevalence of obesity and diabetes in patients with serious mental illness (SMI) and the lack of evidence on the effects of weight loss programs in SMI patients with diabetes, we evaluated the effectiveness of a behavioral weight loss intervention among SMI participants with and without diabetes.Research Design and Methods: Using data from ACHIEVE, a randomized controlled trial to evaluate the effects of a behavioral weight loss intervention among overweight/obese people with SMI, we assessed and compared weight change from baseline to 18 months in participants with and without diabetes using a longitudinal mixed-effects model.Results: Of the 291 trial participants, 82 (28.2%) participants had diabetes (34 and 48 in intervention and control groups, respectively) at baseline. Participants with diabetes were more likely to be taking antipsychotics (31.7% vs. 18.7%, P = 0.02). At 18 months, participants in the control group with diabetes lost 1.2 lb (0.6%) of body weight compared with 0.8 lb (0.7%) among those without diabetes. In the intervention group, participants with diabetes lost 13.7 lb (6.6%) of their initial body weight compared with 5.4 lb (2.9%) for those without diabetes. Corresponding net effects (intervention minus control) were 4.6 lb (2.2%) and 12.5 lb (6.0%) net weight reduction over 18 months in the no diabetes and the diabetes subgroups, respectively. However, the between-group difference in intervention effects was statistically nonsignificant (absolute weight change: P-interaction = 0.08; % weight change: P-interaction = 0.10).Conclusions: A behavioral weight loss intervention is effective among overweight and obese individuals with SMI regardless of their diabetes status. [ABSTRACT FROM AUTHOR]

People with serious mental illnesses (SMIs) die 10–20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achieving widespread implementation of these interventions is a public health priority. In this Perspective, we consider strategies for scaling the ACHIEVE behavioral weight loss intervention for people with SMI, shown to be effective in a randomized clinical trial (RCT), to mental health programs in the U.S. and internationally. Given the barriers to high-fidelity implementation of the complex, multi-component ACHIEVE intervention in often under-resourced mental health programs, we posit that substantial additional work is needed to realize the full public health potential of this intervention for people with SMI. We discuss considerations for successful "scale-up," or efforts to expand ACHIEVE to similar settings and populations as those included in the RCT, and "scale-out," or efforts to expand the intervention to different mental health program settings/sub-populations with SMI. For both, we focus on considerations related (1) intervention adaptation and (2) implementation strategy development, highlighting four key domains of implementation strategies that we believe need to be developed and tested: staff capacity building, leadership engagement, organizational change, and policy strategies. We conclude with discussion of the types of future research needed to support ACHIEVE scale-up/out, including hybrid trial designs testing the effectiveness of intervention adaptations and/or implementations strategies. [ABSTRACT FROM AUTHOR]

Background: It is well established that facing a cognitive challenge while carrying out a motor task interferes with the motor task performance, and in general the ability of handling a dual-task declines progressively with aging. However, the reasons for this decline have not been fully elucidated. Understanding the association between usual-walking gait patterns and dual-task walking performance may provide new insights into the mechanisms that lead to gait deterioration in normal aging and its link to motor and cognitive function.Research Question: Our aim was to assess usual gait parameters in kinematics and kinetics to understand how these parameters are related with a specific task in dual-task walking.Methods: We hypothesized that difficulty in dual-task walking would be associated with gait deteriorations as reflected in range of motion and mechanical work expenditure. We tested this hypothesis by quantifying the gait of 383 participants in the Baltimore Longitudinal Study of Aging (68% of whom successfully completed the dual-task walk, 21% failed the motor task, and 11% failed the cognitive task).Results: Compared to successful performers, participants who failed the single motor task had slower gait speed, shorter stride length, higher cadence, and lower range of motion in the knee and ankle joints (p < 0.05, for all), while the participants who failed the cognitive task while walking had longer double support time (p = 0.003), and greater knee absorptive mechanical work (p = 0. 001) and lower ankle generative mechanical work (p < 0. 001).Significance: These results suggest that dual-task walking may be useful for monitoring subtle and diverse gait deteriorations in aging and possibly for designing interventions for maintaining and regaining proper gait patterns in older adults. [ABSTRACT FROM AUTHOR]

Objectives: To examine the potential contribution of severity of lumbopelvic pain (LPP) in well‐functioning older adults to poorer walking efficiency, lack of endurance, slower gait speed, and decline in these mobility parameters over 1 to 5 years. Design: Longitudinal analysis of Baltimore Longitudinal Study of Aging data. Setting: National Institute on Aging, Clinical Research Unit, Baltimore, Maryland. Participants: Well‐functioning men and women aged 60 to 89 (N=878). Measurements: An interviewer‐administered questionnaire was used to ascertain reported presence and severity of back and hip pain in the preceding 12 months and reported walking ability, including ease of walking a mile. Certified examiners assessed usual gait speed, the energetic cost of walking (oxygen consumption, mL per kg/m), and time taken to walk 400 m as quickly as possible. Covariates included sex, age, age‐squared, race, height, weight, exercise, and smoking. Results: Overall, 31.4% had mild LPP, and 15.7% had moderate to severe LPP. In adjusted analyses, reported walking ability (p<.001), endurance walk performance (p=.007), and energetic cost of walking (p=.049) were worse with increasing LPP severity. Usual gait speed did not vary according to LPP (p=.31). Longitudinally, over an average 2.3 years, persons with new or sustained LPP had worse follow‐up level, greater mean decline, and higher likelihood of meaningful decline in reported walking ability than persons free of LPP or whose LPP resolved. Walking performance did not differ according to LPP follow‐up status. Conclusion: LPP was common in well‐functioning older adults and was associated with greater energetic cost of walking and poorer perceived and observed walking endurance. The longitudinal effect of LPP is unclear, but worsening perception of walking ability and its contribution to future mobility loss warrants further attention. [ABSTRACT FROM AUTHOR]

Background/Aims: Despite widespread Internet adoption, online advertising remains an underutilized tool to recruit participants into clinical trials. Whether online advertising is a cost-effective method to enroll participants compared to other traditional forms of recruitment is not known. Methods: Recruitment for the Survivorship Promotion In Reducing IGF-1 Trial, a community-based study of cancer sur- vivors, was conducted from June 2015 through December 2016 via in-person community fairs, advertisements in period- icals, and direct postal mailings. In addition, ''Right Column'' banner ads were purchased from Facebook to direct participants to the Survivorship Promotion In Reducing IGF-1 Trial website. Response rates, costs of traditional and online advertisements, and demographic data were determined and compared across different online and traditional recruitment strategies. Micro-trials optimizing features of online advertisements were also explored. Results: Of the 406 respondents to our overall outreach efforts, 6% (24 of 406) were referred from online advertising. Facebook advertisements were shown over 3 million times (impressions) to 124,476 people, which resulted in 4401 clicks on our advertisement. Of these, 24 people ultimately contacted study staff, 6 underwent prescreening, and 4 enrolled in the study. The cost of online advertising per enrollee was $794 when targeting a general population versus $1426 when accounting for strategies that specifically targeted African Americans or men. By contrast, community fairs, direct mail, or periodicals cost $917, $799, or $436 per enrollee, respectively. Utilization of micro-trials to assess online ads identified subtleties (e.g. use of an advertisement title) that substantially impacted viewer interest in our trial. Conclusion: Online advertisements effectively directed a relevant population to our website, which resulted in new enrollees in the Survivorship Promotion In Reducing IGF-1 Trial at a cost comparable to traditional methods. Costs were substantially greater with online recruitment when targeting under-represented populations, however. Additional research using online micro-trial tools is needed to evaluate means of more precise recruitment to improve yields in under-represented groups. Potential gains from faster recruitment speed remain to be determined. [ABSTRACT FROM AUTHOR]

Objective: In the ACHIEVE randomized controlled trial, an 18-month behavioral intervention accomplished weight loss in persons with serious mental illness who attended community psychiatric rehabilitation programs. This analysis estimates costs for delivering the intervention during the study. It also estimates expected costs to implement the intervention more widely in a range of community mental health programs.Methods: Using empirical data, costs were calculated from the perspective of a community psychiatric rehabilitation program delivering the intervention. Personnel and travel costs were calculated using time sheet data. Rent and supply costs were calculated using rent per square foot and intervention records. A univariate sensitivity analysis and an expert-informed sensitivity analysis were conducted.Results: With 144 participants receiving the intervention and a mean weight loss of 3.4 kg, costs of $95 per participant per month and $501 per kilogram lost in the trial were calculated. In univariate sensitivity analysis, costs ranged from $402 to $725 per kilogram lost. Through expert-informed sensitivity analysis, it was estimated that rehabilitation programs could implement the intervention for $68 to $85 per client per month.Conclusions: Costs of implementing the ACHIEVE intervention were in the range of other intensive behavioral weight loss interventions. Wider implementation of efficacious lifestyle interventions in community mental health settings will require adequate funding mechanisms. [ABSTRACT FROM AUTHOR]

Background: The impact of excess weight on current and future walking endurance in nondisabled persons is unclear. This study examines the association between obesity and walking endurance among nondisabled persons both in late mid-life and early old age.Methods: Participants in the Baltimore Longitudinal Study of Aging aged 60-79 years (n = 406) who reported no walking limitations, and completed a 400-meter walk "as quickly as possible" without lower-extremity pain, and had a follow-up assessment within 1.7-4.2 years. Adiposity was assessed by weight, body mass index (BMI), BMI category, and percent fat mass by DXA.Results: Adjusting for age, sex, race, height, and physical activity, all adiposity measures were cross-sectionally associated with slower 400 meter time in both 60-69 and 70 to 79-year-olds (weight: β = 1.0 and 1.2; BMI: β = 2.8 and 3.6; and percent fat mass: β = 2.0 and 2.0, respectively, all p < .001). With additional adjustment for initial 400-meter performance and follow-up time, in 60- to 69-year-olds, change in 400-meter time (positive β indicates decline) was associated with all adiposity measures (weight: β = 0.4; BMI: β = 1.0; and percent fat mass: β = 0.5; all p ≤ .05) but not in the older group (weight: β = -0.4; BMI: β = -1.2; and percent fat mass: β = -0.2; all p ≥ .17).Conclusion: Excess weight and adiposity were associated with worse walking endurance in nondisabled persons aged 60-79 years and predicted accelerated decline in endurance in late mid-life adults. Weight management for mobility independence may be best targeted in obese persons approaching traditional retirement age. [ABSTRACT FROM AUTHOR]

Objectives To evaluate perceived fatigability as a predictor of meaningful functional decline in non-mobility-limited older adults. Design Longitudinal analysis of data from the Baltimore Longitudinal Study of Aging ( BLSA). Setting National Institute on Aging, Clinical Research Unit, Baltimore, Maryland. Participants Men and women aged 60 to 89 participating in the BLSA with concurrent perceived fatigability and functional assessments and follow-up functional assessment within 1 to 3 years (N = 540). Measurements Perceived fatigability was ascertained using the Borg rating of perceived exertion ( RPE) after 5 minutes of treadmill walking at 1.5 miles per hour. Functional assessments included usual and fast gait speed, the Health, Aging and Body Composition physical performance battery ( HABC PPB) and reported walking ability. Reported tiredness and energy level were examined as complementary predictors. Covariates included age, age squared, race, follow-up time, and baseline function. Meaningful decline was defined as 0.05 m/s per year for usual gait speed, 0.07 m/s per year for fast gait speed, 0.12 points/year for HABC PPB, and 1 point for walking ability index. Results Over a mean 2.1 years, 20-31% of participants declined across functional assessments. Fatigability was associated with a 13-19% greater likelihood of meaningful decline in all measures ( P = .002- .02) per 1-unit RPE increase. After considering tiredness and energy level separately, findings were essentially unchanged, and neither was associated with gait speed or physical performance decline. In contrast, each separately predicted decline in reported walking ability independent of fatigability ( P = .03 and P < .001, respectively). Conclusion Routine assessment of fatigability may help identify older persons vulnerable to greater-than-expected functional decline. [ABSTRACT FROM AUTHOR]

Objective: In the Weight Loss Maintenance (WLM) Trial, a personal contact (PC) intervention sustained greater weight loss relative to a self-directed (SD) group over 30 months. This study investigated the effects of continued intervention over an additional 30 months and overall weight change across the entire WLM Trial.Methods: WLM had 3 phases. Phase 1 was a 6-month weight loss program. In Phase 2, those who lost ≥4 kg were randomized to a 30-month maintenance trial. In Phase 3, PC participants (n = 196, three sites) were re-randomized to no further intervention (PC-Control) or continued intervention (PC-Active) for 30 more months; 218 SD participants were also followed.Results: During Phase 3, weight increased 1.0 kg in PC-Active and 0.5 kg in PC-Control (mean difference 0.6 kg; 95% CI:-1.4 to 2.7; P = 0.54). Mean weight change over the entire study was -3.2 kg in those originally assigned to PC (PC-Combined) and -1.6 kg in SD (mean difference -1.6 kg; 95% CI:-3.0 to -0.1; P = 0.04).Conclusions: After 30 months of the PC maintenance intervention, continuation for another 30 months provided no additional benefit. However, across the entire study, weight loss was slightly greater in those originally assigned to PC. [ABSTRACT FROM AUTHOR]

Background Understanding the mechanisms that contribute to walking speed decline can provide needed insight for developing targeted interventions to reduce the rate and likelihood of decline. Objective Examine the association between gait characteristics and walking speed decline in older adults. Methods Participants in the Baltimore Longitudinal Study of Aging aged 60 to 89 were evaluated in the gait laboratory which used a three dimensional motion capture system and force platforms to assess cadence, stride length, stride width, percent of gait cycle in double stance, anterior–posterior mechanical work expenditure (MWE), and medial–lateral MWE. Usual walking speed was assessed over 6 m at baseline and follow-up. Gait characteristics associated with meaningful decline (decline ≥0.05 m/s/y) in walking speed were evaluated by logistic regression adjusted for age, sex, race, height, weight, initial walking speed and follow-up time. Results Among 362 participants, the average age was 72.4 (SD = 8.1) years, 51% were female, 27% were black and 23% were identified has having meaningful decline in usual walking speed with an average follow-up time of 3.2 (1.1) years. In the fully adjusted model, faster cadence [OR adj = 0.65, 95% CI (0.43,0.97)] and longer strides [OR adj = 0.87, 95% CI (0.83,0.91)] were associated with lower odds of decline. However age [OR adj = 1.04, 95% CI (0.99,1.10)] was not associated with decline when controlling for gait characteristics and other demographics. Conclusion A sizable proportion of healthy older adults experienced walking speed decline over an average of 3 years. Longer stride and faster cadence were protective against meaningful decline in usual walking speed. [ABSTRACT FROM AUTHOR]

Objective In behavioral studies of weight loss programs, participants typically receive interventions free of charge. Understanding an individual's willingness to pay (WTP) for weight loss programs could be helpful when evaluating potential funding models. This study assessed WTP for the continuation of a weight loss program at the end of a weight loss study. Methods WTP was assessed with monthly coaching contacts at the end of the two-year Hopkins POWER trial. Interview-administered questionnaires determined the amount participants were willing to pay for continued intervention. Estimated maximum payment was calculated among those willing to pay and was based on quantile regression adjusted for age, body mass index, race, sex, household income, treatment condition, and weight change at 24 months. Results Among the participants ( N = 234), 95% were willing to pay for continued weight loss intervention; the adjusted median payment was $45 per month. Blacks had a higher adjusted median WTP ($65/month) compared to Non-Blacks ($45/month), P = 0.021. Conclusions A majority of participants were willing to pay for a continued weight loss intervention with a median monthly amount that was similar to the cost of commercial weight loss programs. [ABSTRACT FROM AUTHOR]

This study examined cardiorespiratory fitness (CRF) among adults with serious mental illness (SMI) participating in group exercise classes. Overweight and obese adults with SMI were randomized to either a control condition or a weight management condition with group exercise classes (n = 222). Submaximal bicycle ergometry was used to assess CRF at baseline, 6 and 18 months. Those with ≥ 66% participation in the exercise classes had a lower heart rate response at 6 and 18 month follow-up. Participation in group exercise classes was associated with improved short and long term cardiovascular fitness among adults with SMI. [ABSTRACT FROM AUTHOR]

Aim Dietary changes occurring during weight loss interventions can vary. The present study tested if pretreatment psychosocial, dietary and demographic factors were associated with changes in fat intake and fruit and vegetable intake during a weight loss intervention. Methods This analysis includes participants who lost at least four kilograms during the initial six month weight loss phase (phase I) of the Weight Loss Maintenance Trial, a group format behavioural intervention emphasising a low-fat diet and increased physical activity. Multiple linear regression was used to determine associations between pretreatment psychosocial, dietary, physical activity, and demographic variables and changes from pretreatment to six months in fat intake and fruit and vegetable intake. Results Participants ( n = 1032) were 63.4% female, 62.4% non- African American, and had a mean age of 55.6 and BMI of 34.1 kg/m2. Being African American ( P < 0.0001) and higher baseline kilojoule intake ( P < 0.01) were associated with smaller reductions in fat intake. Being African American ( p < 0.001) and older age ( P = 0.02) were associated with smaller increases in fruit and vegetable intake, whereas a history of 10 or more past weight loss episodes of at least 10 lb (4.5 kg; P < 0.01) was associated with greater increases. Conclusions Few psychosocial factors examined contributed to variability in dietary change. Even when achieving meaningful weight losses during a behavioural weight loss intervention, African Americans may make fewer beneficial changes in fat and fruit and vegetable intake than non- African Americans. [ABSTRACT FROM AUTHOR]

Objective To examine the behavioral processes through which lifestyle interventions impacted weight loss. Methods The analyses were limited to overweight and obese Black and White adults randomized to a PREMIER lifestyle intervention ( N = 501). Structural equation modeling was conducted to test the direct and indirect relationships of session attendance, days of self-monitoring diet and exercise, change in diet composition and exercise, and 6-month weight change. Results Greater session attendance was associated with increased self-monitoring, which was in turn significantly related to reduction in percent energy from total fat consumed. Change in percent energy from fat and self-monitoring was associated with 6-month percent change in weight. Both a decrease in fat intake and increase in self-monitoring are potential mediators of the relationship between attendance and weight change. Conclusions The findings provide a reasonable model that suggests regular session attendance and use of behavioral strategies like self-monitoring are associated with improved behavioral outcomes that are associated with weight loss. [ABSTRACT FROM AUTHOR]

Past studies have suggested that weight loss history is associated with subsequent weight loss. However, questions remain whether method and amount of weight lost in previous attempts impacts current weight loss efforts. This study utilized data from the Weight Loss Maintenance Trial to examine the association between weight loss history and weight loss outcomes in a diverse sample of high-risk individuals. Multivariate regression analysis was conducted to determine which specific aspects of weight loss history predict change in weight during a 6-month weight loss intervention. Greater weight loss was predicted by fewer previous weight loss attempts with assistance ( p = 0.03), absence of previous dietary/herbal weight loss supplement use ( p = 0.01), and greater maximum weight loss in previous attempts ( p < 0.001). Future interventions may benefit from assessment of weight loss history and tailoring of interventions based on past weight loss behaviors and outcomes. [ABSTRACT FROM AUTHOR]

In this secondary analysis of the Weight Loss Maintenance trial, the authors assessed the relationship between blood pressure (BP) change and weight change in overweight and obese adults with hypertension and/or dyslipidemia who were randomized to 1 of 3 weight loss maintenance strategies for 5 years. The participants were grouped (N=741) based on weight change from randomization to 60 months as: (1) weight loss, (2) weight stable, or (3) weight gain. A significant positive correlation between weight change and systolic BP (SBP) change at 12, 30, and 60 months and between weight change and diastolic BP (DBP) change at 30 months was observed. From randomization to 60 months, mean SBP increased to a similar degree for the weight gain group (4.2±standard error=0.6 mm Hg; P<.001) and weight stable group (4.6±1.1 mm Hg; P<.001), but SBP did not rise in the weight loss group (1.0±1.7 mm Hg, P=.53). DBP was unchanged for all groups at 60 months. Although aging may have contributed to rise in BP at 60 months, it does not appear to fully account for observed BP changes. These results suggest that continued modest weight loss may be sufficient for long-term BP lowering. [ABSTRACT FROM AUTHOR]

Objectives To characterize Practice- Based Opportunities for Weight Reduction ( POWER) trials along the pragmatic-explanatory continuum. Settings The POWER trials consist of three individual studies that target obesity treatment in primary care settings. Design Using the PRagmatic Explanatory Continuum Indicator Summary ( PRECIS) criteria, nine reviewers independently scored each trial. Methods Average and median ratings, inter-rater reliability, and relationships to additional ratings of the extent to which study designs were explanatory (i.e., efficacy) versus pragmatic (i.e., practical) and related to external validity were determined. Principal Findings One trial was consistently rated as being significantly more pragmatic than the others ( R2 = 0.43, p < .001), although all three were in the moderate range on the PRECIS scales. Ratings varied across PRECIS dimensions, being most pragmatic on comparison condition and primary outcome. Raters, although undergoing training and using identical definitions, scored their own study as more pragmatic than the other studies/interventions. Conclusions These results highlight the need for more comprehensive reporting on PRECIS and related criteria for research translation. The PRECIS criteria provide a richer understanding of the POWER studies. It is not clear whether the original criteria are sufficient to provide a comprehensive profile. [ABSTRACT FROM AUTHOR]

Little is known about the transition in behaviors from short-term weight loss to maintenance of weight loss. We wanted to determine how short-term and long-term weight loss and patterns of weight change were associated with intervention behavioral targets. This analysis includes overweight/obese participants in active treatment (n = 507) from the previously published PREMIER trial, an 18-month, multicomponent lifestyle intervention for blood pressure reduction, including 33 intervention sessions and recommendations to self-monitor food intake and physical activity daily. Associations between behaviors (attendance, recorded days/week of physical activity, food records/week) and weight loss of ≥5% at 6 and 18 months were examined using logistic regression. We characterized the sample using 5 weight change categories (weight gained, weight stable, weight loss then relapse, late weight loss, and weight loss then maintenance) and analyzed adherence to the behaviors for each category, comparing means with ANOVA. Participants lost an average of 5.3 ± 5.6 kg at 6 months and 4.0 ± 6.7 kg (4.96% of body weight) by 18 months. Higher levels of attendance, food record completion, and recorded days/week of physical activity were associated with increasing odds of achieving 5% weight loss. All weight change groups had declines in the behaviors over time; however, compared to the other four groups, the weight loss/maintenance group (n = 154) had statistically less significant decline in number of food records/week (48%), recorded days/week of physical activity (41.7%), and intervention sessions attended (12.8%) through 18 months. Behaviors associated with short-term weight loss continue to be associated with long-term weight loss, albeit at lower frequencies. Minimizing the decline in these behaviors may be important in achieving long-term weight loss. [ABSTRACT FROM AUTHOR]

Abstract: As computer use becomes prevalent at work and in leisure pursuits it presents a potential barrier to regular physical activity. However an individual’s confidence in overcoming such barriers may moderate the relationship between computer use and physical activity levels. This study examined the associations among computer use, self-efficacy in overcoming barriers to exercise, and physical activity levels among adult computer users. Participants (N =615) were recruited through national email and newsletters announcements, and completed standardized self-report questionnaires online. Computer use was not associated with meeting physical activity guidelines (adjusted odds ratio, AOR=0.63–1.00, n.s.). Among leisure computer users, the moderate efficacy group (AOR=3.72, 95% CI=1.59–8.69) and the high efficacy group (AOR=5.31, 95% CI=2.37–11.91) had higher odds of meeting physical activity guidelines compared to the low efficacy group. Among the work related computer users, the high efficacy group (AOR=2.83, 95% CI=1.18–6.77) had higher odds of meeting physical activity guidelines than the low efficacy group. These results suggest that barriers posed by high levels of computer use are surmountable. Efforts to increase efficacy in overcoming barriers to exercise may be more practical and have a greater impact on physical activity levels than trying to decrease computer use among adults. [Copyright &y& Elsevier]

Background: Health-related quality of life (HRQOL) is an important aspect of well-being that may improve with health behavior interventions. However, health behavior change is difficult with pressure to maintain status quo. Purpose: This report examines the effects of two lifestyle interventions and an advice-only condition on HRQOL. Effects of meeting behavioral goals and weight loss also were examined. Methods: Participants were 295 men and 467 women (34% African American) with pre-hypertension or stage 1 hypertension from the PREMIER trial. HRQOL was assessed by the Short Form-36. Participants were assigned randomly to (1) advice only (ADVICE), (2) established guidelines for blood pressure control (EST), or (3) established guidelines plus the Dietary Approaches to Stop Hypertension (DASH) dietary pattern (EST + DASH). Results: Assignment to EST resulted in improvement in three HRQOL subscales at 6 months and one at 18 months relative to ADVICE. EST + DASH improved in two subscales at 6 and 18 months compared with ADVICE. Across conditions, total fat, saturated fat, fruit, and vegetable intake change, along with ≥4-kg weight loss, resulted in HRQOL improvements at 6 and 18 months. No improvement was found for change in physical activity, and only a few HRQOL subscales were associated with change in sodium and low-fat dairy intake. Conclusions: Intensive lifestyle interventions can result in improvements in HRQOL. Change in dietary intake and weight loss is also important. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group. Methods/Design: A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m²) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months. Discussion: Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness. Trial Registration: Clinical Trials.gov NCT00902694 [ABSTRACT FROM AUTHOR]

Objectives: The Weight Loss Maintenance Trial (WLM) was a multicenter, randomized trial comparing two weight loss maintenance interventions, a personal contact (PC) program with primarily telephone-based monthly contacts, and an Internet-based program (interactive technology, IT), to a self-directed control group, among overweight or obese individuals at high cardiovascular risk. This study describes implementation costs of both interventions as well as IT development costs. Methods: Resources were micro-costed in 2006 dollars from the primary perspective of a sponsoring healthcare system considering adopting an extant intervention, rather than developing its own. Costs were discounted at 3 percent annually. Length of trial participation was 30 months (randomization during February-November 2004). IT development costs were assessed over 36 months. Univariate and multivariate, including probabilistic, sensitivity analyses were performed. Results: Total discounted IT development costs over 36 months were $839,949 ($2,414 per IT participant). Discounted 30-month implementation costs for 342 PC participants were $537,242 ($1,571 per participant), and for 348 IT participants, were $214,879 ($617 per participant). Under all plausible scenarios, PC implementation costs exceeded IT implementation costs. Conclusions: Costs of implementing and operating an Internet-based intervention for weight loss maintenance were substantially less than analogous costs of an intervention using standard phone and in-person contacts and are of a magnitude that would be attractive to many health systems, subject to demonstration of cost-effectiveness. [ABSTRACT FROM AUTHOR]

Abstract: This study objectively measured physical activity levels in overweight and obese adults with severe mental illness and examined relationships among psychiatric symptoms, cognitive functioning and physical activity. A diverse sample (50% female, 50% African American) of overweight and obese adults (n =55) with mental illness were asked to wear accelerometers for 4 days. Study participants averaged 120 min/week of moderate to vigorous physical activity (MVPA); 35% had ≥150 min/week of MVPA. Only 4% accumulated ≥150 min/week of MVPA in bouts ≥10 min as per public health recommendations. Depressive symptoms, psychological distress and cognitive functioning were not associated with physical activity (p >.05). Although participants appeared to have substantial minutes of MVPA, increased physical activity bouts, or sessions, may be necessary for increased health and weight management benefits for persons with severe mental illness. Efforts are needed to increase physical activity sessions in this vulnerable population. [Copyright &y& Elsevier]

The article presents the study on the accelerometer-based estimates' reliability in the physical activity levels of obese and overweight adults before and after a lifestyle weight loss program. It states that the study incorporates obese and overweight participants. It mentions that during waking hours, the participants wore RT3 accelerometer for seven days at baseline. It concludes that significant increase in reliability is not resulted by the length of wear time requirements. It suggests that researchers should manage a balance between feasibility and what is required in answering the research questions.

Background. Physical activity is important for maintaining functional independence of older persons, especially for those with existing functional deficits. Since such deficits may pose barriers to activity, it would be instructive to examine activity patterns in relation to specific types of deficits to determine the amount and type of physical activity older women pursue. This study sought to identify categories of functional deficits associated with activity levels and evaluated the potential for older women to increase their physical activity levels. Methods. Community-dwelling women, aged 70-79 years, from the Women's Health and Aging Studies I and II (N = 710), were assessed for self-reported physical activity, functional deficits and chronic conditions, along with objective measures of muscle strength. Both type (household chores, exercise, and recreational activity) and amount of physical activity (min/wk) were examined. Meeting physical activity recommendations was defined as ≥ 150 minutes per week of moderate intensity physical activity, and inactivity was defined as no weekly moderate intensity physical activity. Hierarchical categories of functional deficits were based on self-reported difficulty in four functional domains (i.e., mobility/exercise tolerance, upper extremity, higher functioning, and self-care), and self-reports ranged from no difficulty to difficulty in all four domains. Results. The prevalence of inactivity and meeting activity recommendations were 14.4% and 12.7%, respectively. Severity of functional deficits was associated with increased risk of inactivity (adjusted odds ratios [ORsadj] = 3.14-17.61) and reduced likelihood of meeting activity recommendations (ORsadj = .11-.40). Even among those with higher functioning or self-care difficulties, 30% reported walking for exercise. Conclusion. There was evidence that older women with functional deficits can remain physically active. However, for some of these women, meeting the recommended levels of activity may be unrealistic. Efforts to increase physical activity levels among older adults should include treatment or management of functional deficits, chronic conditions, and poor strength. [ABSTRACT FROM AUTHOR]

This study examined the validity of Geriatric Depression Scale-5 (GDS-5) scores among older sedentary adults based on its structural properties and relationship with external criteria. Participants from two samples (Ns = 185 and 93; M ages = 66 and 67 years) completed baseline assessments as part of randomized controlled exercise trials. Confirmatory factor analysis supported a single-factor model for the GDS-5, the GDS-5 exhibited adequate sensitivity and specificity for screening depression, and scores from the 30- and 5-item GDS were strongly related. GDS-5 scores were strongly related with happiness and morale and moderately related with satisfaction with life, loneliness, optimism, pessimism, perceived stress, negative health symptoms, and self-esteem. As expected, GDS-5 scores were weakly related with self-efficacy, cardiorespiratory fitness, and functional fitness. Support is provided for the validity of GDS-5 scores as a measure of depression among older sedentary adults participating in exercise studies. [ABSTRACT FROM AUTHOR]