AgingPLUS: A Randomized Trial to Increase Physical Activity in Middle-Aged and Older Adults

Engagement in physical activity (PA) has well-documented benefits for delaying or preventing age-related diseases. Thus, it is important to study innovative ways to increase PA in the adult population. This symposium describes AgingPLUS, an ongoing trial that addresses three psychological mechanisms to increase adults’ PA: Negative views of aging (NVOA), low self-efficacy beliefs, and deficient goal-planning skills. The symposium also presents preliminary findings, based on a pre-pandemic subsample, on changes in explicit NVOA, implicit VOA, and changes in PA. Diehl et al. describe the theoretical background and study design of the ongoing RCT. This also includes the main study hypotheses. Rebok et al. present preliminary findings showing significant effects of the intervention on NVOA and frequency of moderate intensity exercise. Effects on physical function and accelerometry measures were not statistically significant in this subsample. Tseng et al. examined the effects of the intervention on two measures of implicit VOA: a lexical decision-making task (LDMT) and the Brief Implicit Association Test (BIAT). Findings showed that differences in post-intervention latencies on the LDMT were not statistically significant. Differences on post-intervention BIAT d scores also failed to be significant. Finally, Nehrkorn-Bailey et al. tested a multiple mediator model examining the mediational role of self-efficacy (SE) and exercise intention (EI) on PA. Results showed that Week 4 SE significantly mediated the effect of intervention condition to Week 8 anticipated PA engagement. Week 4 EI significantly mediated the effect of intervention condition on Month 6 PA engagement. Anticipated PA effects predicted subsequent involvement in PA.

Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial

Background Shared decision-making (SDM) is preferred by many patients in cancer care. However, despite scientific evidence and promotion by health policy makers, SDM implementation in routine health care lags behind. This study aimed to evaluate an empirically and theoretically grounded implementation program for SDM in cancer care. Methods In a stepped wedge design, three departments of a comprehensive cancer center sequentially received the implementation program in a randomized order. It included six components: training for health care professionals (HCPs), individual coaching for physicians, patient activation intervention, patient information material/decision aids, revision of quality management documents, and reflection on multidisciplinary team meetings (MDTMs). Outcome evaluation comprised four measurement waves. The primary endpoint was patient-reported SDM uptake using the 9-item Shared Decision Making Questionnaire. Several secondary implementation outcomes were assessed. A mixed-methods process evaluation was conducted to evaluate reach and fidelity. Data were analyzed using mixed linear models, qualitative content analysis, and descriptive statistics. Results A total of 2,128 patient questionnaires, 559 questionnaires from 408 HCPs, 132 audio recordings of clinical encounters, and 842 case discussions from 66 MDTMs were evaluated. There was no statistically significant improvement in the primary endpoint SDM uptake. Patients in the intervention condition were more likely to experience shared or patient-lead decision-making than in the control condition (d=0.24). HCPs in the intervention condition reported more knowledge about SDM than in the control condition (d = 0.50). In MDTMs the quality of psycho-social information was lower in the intervention than in the control condition (d = − 0.48). Further secondary outcomes did not differ statistically significantly between conditions. All components were implemented in all departments, but reach was limited (e.g., training of 44% of eligible HCPs) and several adaptations occurred (e.g., reduced dose of coaching). Conclusions The process evaluation provides possible explanations for the lack of statistically significant effects in the primary and most of the secondary outcomes. Low reach and adaptations, particularly in dose, may explain the results. Other or more intensive approaches are needed for successful department-wide implementation of SDM in routine cancer care. Further research is needed to understand factors influencing implementation of SDM in cancer care. Trial registration clinicaltrials.gov, NCT03393351, registered 8 January 2018.

Reducing behavioral health symptoms by addressing minority stressors in LGBTQ adolescents: a randomized controlled trial of Proud & Empowered

Background Minority stress may lead to poorer mental health for sexual and gender minority adolescents, yet no interventions have been tested through an RCT to address these concerns. Methods We report on an RCT of an intervention—Proud & Empowered—with four high schools. Measures assess the intervention’s impact on mental health symptoms. Results Compared to the control, participants in the treatment condition reported significant differences in minority stress, anxiety, and depressive symptoms. Moderation analyses showed that the intervention significantly moderated the relationship between minority stress and PTSD (b = -1.28, p = .032), depression (b = -0.79, p = .023), and suicidality (b = 0.14, p = .012) symptoms; those in the intervention condition had mitigated relationships between measures of stress and health outcomes compared to those in the control condition. Conclusions Results suggest that Proud & Empowered help reduce mental health symptoms and exposure to minority stressors and build coping strategies. Trial Registration The intervention was registered on clinicaltrials.gov on August 1, 2019 under Trial #NCT04041414.

Examining the Effects of the AgingPLUS Program on Physical Activity: A Multiple Mediator Model

This study examined the effect of the AgingPLUS program on anticipated physical activity (PA) and PA engagement, along with the hypothesized mediator roles of self-efficacy (SE) and exercise intention (EI). Data came from 147 participants (Mage = 60.11 years; SD = 8.28 years) of the ongoing trial. Structural equation modeling tested the effects of the intervention, week 4 EI, and week 4 SE on anticipated PA at week 8 and engagement in PA at 6 months. The pathway from week 8 anticipated PA to month 6 PA was also assessed. Results showed that week 4 SE significantly mediated the pathway of intervention condition to week 8 anticipated PA, whereas week 4 EI significantly mediated the pathway from intervention condition to engagement in PA at 6 months. Furthermore, anticipated PA predicted subsequent engagement in PA. Results from these analyses provide preliminary support for the efficacy of the AgingPLUS program.

Does acceptance-based treatment moderate the effect of stress on dietary lapses?

Weight loss interventions are successful to the extent that participants adhere to calorie-reduced dietary prescriptions and may be undermined by dietary lapses triggered by external or internal factors, such as stress. The purpose of this study was to examine whether an acceptance-based treatment (ABT) versus a standard behavioral treatment (SBT) moderated the effect of stress on dietary lapses. Ecological momentary assessment data were collected from 189 participants who were randomly assigned to either ABT or SBT. Between-subject and within-subject stress were used to predict lapse occurrence along with intervention condition, and the interaction between intervention condition and stress using a generalized linear mixed-effects model. Gender, time of day, and baseline mean lapses/day were included as control variables. Higher mean baseline lapses/day, female gender, and later time of day were significantly associated with increased odds of lapse. Between-subject stress was positively and significantly related to the odds of lapse. Compared to SBT, ABT showed a significant decrease in the odds of lapse at an individual’s average level of within-subject stress, but the interaction of intervention condition with within-subject stress was not statistically significant. Participants with high overall stress levels lapsed more frequently than those with low overall stress levels. There was a significant decrease in the odds of lapse for the ABT group at a participant’s own average stress level, suggesting that ABT may be beneficial at participants’ usual stress levels but when they deviate from their usual stress level, there are no treatment differences.

Effects Of Exogenous Melatonin On Sleep And Circadian Rhythms In Women With Premenstrual Dysphoric Disorder

We previously found normal polysomnographic (PSG) sleep efficiency, increased slow wave sleep (SWS) and a blunted melatonin secretion in women with premenstrual dysphoric disorder (PMDD) compared to controls. Here, we investigated the effects of exogenous melatonin in five patients previously studied. They took 2 mg of slow-release melatonin 1 hour before bedtime during their luteal phase (LP) for three menstrual cycles. At baseline, patients spent every third night throughout one menstrual cycle sleeping in the laboratory. Measures included morning urinary 6-sulfatoxymelatonin (aMt6), PSG sleep, nocturnal core body temperature (CBT), visual analogue scale for mood (VAS-Mood), Prospective Record of the Impact and Severity of Menstrual Symptoms (PRISM), and ovarian hormones. Participants also underwent two 24-hour intensive physiological monitoring (during the follicular phase and LP) in time-isolation/constant conditions to determine 24-hour plasma melatonin and CBT rhythms. The same measures were repeated during their third menstrual cycle of melatonin administration. In the intervention condition compared to baseline, we found increased urinary aMt6 (p<0.001), reduced objective SOL (p=0.01), reduced SWS (p<0.001) and increased Stage 2 sleep (p<0.001). Increased urinary aMt6 was associated with reduced SWS (r=-0.51, p<0.001). Circadian parameters derived from 24-hour plasma melatonin and CBT did not differ between conditions, except for an increased melatonin mesor in the intervention condition (p=0.01). Ovarian hormones were comparable between the conditions (p≥0.28). Symptoms improved in the intervention condition, as measured by the VAS-Mood (p=0.02) and the PRISM (p<0.001). These findings support a role for disturbed melatonergic system in PMDD that can be partially corrected by exogenous melatonin.

Evaluation of a bibliotherapy-based stress management training for teachers

The study was a randomized control trial of a cognitive-behavioral bibliotherapy-based stress management training for teachers. The intervention consisted of the Stress Management for Teachers book, an in-person meeting, and three brief follow-up webinars with weekly practice over the course of 4 weeks. There were 53 participants in the study and teachers were randomly assigned to the intervention or waitlist control conditions. Multilevel regression was used to examine the intervention effects accounting for teachers nested in schools and controlling for school district, years of teaching experience, and the baseline measure. The intervention reduced stress on the Perceived Stress Scale (? = -0.53). Teachers also increased in specific coping strategies of planning (? = 0.62), positive reframing (? = 0.66), and decreased in self-reported substance use (? = -0.44). The intervention did not have statistically significant effects on contextual factors or on observed classroom behaviors. The intervention demonstrated treatment effects on anxiety symptoms on the GAD-7 (? = -0.51). Further, in comparison to participants in the control group, teachers in intervention condition had statistically significant changes in symptom severity level in anxiety on the GAD-7 (Cramer's V = .45) and in depression on the PHQ-8 (Cramer's V = .42). From progress monitoring data, teachers in the intervention condition had greater rates of improvement in increased coping, confidence and use of coping strategies (p's < .05). Additional supports may be needed to enhance coping with stressors related to classroom management and organizational health and to optimize the intervention delivery.

COMPARISON OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION AND NEUROMUSCULAR RE-EDUCATION WITH CONVENTIONAL TREATMENT AND HOME BASED EXERCISE PLAN ALONG WITH FACIAL NERVE STIMULATION FOR REDUCING FACIAL DISABILITY IN PATIENTS WITH BELL’S PALSY

The purpose of the present study was to compare the proprioceptive neuromuscular facilitation and neuromuscular re-education with conventional treatment and home based exercise plan along with facial nerve stimulation for reducing facial disability in patients with Bell’s Palsy. In the present study, purposively selected 20 patients (both male and female) with Bell’s palsy with age group 20-70 years were considered. Further, the patients were allocated equally into two treatment groups. In Group-A, patients were treated with Proprioceptive Neuromuscular Facilitation (PNF) and Neuromuscular Re-Education (NRE) along with interrupted galvanic stimulation, facial massage and home based exercises. In Group-B, patients received the treatment of interrupted galvanic stimulation and manual facial massage along with home based facial exercises program in front of mirror. The outcome measures included Facial Disability Index-Physical Function (FDI-PF), Facial Disability Index-Social Function (FDI-SF), Synkinesis Assessment Questionnaire (SAQ) and Sunnybrook Facial Grading Scale (SFGS). In results. it was found that in pre-intervention condition, no significant differences were noted in FDI-PF, FDI-SF, SAQ and SFGS between these two groups. However, significant differences (p<0.001) were observed in FDI-PF, FDI-SF and SFGS in post intervention condition between the patients treated in Group-A and Group-B. Statistically significant increase (p<0.001) was found in FDI-PF and SFGS and significant decrease (p<0.013-0.001) was found in FDI-SF and SAQ between pre- and post-intervention in Group-A. Statistically significant decrease (p<0.003-0.001) was found in FDI-PF, FDI-SF, SAQ and SFGS between pre- and post-intervention in patients treated in Group-B. From the findings of the study it could be concluded the treatment protocol comprised of PNF and NRE along with interrupted galvanic stimulation, facial massage and home based exercises was more effective than only interrupted galvanic stimulation, facial massage and home based exercises in improving facial symmetry and reducing facial disability in patients with Bell’s palsy. Keywords: Proprioceptive neuromuscular technique, Neuromuscular re-education technique, Interrupted galvanic stimulation, Facial massage, Home based exercises, Bell’s palsy, Facial disability, Synkinesis.

Splash and Bubbles for Parents App: Field Study Report

This report prepared for The Jim Henson Company shares findings of a field study examining the promise of the Splash and Bubbles for Parents app, a second-screen digital resource designed for parents and caregivers to support young children’s learning of ocean science. The study conducted in 2020 involved a two-group, quasi-experimental design in which family participants were randomly assigned to either the intervention condition (who watched the show and used the app) or the comparison condition (who watched the show but did not have access to the app). Findings from this study provided information about how the app supported families to talk about science together; what science concepts and practices children learned through engaging with the app and related science activities; and how families shifted their attitudes, beliefs, or practices around science and media. Another finding highlighted parents and caregivers’ need for support around ways to engage with and use the app given that this represents a new type of digital tool.

Effects of a Content Knowledge Intervention on Instruction and Learning: A Pilot Study

The purpose of this pilot study was to examine the effects of improving a physical education teacher’s content knowledge and, in turn, the teacher’s instructional effectiveness and student learning in an upper elementary physical education setting. Four classes were randomly assigned to either a comparison condition (n4th = 9 students; n5th = 17) or an intervention condition (n4th = 7; n5th = 10). The teacher taught both conditions. The teacher first taught two classes in the comparison condition in a manner that he had taught for the past five years. Following the completion of the teaching, he received a content knowledge workshop. After the workshop, the teacher taught two classes in the intervention condition. Assessment of the teacher following the workshop showed that he obtained higher content knowledge scores than prior to the workshop. These improvements in content knowledge positively impacted his enacted teaching with more appropriate task selection and better instruction. Student learning also significantly improved in the intervention condition, not in the comparison condition, from pre- to posttest. The findings of this study extend the research demonstrating the effectiveness of improving the content knowledge of teachers in impacting student learning, in this case in the upper elementary grade band.