Recruitment for a Diabetes Prevention Program translation effort in a worksite setting

BackgroundThe success of the Diabetes Prevention Program (DPP) lifestyle intervention has led to community-based translation efforts in a variety of settings. One community setting which holds promise for the delivery of prevention intervention is the worksite; however, information regarding recruitment in this setting is limited. The current effort describes the initial processes surrounding provision of an adapted DPP lifestyle intervention at a corporate worksite.MethodsInvestigators and key management at the worksite collaborated to develop and implement a recruitment plan for the intervention focusing on 1) in-person onsite activities and 2) implementation of a variety of media recruitment tools and methods.ResultsAdult, non-diabetic overweight/obese employees and family members with pre-diabetes and/or the metabolic syndrome were eligible for the study. Telephone pre-screening was completed for 176 individuals resulting in 171 eligible for onsite screening. Of that number, 160 completed onsite screening, 107 met eligibility criteria, and 89 enrolled in the study. Support from worksite leadership, an invested worksite planning team and a solid recruitment plan consisting of multiple strategies were identified as crucial elements of this effective workplace recruitment effort.ConclusionA worksite team successfully developed and implemented a recruitment plan using existing mechanisms appropriate to that worksite in order to identify and enroll eligible individuals. The results of this effort indicate that employee recruitment in a worksite setting is feasible as the first step in offering onsite behavioral lifestyle intervention programs as part of a widespread dissemination plan to prevent diabetes and lower risk for cardiovascular disease.     

Implementation of a Person-Centred Activity Program on a Sub-Acute Inpatient Dementia Ward

Abstract

Aim: This study explored the impact of a person-centered activity program for sub-acute inpatients with Behavioral and Psychological Symptoms of Dementia (BPSD). Method: A prospective observational study was conducted in a 15-bed secure wing of a sub-acute metropolitan hospital ward in Australia. Using convenience sampling, patients presenting with delirium or dementia exhibiting BPSD were considered for inclusion. Activity programs were implemented with data collected through observation of behavioral incidences, pre- and post-implementation. Results: Participants were observed over two stages of five weeks (n?=?30 pre-intervention, n?=?29 post-intervention). The mean age of participants pre-intervention was 80.3?years (SD 15.01) and post-intervention was 85.5 (SD 6.99). There was a 26% decrease of ‘overall’ behaviors with a statistically significant reduction in ‘physical’ behaviors (i.e. agitation, restlessness) post-intervention reported as 54% (p?=?.01). Conclusion: A person-centered activity program can be successfully implemented on a dementia/delirium specific inpatient ward with the reduction of BPSD incidence.     

Changes in body image during a 6-month lifestyle behaviour intervention in a sample of overweight and obese individuals

BackgroundIndividuals with long-term chronic body image dissatisfaction may experience excessive stress and negative cognitions and feelings. Changes in negative cognition about body image are often reported as outcomes of obesity treatment. In turn, body image dissatisfaction also influences behavioural adherence and success in weight loss.ObjectivesThe purpose of the present study was to elucidate psychological changes during 6 months of lifestyle behaviour intervention and the association of these changes with actual weight loss.MethodsThe study examined associations between body image dissatisfaction and obesity treatment-related variables among 33 overweight and obese adults (age = 38.9 ± 6.5 years) participating in a 6-month diet and exercise weight loss intervention. Measurements of body image dissatisfaction and anthropometric variables were taken at baseline and after 6-months.DiscussionSignificant improvements were observed in all physical variables (e.g. weight, percentage of body fat mass, waist and hip circumference) after intervention. Body image dissatisfaction improved significantly over the treatment, and these changes were associated with changes in obesity indicators.ConclusionsChanges in weight and body image probably influence each other dynamically. Results from this study support the inclusion of cognitive intervention aimed at improving body image in weight management programs.     

Music Therapy as a Nonpharmacological Intervention for Anxiety in Patients with a Thought Disorder

Music therapy has been identified as a non-pharmacological adjunct therapy to treat anxiety. This QI project aimed to assess the effects of music therapy on anxiety in a sample of patients hospitalized with a thought disorder. Participants were assessed pre- and post-group using a visual analog scale for anxiety. The intervention significantly reduced VAS scores from 3.1 pre-intervention to .897 immediately post-intervention (p = 0.008). This data suggests that music therapy may be beneficial in the short term for this population and is a low risk intervention that provides positive outcomes without the risks associated with medications, seclusion, and restraint.     

The pragmatic language abilities of children with ADHD following a play-based intervention involving peer-to-peer interactions

Abstract

Children with Attention Deficit Hyperactivity Disorder (ADHD) commonly experience significant pragmatic language deficits which put them at risk of developing emotional and social difficulties. This study aimed to examine the pragmatic language exhibited in a peer-to-peer interaction between the children with ADHD and their playmates following a pilot play-based intervention. Participants were children (aged 5–11 years) diagnosed as having ADHD (n = 14) and their self-selected typically-developing playmate. Pragmatic language was measured using the Pragmatic Protocol (PP) and the Structured Multidimensional Assessment Profiles (S-MAPs). Children's structural language was also screened and compared against their pragmatic language skills pre–post play-based intervention. The pragmatic language of children with ADHD improved significantly from pre–post intervention as measured by both the PP and S-MAPs. Both children with and without structural language difficulties improved significantly from pre- to post-intervention using S-MAPs; only children with structural language difficulties improved significantly using PP. The findings support the notion that pragmatic skills may improve following a play-based intervention that is characterized by didactic social interaction. As pragmatic language is a complex construct, it is proposed that clinicians and researchers reconsider the working definition of pragmatic language and the operationalization thereof in assessments.     

Lifestyle changes after a health dialogue Results from the Live for Life health promotion programme

Objective – To evaluate the effect of a health dialogue on lifestyle habits, and to relate the lifestyle changes to changes of biological risk markers for ischaemic heart disease. Design – Cross-sectional study, intervention and follow-up. Setting – The community of Habo, population 9500, located in Skaraborg, Sweden. Patients – All 35-year-old inhabitants in Habo were invited to a health examination during a study period between 1989 and 1992. A community intervention programme was combined with a health examination consisting of a health dialogue with a specially trained nurse and use of a “health curve” as an educational tool. The effect of the health examination was examined by comparing baseline characteristics of participants in 1989–1992 with their follow-up data in 1993. Results – Participants in the health dialogue who were re-examined reported lifestyle improvements including less smoking, decreased dietary fat intake and increased physical activity. Those who reported improved dietary intake and increased physical activity improved their biological risk markers correspondingly (body mass index, waist to hip ratio, serum cholesterol concentration). Conclusions – The combination of a community and an individually based health programme can be effective with respect to lifestyle variables and, in those improving their lifestyle, in biological risk markers.     

Impact of death education courses on emergency nurses' perception of effective behavioral responses in dealing with sudden death in China: A quasi-experimental study

BackgroundNurses in emergency departments have to provide rescue care and life support for moribund patients, but also emotional support to patients' relatives. On the other hand, emergency nurses are also the most vulnerable to the sudden death of patients. Nurses working in the emergency department were invited to participate in a death education course.ObjectiveTo explore the impact of a death education course on the emergency nurses' perception of effective behavioral responses in dealing with sudden death.DesignA quasi-experimental study.SettingsA level A tertiary general hospital in China.ParticipantsA total number of 34 emergency nurses who met the inclusion criteria were randomly selected from the emergency department.MethodsParticipants received a death education course of 20 credit hours based on dealing with a sudden-death model. The general data questionnaire and the Chinese version of the list proposed by Fraser & Atkins were completed before the intervention and six weeks post-intervention. The scores of each item in the effective behavioral response to the sudden death questionnaire of the emergency nurses before and after the intervention were compared.ResultsAfter the intervention, the nurses considered that 10 items were relatively helpful (above 4 points) and 2 items relatively less helpful (<3 points). The post-intervention average scores of all items were higher than the pre-intervention ones, and there were significant differences in the scores of the 13 items pre- and post-intervention.ConclusionThe death education course enhanced emergency nurses' perceptions of effective behavioral responses in dealing with sudden death, which contributes to the improvement of the quality of their work.     

Lifestyle intervention to prevent gestational diabetes mellitus and adverse maternal outcomes among pregnant women at high risk for gestational diabetes mellitus

ObjectiveWe assessed the effects of a lifestyle intervention on gestational diabetes mellitus (GDM) incidence and risk of adverse maternal outcomes among pregnant women at high risk for GDM.MethodsFrom July to December 2018, we enrolled 1822 eligible pregnant women; of these, 304 had at least one risk factor for GDM. Participants were randomly allocated to the intervention or control group. Usual prenatal care was offered to both groups; the intervention group also received individually modified education on diet, physical activity, and weight control. The GDM diagnosis was based on an oral glucose tolerance test at 24–28 gestational weeks. Multivariate logistic regression was used to evaluate the effects of the lifestyle intervention on risk of GDM and adverse maternal outcomes.ResultsA total of 281 women (139 in the intervention group and 142 controls) were included. Incidences of GDM and adverse maternal outcomes were all significantly lower in the intervention than in the control group. Multivariate logistic regression indicated that women in the intervention group had a lower risk of GDM and adverse maternal outcomes, after adjusting potential confounding factors.ConclusionThe present lifestyle intervention was associated with lower risks of GDM and adverse maternal outcomes.     

小檗碱对非酒精性脂肪性肝病患者血清骨钙素的影响

目的:探讨小檗碱对伴糖代谢紊乱的非酒精性脂肪性肝病(NAFLD)患者的血清未羧化骨钙素(ucOC)水平的影响。方法:对伴有糖耐量受损或2型糖尿病的114例NAFLD患者,进行生活方式干预,其中57例(小檗碱组)加小檗碱治疗(0.5 g/次,每日3次),共干预16周,其余57例仅进行生活方式干预,作为对照组。评价干预前后患者ucOC水平变化及血糖、血脂和肝脏脂肪含量(HFC)等指标,分析ucOC变化的影响因素。结果:与对照组相比,小檗碱组患者血清ucOC水平升高更明显(P0.001)。校正年龄、性别和体质指数(BMI)后,小檗碱组血清ucOC的改善情况[4.60(3.50, 5.70)]仍明显优于对照组[0.96(-0.14, 2.05),P0.001],平均差异为3.64 (95%CI 1.74～5.55)。亚组分析显示,在非肥胖老年男性患者中,小檗碱升高ucOC的作用更加明显。偏相关分析显示,在校正年龄、性别后,治疗前后血清ucOC水平差值与BMI、体质量、腰围、HFC、糖化血红蛋白(HbA1c)、总胆固醇(TC)的差值负相关(P0.05)。结论:小檗碱能改善伴糖代谢紊乱的非酒精性脂肪性肝病患者代谢异常,可能与其升高血清ucOC水平有关。     

The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: Design and methods

Disseminating and implementing evidence-based, cardiovascular disease (CVD) prevention lifestyle interventions in community settings and in ethnic minority populations is a challenge. We describe the design and methods for the South Asian Heart Lifestyle Intervention (SAHELI) study, a pilot study designed to determine the feasibility and initial efficacy of a culturally-targeted, community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians (SAs). Participants with at least one CVD risk factor will be randomized to either a lifestyle intervention or a control group. Participants in both groups will be screened in a community setting and receive a primary care referral after randomization. Intervention participants will receive 6 weeks of group classes, followed by 12 weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal. Control participants will receive their screening results and monthly mailings on CVD prevention. Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline, 3-, and 6-month follow-up. Secondary outcomes will be changes in weight, clinical risk factors, primary care visits, self-efficacy, and social support. This study will be one of the first to pilot-test a lifestyle intervention for SAs, one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk. Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population.     

The effects of calf muscle self-massage on ankle joint range of motion and tendon-muscle morphology

IntroductionSelf-massage using a foam roller (foam rolling) has been used to improve joint range of motion (ROM). However, the effect of foam rolling on the morphology of a targeted muscle, tendon, and muscle-tendon unit (MTU) has not been fully clarified. This study aimed to investigate extensibility changes in the gastrocnemius muscle (GM), MTU, and the Achilles tendon (AT) in terms of maximum ankle dorsiflexion (max-DF) following a foam rolling intervention. This was an interventional study with no controls.MethodsStudy participants comprised 10 male and female students (mean [standard deviation]: 22.7 [2.5] years; height, 164.2 [6.7] cm; weight, 57.9 [7.9] kg). The foam rolling intervention was performed on the right leg plantar flexor muscles for 3 min. The outcomes were max-DF with specified resistance values (ROM-SR) and non-specified resistance values (ROM-NSR) and GM, MTU, and AT extensibility. An ultrasound device was used to determine the rate of change by subtracting the value in a neutral ankle joint position (0°) from the ankle max-DF to identify GM, MTU, and AT extensibility. All outcomes were measured pre- and post-intervention.ResultsThe range of ankle joint dorsiflexion increased significantly following the foam rolling intervention (Δ: ROM-SR, +4.35 [5.79]; ROM-NSR, +4.18 [4.43]), whereas GM extensibility increased 4.0 mm, although no significant difference was observed pre- and post-intervention.ConclusionFoam rolling was effective in increasing ankle joint dorsiflexion ROM. Moreover, it was suggested that the GM morphology might be affected by the intervention.     

Evaluation of an outpatient,peer group intervention for people with acquired brain injury based on the ICF ‘Environment’ dimension

Purpose. This study aimed to evaluate the effectiveness of an intervention based on the ICF ‘Environment’ dimension for enhancing the well-being and psychosocial outcomes of patients with acquired brain injury in an outpatient (day hospital) setting.

Method. A mixed methodology cohort study comparing an intervention group with an historical non-intervention group using pre- and post-intervention and follow-up measures. The 6-week group intervention involved participants and their significant others. Pre- and post-intervention data from the intervention group and the non-intervention group were compared using 2 × 2 analyses of variance for five standardised outcome measures. Semi-structured interviews with intervention participants and significant others were used to provide qualitative feedback.

Results. A significant group by time interaction was found for level of community integration on the Sydney Psychosocial Reintegration Scale and depression scores on the Hospital Anxiety and Depression Scale, with greater improvements for the intervention group compared with the non-intervention group. No other significant differences between groups were found. Gains in community integration were maintained by the intervention group at 1-month follow-up. Qualitative feedback from participants indicated the value of: sharing experiences, the group content, goal setting, comparing with others and the group processes.

Conclusions. The Environment-focused intervention was useful in improving patient outcomes in terms of better self-reported community integration.     

Testing the ‘Teaching Kids to Cope with Anger’ Youth Anger Intervention Program in a Rural School-based Sample

The purpose of this paper is to report the longitudinal effects of the ‘Teaching Kids to Cope with Anger’ (TKC-A) program on self-reported anger in rural youth. Through a randomized controlled trial, 179 youths of 14–18 years of age, from three rural high schools, were randomized into a control (n = 86) and an intervention group (n = 93) for eight TKC-A weekly sessions. These students completed the STAXI-2 anger instrument questionnaires at baseline, post-intervention, 6 months, and at 1 year. T-test statistics were used to analyze and compare the control and intervention groups. Through analysis of the Anger Index sub-scale of the STAXI-2 at 1 year post-intervention, a significant difference was reported between the control and intervention group. Participants reported that the TKC-A intervention was helpful in coping with emotional, behavioral, and social aspects of anger. Future research may utilize the TKC-A with youth who have anger management problems. Psychiatric-mental health nurses can screen youth for anger and be cognizant of coping skills of youth, assess for anger problems and provide health education to youth about approaches for coping with anger.     

Effect of a Peer-led Lifestyle Intervention on Individuals With Normal Weight Obesity: Insights From the Kerala Diabetes Prevention Program

PurposeNormal weight obesity (NWO) is a unique phenotype of obesity associated with high cardiovascular mortality. There is limited literature on assessing the effect of therapeutic interventions on the cardiometabolic health of these individuals. We studied the effect of a peer-led lifestyle intervention on key cardiometabolic parameters (blood glucose, blood pressure, and plasma lipids) in individuals with NWO.MethodsThis study is a secondary data analysis of the Kerala Diabetes Prevention Program, a cluster-randomized controlled study that involves a peer-led, real-life lifestyle intervention for individuals from the community between the ages of 30 and 60 years with a high diabetes risk. Participants underwent a rigorous cardiometabolic evaluation at baseline and at 2-year follow-up.FindingsA total of 292 recruited individuals with NWO were randomized into the intervention (n = 159) and control (n = 133) arms. At 2 years of follow-up, there was minimal but statistically significant improvement in systolic blood pressure and serum HDL level in the intervention arm, but no statistical difference was seen in other lipid and glycemic parameters.ImplicationsThis study provides early evidence of the effect of a lifestyle intervention in a cohort of individuals with NWO. Only systolic blood pressure and serum HDL level had a mild favorable change in the intervention arm when compared with the control arm.     

Wheelchair skills training for occupational therapy students: comparison of university-course versus “boot-camp” approaches

Abstract

Objective: To test the hypothesis that occupational therapy students who receive wheelchair skills training education using a distributed-practice university-course approach versus a condensed-practice boot-camp approach results in greater improvements post-intervention in relevant outcomes.

Design: A quasi-experimental, nonequivalent control group design.

Setting: A university occupational therapy program.

Participants: Occupational therapy students (experimental group) and recent occupational therapy graduates (control group) (N?=?58).

Interventions: A 15-week, 45-hour wheelchair provision course in which a total of 24?hours were dedicated to wheelchair skills testing and training education (experimental group) versus an 8-hour wheelchair skills training boot-camp (control group).

Main outcome measures: Assessments were conducted pre- and post-intervention using the Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon) and Self-Efficacy on Assessing, Training and Spotting wheelchair skills (SEATS).

Results: Compared to baseline, the WST-Q, WheelCon and SEATS scores improved significantly for both groups (p?<?.001). There were no significant differences in change scores (post-intervention – baseline values) between the groups for WST-Q, WheelCon or SEATS scores, however, the experimental group demonstrated a trend (p?<?.051) of higher scores for all outcome measures.

Conclusions: Occupational therapy students who received wheelchair skills training using either a distributed-practice university-course or condensed-practice boot-camp approach demonstrated significant post-training improvements in their WST-Q, WheelCon and SEATS scores, but no significant differences were found between groups.

• Implications for Rehabilitation

• Both a distributed-practice university-course approach and a condensed-practice bootcamp approach for training wheelchair skills to occupational therapy students results in large post-intervention improvements in wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills.

• The pre-education (optional course) wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills scores found in this cohort of occupational therapy students confirms the need to include this wheelchair content in mandatory occupational therapy curricula.

     

A pilot observational study of recreational trail riding for Veterans with addictive disorders

ObjectivesThe aim of study was to assess the safety, feasibility, and preliminary outcomes of recreational trail riding for Veterans with addictive disorders.DesignThis was an observational pilot study.SettingUnited States Veterans Health Care Administration Medical Center. Participants were 18 Veterans, 13 males and 5 females All had at least one addictive disorder, with most common being alcohol use disorder.InterventionA recreational trail ride of approximately two hours duration.Main outcome measuresAssessment of safety and pre- and post-intervention instruments, The State-Trait Anxiety Inventory, Craving Experience Questionnaire, Positive and Negative Affect Scale and Conner-Davidson Resilience Scale were utilized to assess changes in anxiety, craving, affect, and resilience, respectively.ResultsThe intervention was feasible to utilize for the population studied. In addition, it was possible to conduct the rides in such a way as to minimize risk to participants and there were no serious adverse outcomes to patients, staff, or equines. However, there was one incident that had potential to cause injury. There were significant pre- to post-intervention decreases in anxiety, negative affect and craving as well as increased positive affect. There was not a statistically significant increase in resilience.ConclusionsThese results indicate that recreational trail riding is, at least in some settings, feasible to utilize for this population. The safety assessment indicated that this intervention can be conducted in a manner such that risk can be mitigated. However, trail riding is a dangerous activity that can result in serious injury or death to participants. Thus, such activities should only be considered by programs that have the ability to implement stringent safety protocols. Preliminary outcomes suggest that this intervention has the potential to be beneficial to for Veterans with addictive disorders. Additional, more rigorous randomized, controlled studies are warranted.     

Chronic psychological stress seems associated with elements of the metabolic syndrome in patients with ischaemic heart disease

Background and objectives: Chronic psychological stress, the metabolic syndrome (MS) and ischaemic heart disease (IHD) seem closely connected. In this study, we evaluate the association between chronic stress and elements of MS in patients with stable IHD.

Design: Cross-sectional cohort study.

Methods: Three hundred and fifty patients with stable IHD were included. Chronic stress was evaluated by the two questionnaires, Major Depression Inventory (MDI) and the psychological wellbeing index WHO-5, as well as by Pressure Pain Sensitivity (PPS), a physiological measure of hyperalgesia at the sternum known to be associated to elements of the chronic stress syndrome. Elements of MS were evaluated by dual-energy X-ray absorptiometry, body weight, HOMA-IR and blood lipids.

Results: Depressive symptoms were associated with a high percentage of body fat (β?=?0.179, p?=?.001), and high level of triglycerides (β?=?0.150, p?=?.007). Low psychological wellbeing was associated with a high percentage of body fat (β?=?–0.165, p?=?.002) and low level of HDL cholesterol (β?=?0.128, p?=?.024). Chronic stress measured by PPS was associated with a high percentage body fat (β?=?0.327, p?<?.001), low body weight (β?=?–0.218, p?<?.001) and low HDL-cholesterol (β?=?–0.137, p?=?.013). Adjusting for several life style factors did not change these results.

Conclusions: In patients with stable IHD, different measures of chronic psychological stress seem associated with a high percentage of body fat and adverse blood lipids independent of several lifestyle factors.     

Combined diet and exercise intervention in the workplace: effect on cardiovascular disease risk factors.

This study assessed the effectiveness of a 12-week pilot employee wellness program in reducing risk factors for coronary heart disease. Fifty university employees with at least one cardiovascular disease risk factor participated in the program. Interventions focused on diet, exercise, and monthly workshops. Pre- and post-intervention measurements included weight, body composition, blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and blood sugar. Twenty-five employees had post-intervention measurements. A survey was administered to assess adherence. The correlation between adherence and improvement in cardiovascular disease risk factors was also tested. Significant differences were observed between pre- and post-intervention measurements of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and weight. A significant correlation existed between self-reported level of participation in the diet aspect of the program and improvement in LDL levels. This multi-component, 12-week pilot employee wellness program was effective in reducing cardiovascular disease risk.     

A pilot test of the GoWoman weight management intervention for women with mobility impairments in the online virtual world of Second Life®

Abstract

Objective: Pilot test GoWoman, a small-group weight management intervention for mobility impaired women that was a disability- and gender-responsive adaptation of the Diabetes Prevention Program delivered in the online virtual world of Second Life^®. Objectives were to (1) examine pre-/post-intervention differences in weight, waist circumference, diet, physical activity, self-efficacy for diet and physical activity, nutrition knowledge and social support for weight management, (2) determine intervention feasibility (fidelity, attrition, engagement, acceptability).

Design: Single-group modified interrupted time series quasi-experimental design whereby participants served as their own controls.

Results: Thirteen women attended ≥8 of 16 GoWoman weekly sessions and lost an average of 5.97 pounds (2.71?kg) (3.31%) body weight (Cohen’s d?=?0.74) and 1.44 inches (3.66?cm) (3.58%) waist circumference (Cohen’s d?=?0.83). There were significant improvements in physical activity, diet and self-efficacy for diet and physical activity. All benchmarks for feasibility were met. Ratings of intervention content, group interactions and support and virtual world experiences were highly positive.

Conclusion: Findings suggest that a disability- and gender-responsive weight management intervention with peer group support delivered in an online virtual world is feasible, meaningful and may assist with weight management for mobility impaired women.

• Implications for Rehabilitation

• This study addresses a gap in the general and rehabilitation research literature by addressing the disproportionately high rates of obesity among women with mobility impairments, who are generally excluded from tests of weight management interventions if they have limited ability to engage in vigorous physical activity.

• The GoWoman program is an adaptation of the Diabetes Prevention Program Lifestyle Change curriculum that is tailored to meet the unique weight management needs of women with mobility impairments, and was created to become a publicly available, disability- and gender-responsive intervention that can be used in community and rehabilitation settings.

• More rehabilitation and health promotion program should be offered in the free, online, virtual world of Second Life^® since participants in this pilot study offered many favorable comments about the new learning and social opportunities available to them there and they did not have to deal with the disability-related environmental and health challenges that often prevent them from participating in face-to-face workshops.

• Preliminary indications of improvements in body weight, waist circumference, diet and physical activity after attending the GoWoman weight management intervention offered in Second Life^® tell us that these strategies are feasible for helping women with mobility impairments manage their weight and should undergo further testing.

     

Can metabolic function and physical fitness improve without weight loss for inactive,obese, Hispanic adolescents? A feasibility study

Introduction: A case series that examines the effects of a 12-week combined resistance and aerobic training program for four sedentary obese, Hispanic adolescents without weight loss. Subjects/Methods: Baseline and post-intervention anthropometric, metabolic and physical fitness measures were obtained. Body composition, hepatic, visceral, and intramuscular fat contents were analyzed via imaging. Fasting levels of alanine transaminase (ALT), insulin, glucose, free fatty acids, triglycerides, high- and low-density lipoproteins (LDL), and C-reactive protein were obtained via blood samples. Results: Two subjects decreased their glucose levels by 1.86% and 4.06%. Subjects 1, 3, and 4 increased their lean body mass by 4.12%, 9.70%, and 5.48%. ALT was reduced 13.0%, 16.0%, and 35.7% for subjects 2, 3, and 4, respectively. LDLs were reduced by 37.7%, 4.5%, and 7.5% for subjects 1, 2, and 3. Triglycerides were reduced by 25.4%, 37.8%, and 4.6% for subjects 1, 2, and 3. Visceral fat reductions by 16.5%, 14.2%, and 13.0% occurred for subjects 1, 2, and 3. C-reactive protein was reduced for subjects 1, 2, and 3 by 19.4%, 16.3%, and 32.0%. Conclusion: Expected directions of change were made for most indicators of metabolic function and body composition, but measures of physical fitness improved for all four subjects.