Mary M. Mulvihill

Behavioral intervention to improve calorie intake of children with cystic fibrosis : Treatment versus wait list control

Changes in calorie intake and weight gain were evaluated in five children with cystic fibrosis (CF) who received behavioral intervention and four children with CF who served as wait list controls. The behavioral intervention was a 6-week group treatment that provided nutritional education plus management strategies aimed at mealtime behaviors that parents find most problematic. The control group was identified prospectively and was evaluated on all dependent measures at the same points in time pre- and posttreatment as the intervention group. Difference scores on calorie intake and weight gain from pre- to posttreatment were compared between groups using t tests for independent samples. The behavioral intervention group increased their calorie intake by 1,032 calories per day, while the control groups intake increased only 244 calories per day from pre- to posttreatment [t(6) = 2.826, p = 0.03]. The intervention group also gained significantly more weight (1.7 kg) than the control group (0 kg) over the 6 weeks of treatment [t(7) = 2.588, p = 0.03] and demonstrated catchup growth for weight, as indicated by improved weight Z scores (-1.18 to -0.738). The control group showed a decline in weight Z scores over this same time period (-1.715 to -1.76). One month posttreatment, the intervention was replicated with two of the four children from the control group. Improved calorie intake and weight gain pre- to posttreatment were again found in these children. At 3- and 6-month follow-up study of children receiving intervention, maintenance of calorie intake and weight gain was confirmed. No changes were found on pulmonary functioning, resting energy expenditure, or activity level pre- to posttreatment. This form of early intervention appears to be promising in improving nutritional status and needs to be investigated over a longer period of time to evaluate the effects of treatment gains on the disease process.

Culturally Tailored Aerobic Exercise Intervention for Low-income Latinas

Purpose. To determine the efficacy of community-based, culturally tailored exercise intervention on the moderate and vigorous physical activity and physiologic outcomes of low-income Latino women (Latinas). Design. A randomized trial contrasted safety education to an aerobic dance intervention. Setting. Interventions were held in a “store-front” exercise site near a community clinic. Subjects. Sedentary low-income Latinas (N = 151; 18—55 years; 70% overweight/obese) were recruited. Retention was 91% for follow-up measures. Intervention. Three sessions per week of supervised aerobic dance were provided for 6 months. Controls attended 18 safety education sessions over 6 months. Measures. Physical activity and aerobic fitness (VO2max) were primary outcomes. Results. Participants in the exercise group reported more vigorous exercise (p < .001) and walking (p = .005) at post-test than controls. Aerobic dance and unsupervised activity resulted in a five-fold greater increase in relative VO2max compared with controls (p < .001). Although exercise and fitness decreased at follow-up, vigorous exercise (p = .001) and relative VO2max (p < .001) remained higher in the exercise group, suggesting maintenance at 1 year. Conclusion. Culturally tailored aerobic dance can increase vigorous physical activity, possibly generalizing to walking, and the combination can improve cardiorespiratory fitness in low-income, overweight, sedentary Latinas.

Child behavior and parent management strategies at mealtimes in families with a school-age child with cystic fibrosis

Parent and child mealtime behaviors in school-age children with cystic fibrosis (CF; n = 28) and children without CF (n = 28) were examined during dinner meals by using multivariate analysis of variance. Parents of children with CF were found to differ from comparison parents in the frequency and rate of child management strategies. No differences were found in child behaviors. As the meal progressed, children displayed an increase in behaviors incompatible with eating, and parents increased behaviors to encourage eating. Slow eaters (> 20 min) with CF consumed more calories at the dinner meal than fast eaters (< 20 min) but did not achieve a higher daily caloric intake. Interventions targeting improvement of parent- child interactions during the mealtime are needed to achieve optimal dietary intake.