Publications by authors named "Andrea L Dunn"

39 Publications

Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies.

Am J Psychiatry 2018 07 25;175(7):631-648. Epub 2018 Apr 25.

From La Salle University, Canoas, Brazil; the School of Physical Education, Physiotherapy, and Dance and the Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; KU Leuven-University of Leuven, Department of Rehabilitation Sciences, and University Psychiatric Center, Leuven-Kortenberg, Belgium; the NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney, Australia; the School of Psychiatry, University of New South Wales Sydney, Black Dog Institute, and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Sydney, Australia; the Department of Public Health Sciences, Karolinska Institute, Stockholm; the Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; the Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London; and the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London.

Objective: The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators.

Method: Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale.

Results: A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I=0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations.

Conclusions: Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.
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http://dx.doi.org/10.1176/appi.ajp.2018.17111194DOI Listing
July 2018

How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review.

Transl Behav Med 2017 12;7(4):751-772

School of Medicine, University of Colorado, Aurora, CO, USA.

Although regular physical activity (PA) is a cornerstone of treatment for type 2 diabetes (T2D), most adults with T2D are sedentary. Randomized controlled trials (RCTs) have proven the effectiveness of PA behavioral interventions for adults with T2D but have rarely been conducted in healthcare settings. We sought to identify PA interventions that are effective and practical to implement in clinical practice settings. Our first aim was to use the valid Pragmatic-Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool to assess the potential for future implementation of PA interventions in clinical practice settings. Our second aim was to identify interventions that effectively increased PA and glycemic control among the interventions in the top tertile of PRECIS-2 scores. We searched PubMed MEDLINE from January 1980 through May 2015 for RCTs of behavioral PA interventions coordinated by clinical practices for patients with T2D. Dual investigators assessed pragmatism by PRECIS-2 scores, and study effectiveness was extracted from original RCT publications. The PRECIS-2 scores of the 46 behavioral interventions (n = 13,575 participants) ranged from 3.0 to 4.8, where 5 is the most pragmatic score. In the most pragmatic tertile of interventions (n = 16) by PRECIS-2 scores, 30.8 and 31.3% of interventions improved PA outcomes and hemoglobin A1c, respectively. A minority of published evidence-based PA interventions for adults with T2D were both effective and pragmatic for clinical implementation. These should be tested for dissemination using implementation trial designs.
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http://dx.doi.org/10.1007/s13142-017-0502-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684078PMC
December 2017

"My hair or my health:" Overcoming barriers to physical activity in African American women with a focus on hairstyle-related factors.

Women Health 2016 23;56(4):428-47. Epub 2015 Oct 23.

e ALDunn Health Consulting, LLC , Loveland , Colorado , USA.

Physical activity disparities among African American (AA) women may be related to sociocultural barriers, including difficulties with restyling hair after exercise. We sought to identify physical activity barriers and facilitators in AA women with a focus on sociocultural factors related to hairstyle maintenance. Participants (n = 51) were AA women aged 19-73 years who completed valid surveys and participated in structured focus groups, stratified by age and physical activity levels, from November 2012 to February 2013. The Constant Comparison method was used to develop qualitative themes for barriers and facilitators. The most frequently reported general physical activity barrier among exercisers was "lack of money" (27%) and among non-exercisers was "lack of self-discipline" (57%). A hairstyle-related barrier of "sweating out my hairstyle" was reported by 7% of exercisers and 29% of non-exercisers. This hairstyle-related barrier included the need for extra time and money to restyle hair due to perspiration. Hairstyle-related facilitators included: prioritizing health over hairstyle and high self-efficacy to restyle hair after perspiration. Participants were interested in resources to simplify hairstyle maintenance. AA women whose hairstyle is affected by perspiration may avoid physical activity due to time and financial burdens. Increasing self-efficacy to restyle hair after perspiration may help to overcome this barrier.
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http://dx.doi.org/10.1080/03630242.2015.1101743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944653PMC
September 2016

An international survey of assisted reproductive technologies (ARTs) policies and the effects of these policies on costs, utilization, and health outcomes.

Health Policy 2014 Jun 15;116(2-3):238-63. Epub 2014 Mar 15.

Health Technology and Policy Unit, School of Public Health, Department of Public Health Sciences, University of Alberta, Room 3021, Research Transition Facility, 8308 114 Street, Edmonton, Alberta T6G 2V2, Canada. Electronic address:

Objectives: The purpose of this study was to compare existing policies regarding access to 7 assisted reproductive technologies (ARTs) and to examine the effects of these policies on costs, utilization, and health outcomes in 14 countries and 2 Canadian provinces based on publicly available information.

Methods: A systematic review of publicly available information from peer-reviewed literature (using biomedical and social science databases) and grey literature (e.g., health ministry websites, health technology assessment agency websites, etc.) was performed.

Results: ARTs services permitted or funded vary across jurisdictions. The goals and eligibility restrictions (e.g., on maternal age, number of embryos transferred, and number of cycles) defined in ARTs policies also vary across jurisdictions. Studies on the impact of such policies have primarily been retrospective and focused on short-term service utilization. Nevertheless, they suggest that the policies have achieved specific outcomes, such as reductions in multiple births and in costs to payers.

Conclusions: Based on the evidence reviewed, policies aimed at reducing public coverage of ARTs or restricting the number of embryos transferred have achieved these goals. However, their effects on maternal and infant health outcomes have not been well explored.
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http://dx.doi.org/10.1016/j.healthpol.2014.03.006DOI Listing
June 2014

Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements.

Am J Obstet Gynecol 2014 Mar 8;210(3):244.e1-11. Epub 2013 Nov 8.

Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA.

Objective: The purpose of this study was to determine the efficacy of 3 nonhormonal therapies for the improvement of menopause-related quality of life in women with vasomotor symptoms.

Study Design: We conducted a 12-week 3 × 2 randomized, controlled, factorial design trial. Peri- and postmenopausal women, 40-62 years old, were assigned randomly to yoga (n = 107), exercise (n = 106), or usual activity (n = 142) and also assigned randomly to a double-blind comparison of omega-3 (n = 177) or placebo (n = 178) capsules. We performed the following interventions: (1) weekly 90-minute yoga classes with daily at-home practice, (2) individualized facility-based aerobic exercise training 3 times/week, and (3) 0.615 g omega-3 supplement, 3 times/day. The outcomes were assessed with the following scores: Menopausal Quality of Life Questionnaire (MENQOL) total and domain (vasomotor symptoms, psychosocial, physical and sexual).

Results: Among 355 randomly assigned women who average age was 54.7 years, 338 women (95%) completed 12-week assessments. Mean baseline vasomotor symptoms frequency was 7.6/day, and the mean baseline total MENQOL score was 3.8 (range, 1-8 from better to worse) with no between-group differences. For yoga compared to usual activity, baseline to 12-week improvements were seen for MENQOL total -0.3 (95% confidence interval, -0.6 to 0; P = .02), vasomotor symptom domain (P = .02), and sexuality domain (P = .03) scores. For women who underwent exercise and omega-3 therapy compared with control subjects, improvements in baseline to 12-week total MENQOL scores were not observed. Exercise showed benefit in the MENQOL physical domain score at 12 weeks (P = .02).

Conclusion: All women become menopausal, and many of them seek medical advice on ways to improve quality of life; little evidence-based information exists. We found that, among healthy sedentary menopausal women, yoga appears to improve menopausal quality of life; the clinical significance of our finding is uncertain because of the modest effect.
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http://dx.doi.org/10.1016/j.ajog.2013.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976276PMC
March 2014

Efficacy of exercise for menopausal symptoms: a randomized controlled trial.

Menopause 2014 Apr;21(4):330-8

From the 1Division of Research, Kaiser Permanente, Oakland, CA; 2Fred Hutchison Cancer Research Center, Seattle, WA; 3University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN; 4Klein Buendel Inc, Denver, CO; 5Division of Nutritional Sciences, Cornell University, Ithaca, NY; 6School of Nursing, Indiana University, Indianapolis, IN; 7Group Health Research Institute, Seattle, WA; 8University of Washington, Seattle, WA; 9Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA; 10Massachusetts General Hospital, Harvard University, Boston, MA; and 11National Institute for Fitness and Sport, Indianapolis, IN.

Objective: This study aims to determine the efficacy of exercise training for alleviating vasomotor and other menopausal symptoms.

Methods: Late perimenopausal and postmenopausal sedentary women with frequent vasomotor symptoms (VMS) participated in a randomized controlled trial conducted in three sites: 106 women randomized to exercise and 142 women randomized to usual activity. The exercise intervention consisted of individual facility-based aerobic exercise training three times per week for 12 weeks. VMS frequency and bother were recorded on daily diaries at baseline and on weeks 6 and 12. Intent-to-treat analyses compared between-group differences in changes in VMS frequency and bother, sleep symptoms (Insomnia Severity Index and Pittsburgh Sleep Quality Index), and mood (Patient Health Questionnaire-8 and Generalized Anxiety Disorder-7 questionnaire).

Results: At the end of week 12, changes in VMS frequency in the exercise group (mean change, -2.4 VMS/d; 95% CI, -3.0 to -1.7) and VMS bother (mean change on a four-point scale, -0.5; 95% CI, -0.6 to -0.4) were not significantly different from those in the control group (-2.6 VMS/d; 95% CI, -3.2 to -2.0; P = 0.43; -0.5 points; 95% CI, -0.6 to -0.4; P = 0.75). The exercise group reported greater improvement in insomnia symptoms (P = 0.03), subjective sleep quality (P = 0.01), and depressive symptoms (P = 0.04), but differences were small and not statistically significant when P values were adjusted for multiple comparisons. Results were similar when considering treatment-adherent women only.

Conclusions: These findings provide strong evidence that 12 weeks of moderate-intensity aerobic exercise do not alleviate VMS but may result in small improvements in sleep quality, insomnia, and depression in midlife sedentary women.
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http://dx.doi.org/10.1097/GME.0b013e31829e4089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858421PMC
April 2014

Design and methods of a multi-site, multi-behavioral treatment trial for menopausal symptoms: the MsFLASH experience.

Contemp Clin Trials 2013 May 24;35(1):25-34. Epub 2013 Feb 24.

Division of Research, Kaiser Permanente, Oakland, CA, United States.

Background: Behavioral strategies are recommended for menopausal symptoms, but little evidence exists regarding efficacy.

Purpose: Describe design and methodology of a randomized controlled 3 by 2 factorial trial of yoga, exercise and omega-3 fatty acids.

Methods: Women from three geographic areas with a weekly average of ≥14 hot flashes/night sweats, who met exclusion/inclusion criteria, were randomized to 12weeks of: 1) yoga classes and daily home practice; 2) supervised, facility-based aerobic exercise training; or 3) usual activity. Women in each arm were further randomized to either omega-3 supplement or placebo. Standardized training, on-going monitoring, and site visits were adopted to ensure consistency across sites and fidelity to the intervention. Participant adherence to the intervention protocol was monitored continuously, and retention was actively encouraged by staff. Information on adverse events was systematically collected.

Results: Of 7377 women who responded to mass mailings, 355 (4.8%) were randomized; mean age was 54.7 (sd=3.7), 26.2% were African American, 81.7% were post-menopausal, and mean baseline frequency of daily hot flashes/night sweats was 7.6 (sd=3.8). Adherence of ≥80% was 59% for yoga, 77% for exercise training, and 80% for study pills. Final week 12 data were collected from 95.2%

Conclusions: Conducting a multi-site, multi-behavioral randomized trial for menopausal symptoms is challenging but feasible. Benefits included cost-effective study design, centralized recruitment, and methodologic standardization.
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http://dx.doi.org/10.1016/j.cct.2013.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670607PMC
May 2013

Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia.

Pediatr Blood Cancer 2013 Aug 15;60(8):1358-64. Epub 2013 Feb 15.

Departments of Pediatrics and Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.

Background: Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited.

Procedure: To assess cardiorespiratory fitness, maximal oxygen uptake (VO2 max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2 max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest.

Results: Compared to NHANES participants, ALL survivors had a substantially lower VO2 max (mean 30.7 vs. 39.9 ml/kg/min; adjusted P < 0.0001). For any given percent total body fat, ALL survivors had an 8.9 ml/kg/min lower VO2 max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2 max compared with NHANES participants (all comparisons, P < 0.001). Almost two-thirds (66.7%) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3% of NHANES participants (adjusted P < 0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2 max. Among females, CRT was associated with low VO2 max (P = 0.02), but anthracycline exposure was not (P = 0.58). In contrast, among males, anthracycline exposure ≥ 100 mg/m(2) was associated with low VO2 max (P = 0.03), but CRT was not (P = 0.54).

Conclusion: Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.
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http://dx.doi.org/10.1002/pbc.24492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725590PMC
August 2013

Adopting an Evidence-Based Lifestyle Physical Activity Program: Dissemination Study Design and Methods.

Transl Behav Med 2012 Jun;2(2):199-208

Klein Buendel, Inc.

BACKGROUND: There is a scarcity of research studies that have examined academic-commercial partnerships to disseminate evidence-based physical activity programs. Understanding this approach to dissemination is essential because academic-commercial partnerships are increasingly common. Private companies have used dissemination channels and strategies to a degree that academicians have not, and declining resources require academicians to explore these partnerships. PURPOSE: This paper describes a retrospective case-control study design including the methods, demographics, organizational decision-making, implementation rates, and marketing strategy for Active Living Every Day (ALED), an evidence-based lifestyle physical activity program that has been commercially available since 2001. Evidence-based public health promotion programs rely on organizations and targeted sectors to disseminate these programs although relatively little is known about organizational-level and sector-level influences that lead to their adoption and implementation. METHODS: Cases (n=154) were eligible if they had signed an ALED license agreement with Human Kinetics (HK), publisher of the program's textbooks and facilitator manuals, between 2001 and 2008. Two types of controls were matched (2:2:1) and stratified by sector and region. Active controls (Control 1; n=319) were organizations that contacted HK to consider adopting ALED. Passive controls (Control 2; n=328) were organizations that received unsolicited marketing materials and did not initiate contact with HK. We used Diffusion of Innovations Theory (DIT) constructs as the basis for developing the survey of cases and controls. RESULTS: Using the multi-method strategy recommended by Dillman, a total of n=801 cases and controls were surveyed. Most organizations were from the fitness sector followed by medical, nongovernmental, governmental, educational, worksite and other sectors with significantly higher response rates from government, educational and medical sectors compared with fitness and other sectors, (p=0.02). More cases reported being involved in the decision to adopt ALED (p<0.0001). Data indicate that a low percentage of controls had ever heard of ALED despite repeated marketing and offering other types of physical activity programs and services. Finally, slightly over half of the adopters reported they had actually implemented the ALED program. CONCLUSION: Dissemination research requires new perspectives and designs to produce valid insights about the results of dissemination efforts. This study design, survey methods and theoretically-based questions can serve as a useful model for other evidence-based public health interventions that are marketed by commercial publishers to better understand key issues related to adoption and implementation of evidence-based programs.
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http://dx.doi.org/10.1007/s13142-011-0063-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503455PMC
June 2012

Baseline results from Hawaii's Nā Mikimiki Project: a physical activity intervention tailored to multiethnic postpartum women.

Women Health 2012 ;52(3):265-91

University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii, USA.

During the postpartum period, ethnic minority women have higher rates of inactivity/under-activity than white women. The Nā Mikimiki ("the active ones") Project is designed to increase moderate-to-vigorous physical activity over 18 months among multiethnic women with infants 2-12 months old. The study was designed to test, via a randomized controlled trial, the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website materials-only condition. Healthy, underactive women (mean age = 32 ± 5.6 years) with a baby (mean age = 5.7 ± 2.8 months) were enrolled from 2008-2009 (N = 278). Of the total sample, 84% were ethnic minority women, predominantly Asian-American and Native Hawaiian. Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition, ethnicity, infant's age, maternal body mass index, or maternal employment. Women had high scores on perceived benefits, self-efficacy, and environmental support for exercise but low scores on social support for exercise. This multiethnic sample's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women. The Nā Mikimiki Project's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women.
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http://dx.doi.org/10.1080/03630242.2012.662935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379789PMC
June 2012

Exercise as an augmentation treatment for nonremitted major depressive disorder: a randomized, parallel dose comparison.

J Clin Psychiatry 2011 May;72(5):677-84

Division on Mood Disorders, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA.

Objective: Most patients with major depressive disorder (MDD) require second-step treatments to achieve remission. The Treatment with Exercise Augmentation for Depression (TREAD) study was designed to test the efficacy of aerobic exercise as an augmentation treatment for MDD patients who had not remitted with antidepressant treatment.

Method: Eligible participants in this randomized controlled trial were sedentary individuals (men and women aged 18-70 years) diagnosed with DSM-IV nonpsychotic MDD who had not remitted with selective serotonin reuptake inhibitor (SSRI) treatment. Participants were recruited through physician referrals and advertisements. A total of 126 participants were randomized to augmentation treatment with either 16 kcal per kg per week (KKW) or 4 KKW of exercise expenditure for 12 weeks while SSRI treatment was held constant. Supervised sessions were conducted at The Cooper Institute, Dallas, Texas, with additional home-based sessions as needed to fulfill the weekly exercise prescription. The primary outcome was remission (as determined by a score ≤ 12 on the Inventory of Depressive Symptomatology, Clinician-Rated). The study took place between August 2003 and August 2007.

Results: There were significant improvements over time for both groups combined (F₁,₁₂₁ = 39.9, P < .0001), without differential group effect (group effect: F₁,₁₃₄ = 3.2, P = .07; group-by-time effect: F₁,₁₁₉ = 3.8, P = .06). Adjusted remission rates at week 12 were 28.3% versus 15.5% for the 16-KKW and 4-KKW groups, respectively, leading to a number needed to treat (NNT) of 7.8 for 16 KKW versus 4 KKW. Men, regardless of family history of mental illness, and women without a family history of mental illness had higher remission rates by week 12 with higher-dose (women, 39.0%; men, 85.4%) than with lower-dose exercise (women, 5.6%; men, 0.1%) (women: t₉₅ = 2.1, P = .04; men: t₈₈ = 5.4, P < .0001) (NNT: women, 3.0; men, 1.2).

Conclusions: There was a trend for higher remission rates in the higher-dose exercise group (P < .06), with a clinically meaningful NNT of 7.8 in favor of the high exercise dose. Significant differences between groups were found when the moderating effects of gender and family history of mental illness were taken into account and suggest that higher-dose exercise may be better for all men and for women without a family history of mental illness.

Trial Registration: clinicaltrials.gov Identifier: NCT00076258.
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http://dx.doi.org/10.4088/JCP.10m06743DOI Listing
May 2011

My baby, my move: examination of perceived barriers and motivating factors related to antenatal physical activity.

J Midwifery Womens Health 2011 Jan-Feb;56(1):33-40

Introduction: Based on a socioecological model, the present study examined multilevel barriers and facilitators related to physical activity engagement during pregnancy in women of low socioeconomic status.

Methods: Individual and paired interviews were conducted with 25 pregnant women (aged 18-46 years, 17-40 weeks' gestation) to ask about motivational factors and to compare differences in activity level and parity. Atlas/Ti software was used to code verbatim interview transcripts by organizing codes into categories that reflect symbolic domains of meaning, relational patterns, and overarching themes.

Results: Perceived barriers and motivating factors differed between exercisers and nonexercisers at intrapersonal, interpersonal, and environmental levels.

Discussion: Future interventions should take into account key motivating multilevel factors and barriers to tailor more meaningful advice for pregnant women.
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http://dx.doi.org/10.1111/j.1542-2011.2010.00004.xDOI Listing
June 2011

Review: exercise programmes reduce anxiety symptoms in sedentary patients with chronic illnesses.

Authors:
Andrea L Dunn

Evid Based Ment Health 2010 Aug;13(3):95

Klein Buendel, Inc., Golden, CO, USA.

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http://dx.doi.org/10.1136/ebmh.13.3.95DOI Listing
August 2010

The effect of exercise on mental health.

Curr Sports Med Rep 2010 Jul-Aug;9(4):202-7

Senior Scientist, Klein Buendel, Inc., Golden, CO, USA.

Including exercise for the prevention and treatment of mental disorders is a promising area of research for exercise scientists since data indicate that many of these disorders are not treated at all, and there is a significant delay in treatment. This review provides an appraisal of the recent use of exercise to prevent and treat specific mental disorders and provides a recommended framework for future progress of this research. More research is needed to overcome methodological issues to demonstrate the efficacy and effectiveness of exercise and to integrate mental and physical healthcare for widespread dissemination.
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http://dx.doi.org/10.1249/JSR.0b013e3181e7d9afDOI Listing
March 2011

Psychosocial mediators of physical activity and fitness changes in the activity counseling trial.

Ann Behav Med 2010 Jun;39(3):274-89

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

Background: Improved understanding of the mediators of physical activity (PA) interventions could lead to improvements in theory and programs.

Purpose: To examine the 24-month mediating effects of psychosocial variables on PA and cardiorespiratory fitness (CRF) outcomes in 878 initially sedentary adults aged 35-75 participating in the Activity Counseling Trial.

Methods: Participants were assigned to one of three intervention arms: physician advice, assistance, or counseling. MacKinnon's product of coefficients was used to test for longitudinal and contemporaneous mediation.

Results: Changes in behavioral processes of change from baseline to 24 months significantly mediated the relationship between the active intervention arms and improvements in PA and CRF from baseline to 24 months in both men and women. None of the other psychosocial variables tested met criteria for mediation.

Conclusions: Results indicate that behavioral interventions should incorporate methods to encourage participants to use these behavioral strategies as they attempt to become more active.
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http://dx.doi.org/10.1007/s12160-010-9178-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144540PMC
June 2010

The Effectiveness of Lifestyle Physical Activity Interventions to Reduce Cardiovascular Disease.

Authors:
Andrea L Dunn

Am J Lifestyle Med 2009 Jul;3(1):11S-18S

Klein Buendel, Inc., 1667 Cole Blvd, Suite 225, Golden, Colorado 80401 , 3030-56504342.

Lifestyle interventions have evolved from proof of concept pilot studies to efficacy and effectiveness studies and have now moved toward translation and dissemination studies because of their demonstrated ability to improve cardiovascular diseases (CVD) outcomes including blood pressure. When combined with diet, they also have demonstrated the ability to normalize blood glucose and help to regulate weight. This review highlights the converging lines of evidence that led to lifestyle physical activity interventions beginning with early epidemiology studies and provides evidence for the efficacy and effectiveness of lifestyle interventions. However, if lifestyle interventions are to play a role in preventing CVD and improving CVD outcomes, their use must be more widespread. This will require translational and dissemination research in order to understand how to move into real world settings. Successful examples of translational studies will be highlighted and issues related to theoretical and practical issues as well as capacity building will be discussed. Building bridges between research and practice must be done if lifestyle interventions are to deliver on their public health promise.
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http://dx.doi.org/10.1177/1559827609336067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777660PMC
July 2009

Prevalence of self-reported postpartum depression specific to season and latitude of birth: evaluating the PRAMS data.

Matern Child Health J 2010 Mar;14(2):261-7

Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA.

To determine whether season of infant birth or amount of daylight at time and location of birth is a risk factor for self-reported postpartum depression (PPD). The primary hypothesis was that the prevalence of PPD will peak during the darkest winter months. A cross-sectional analysis was conducted using the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 5 (2004-2006) data set (N = 67,079). Self-reported PPD was established using a modified version of the Patient Health Questionnaire-2 (PHQ-2) included in the PRAMS questionnaire. Logistic regression for complex survey design was used to determine odds ratios and 95% confidence intervals. No significant relationship was found between mild or moderate PPD and either season of birth or length of daylight at birth. By analyzing a large, multi-state sample, this study adds to the equivocal preexisting literature suggesting that there is no significant relationship between the season of birth or length of daylight at birth and PPD.
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http://dx.doi.org/10.1007/s10995-009-0498-6DOI Listing
March 2010

Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia.

J Clin Oncol 2009 Aug 29;27(22):3698-704. Epub 2009 Jun 29.

Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.

Purpose: To determine the prevalence of insulin resistance and other risk factors for cardiovascular disease (CVD) in young adult survivors of childhood acute lymphoblastic leukemia (ALL).

Patients And Methods: In this cross-sectional evaluation of 118 survivors of childhood ALL (median age, 23.0 years; range, 18 to 37 years), insulin resistance was estimated using the homeostasis model for assessment of insulin resistance (HOMA-IR). Sex-specific comparisons were made with a cohort of 30- to 37-year-old individuals from the same region participating in the Dallas Heart Study (DHS, N = 782). ALL survivors were stratified by treatment with and without cranial radiotherapy (CRT).

Results: Female ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.6, 95% CI, 3.6 to 5.7; no CRT, mean 3.3, 95% CI, 2.8 to 3.8) in comparison with DHS women (mean 2.4, 95% CI, 2.2 to 2.7). Eighty percent of women treated with CRT had at least three of six CVD risk factors, and they were significantly more likely to have three or more risk factors compared with DHS women (odds ratio [OR], 5.96; 95% CI, 2.15 to 16.47). Male ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.0, 95% CI, 2.8 to 5.6; no CRT, mean 3.4, 95% CI, 2.9 to 3.9) in comparison with DHS men (mean 2.3, 95% CI, 2.1 to 2.6), but were not more likely to have multiple CVD risk factors.

Conclusion: ALL survivors had an increased prevalence of insulin resistance in comparison with a cohort of older individuals from the same community. Importantly, women treated with CRT seem to have an increased prevalence of multiple CVD risk factors, warranting close monitoring and risk-reducing strategies.
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http://dx.doi.org/10.1200/JCO.2008.19.7251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720083PMC
August 2009

Social-cognitive correlates of physical activity in a multi-ethnic cohort of middle-school girls: two-year prospective study.

J Pediatr Psychol 2010 Mar 25;35(2):188-98. Epub 2009 May 25.

University of Georgia, Athens, GA 30602-6554, USA.

Objective: The study examined social-cognitive correlates of physical activity in a multi-ethnic cohort of girls from six regions of the United States who participated in the Trial of Activity for Adolescent Girls during their 6th and 8th grade school years.

Methods: Girls completed validated questionnaires and wore accelerometers that measured weekly physical activity in the spring of 2002 and 2005.

Results: In 8th grade, self-efficacy and perceived social support had indirect relations with physical activity mediated through perceived barriers, which was inversely related to physical activity. Self-efficacy also had a direct relation with physical activity.

Conclusions: Correlations were smaller than those obtained in studies that measured physical activity by self-reports, suggesting that previous estimates were inflated by common method artifact. Nonetheless, physical activity trials among girls during early adolescence might focus on increasing self-efficacy for overcoming barriers to physical activity and on ways by which perceived barriers can otherwise be reduced.
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http://dx.doi.org/10.1093/jpepsy/jsp042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902830PMC
March 2010

Validity of social-cognitive measures for physical activity in middle-school girls.

J Pediatr Psychol 2010 Jan-Feb;35(1):72-88. Epub 2009 May 11.

Department of Kinesiology, The University of Georgia, Ramsey Student Center, Athens, GA 30602-6554, USA.

Objective: The factorial validity and measurement equivalence/invariance of scales used to measure social-cognitive correlates of physical activity among adolescent girls were examined.

Methods: Confirmatory factor analysis was applied to questionnaire responses obtained from a multi-ethnic sample (N = 4885) of middle-school girls from six regions of the United States. A cohort of 1893 girls completed the scales in both sixth and eighth grades, allowing longitudinal analysis.

Results: Theoretically and statistically sound models were developed for each scale, supporting the factorial validity of the scales in all groups. Multi-group and longitudinal invariance was confirmed across race/ethnicity groups, age within grade, BMI categories, and the 2-year period between grades.

Conclusions: The scores from the scales provide valid assessments of social-cognitive variables that are putative mediators or moderators of change in physical activity. The revised scales can be used in observational studies of change or interventions designed to increase physical activity among girls during early adolescence.
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http://dx.doi.org/10.1093/jpepsy/jsp031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910934PMC
March 2010

Obesity among those with mental disorders: a National Institute of Mental Health meeting report.

Am J Prev Med 2009 Apr;36(4):341-50

University of Alabama at Birmingham, Birmingham, Alabama, USA.

The National Institute of Mental Health convened a meeting in October 2005 to review the literature on obesity, nutrition, and physical activity among those with mental disorders. The findings of this meeting and subsequent update of the literature review are summarized here. Levels of obesity are higher in those with schizophrenia and depression, as is mortality from obesity-related conditions such as coronary heart disease. Medication side effects, particularly the metabolic side effects of antipsychotic medications, contribute to the high levels of obesity in those with schizophrenia, but increased obesity and visceral adiposity have been found in some but not all samples of drug-naïve patients as well. Many of the weight-management strategies used in the general population may be applicable to those with mental disorders, but little is known about the effects of these strategies on this patient population or how these strategies may need to be adapted for the unique needs of those with mental disorders. The minimal research on weight-management programs for those with mental disorders indicates that meaningful changes in dietary intake and physical activity are possible. Physical activity is an important component of any weight-management program, particularly for those with depression, for which a substantial body of research indicates both mental and physical health benefits. Obesity among those with mental disorders has not received adequate research attention, and empirically-based interventions to address the increasing prevalence of obesity and risk of cardiovascular and metabolic diseases in this population are lacking.
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http://dx.doi.org/10.1016/j.amepre.2008.11.020DOI Listing
April 2009

Active for life: final results from the translation of two physical activity programs.

Am J Prev Med 2008 Oct;35(4):340-51

University of South Carolina (USC), Department of Exercise Science, Arnold School of Public Health, Columbia, South Carolina 29208, USA.

Background: Most evidence-based programs are never translated into community settings and thus never make a public health impact.

Design: Active for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008.

Setting/participants: Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white).

Intervention: In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4.

Main Outcome Measure: Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure.

Results: Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites.

Conclusions: Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adult's health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.
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http://dx.doi.org/10.1016/j.amepre.2008.07.001DOI Listing
October 2008

Depressive symptoms and physical activity in adolescent girls.

Med Sci Sports Exerc 2008 May;40(5):818-26

Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA.

Purpose: To evaluate the relationship between depressive symptoms and physical activity in a geographically and ethnically diverse sample of sixth-grade adolescent girls.

Methods: The Trial of Activity for Adolescent Girls (TAAG) baseline measurement included a random sample (N = 1721) of sixth-grade girls in 36 schools at six field sites. Measurements were accelerometry and the 3-d Physical Activity Recall (3DPAR) for physical activity, and the Center for Epidemiological Studies-Depression scale (CES-D) for depressive symptoms.

Results: Girls with complete data (N = 1397), mean age 12 yr, had an average CES-D score of 14.7 (SD = 9.25) and engaged in an average of about 460 min of sedentary activity, < 24 min of moderate to vigorous physical activity (MVPA), and < 6 min of vigorous physical activity (VPA) in an 18-h day. Thirty-minute segments of MVPA ranged in number from 3.9 to 1.2, and METS for these segments ranged from > 3.0 to > 6.5. Mixed-model regression indicated no relationship between depressive symptoms and physical activity; however, a significant but modest inverse relationship between sedentary activity and depressive symptoms was observed.

Conclusion: A sufficient sample size, standardized procedures, and validated instruments characterized this study; however, a relationship between depressive symptoms and physical activity was not observed for sixth-grade girls from diverse geographic locations. The average CES-D score was lower than is considered clinically meaningful for either adolescents or adults, and MET-minutes of sedentary activity were high. This combination of data may be different from other studies and could have contributed to the unexpected finding. This unexpected finding is informative, however, because it shows the need for additional research that includes a wider range of possible combinations of data, especially with young adolescent girls.
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http://dx.doi.org/10.1249/MSS.0b013e3181632d49DOI Listing
May 2008

Abdominal obesity, liver fat, and muscle composition in survivors of childhood acute lymphoblastic leukemia.

J Clin Endocrinol Metab 2007 Oct 24;92(10):3816-21. Epub 2007 Jul 24.

School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada K7L 3N6.

Context: Survivors of childhood acute lymphoblastic leukemia (ALL) become obese, and are at increased risk for morbidity and mortality post therapy.

Objective: We determined the association of cranial radiotherapy (CRT) and/or sex with levels of total, regional, and ectopic fat storage, metabolic risk, IGF-I, and leptin in adult ALL survivors.

Design, Setting, Patients: A cross-sectional analysis of 52 male (15 CRT treated) and 62 female (24 CRT treated) young adult ALL survivors was conducted.

Main Outcomes: We assessed levels of visceral fat, sc abdominal and thigh fat, and liver and muscle fat using computed tomography, total fat and lean body mass using dual-energy x-ray absorptiometry, and IGF-I and leptin levels by radioimmunoassay.

Results: Controlled for age and race, ALL survivors treated with CRT had higher levels of abdominal and visceral fat, body fat percentage, metabolic risk (insulin resistance and dyslipidemia), and leptin but lower lean mass and IGF-I levels than non-CRT survivors (P 0.1).

Conclusion: Among young adult ALL survivors, CRT is a risk factor for elevated total, abdominal, and visceral adiposity, a reduced fat-free mass, elevated metabolic risk, and altered IGF-I and leptin levels.
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http://dx.doi.org/10.1210/jc.2006-2178DOI Listing
October 2007

Moderator analyses of participants in the Active for Life after cancer trial: implications for physical activity group intervention studies.

Ann Behav Med 2007 Feb;33(1):99-104

Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77230-1439, USA.

Background: Prostate cancer patients on hormonal therapy experience significant treatment-related physical and psychological sequelae.

Purpose: We examined moderator variables to determine whether certain participants demonstrated quality of life (QOL) benefits from a group-based lifestyle physical activity program compared to a group-based educational support program and standard care.

Methods: Participants were 134 prostate cancer patients on continuous androgen ablation in a controlled trial that used adaptive allocation.

Results: As reported elsewhere, no significant differences were found between study conditions on primary QOL outcomes following the 6-month interventions. However, in a secondary analysis, several significant interactions indicated that both group programs benefited patients with lower psychosocial functioning at baseline; patients with lower mental health and social support scores had significant improvements in these measures compared with standard care. For those with higher pain, the educational support program resulted in significant improvements compared with the other two conditions. Twelve-month findings indicated lasting effects.

Conclusions: Consistent with existing research, results indicate that group interventions benefit cancer patients with limitations in psychosocial functioning. Findings underscore the importance of physical activity/exercise studies to employ control conditions that consider the attention and support provided by health educators and group members, particularly when examining psychosocial outcomes and pain.
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http://dx.doi.org/10.1207/s15324796abm3301_11DOI Listing
February 2007

Improving measurement methods for behavior change interventions: opportunities for innovation.

Health Educ Res 2006 Dec 31;21 Suppl 1:i121-124. Epub 2006 Oct 31.

Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA.

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http://dx.doi.org/10.1093/her/cyl141DOI Listing
December 2006

Diffusion and dissemination for increasing physical activity in world populations.

Am J Prev Med 2006 Oct;31(4 Suppl):S94-6

Klein Buendel, Inc., Golden Colorado, USA.

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http://dx.doi.org/10.1016/j.amepre.2006.06.017DOI Listing
October 2006

Outcomes from the women's wellness project: a community-focused physical activity trial for women.

Prev Med 2006 Dec 17;43(6):447-53. Epub 2006 Aug 17.

The Miriam Hospital and Brown Medical School, Centers for Behavioral and Preventive Medicine, Providence, RI 02903, USA.

Background: Given the low rates of physical activity participation, innovative intervention approaches are needed to make a public health impact.

Methods: The study was conducted at the Miriam Hospital/Brown Medical School in Providence, RI, and in communities of Southeastern Massachusetts from 2002 to 2005. Previously sedentary women (n = 280; mean age = 47.1; 94.6% Caucasian) were randomly assigned to one of three conditions: (1) Choose to Move, a self-help printed booklet (n = 93), (2) Jumpstart, a motivationally tailored, print based intervention (n = 95); or (3) Wellness, women's health materials (n = 92). Face-to-face contact at months 3 (M3) and 12 (M12) occurred within participants' communities in local libraries.

Results: At M3, participants in the Jumpstart condition reported significantly more minutes of physical activity per week (M = 140.4, SE = 14.82) than participants in the Wellness condition (M = 98.1, SE = 15.09), (t(275) = 2.00, p < 0.05). The Jumpstart arm showed a trend towards significance (t(275) = 1.93, p = 0.054) when compared with the CTM arm (M = 99.5, SE = 15.11); there was no significant difference between the CTM and Wellness arms (t(275) = 0.07, p = NS). At M12, there were no significant differences (F(2,275) = 0.147, p = NS) between any of the treatment arms.

Conclusions: Results suggest that print-based programs for physical activity may be efficacious short-term, but more research is needed to find approaches that are effective long-term. It is possible to deliver print-based programs through existing community infrastructures, however these approaches need further evaluation to examine maintenance effects apart from the demand characteristics of a research study.
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http://dx.doi.org/10.1016/j.ypmed.2006.06.011DOI Listing
December 2006

Identifying subgroups that succeed or fail with three levels of physical activity intervention: the Activity Counseling Trial.

Health Psychol 2006 May;25(3):336-47

Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, CA 94305-5705, USA.

The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.
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http://dx.doi.org/10.1037/0278-6133.25.3.336DOI Listing
May 2006

Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients.

Psychooncology 2006 Oct;15(10):847-62

Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, 77230-1439, USA.

Background: Active for Life After Cancer is a randomized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program (Lifestyle) for prostate cancer patients to improve quality of life (QOL) including physical and emotional functioning compared to a group-based Educational Support Program and a Standard Care Program (no group).

Method: A total of 134 prostate cancer patients receiving continuous androgen-ablation were randomly assigned to one of the three study conditions.

Results: Results indicated no significant improvements in QOL at 6 or 12 months. Both group-based programs were positively received and yielded good attendance and retention. Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity. Despite these improvements, no significant changes were found for most physical activity measures.

Conclusions: Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients.
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http://dx.doi.org/10.1002/pon.1023DOI Listing
October 2006
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