Effectiveness of a Multidisciplinary Worksite Stress Reduction Programme for Women

It has been well established that a high level of stress is associated with medical problems, mental health difficulties and absenteeism at the workplace. The aim of this single‐arm study design was to examine the potential effectiveness of a 12‐session multidisciplinary stress reduction programme on reducing perceived stress and improving health behaviours and quality of life. One hundred and four women participated in a programme that incorporated group support, skill building and cognitive behavioural and relaxation techniques. A series of Bonferroni corrected t‐tests found that the participants reported having significantly (p < 0.001) lower levels of perceived stress, improved health behaviours (sleep, nutrition, physical activity) improved overall health and improved quality of life at the end of the 12 week programme and at 1‐month follow‐up. Although the effect sizes for improvement were all large, there was no control group, so regression to the mean or selection bias may have impacted the results. Therefore, these results provide initial support for the implementation of gender‐based worksite stress reduction programmes and provide guidance in designing an effective worksite stress reduction programme. Further research using randomized controlled trials is warranted. Copyright © 2011 John Wiley & Sons, Ltd.     

The effects of a mindfulness‐based stress reduction programme on pre‐sleep cognitive arousal and insomnia symptoms: a pilot study

The use of mindfulness meditation for stress management has grown in recent years. Practising mindfulness meditation has been shown to help manage stress and decrease arousal, both of which are associated with difficulty sleeping; thus, mindfulness‐based stress management programmes may have a positive impact on sleep. The effects of an 8‐week mindfulness‐based stress management programme on pre‐sleep cognitive arousal and insomnia symptoms were examined. Sleep was assessed with self‐report measures and objectively with actigraphy. Results showed lower levels of pre‐sleep arousal and milder subjective insomnia symptoms post‐intervention. Longer duration of meditation practice in the final week was associated with greater decreases in cognitive arousal scores. No improvements were found in objectively measured sleep variables. The results of this study suggest that mindfulness‐based stress management can lead to improvements in cognitive arousal and self‐reports of sleep, even in the absence of objective evidence of sleep improvement. Copyright © 2010 John Wiley & Sons, Ltd.     

A Pilot Evaluation on a Stress Management Programme Using a Combined Approach of Cognitive Behavioural Therapy (CBT) and Complementary and Alternative Medicine (CAM) for Elementary School Teachers

The aim of this study is to explore the efficacy of implementing a stress management programme based on a combined approach using cognitive behavioural therapy and complementary and alternative medicine for elementary school teachers who experienced mild level of stress, anxiety and/or depressive symptoms in Hong Kong. A 12‐h programme involving cognitive behavioural therapy, self‐management, relaxation techniques (diaphragmatic breathing and progressive muscle relaxation), mindful exercises (qigong and yoga), aromatherapy and acupressure was conducted. A quasi‐experimental design was used to compare the intervention groups (n = 47) with the wait‐list control groups (n = 46). The primary outcome measures were depression, anxiety and stress. Results indicated that the intervention group had significant reduction in depression [(F = 3.93; degrees of freedom (df) = 2.90; p = 0.023)], anxiety (F = 3.37; df = 2.90; p = 0.039) and stress (F = 3.63; df = 2.89; p = 0.031) when compared with the control group. Participants in both groups demonstrated lowered level of salivary cortisol at the post‐assessment. The pilot results provided preliminary support to the multi‐component stress management programme in relieving affective symptoms of teachers. The programme may be considered as an initial strategy to empower teachers with the abilities to cope with their affective symptoms. Further evaluation using a better designed randomized study with a larger sample size is warranted. (word: 198; max.: 200). Copyright © 2013 John Wiley & Sons, Ltd.     

Using lifestyle and coping to reduce job stress and improve health in ‘at risk’ office workers

This study assessed the effectiveness of an intervention programme which employed previously identified lifestyle and coping strategies to reduce the subjective experience and effects of work‐related stress. Employees (104) working in a government tax office with identified stress‐related symptoms were randomized to enter an intervention group (52) or a control group (52). Pre‐ and post‐programme questionnaire assessments of work‐related stress, coping strategies, physical health and lifestyle as well as physiological assessments (blood pressure and body mass index) were used to evaluate changes following an 8‐week programme implementation phase. The programme comprised four weekly workshops on stress and lifestyle education as well as stress‐coping skills training, followed by individual counselling sessions and a personalized action plan. Control group members were offered the same programme after post‐programme assessment. There were no statistically significant differences between the intervention and control groups for stress and health indicators at post‐programme. A 12‐week post‐intervention follow‐up showed reductions in perceived workplace (p<0.01) and home/work (p=0.05) stress. The data suggest that relatively short interventions with individual follow‐up can reduce perceptions of stress even where workplace stressors have not changed. Copyright © 1999 John Wiley & Sons, Ltd.     

A Pilot Study: Short‐term Reduction in Salivary Cortisol Following Low Level Physical Exercise and Relaxation among Adolescents and Young Adults on the Autism Spectrum

Many adolescents and young adults with autism spectrum disorders (ASD) experience high levels of stress and anxiety. The purpose of this pilot study was to examine whether physical exercise and relaxation could reduce stress and anxiety among those with ASD. Salivary cortisol levels were collected before and after each of three sessions during an 8‐week exercise programme. Our findings showed a significant reduction in cortisol at the end of the sessions compared with the beginning. This was supported by a self‐report anxiety measure. Although reductions in these stress measures were not sustained over time, our results highlight the potential of exercise and relaxation for improving symptoms of stress. Future studies are needed which examine longer term reductions in stress following physical exercise interventions. Copyright © 2011 John Wiley & Sons, Ltd.     

Effectiveness of an intensive stress intervention workshop for senior managers

This study investigates the efficacy of an intensive, integrated approach to stress reduction and coping enhancement directed towards an educated, upper level management population. Ninety‐five US governmental senior managers participated in a 35‐h stress management retreat held over a 3.5‐day period. The retreat combined didactic and experiential activities that were designed to increase participants' knowledge of stress liabilities and coping skills. Participants were encouraged to make positive lifestyle changes and to create specific action plans for the year following the workshop. Evaluations of participant satisfaction were completed at the close of the workshop. Eighty‐three participants completed baseline and follow‐up Stress and Coping Inventory (SCI) assessments in order to identify durable changes in these measures. Across 10 months, participants showed significant improvements in their overall Global Balance scores, psychological symptoms, depression symptoms, and all major coping scales, including Health Habits, Social Support, Responses to Stress and Life Satisfactions. Therefore, an intensive, multifaceted approach to stress intervention is a viable option for encouraging sustained behavioural change. Copyright © 2003 John Wiley & Sons, Ltd.     

Cognitive behavioural treatment for essential hypertension: A controlled study

Sixteen patients with essential hypertension from the northwest of Spain were exposed to a three—four week baseline period and later divided into two groups of eight patients each. One of these groups was treated with a six-week cognitive behavioural programme based mainly on stress inoculation training and the other group was assigned to an attention—placebo condition based on individual regular contacts between the therapist and the patient, including discussions about the lifestyle of the latter but without any training on cognitive or behavioural strategies. After the six-week intervention period, and at a six months' follow-up, subjects treated with the cognitive behavioural programme showed a significantly higher reduction of diastolic blood pressure than patients exposed to the attention—placebo condition, considering measurements taken both at hospital and at patients' homes. Similarly, the group treated with cognitive behavioural therapy showed a significant within-group reduction over the measurement taken at hospital.     

The role of and possibilities for physical conditioning programmes in the rehabilitation of traumatically brain-injured persons

The development of rehabilitation programmes for traumatically brain-injured persons is a complex and multidisciplinary effort. One aspect of such programmes is the development of physical work capacity via exercise or physical conditioning. This paper reviews literature dealing with the physical work capacity following traumatic brain injury and its responses to training. The incorporation of physical activity into a specific rehabilitation programme is described and the possible roles of exercise in the rehabilitation programme are discussed.     

More habitual physical activity is linked to the use of specific,more adaptive cognitive reappraisal strategies in dealing with stressful events

Physical activity may improve stress resilience and well‐being. However, specific links to individuals' coping abilities with stressful events are sparse. This study tested whether individuals reporting more physical activity in daily life showed a higher capacity for cognitive reappraisal in dealing with potential stressors. Ninety‐eight participants reported their regular physical activity in the Freiburger Questionnaire on Physical Activity and completed a maximum performance test of their inventiveness in generating reappraisals for situations depicting real‐life stressors. The latter provides scores for overall cognitive reappraisal capacity (quantity of ideas) and preference for specific cognitive reappraisal strategies (quality of ideas; positive reinterpretation; problem‐oriented, de‐emphasizing reappraisals). Additionally, participants' anxious and depressive dispositions and general creative abilities were assessed. Results showed no association between time spent on physical activities per week and total quantity of generated reappraisal ideas. However, a higher degree of physical activity was specifically linked to a greater relative preference for the reappraisal strategy of positive reinterpretation. Opposite associations emerged for the strategy of de‐emphasizing reappraisals. The findings support the notion of more adaptive cognitive reappraisal use in more physically active individuals and may advance research on interrelationships between physical activity and cognitive and affective functions implicated in stress management.     

Evaluating the effectiveness of a self‐management exercise intervention on wound healing,functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence‐based care on the healing rates, functional ability and health‐related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12‐week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health‐related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention‐to‐treat) analysis to highlight the importance of adherence to an exercise intervention. Intention‐to‐treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health‐related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health‐related quality of life), intention‐to‐treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self‐management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.     

Stress management and erectile dysfunction: a pilot comparative study

Erectile dysfunction (ED) is a complex disorder with various biopsychosocial implications leading the individual into a state of chronic stress that further worsens ED symptoms. The aim of this study is to investigate the effects of a 8‐week stress management programme on erectile dysfunction (ED). A convenience sample of 31 newly diagnosed men with ED, aged between 20 and 55 years, was recruited during a period of 5 months to receive either tadalafil (12 patients) or tadalafil and the 8‐week stress management programme. Both groups showed statistical significant improvement of both perceived stress and erectile function scores. Men practising stress management showed a statistical significant reduction in perceived stress score compared with men receiving tadalafil alone. No other statistical significant differences were noted between the two groups, although the stress management group showed a lower daily exposure to cortisol compared with the control group after 8 weeks. Finally, perceived stress and cortisol showed some interesting correlations with sexual function measurements. These findings provide important insight into the role of stress management, as part of the recommended biopsychosocial approach, in ED. Future studies should focus on randomised, controlled trials with larger samples and longer follow‐up time.     

Participant experiences in a feasibility trial of supervised exercise training in adults with venous leg ulcers: A qualitative study

Exercise training can improve lower‐limb cutaneous microvascular reactivity in adults with venous leg ulceration; however, there is a lack of research on patients' views about the acceptability and feasibility of exercise interventions. The aim of this study was to explore participants' experiences of the trial “Exploring the Feasibility of Implementing a Supervised Exercise Training and Compression Hosiery Intervention in Patients with Venous Ulceration” (FISCU). Semi‐structured face‐to‐face and telephone interviews were used to investigate participants' experiences (n = 16) of taking part in the FISCU trial. Data were analysed using thematic analysis. Three overarching themes were identified, along with 11 sub‐themes: (a) sedentary cautious living (because of pain and reduced mobility, treatment and perceived control, and advice to rest and be careful), (b) key components of the exercise trial (including motivation, an individualised intervention supervised by a specialist exercise professional, and satisfaction with the intervention), and (c) benefits of exercise (physical benefits and healing, psychological well‐being, positive impact on comorbidities, and an improved self‐management strategy). This study found that an exercise intervention was viewed by participants as positive, acceptable, and feasible while living with a venous leg ulcer. An individualised and supervised exercise programme was key to build confidence to exercise.     

Efficacy of home‐based exercise programme on physical function after hip fracture: a systematic review and meta‐analysis of randomised controlled trials

We performed a meta‐analysis to evaluate the effect of home exercise programmes on body function after hip fractures. A computerised literature search was performed for published trials in PubMed, EMBASE, CENTRAL, and Cochrane Database of Systematic Reviews. Randomised trials were selected investigating home‐based exercise programmes vs usual care without home‐based exercise in hip fracture patients. Physical health (measured by Short Form 36), normal gait speed, fast gait speed, balance, instrumental activities of daily living (IADL), activities of daily living (ADL), lower extremity strength, leg strength in fractured leg, leg strength in non‐fractured leg, and Six‐Minute Walk Test (6MWT) per randomised patient were measured as outcomes. Eleven randomised controlled trials of 1068 subjects were included, 533 in the home‐based exercise group and 535 in the control group. The results of this meta‐analysis showed that the home‐based exercise programmes were not significantly associated with physical health, normal gait speed, fast gait speed, balance, IADL, ADL, and lower extremity strength but were significantly associated with leg strength in the fractured leg, leg strength in the non‐fractured leg, and 6MWT. The home‐based exercise programme had a positive, although not significant, effect on physical function after hip fracture. Low‐intensity training and poor patient compliance are unavoidable problems in home‐based exercise rehabilitation. A more task‐oriented rehabilitation programme might possibly yield more benefits for disability outcomes.     

Brain injury: Analysis of outcome in a post-acute rehabilitation system. Part 1: General analysis

During the past decade the rehabilitation field has developed new, non-hospital based programmes of cognitive, behavioural, social, educational and vocational treatments to address the higher order cognitive, behavioural and social deficits following brain injury. These new arrays of programmes are referred to under the term 'post-acute' rehabilitation. No comprehensive, methodologically sound study of the effects of these new treatments has been made to date. This paper reports data from brain-injured patients who underwent treatment within a co-ordinated system of post-acute brain-injury rehabilitation programmes. This system consists of a continuum of neurobehavioural, residential, day treatment and community and home programmes, and provides overt components of medical and rehabilitation care: behavioural management; activities of daily living, self-management, substance-abuse, social, academic and vocational skills training; counselling; and family education. The changes in function during the course of treatment by this post-acute sequence of rehabilitation have been obtained and arc reported here. A defined total population of N =192 is examined, with exclusions for appropriate causes (e.g. patients seen only for evaluation) producing a study population of N =173; of these, follow-up was achieved in 145 cases, a follow-up rate of 83.8%. Time from date of injury to data of admission, severity of deficit at time of admission to programme, and other appropriate independent variables are used to characterize the population. A single-blind interview methodology was employed in obtaining dependent measures of outcome at 6, 12, or 24 month periods post-discharge. Measures of outcome included residential status, level of productivity activity and hours per day of attendant care or supervision required. Dependent variables were analysed for the total study population and a subgroup greater than 1 year from date of injury at entry to treatment and not from a treatment facility. Results are presented in terms of the percentage change in dependent measures from the point of admission to follow-up. Appropriate parametric and non-parametric statistical analyses of significance have been carried out. The results document substantial improvements in function during the post-acute rehabilitation of this population and such improvements are unlikely to be the result of spontaneous improvement alone.     

The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial.

OBJECTIVES: The purpose of this study is to determine whether a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling could improve behavioural change, physical fitness, physiological condition and health-related quality of life of sedentary haemodialysis patients in The Netherlands. METHODS: Ninety-six haemodialysis patients of the Groningen Dialysis Center were randomized into an exercise group (n = 53) and a control group (n = 43). The exercise programme consists of cycling during dialysis together with a pre-dialysis strength training programme lasting 12 weeks. The intensity of the exercise programme is condition level 12-16 according to the rate of perceived exertion (RPE). Motivational interviewing techniques were used for exercise counselling. Before and after the intervention, both groups were tested on behavioural change and physical fitness components such as reaction time, manual dexterity, lower extremity muscle strength and VO2 peak. Physiological conditions such as weight, blood pressure, haemoglobin and haematocrit values, cholesterol and Kt/V were obtained from the medical records. Health-related quality of life assessment included RAND-36 scores, symptoms and depression. RESULTS: A group x time analysis with MANOVA (repeated measures) demonstrates that participation in a low-to-moderate intensity exercise programme linked with exercise counselling yields a significant increase in behavioural change, reaction time, lower extremity muscle strength, Kt/V and three components of quality of life, and no significant effects in the control group. CONCLUSION: Participating in a low-to-moderate intensity pre-conditioning exercise programme showed beneficial effects on behavioural change, physical fitness, physiological conditions and health-related quality of life.     

Alcohol‐involved assault and the course of PTSD in female crime victims

Although alcohol use has been associated with increased risk of victimization, little is known about how victim substance use at the time of assault may affect posttraumatic stress disorder (PTSD) symptom development. The present study is a longitudinal examination of substance use on PTSD symptom severity and course. A community sample of female crime victims (n = 60) were assessed within 5 weeks of sexual or physical assault with 3 and 6 month postassault follow‐ups. Twenty‐three participants had consumed alcohol or alcohol/drugs prior to the assault (38%) and 37 had consumed neither alcohol nor drugs. Analyses were conducted using hierarchical linear modeling. Participants who had consumed alcohol had lower initial intrusive symptoms, but their symptoms improved less over time.     

Patients with problematic opioid use can be weaned from codeine without pain escalation

Background: Brief treatments for chronic non‐malignant pain patients with problematic opioid use are warranted. The aims of the present study were to investigate (1) whether it is possible to withdraw codeine use in such patients with a brief cognitive‐behavioural therapy (CBT), (2) whether this could be done without pain escalation and reduction in quality of life and (3) to explore the effects of codeine reduction on neurocognitive functioning. Methods: Eleven patients using codeine daily corresponding to 40–100 mg morphine were included. Two specifically trained physicians treated the patients with six CBT sessions, tapering codeine gradually within 8 weeks. Codeine use, pain intensity, quality of life and neuropsychological functioning were assessed at pre‐treatment to the 3‐month follow‐up. Results: Codeine use was significantly reduced from mean 237 mg [standard deviation (SD) 65] pre‐treatment to 45 mg (SD 66) post‐treatment and to 48 mg (SD 65) at follow‐up without significant pain escalation or reductions in quality of life. Moreover, neuropsychological functioning improved significantly on some tests, while others remained unchanged. Conclusion: The promising findings of codeine reduction in this weaning therapy programme for pain patients with problematic opioid use should be further evaluated in a larger randomized control trial comparing this brief CBT with both another brief treatment and attention placebo condition.     

Exercise in patients with chronic obstructive pulmonary disease.

Sporadic visits to the local doctor followed sometimes by changes in oral and inhaled bronchodilators and occasionally by the addition of steroids frequently does little to significantly improve symptoms and function in the disabled patient with COPD. As in other chronic diseases, the management of these patients is facilitated by a team approach in conjunction with general rehabilitation principles. The rationale and practical implementation of such a programme has recently been outlined by the American Association of Cardiopulmonary Rehabilitation. These are multifaceted programmes but a key component, as outlined above, is exercise training. In this brief review the various approaches available have been described. Controversy still reigns regarding the optimal modes of training and there are important differences among the several approaches. Two main groups can be delineated. One emphasises the detailed definition of the impaired physiology with therapeutic measures targeted to specific defects. There is good documentation that, conversely, unstructured programmes that use treadmill and free range walking and cycling also improve endurance for walking. Upper extremity training is of additional benefit. Programmes with as little as three sessions per week of 1-2 hours of low intensity activity have achieved success so we know that simple programmes can be helpful. Moreover, without the necessity for complex testing and training methods these programmes can be implemented with relatively low costs. Future investigations to examine the relationship between improved exercise capacity for walking and arm exercise on the one hand, and the ease of performance of activities of daily living on the other, will help to reinforce the effectiveness of exercise programmes.     

Clinical, socio-demographic and radiological predictors of short-term outcome in rotator cuff disease

Background

Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active.

Methods/Design

The proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled trial.

Discussion

This paper describes the rationale and design of a study which will test the feasibility of using a structured, pedometer-driven walking programme in participants with chronic low back pain.

Trial Registration

[ISRCTN67030896]