Georita M. Frierson

Home-Based Physical Activity Intervention for Breast Cancer Patients

PURPOSE The efficacy of a home-based physical activity (PA) intervention for early-stage breast cancer patients was evaluated in a randomized controlled trial. PATIENTS AND METHODS Eighty-six sedentary women (mean age, 53.14 years; standard deviation, 9.70 years) who had completed treatment for stage 0 to II breast cancer were randomly assigned to a PA or contact control group. Participants in the PA group received 12 weeks of PA counseling (based on the Transtheoretical Model) delivered via telephone, as well as weekly exercise tip sheets. Assessments were conducted at baseline, after treatment (12 weeks), and 6 and 9 month after baseline follow-ups. The post-treatment outcomes are reported here. RESULTS Analyses showed that, after treatment, the PA group reported significantly more total minutes of PA, more minutes of moderate-intensity PA, and higher energy expenditure per week than controls. The PA group also out-performed controls on a field test of fitness. Changes in PA were not reflected in objective activity monitoring. The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines. No significant group differences were found in body mass index and percent body fat. Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group. There was a positive trend in intervention effects on overall mood and body esteem. CONCLUSION The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients. The success of a home-based PA intervention has important implications for promoting recovery in this population.

Traumatic Stress, Perceived Global Stress, and Life Events: Prospectively Predicting Quality of Life in Breast Cancer Patients.

The authors investigated the relationship between stress at initial cancer diagnosis and treatment and subsequent quality of life (QoL). Women (n = 112) randomized to the assessment-only arm of a clinical trial were initially assessed after breast cancer diagnosis and surgery and then reassessed at 4 months (during adjuvant treatment) and 12 months (postadjuvant treatment). There were 3 types of stress measured: number of stressful life events (K. A. Matthews et al., 1997), cancer-related traumatic stress symptoms (M. J. Horowitz, N. Wilner, & W. Alvarez, 1979), and perceived global stress (S. Cohen, T. Kamarck, & R. Mermelstein, 1983). Using hierarchical multiple regressions, the authors found that stress predicted both psychological and physical QoL (J. E. Ware, K. K. Snow, & M. Kosinski, 2000) at the follow-ups (all ps < .03). These findings substantiate the relationship between initial stress and later QoL and underscore the need for timely psychological intervention.

Assessing Stress in Cancer Patients A Second-Order Factor Analysis Model for the Perceived Stress Scale

Using the Perceived Stress Scale (PSS), perceptions of global stress were assessed in 111women following breast cancer surgery and at 12 and 24 months later. This is the first study to factor analyze the PSS. The PSS data were factor analyzed each time using exploratory factor analysis with oblique direct quartimin rotation. Goodness-of-fit indices (root mean square error of approximation [RMSEA]), magnitude and pattern of factor loadings, and confidence interval data revealed a two-factor solution of positive versus negative stress items. The findings, replicated across time, also indicate factor stability. Hierarchical factor analyses supported a second-order factor of “perceived stress.” This alternative factor model of the PSS is presented along with observations regarding the measure’s use in cancer research.

Determinants of physical activity among women treated for breast cancer in a 5-year longitudinal follow-up investigation.

Objective: To estimate the 5‐year trajectory of physical activity among women with breast cancer, and to evaluate biopsychosocial variables (health status, physical symptoms, health‐related quality of life (HRQL), depressive symptoms, and social support), measured soon after breast cancer diagnosis, as predictors of the 5‐year trajectory.

The Efficacy of Vigorous-Intensity Exercise as an Aid to Smoking Cessation in Adults With High Anxiety Sensitivity: A Randomized Controlled Trial.

Objectives High anxiety sensitivity predicts poor smoking cessation outcomes. Aerobic exercise reduces anxiety sensitivity and aspects of the risk conferred by anxiety sensitivity. In the current study, we examined whether exercise can aid smoking cessation in adults with high anxiety sensitivity. Methods Participants were sedentary and low-activity adult daily smokers (n = 136) with elevated prescreen anxiety sensitivity. Participants received 15 weeks of standard smoking cessation treatment (ST; cognitive behavioral therapy plus nicotine replacement therapy). In addition, participants were simultaneously randomized to 15 weeks of either an exercise intervention (ST + EX; n = 72) or a wellness education control condition (ST + CTRL; n = 64). Self-reported smoking abstinence was assessed weekly during the intervention, at the end of treatment (10 weeks after the target quit date), and at 4 and 6 months after the target quit date. Abstinence was verified by expired carbon monoxide readings and saliva cotinine. Results Results indicated that point prevalence abstinence (PPA) and prolonged abstinence (PA) rates were significantly higher for ST + EX than for ST + CTRL at each of the major end points among persons with high anxiety sensitivity (PPA: b = −0.91, standard error [SE] = 0.393, t(1171) = −2.33, p = .020; PA: b = −0.98, SE = 0.346, t(132) = −2.84, p = .005), but not among those with low anxiety sensitivity (PPA: b = −0.23, SE = 0.218, t(1171) = −1.06, p = .29; PA: b = −0.31, SE = 0.306, t(132) = −1.01, p = .32). Conclusions The present results suggest that exercise facilitates the odds of quit success for smokers with high levels of anxiety sensitivity and therefore may be a useful therapeutic tactic for this high-risk segment of the smoking population. Trial Registration: ClinicalTrials.gov, NCT01065506.

The efficacy of vigorous-intensity exercise as an aid to smoking cessation in adults with elevated anxiety sensitivity: study protocol for a randomized controlled trial

BackgroundAlthough cigarette smoking is a leading cause of death and disability in the United States (US), over 40 million adults in the US currently smoke. Quitting smoking is particularly difficult for smokers with certain types of psychological vulnerability. Researchers have frequently called attention to the relation between smoking and anxiety-related states and disorders, and evidence suggests that panic and related anxiety vulnerability factors, specifically anxiety sensitivity (AS or fear of somatic arousal), negatively impact cessation. Accordingly, there is merit to targeting AS among smokers to improve cessation outcome. Aerobic exercise has emerged as a promising aid for smoking cessation for this high-risk (for relapse) group because exercise can effectively reduce AS and other factors predicting smoking relapse (for example, withdrawal, depressed mood, anxiety), and it has shown initial efficacy for smoking cessation. The current manuscript presents the rationale, study design and procedures,and design considerations of the Smoking Termination Enhancement Project (STEP).MethodsSTEP is a randomized clinical trial that compares a vigorous-intensity exercise intervention to a health and wellness education intervention as an aid for smoking cessation in adults with elevated AS. One hundred and fifty eligible participants will receive standard treatment (ST) for smoking cessation that includes cognitive behavioral therapy (CBT) and nicotine replacement therapy (NRT). In addition, participants will be randomly assigned to either an exercise intervention (ST+EX) or a health and wellness education intervention (ST+CTRL). Participants in both arms will meet 3 times a week for 15 weeks, receiving CBT once a week for the first 7 weeks, and 3 supervised exercise or health and wellness education sessions (depending on randomization) per week for the full 15-week intervention. Participants will be asked to set a quit date for 6 weeks after the baseline visit, and smoking cessation outcomes as well as putative mediator variables will be measured up to 6 months following the quit date.DiscussionThe primary objective of STEP is to evaluate whether vigorous-intensity exercise can aid smoking cessation in anxiety vulnerable adults. If effective, the use of vigorous-intensity exercise as a component of smoking cessation interventions would have a significant public health impact. Specifically, in addition to improving smoking cessation treatment outcome, exercise is expected to offer benefits to overall health, which may be particularly important for smokers. The study is also designed to test putative mediators of the intervention effects and therefore has the potential to advance the understanding of exercise-anxiety-smoking relations and guide future research on this topic.Clinical trials registryClinicalTrials.gov, NCT01065506, http://clinicaltrials.gov/ct2/show/NCT01065506

Lumbar Spine Flexion and Extension Extremes of Motion in Women of Different Age and Racial Groups The WIN Study

Study Design. Observational. Objective. To provide normative values of lumbar flexion and extension for women of different age and racial groups. Summary of Background Data. Spinal range of motion (ROM) is one of the AMA Guides criteria used to estimate level of impairment and subsequent compensation entitlement. Studies show that spinal ROM varies with age, gender, and possibly race/ethnicity, but adequate normative values for different age and racial/ethnic groups do not exist. Methods. A cohort of free-living women was recruited for the Womens Injury Study at The Cooper Institute in Dallas. Originally, 917 women between the ages of 20 and 83 (M = 52 ± 13) underwent an orthopedic examination including lumbar spine flexion and extension measurement using an electronic inclinometer. Measurements were taken in the fully extended and flexed positions, respectively. This removes the influence of initial resting posture and is termed “extreme of motion” (EOM) as opposed to ROM. Age and racial groups were compared using a 2-way multivariate analysis of variance (MANOVA) followed with post hoc tests. Results. Means (±SD) were calculated for racial (white, N = 619, African-American, N = 147) and age groups (young, 20–39 years, n = 126; middle, 40–59 years, n = 412; older, ≥60 years, n = 228). Lumbar extension for African-American women (60.1°) was significantly greater (P < 0.05) than for white women (52.6°), but flexion was not different (15.2° and 17.0°), respectively. Extension EOM for the young group (61.6°) was greater (P < 0.05) than the middle (56.6°) and older (50.8°) groups. Extension difference between the middle and older groups was significant. Flexion EOM for the young group (20.1°) was greater (P < 0.05) than the middle (15.2°) and older (12.8°) groups. The difference in flexion between the middle and older groups was not significant. Conclusion. Normative values of lumbar extension are different for white and African-American women. Values for lumbar flexion and extension are different between age groups. Different criteria should be used to estimate impairment level in women of different racial and age groups.

A systematic review of the association between depression and health care utilization in children and adults with sickle cell disease

Patients with sickle cell disease (SCD) experience a disproportionately high use of health care resources. Several studies have examined depression and other negative mood states as risk factors for increased health care utilization; however, there have been no systematic reviews examining and summarizing this evidence in SCD. The aim of this systematic review, therefore, was to determine whether depression or depressive symptoms are associated with health care utilization among children and adults with SCD. We followed a quantitative systematic review protocol based on the Preferred Reporting Items for Systematic Reviews and Meta‐ Analyses guidelines and performed a literature search of records from January 1980 to April 2014 using six databases. Empirical studies were eligible if the sample was primarily composed of patients with SCD and included data on depression, mood disorder diagnosis or depressive symptoms and health care utilization. We included 12 studies involving 54 036 unique participants. The prevalence estimates for depression ranged from 2–57%. Seven studies found a significant, or marginally significant, association between depression and utilization while five did not. Patients reporting depression had an estimated 2·8 times greater relative risk of being a high utilizer, and 2·9 versus 1·8 hospitalizations per year on average compared to patients without depression. Overall, depressive symptoms are common in SCD and may increase risk for poor outcomes including health care utilization. The available studies on depression in SCD, however, are limited by small sample sizes, retrospective designs or short follow‐up. This systematic review found a modest association between depression and health care utilization in SCD.

Recruitment of a racially and ethnically diverse sample into a physical activity efficacy trial

Background Healthy People 2010 underscores the relevance of eliminating health disparities. Thus, it is paramount to create interventions that promote health for all individuals. Purpose This study examined differences in rates of and reasons for ineligibility among non-Hispanic blacks and whites in a randomized controlled physical activity intervention study. Methods Participants (1245 adults) responded to community advertising for the research study. Eligibility at the four pre-randomization assessment sessions was determined by self-reported medical information, resting EKG, 7-Day Physical Activity Recall, fitness test and Stage of Change. We used t-tests to examine the rates of eligibility among participant subgroups. Results Blacks had higher rates of overall ineligibility (86.9%) than whites (75.1%; p < 0.01) and were more likely to be ineligible due to lack of interest or no-show at a pre-randomization appointment (35.4% vs. 24.3%; p < 0.01). Blacks were more likely to be ineligible for medical reasons after the telephone screen (16.3% vs. 7.8%; p = 0.01). Limitations This study did not use a random sampling of potential participants from each of the racial/ethnic groups and thus, there is the potential for selection bias. Conclusions Blacks were more likely to choose not to enroll in the study due to a lack of interest, but had similar rates of overall medical ineligibility to whites. This highlights the importance of strategies that enhance interest among blacks, who initially respond to recruitment advertising. Clinical Trials 2008; 5: 504—516. http://ctj.sagepub.com

Elucidating satisfaction with physical activity: An examination of the day-to-day associations between experiences with physical activity and satisfaction during physical activity initiation

Satisfaction with physical activity is known to be an important factor in physical activity maintenance, but the factors that influence satisfaction are not well understood. The purpose of this study was to elucidate how ongoing experiences with recently initiated physical activity are associated with satisfaction. Participants (n = 116) included insufficiently active volunteers who initiated a self-directed physical activity regimen and completed daily diaries about their experiences for 28 days. We used multilevel models to examine the associations between experiences with physical activity and satisfaction. Significant between-person effects demonstrated that people reporting higher average levels of positive experiences and lower levels of thinking about the negative aspects of exercise were more likely to report higher levels of satisfaction (ps < .05). Positive experiences and perceived progress toward goals had significant within-person effects (ps < .01), suggesting that day-to-day fluctuations in these experiences were associated with changes in satisfaction. These findings elucidate a process through which people may determine their satisfaction with physical activity.