Stefanie De Jesus

The effects of acute exercise on tobacco cravings and withdrawal symptoms in temporary abstinent pregnant smokers

INTRODUCTION Smoking during pregnancy is common, and quitting at any point during pregnancy can yield benefits to both the fetus and mother. Smoking cessation is typically followed by withdrawal symptoms and a strong desire to smoke, both of which are likely to contribute to relapse. Research has shown that a bout of exercise minimizes cravings and tobacco withdrawal symptoms (TWS) after temporary abstinence in smokers, but these findings have not been replicated in pregnant smokers. This study examined the effect of 20min of exercise on cravings (primary outcome) and TWS (secondary outcomes) among temporary abstinent, inactive pregnant smokers. METHODS Thirty female smokers (Mean(M) age=25.7years, Standard Deviation(SD)=5.5; M weeks pregnant=18.2, SD=5.3; Fagerstrom Test for Cigarette Dependence=3.3, SD=2.2; M 9.3 cigarettes/day, SD=4.7; M hours abstained=17.2, SD=2.8) were randomized to 20 min of mild-to-moderate intensity exercise (EC; n=14) or passive (PC; n=16) condition. Cravings and TWS were assessed immediately before, during (at 10 min), immediately post, and at 10, 20, and 30 min post-condition. RESULTS A 2 (condition)×6 (time) repeated measures ANOVA revealed that the EC significantly (p<0.05) reduced cravings (ή(2)=0.46) compared with the PC, across time. Non-significant, but nevertheless, large effects were evident favouring the EC over time for TWS restlessness (ή(2)=0.34), stress (ή(2)=0.24), irritability (ή(2)=0.21), tension (ή(2)=0.15), and depression (ή(2)=0.14). CONCLUSIONS Consistent with previous research, this study reveals that in pregnant smokers, a bout of exercise is associated with a reduction in cravings and similar patterns exist for TWS. Therefore, exercise may have the potential to assist in the initial stages of smoking cessation attempts during pregnancy.

Effects of a Comprehensive, Intensive Lifestyle Intervention Combined with Metformin Extended Release in Obese Adolescents

Objective. To assess a comprehensive, intensive lifestyle intervention in combination with metformin extended release (MXR) or placebo on body mass index (BMI) and risk factors for type 2 diabetes and cardiovascular disease in obese adolescents. Study Design. Sixty-nineobese adolescents (mean BMI 32.5) received a comprehensive lifestyle intervention with structured dietary, physical activity, and behavioral components for 24 months. Subjects were randomized to 1 of 4 groups: MXR (33) 2,000 mg daily or placebo, with either moderate or vigorous intensity exercise for the first 3 months. Subsequently the exercise intervention was the same for all 4 groups. Results. Anthropometry measurements did not differ with initial exercise intensity at any time. At 3 months % body fat decreased in all 4 groups (P < 0.006). BMI and % body fat decreased in the MXR groups, but not the placebo groups, at 6 (−0.88, −3.16) and 12 months (−0.56, −2.34) (P < 0.05). Insulin resistance, fasting blood glucose, and leptin improved in all groups at 6 and 12 months. A high subject attrition rate (58%) occurred by 24 months. Conclusion. A comprehensive, intensive lifestyle intervention combined with MXR led to a decline in BMI and % body fat at 1 year independent of initial exercise intensity. This trial is registered with ClinicalTrials.gov NCT00934570 .

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors

The health consequences of smoking are well documented, yet quit rates are modest. While exercise has supported decreased cravings and withdrawal symptoms in temporarily abstinent smokers, it has yet to be applied when smokers are experiencing concurrent stressors. This study examined the effect of an acute bout of moderate intensity exercise on cravings (primary outcome) and ad libitum smoking (secondary outcome) following concurrent stressors (i.e., temporary abstinence and environmental manipulation-Stroop cognitive task+cue-elicited smoking stimuli). Twenty-five smokers (>10cig/day; Mean age=37.4years) were randomized into either exercise (n=12) or passive sitting conditions. A repeated measure (RM) ANOVA showed that psychological withdrawal symptoms (a measure of distress) were significantly exacerbated after temporary abstinence and then again after the environmental manipulation for all participants (p<.0001, η(2)=.50). Furthermore, a treatment by time RM ANOVA revealed decreases in psychological withdrawal symptoms for only the exercise condition (p<.001, η(2)=.42). A treatment by time RM ANOVA also revealed craving reductions for only the exercise condition (p<.0001, η(2)=.82). Exercise had no effect on ad libitum smoking. This is the first study to use a lab-based scenario with high ecological validity to show that an acute bout of exercise can reduce cravings following concurrent stressors. Future work is now needed where momentary assessment is used in peoples natural environment to examine changes in cigarette cravings following acute bouts of exercise.

Feasibility of an exercise intervention for fatigued breast cancer patients at a community-based cardiac rehabilitation program

Purpose Exercise is beneficial to quality of life after cancer treatment, yet few cancer survivors meet exercise guidelines. Our study sought to determine the feasibility of an oncology rehabilitation exercise program embedded within a cardiac rehabilitation program. Methods Patients who rated their fatigue >4/10 after completion of adjuvant chemotherapy for breast cancer were screened for eligibility and the outcomes were assessed (Piper Fatigue Scale, Functional Assessment of Cancer Therapy-Breast [FACT-B], Edmonton Symptom Assessment System, body composition, stress test, and physical activity measurement [accelerometer]). Participants received individualized exercise prescription. Following the 16-week program, repeat assessment plus patient acceptance and satisfaction survey was completed. The primary end point was the composite of accrual rate >25%, program adherence >80%, and mean compliance with accelerometer use >80%. Results Twenty of 24 screened patients consented to the study and completed the baseline assessment. Adherence was 30.3%. Mean accelerometer use was 3.88/7 days (78%). Fatigue at baseline was rated at 4.82/10, and at 3.59 (p = 0.09) after the intervention. Overall well-being (FACT-B) score changed from 92.7 to 98.3 (p = 0.05). There were no significant changes in body composition (except for bone mineral content), aerobic exercise capacity, or activity patterns. Conclusion Although the primary outcome was not met, our study indicates that an oncology exercise rehabilitation program can be incorporated into an existing cardiac rehabilitation program. Based on feedback received, we propose that in order to achieve exercise goals, frequent, encouraging, and tailored feedback and group sessions to foster a sense of community may additionally be needed to strengthen adherence to a prescribed exercise program.

I sit because I have fun when I do so! Using self-determination theory to understand sedentary behavior motivation among university students and staff

ABSTRACT Objectives. Evidence exists that independently of physical activity, a dose–response relationship exists between sedentary time and adverse health outcomes. However, little is known about motivations underlying sedentary behavior. The purpose of this study was to (i) examine the factor structure and composition of sedentary-derived autonomous (identified and intrinsic) and controlled (external and introjected) motives within an Organismic Integration Theory (OIT) framework and (ii) determine whether these motivational constructs are related with overall sitting time as well as sitting for work/school and recreation/leisure on weekdays and weekends. Method. University students or staff (n = 571) completed an Internet-based survey within a cross-sectional design. After completing a modified Sedentary Behavior Questionnaire, participants were randomized to one of five groups (general, weekday work/school, weekday recreation/leisure, weekend work/school, weekend recreation/leisure) and completed a sedentary-derived 15-item modified Behavioral Regulation in Exercise Questionnaire. Results. Factor analysis findings support the tenability of a four-factor model for weekday work/school, weekend work/school, and weekend leisure/recreation sedentary behavior and a three-factor model for general and weekday leisure/recreation behavior. Regression analyses showed the motivational constructs explained a significant amount of sedentary behavior variance for weekend work/school (10%), weekend leisure/recreation (9%), weekday work/school (4%), and weekday leisure/recreation (3%). General sedentary behavior was unrelated with the motivational constructs. In general, autonomous motives underlied leisure/recreational sitting while controlled motives were more strongly associated with work/school behavior. Conclusions. Our findings support the hypothesis that motivational constructs grounded in OIT have the potential to further our understanding of sedentary behavior.

The effects of a peer modeling intervention on cardiorespiratory fitness parameters and self-efficacy in obese adolescents.

Inconsistencies exist in the assessment and interpretation of peak VO2 in the pediatric obese population, as cardiorespiratory fitness assessments are effort-dependent and psychological variables prevalent in this population must be addressed. This study examined the effect of a peer modeling intervention on cardiorespiratory fitness performance and task self-efficacy in obese youth completing a maximal treadmill test. Forty-nine obese (BMI ≥ 95th percentile for age and sex) youth were randomized to an experimental (received an intervention) or to a control group. The outcome variables were mean and variability cardiorespiratory fitness (peak VO2, heart rate, duration, respiratory exchange ratio), rating of perceived exertion, and task self-efficacy scores. Irrespective of whether a mean or variability score was used, receiving the intervention was associated with non-significant trends in fitness parameters and task self-efficacy over time, favoring the experimental group. Cardiorespiratory fitness and task self-efficacy were moderately correlated at both time points. To elucidate the aforementioned findings, psychosocial factors affecting obese youth and opportunities to modify the peer modeling intervention should be considered. Addressing these factors has the potential to improve standard of care in a clinical setting regarding pretest patient education.

Smoking behaviour and sensations during the pre-quit period of an exercise-aided smoking cessation intervention

INTRODUCTION Previous research has shown reductions in cigarette consumption during the pre-quit period of exercise-aided smoking cessation interventions. Smoking topography and sensation patterns during this period is unknown and may provide valuable insight into compensation and cessation readiness. METHODS Female smokers (N = 236, M age = 43, M cigarettes/day = 17.0) enrolled in an exercise-aided smoking cessation intervention self-reported daily cigarette use and cigarette sensory experiences. Breath carbon monoxide and smoking topography data were collected during the period leading up to the targeted quit date (i.e., baseline, week 1, and week 3), which was set for week 4. RESULTS Repeated measures ANOVAs revealed that cigarette consumption (p < 0.001, eta = 0.32), carbon monoxide (p < 0.001, eta = 0.14), puff duration (p = 0.01, eta = 0.05), smoking satisfaction (p < 0.001, eta = 0.34), psychological reward (p < 0.001, eta = 0.43), enjoyment of respiratory tract sensations (p < 0.001, eta = 0.29), and craving (p < 0.001, eta = 0.39) decreased, whereas average puff flow (p = 0.01, eta = 0.05) increased. CONCLUSIONS This is the first study to establish that regular exercise during the pre-quit period served as a conduit for facilitating behavioral and sensory harm reduction with cigarettes. Furthermore, the pattern of change observed between cigarette consumption and smoking topography does not support compensation. These findings imply that female smokers who exercise prior to a quit attempt are in a favourable state to achieve cessation.

Implementation of clinical research trials using web-based and mobile devices: challenges and solutions

BackgroundWith the increasing implementation of web-based, mobile health interventions in clinical trials, it is crucial for researchers to address the security and privacy concerns of patient information according to high ethical standards. The full process of meeting these standards is often made more complicated due to the use of internet-based technology and smartphones for treatment, telecommunication, and data collection; however, this process is not well-documented in the literature.ResultsThe Smart Heart Trial is a single-arm feasibility study that is currently assessing the effects of a web-based, mobile lifestyle intervention for overweight and obese children and youth with congenital heart disease in Southwestern Ontario. Participants receive telephone counseling regarding nutrition and fitness; and complete goal-setting activities on a web-based application. This paper provides a detailed overview of the challenges the study faced in meeting the high standards of our Research Ethics Board, specifically regarding patient privacy.ConclusionWe outline our solutions, successes, limitations, and lessons learned to inform future similar studies; and model much needed transparency in ensuring high quality security and protection of patient privacy when using web-based and mobile devices for telecommunication and data collection in clinical research.

Anthropometric and body composition changes in smokers vs abstainers following an exercise-aided pharmacotherapy smoking cessation trial for women

INTRODUCTION Post-cessation weight gain contributes to smoking relapse, especially for women. Furthermore, excess weight in the form of android or visceral fat is associated with metabolic health problems. For this study, a secondary analysis was conducted in 2015 to determine whether quitting status, achieved through a 14 week supervised exercise-aided nicotine replacement therapy (NRT) cessation program [Getting Physical on Cigarette Trial-2009 to 2013; Prapavessis, et al., 2016], affects anthropometric and body composition parameters in female smokers (N = 413, M age = 42.39 years). METHODS Anthropometric (weight and BMI) and body composition (% total body fat, % android fat, lean mass and visceral fat) indices were assessed at baseline and end of treatment. Smoking status was confirmed weekly from expired breath carbon monoxide. Adherence to exercise and NRT patch was calculated from the number of exercise sessions attended and patches worn to the number of exercise sessions offered and patches supplied, respectively. RESULTS Factorial (smoking status) ANCOVAs controlling for baseline anthropometric and body composition parameters as well as adherence to exercise and NRT revealed significant differences in weight (p = .033; ɳp2 = 0.017) and BMI (p = .020; ɳp2 = 0.020) at week 14. This equated to abstainers weighing 1.26 kg more and having a 0.52 higher BMI than smokers. No significant differences were found for any of the body composition parameters at week 14 (ɳp2 range from 0.001-0.007). CONCLUSIONS Abstainers gain modest weight compared to smokers. This weight gain is related to increases in lean mass and not total, android, or visceral fat.

Affect and cortisol mechanisms through which acute exercise attenuates cigarette cravings during a temporary quit attempt

INTRODUCTION A number of mechanisms have been proposed to explain how exercise attenuates cravings among temporarily abstinent smokers; however, research has presented mixed findings. The aim of this study was to further investigate the mechanistic role of positive and negative affect and cortisol in the exercise-craving reduction relationship. METHODS Adult smokers (N=110, male=56, M age=33.1, M cigarettes/day=15.4) provided baseline affective and cortisol data (T1). After an 18-h period of abstinence, participants were randomized to a passive sitting (PSG) or moderate exercise group (MEG; 40-68% of heart rate reserve) for 10min. Affect and cortisol data were also collected immediately before (T2) and after (T3) the condition. RESULTS The smoking abstinence manipulation increased cravings (p<0.001, eta=0.40) and negative affect (p<0.001, eta=0.17), as well as decreased positive affect (p<0.001, eta=0.08) and cortisol (trending, p=0.07, η2=0.04). As expected, a significant reduction in cravings from T2 to T3 was found for MEG but not PSG (p<0.001, eta=0.25). Mediation was tested using Sobel and bootstrapping tests with residual change scores of mediators and cravings. Findings showed that both positive and negative affect, but not cortisol, mediated the relationship between exercise and cravings. CONCLUSIONS Understanding the mechanisms by which exercise induces craving reductions will better allow researchers and healthcare professionals to infer causality and implement interventions guided by the processes that yield such desirable outcomes.