Patricia E. Durning

Adherence to Exercise Prescriptions: Effects of Prescribing Moderate Versus Higher Levels of Intensity and Frequency

Sedentary adults (N = 379) were randomly assigned in a 2 x 2 design to walk 30 min per day at a frequency of either 3-4 or 5-7 days per week, at an intensity of either 45%-55% or 65%-75% of maximum heart rate reserve. Analyses of exercise accumulated over 6 months showed greater amounts completed in the higher frequency (p = .0001) and moderate intensity (p = .021) conditions. Analyses of percentage of prescribed exercise completed showed greater adherence in the moderate intensity(p = .02) condition. Prescribing a higher frequency increased the accumulation of exercise without a decline in adherence, whereas prescribing a higher intensity decreased adherence and resulted in the completion of less exercise.

Extended-Care Programs for Weight Management in Rural Communities: The Treatment of Obesity in Underserved Rural Settings (TOURS) Randomized Trial

BACKGROUND Rural counties in the United States have higher rates of obesity, sedentary lifestyle, and associated chronic diseases than nonrural areas, yet the management of obesity in rural communities has received little attention from researchers. METHODS Obese women from rural communities who completed an initial 6-month weight-loss program at Cooperative Extension Service offices in 6 medically underserved rural counties (n = 234) were randomized to extended care or to an education control group. The extended-care programs entailed problem-solving counseling delivered in 26 biweekly sessions via telephone or face to face. Control group participants received 26 biweekly newsletters containing weight-control advice. RESULTS Mean weight at study entry was 96.4 kg. Mean weight loss during the initial 6-month intervention was 10.0 kg. One year after randomization, participants in the telephone and face-to-face extended-care programs regained less weight (mean [SE], 1.2 [0.7] and 1.2 [0.6] kg, respectively) than those in the education control group (3.7 [0.7] kg; P = .03 and .02, respectively). The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight-management strategies, and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention. CONCLUSIONS Extended care delivered either by telephone or in face-to-face sessions improved the 1-year maintenance of lost weight compared with education alone. Telephone counseling constitutes an effective and cost-efficient option for long-term weight management. Delivering lifestyle interventions via the existing infrastructure of the Cooperative Extension Service represents a viable means of adapting research for rural communities with limited access to preventive health services. Trial Registration clinicaltrials.gov Identifier: NCT00201006.

Psychometric Properties and Reference Point Data for the Revised Edition of the School Observation Coding System

The psychometric properties of a new observation coding system for childrens disruptive classroom behavior were evaluated. The Revised Edition of the School Observation Coding System (REDSOCS) was used to observe 51 young children clinic-referred for conduct-disordered behavior and 182 nonreferred children from the classrooms of the referred children. Reference point data for the REDSOCS categories with preschoolers were obtained from the sample of nonreferred children. Interobserver reliability and concurrent validity of the three REDSOCS categories with teacher rating scales of oppositional behavior and hyperactivity were demonstrated. Initial evidence of convergent and discriminant validity was established through correlations of the REDSOCS categories with the subscales of the Revised Conners Teacher Rating Scale. Differences in REDSOCS scores between the nonreferred children and children referred for school behavior problems provided

Comparing Costs of Telephone vs Face-to-Face Extended-Care Programs for the Management of Obesity in Rural Settings

BACKGROUND A major challenge after successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge can be exacerbated in rural areas with limited local support resources. OBJECTIVE This study describes and compares program costs and cost effectiveness for 12-month extended-care lifestyle maintenance programs after an initial 6-month weight-loss program. DESIGN We conducted a 1-year prospective randomized controlled clinical trial. PARTICIPANTS/SETTING The study included 215 female participants age 50 years or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003 to May 31, 2007. INTERVENTION The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly assigned to a 12-month extended-care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). MAIN OUTCOME MEASURES Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. STATISTICAL ANALYSES PERFORMED Nonparametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. RESULTS Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs (

Comparative effectiveness of three doses of weight-loss counseling: Two-year findings from the rural LITE trial

420 per participant) when compared with individual telephone counseling (

Validity of the Psycho-Oncology Screening Tool (POST).

268 per participant) and control (

MMPI Profiles of Liver and Heart Transplant Candidates With and Without Significant Histories of Heavy Alcohol Use

226 per participant) programs. Although the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared with the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program (

Prescribing exercise at varied levels of intensity and frequency: a randomized trial.

47/kg) compared with the other two programs (approximately

Prescribing Exercise at Varied Levels of Intensity and Frequency

33/kg for telephone and control). CONCLUSIONS Both the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost but similar outcomes compared with the face-to-face format.

Oncology and Psycho‐Oncology

To evaluate the effects and costs of three doses of behavioral weight‐loss treatment delivered via Cooperative Extension Offices in rural communities.