Diana Gilleland

A Mixed Methods Evaluation of a 12-Week Insurance-Sponsored Weight Management Program Incorporating Cognitive-Behavioral Counseling

Physical activity is critical in healthy weight loss, yet there is still much to be learned about psychosocial mechanisms of physical activity behavior change in weight loss. A sequential mixed methods approach was used to assess the physical and psychosocial impact of a 12-week cognitive—behavioral weight management program and explore factors associated with weight loss. Quantitative data (N = 55) revealed program completion rate and mean percentage weight loss that compare favorably with other interventions, and differential psychosocial impacts on those losing more weight. Telephone interviews (n = 11) revealed four potential mechanisms for these differential impacts: (a) fostering accountability, (b) balancing perceived effort and success, (c) redefining ‘‘success,’’ and (d) developing cognitive flexibility.

Academic integrity in the online learning environment for health sciences students

BACKGROUND The online learning environment not only affords accessibility to education for health sciences students, but also poses challenges to academic integrity. Technological advances contribute to new modes of academic dishonesty, although there may be a lack of clarity regarding behaviors that constitute academic dishonesty in the online learning environment. OBJECTIVE To evaluate an educational intervention aimed at increasing knowledge and improving attitudes about academic integrity in the online learning environment among health sciences students. DESIGN A quasi-experimental study was conducted using a survey of online learning knowledge and attitudes with strong reliability that was developed based on a modified version of a previously developed information technology attitudes rating tool with an added knowledge section based on the academic integrity statement. SETTING Blended-learning courses in a university health sciences center. PARTICIPANTS 355 health sciences students from various disciplines, including nursing, pre-medical, and exercise physiology students, 161 in the control group and 194 in the intervention group. METHOD The survey of online learning knowledge and attitudes (SOLKA) was used in a pre-post test study to evaluate the differences in scores between the control group who received the standard course introduction and the intervention group who received an enhanced educational intervention about academic integrity during the course introduction. RESULTS Post-intervention attitude scores were significantly improved compared to baseline scores for the control and intervention groups, indicating a positive relationship with exposure to the information, with a greater improvement among intervention group participants (p<0.001). There was a significant improvement in the mean post-intervention knowledge score of the intervention group compared to the control group (p=0.001). CONCLUSION Recommendations are provided for instructors in promoting academic integrity in the online environment. Emphasis should be made about the importance of academic integrity in the online learning environment in preparation for professional behavior in the technologically advancing health sciences arena.

Resistance Exercise Reduces Skeletal Muscle Cachexia and Improves Muscle Function in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune, inflammatory disease associated with cachexia (reduced muscle and increased fat). Although strength-training exercise has been used in persons with RA, it is not clear if it is effective for reducing cachexia. A 46-year-old woman was studied to determine: (i) if resistance exercise could reverse cachexia by improving muscle mass, fiber cross-sectional area, and muscle function; and (2) if elevated apoptotic signaling was involved in cachexia with RA and could be reduced by resistance training. A needle biopsy was obtained from the vastus lateralis muscle of the RA subject before and after 16 weeks of resistance training. Knee extensor strength increased by 13.6% and fatigue decreased by 2.8% Muscle mass increased by 2.1%. Average muscle fiber cross-sectional area increased by 49.7%, and muscle nuclei increased slightly after strength training from 0.08 to 0.12 nuclei/μm2. In addition, there was a slight decrease (1.6%) in the number of apoptotic muscle nuclei after resistance training. This case study suggests that resistance training may be a good tool for increasing the number of nuclei per fiber area, decreasing apoptotic nuclei, and inducing fiber hypertrophy in persons with RA, thereby slowing or reversing rheumatoid cachexia.

Resveratrol Enhances Exercise-Induced Cellular and Functional Adaptations of Skeletal Muscle in Older Men and Women.

Older men (n = 12) and women (n = 18) 65-80 years of age completed 12 weeks of exercise and took either a placebo or resveratrol (RSV) (500 mg/d) to test the hypothesis that RSV treatment combined with exercise would increase mitochondrial density, muscle fatigue resistance, and cardiovascular function more than exercise alone. Contrary to our hypothesis, aerobic and resistance exercise coupled with RSV treatment did not reduce cardiovascular risk further than exercise alone. However, exercise added to RSV treatment improved the indices of mitochondrial density, and muscle fatigue resistance more than placebo and exercise treatments. In addition, subjects that were treated with RSV had an increase in knee extensor muscle peak torque (8%), average peak torque (14%), and power (14%) after training, whereas exercise did not increase these parameters in the placebo-treated older subjects. Furthermore, exercise combined with RSV significantly improved mean fiber area and total myonuclei by 45.3% and 20%, respectively, in muscle fibers from the vastus lateralis of older subjects. Together, these data indicate a novel anabolic role of RSV in exercise-induced adaptations of older persons and this suggests that RSV combined with exercise might provide a better approach for reversing sarcopenia than exercise alone.

Impact of an exercise program on adherence and fitness indicators.

Adherence to exercise is one of the most problematic health behaviors. This pilot study describes the impact of an exercise program on adherence to exercise and fitness indicators for overweight and obese adults enrolled in an insurance reimbursed exercise plan. Chart reviews were conducted retrospectively in a convenience sample of 77 subjects from a human performance lab (HPL) at a large southern university. Charts from 2004 to 2009 were reviewed for health history, fitness indicators (fitness level, weight, BMI, hip/waist ratio, % body fat, BP, HR, cholesterol), and adherence (number of exercise sessions/month). Exercise supervision was operationalized in two phases over 12 months: Phase I (3 months supervised exercise) and Phase II (9 months unsupervised exercise). Fifty-eight participants completed Phase I, and 8 completed Phase II. Six-nine percent of those completing Phase I visited the gym at least 8 times/month with significant (α=.05) improvement in all fitness indicators. Those visiting <8 times/month had improvement in fitness level, weight, BMI, and % body fat. Twenty-four subjects continued into Phase II, with only eight completing Phase II. Of those eight, only one subject visited the HPL at least 8 times/month. Health history data including co-morbidities, symptoms, habits, perceived tension, job stress, and fitness level were not associated with adherence. Symptoms of swollen, stiff, painful joints, and swollen ankles and legs were associated with decreased adherence to exercise. Supervised exercise was positively related to adherence and improved fitness indicators. Adults with joint symptoms may require more support. Based on these pilot data, designing a study with a larger sample and the inclusion of barriers and facilitators for adherence to self-directed exercise would allow additional analysis. Innovative interventions are needed that mimic the supervised environment, shifting responsibility for the exercise plan from the supervisor to those exercising.

Abstract P1-09-12: Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial

Regular physical activity and healthy body composition are important predictors of good outcomes for breast cancer survivors, especially in overweight/obese individuals. However, individualized exercise and healthy eating programs have not focused on lifestyle changes and outcomes among women recovering from triple-negative breast cancer. Our purpose was to examine the associations between baseline levels of inflammatory cytokines and obesity-related adipokines after weight loss, diet and physical activity intervention in survivors of triple-negative breast cancer. We enrolled overweight/obese survivors (average time since diagnosis, 4 years) and randomly assigned them to a 12-week supervised exercise and low-fat diet (n=18) or a usual care group (n=10). The program consisted of supervised exercise 3 times/week, as well as 2 unsupervised sessions per week. The goal of our Get Fit for the Fight® program was to complete 150 min/week of moderate-intensity aerobic exercise. Participants completed a 3-day diet record during baseline testing and the dietitian recommended ways to cut calories from these typical eating patterns. The goal of caloric restriction was to decrease dietary fat in order for the participant to consume 200 kcal/week less. Assessments included aerobic fitness, body composition, and self-reported physical activity, mood and quality of life. Blood cytokines and obesity-related adipokines were also analyzed before and after the intervention period. The intervention group lost an average of 2% body fat compared with the control group (p Citation Format: Linda Vona-Davis, Jame Abraham, Daniel Bonner, Diana Gilleland, Gerald Hobbs, Sobha Kurian, Mary Anne Yanosik, Anne Swisher. Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-12.

Potential clinical utility of partial body weight support on treadmill walking time in persons with intermittent claudication: a single case report.

Intermittent claudication can seriously limit an individuals walking capacity. Walking programs are known to improve this limitation but could be limited by a persons ability to carry his or her own full body weight to perform the walking. We theorized that decreasing body weight, through mechanical unloading, might allow longer pain-free walking, thus potentially accelerating exercise training. This case report describes the effect of partial body weight support (PBWS) on walking time in a patient with claudication. A 60-year-old male with calf pain that prevented him from walking long distances or walking quickly was studied. The patient completed three treadmill walking tests (0%, 25%, and 50% PBWS) until claudication pain stopped him or 15 minutes elapsed. The participant walked 4:31 minutes at 0% PBWS with a pain rating of 3/4. He walked the full 15 minutes under each support condition with the same or less claudication pain (3/4 for 25% PBWS, 2/4 for 50% PBWS). This case reports the successful use of PBWS treadmill training for increasing walking time in an individual with intermittent claudication. If this finding holds true for a larger sample, PBWS may be a way for these individuals to participate in exercise training programs with less pain.