Michelle Segar

Internet-enhanced management of fibromyalgia: A randomized controlled trial

&NA; Both pharmacological and non‐pharmacological interventions have demonstrated efficacy in the management of fibromyalgia (FM). Non‐pharmacological interventions however are far less likely to be used in clinical settings, in part due to limited access. This manuscript presents the findings of a randomized controlled trail of an Internet‐based exercise and behavioral self‐management program for FM designed for use in the context of a routine clinical care. 118 individuals with FM were randomly assigned to either (a) standard care or (b) standard care plus access to a Web‐Enhanced Behavioral Self‐Management program (WEB‐SM) grounded in cognitive and behavioral pain management principles. Individuals were assessed at baseline and again at 6 months for primary endpoints: reduction of pain and an improvement in physical functioning. Secondary outcomes included fatigue, sleep, anxiety and depressive symptoms, and a patient global impression of improvement. Individuals assigned to the WEB‐SM condition reported significantly greater improvement in pain, physical functioning, and overall global improvement. Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period. A no‐contact, Internet‐based, self‐management intervention demonstrated efficacy on key outcomes for FM. While not everyone is expected to benefit from this approach, this study demonstrated that non‐pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes.

TYPE OF PHYSICAL ACTIVITY GOAL INFLUENCES PARTICIPATION IN HEALTHY MIDLIFE WOMEN

BACKGROUND Regular physical activity can help to prevent cardiovascular disease in women. Understanding midlife womens exercise goals could offer insight into their motivational facilitators and barriers, and assist in the development of better primary prevention strategies for this population. OBJECTIVES We sought to investigate the relationship between midlife womens physical activity goals and their physical activity participation over time. METHODS A random sample of healthy, midlife women (40-60 years of age) was selected to participate in a longitudinal study (n = 156). This study fit a linear mixed model to the data to investigate the fixed effects of physical activity goals on physical activity participation, controlling for Body Mass Index (BMI) and Social Support. Mediational analyses were conducted to investigate whether commitment and planning mediated these results. RESULTS There were significant differences between participants with distinct types of goals on physical activity participation over time (i.e., baseline, 1 month, and 1 year postbaseline), controlling for the effects of BMI and Social Support. Participants with Weight Loss and Health Benefits goals participated in significantly less physical activity than those with Sense of Well-being and Stress Reduction goals. Commitment and Planning each mediated the relationship between participant goals and their physical activity participation. CONCLUSIONS These data suggest having physical activity goals that aim to decrease weight or benefit health may not bode well for healthy midlife women who desire to sustain physically active lives. Instead, health care providers and health promotion specialists might better facilitate long-term participation among healthy women if they emphasize physical activity as a means to enhance their quality of life.

Fitting Fitness into Women's Lives: Effects of a Gender-tailored Physical Activity Intervention

Although regular exercise has important health benefits, womens physical activity participation remains low. Addressing the gender- and generation-specific barriers in an intervention may help women become more physically active. Fifty women (mean age = 45 years) participated in a six-session cognitive-behavioral intervention. Baseline, post-intervention, and follow-up data were collected. Total physical activity levels increased from baseline to post-intervention and were maintained at long-term follow-up. This research suggests that participation in a comprehensive, cognitive-behavioral, and empowerment-based physical activity intervention, tailored to address womens distinct constraints and pressures due to sociopsychological experiences, can facilitate increased physical activity among white, middle-aged women.

Prescribing Pleasure and Meaning Cultivating Walking Motivation and Maintenance

Introduction Regular physical activity such as daily walking has numerous health benefits.Walking is a simple type of physical activity that can be done almost anywhere and is the most commonly reported form of physical activity among adults. CDC data show that people who walk are three timesmore likely to meet the physical activity guidelines than those who do not. Encouraging inactive individuals to integrate walking into their daily routine has the potential to yield significant public health benefits. To promote walking among Americans and achieve these benefits, new population-wide initiatives are being launched, including an upcoming Surgeon General’s Walking Call to Action (planned release Fall 2014) and the EveryBodyWalk! initiative. How health professionals and organizations communicate about walking brands it to the public and will influence the ultimate success of this new walking movement. Messages to promote walking that deliver accurate health information but ignore evidence-based principles of motivation and decision making, the underlying mechanisms of behavioral sustainability, will inadvertently undermine these population-level initiatives. To optimize the behavioral impact of these national initiatives, the messaging to promote walking delivered in communities and health clinics should be informed by relevant affective and behavioral science. It is important to shift from a medical to a marketing paradigm to move beyond simply delivering health education to actually motivating consistent walking behavior. Although counterintuitive, the benefits of walking typically emphasized by clinicians and social marketing, such as “better health” and “disease prevention,” are not the same

Delivery of Health Coaching by Medical Assistants in Primary Care

Background: Health coaching is potentially a practical method to assist patients in achieving and maintaining healthy lifestyles. In health coaching, the coach partners with the patient, helping patients discover their own strengths, challenges, and solutions. Methods: Two medical assistants were provided with brief training. The 12-week program consisted of telephone coaching with in-person visits at the beginning and end of the program. Coaching targeted improvements in diet, physical activity, and/or sleep habits using a self-care planning form. Results: A total of 82 subjects enrolled in the program, 72% completed 8 weeks and 49% completed 12 weeks. Subjects who completed assessments at 12 weeks had significant weight loss despite the fact that weight loss was not a study goal. There also were improvements in diet and physical activity. Subject who completed the study were highly satisfied with the program and felt that health coaching should be available in all family medicine clinics. The main barrier providers voiced was remembering to refer patients. The medical providers indicated high satisfaction with the study and valued having coaching available for their patients. Conclusions: Medical assistants can be trained to assist patients with lifestyle changes that are associated with improved health and weight control.

Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees.

INTRODUCTION Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurers lifestyle modification program on healthcare costs of obese individuals. METHODS This nonrandomized comparative effectiveness study evaluated changes in healthcare costs for participants in two incentivized programs, an Internet-mediated pedometer-based walking program (WalkingSpree, n=7,594) and an in-person weight-loss program (Weight Watchers, n=5,764). The primary outcome was the change in total healthcare costs from the baseline year to the year after program participation. Data were collected from 2009 to 2011 and the analysis was done in 2014-2015. RESULTS After 1 year, unadjusted mean costs decreased in both programs, with larger decreases for Weight Watchers participants than WalkingSpree participants (-

Characterizing Employees’ Preferences for Incentives for Healthy Behaviors: Examples to Improve Interest in Wellness Programs

1,055.39 vs -

Moving Towards Wellness: Physical activity practices, perspectives, and preferences of users of outpatient mental health service

577.10, p=0.019). This difference was driven by higher rates of women in Weight Watchers, higher baseline total costs among women, and a greater decrease in costs for women in Weight Watchers (-

Go figure? Body-shape motives are associated with decreased physical activity Participation among midlife women

1,037.60 vs -

Rebranding exercise: closing the gap between values and behavior.

388.50, p=0.014). After adjustment for baseline costs, there were no differences by program or gender. CONCLUSIONS Comparable cost reductions in both programs suggest that employers may want to offer more than one choice of incentivized wellness program with monitoring to meet the diverse needs of employees.