Adiposity Adversely Influences Quality of Life Among Adolescents

ObjectiveWe aimed to investigate the cross-sectional and longitudinal relationship between body mass index (BMI), waist circumference, percent body fat (%BF), and weight status (overweight/obese) with health-related quality of life (QOL) in adolescents.MethodsOf 2,353 children (median age 12.7 years) examined, 1,213 (51.7%) with complete data were resurveyed 5 years later, and an additional 475 adolescents were newly recruited. Weight, height, waist circumference, %BF, and body mass index were obtained and defined using standardized protocols. QOL was assessed using the Pediatric Quality of Life Inventory (PedsQL).ResultsIn cross-sectional analyses, obese boys differed significantly from normal weight boys in the PedsQL physical summary only (multivariable-adjusted p = .005). Boys with the highest %BF (≥95th percentile) compared to their peers in the 6th to 94th percentiles had a significantly lower total PedsQL score (7.7-unit difference, p = .0003), and had adjusted mean scores: 7.92, 7.54, 7.35, 6.51, and 8.56 units lower in the physical summary (p = .0003), psychosocial summary (p = .004), emotional (p = .03), social (p = .02), and school (p = .04) domains, respectively. Nonsignificant cross-sectional associations were observed in girls. Adolescents who remained obese (n = 41) compared to those who were non-overweight/obese (n = 704) over the study period, had lower PedsQL physical summary score 5 years later: 85.6 versus 90.5 (p = .03). Conversely, individuals who were overweight/obese at baseline but who became non-overweight/obese at follow-up (n = 92), had significantly higher physical summary scores than those who remained obese 5 years later (n = 41), 91.4 versus 85.6 (p = .03).ConclusionAdiposity in adolescent boys, but not girls, was associated with poorer QOL.     

The effect of physical activity on quality of life and parenting stress in children with attention-deficit/hyperactivity disorder: A randomized controlled trial

BackgroundPoorer quality of life (QoL) is commonly observed in children with Attention-deficit/Hyperactivity Disorder (ADHD). Parents of children with ADHD also perceived elevated levels of parenting stress. Previous research has documented the positive effects of physical activity (PA) on managing ADHD symptoms. It is critical to implement ADHD management with broader functioning from both children's and parents' perspectives.ObjectiveThis study aimed to examine whether PA would exert an influence on the QoL of children with ADHD and parenting stress of their parents.MethodsForty-three children with ADHD (6–12 years) were randomly assigned to the PA intervention and waitlist control groups. Children in the intervention group participated in a 12-week PA program. Parent-reported QoL and parenting stress were assessed before and immediately after the intervention. Analysis of covariance with a mixed factorial design of 2 (time: before vs. after intervention) × 2 (group: PA intervention vs. waitlist control) was conducted to examine changes in QoL and parenting stress over the 12 weeks.ResultsCompared to the control group, parents of children in the intervention group reported significant reduced overall parenting stress (p = .021, η² = 0.142) and child domain of parenting stress (p = .024, η² = 0.138) after the intervention. No significant improvement in QoL was documented in either group.ConclusionsThe participation of PA intervention positively impacts parenting stress perceived by parents of children with ADHD, which provides further evidence of the family-wide benefits of the PA intervention.     

Short message service text messaging was feasible as a tool for data collection in a trial of treatment for irritable bowel syndrome

ObjectivesTo examine the feasibility of collecting data relating to irritable bowel syndrome (IBS), symptoms by short message service (SMS) text and explore the data to assess its usefulness.Study Design and SettingIn a randomized parallel group design substudy, 59 consenting participants recruited from primary care to a trial of acupuncture for IBS (ISRCTN 08827905) were randomized to receive a one-question SMS message at either 9:30 am or at 6:30 pm for 7 days: “On a scale of 0–9, with 0 being no symptoms and 9 being the worst symptoms you could have, how would you score your IBS symptoms now? Please text back a single number.”ResultsOf the total messages, 59% (n = 203) were answered within 15 minutes, 73.4% (n = 254) within 1 hour, and 97% (n = 334) within 10 hours. Response rates to evening texts were higher (93.5% vs. 87.6% P = 0.05) and response times shorter though not significantly (median: 0 vs. 5 hours; P = 0.12). There was no difference in mean scores, and morning symptoms varied more. Mean scores correlated significantly with IBS trial primary outcome measure, the IBS symptom severity score, and secondary outcome measures.ConclusionAmong IBS trial participants, data collection by SMS is feasible and acceptable, and there is potential for deriving meaningful data from the scores.     

Evaluation of the similarities and differences in response patterns to the Pediatric Quality of Life Inventory and the Child Oral Health Impact Scores among youth with cleft

Purpose

To examine (a) the pattern of responses to a generic health-related quality of life (HRQL) measure (Pediatric Quality of Life Inventory—PedsQL) and an oral health-related quality of life (OHRQoL) measure (Child Oral Health Impact Profile—COHIP), and (b) the associations of these scores with surgical recommendation status among youth with cleft.

Methods

Cross-sectional data (baseline) regarding clinicians’ surgical recommendations and quality of life (QoL) measures were examined from an ongoing observational study on treatment outcomes. Approximately one-third of the racially and geographically diverse sample (N = 1,200; $\bar{x}$  = 11.6 years) received surgical recommendations to correct either visible (aesthetic) or invisible (functional) defects. Effect sizes were used to quantify differences in QoL based on surgical recommendation and to compare the sensitivity of the PedsQL and COHIP subscales. Using Pearson coefficients, the scores of those recommended for surgery were compared with those without a surgical recommendation.

Results

A moderate correlation (0.52) was found between the total scores on the PedsQL and COHIP (p < 0.0001). Subscale correlations between the QoL measures ranged from 0.19 to 0.48 with the strongest correlation between the PedsQL Emotional (r = 0.47) and COHIP Socioemotional Well-being subscale. The effect size for the COHIP Socioemotional Well-being (0.39) was larger than the PedsQL Social/Emotional (0.07/0.11) subscale (Z = 5.30/Z = 4.64, p < 0.0001, respectively), and the total COHIP (0.31) was significantly greater than the total PedsQL scale (0.15, z = 2.65, p = 0.008).

Conclusions

A significant relationship was found between generic HRQL, OHRQoL, and surgical needs among youth with cleft with the COHIP having larger effect sizes than the PedsQL among surgical groups.     

Impact of emotional and behavioral symptoms on quality of life in children and adolescents

Purpose

To evaluate how levels of anxiety, depressive and behavioral symptoms influence self-perceived quality of life (QOL) in general population of children and adolescents.

Method

A total of 237 children and adolescents aged 8–18 years participated in the study. The Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED), Short Mood and Feeling Questionnaire (SMFQ) and Strengths and Difficulties Questionnaire (SDQ) were used to assess levels of anxiety, depressive and behavioral symptoms, respectively. The Pediatric Quality of Life Inventory (PedsQL) was used for QOL assessments. In a regression model, the PedsQL score was the dependent variable, while anxiety, depressive and behavioral symptoms were the QOL predictors.

Results

In children, the SCARED and SMFQ scores together with age and gender explained 30 % of the variance in the PedsQL scores (F = 12.31, p < 0.001), while in adolescents, the same set of variables was responsible for 36 % of the variance (F = 15.77, p < 0.001). The SCARED was a more significant predictor than the SMFQ. The SDQ scores did not emerge as the PedsQL predictors.

Conclusion

Levels of anxiety and depressive symptoms, but not behavioral ones, significantly affect self-reported QOL in general population of children and adolescents.     

Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder

ObjectiveThis study compared the benefits of cognitive–behavioral therapy for insomnia for sleep, mental health symptoms, and quality of life (QoL) in a sample of women veterans with and without probable post-traumatic stress disorder (PTSD) comorbid with insomnia disorder.MethodsSeventy-three women veterans (30 with probable PTSD) received a manual-based 5-week cognitive–behavioral therapy for insomnia treatment as part of a behavioral sleep intervention study. Measures were completed at baseline, post-treatment, and 3-month follow-up. Sleep measures included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, sleep efficiency measured by actigraphy, and sleep efficiency and total sleep time measured by sleep diary. Mental health measures included the PTSD Checklist-5, nightmares per week, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scale. QoL was measured with the Short Form-12. Linear mixed models compared changes over time across groups. Independent t tests examined PTSD symptom changes in women veterans with probable PTSD.ResultsBoth groups demonstrated improvements across sleep (ps < .001–.040), mental health symptoms (ps < .001), and QoL measures (ps < .001). The probable PTSD group reported greater improvements in diary sleep efficiency (p = .046) and nightmares per week (p = .001) at post-treatment and in total sleep time (p = .029) and nightmares per week (p = .006) at follow-up. Most participants with probable PTSD experienced clinically significant reductions in PTSD symptoms at post-treatment (66.7%) and follow-up (60.0%). Significant reductions in intrusive and arousal/reactivity symptoms were maintained at follow-up.ConclusionsCognitive–behavioral therapy for insomnia improves insomnia, mental health symptoms, and QoL among women veterans, with greater improvement in those with probable PTSD.     

PROMIS Fatigue Item Bank had Clinical Validity across Diverse Chronic Conditions

ObjectiveTo evaluate the comparability and responsiveness of Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue item bank across six chronic conditions.Study Design and SettingIndividuals (n = 1,430) with chronic obstructive pulmonary disease (n = 125), chronic heart failure (n = 60), chronic back pain (n = 218), major depressive disorder (n = 196), rheumatoid arthritis (n = 521), and cancer (n = 310) completed assessments from the PROMIS fatigue item bank at baseline and a clinically relevant follow-up. The cancer and arthritis samples were followed in observational studies; the other four groups were enrolled immediately before a planned clinical intervention. All participants completed global ratings of change at follow-up. Linear mixed-effects models and standardized response means were estimated to examine clinical validity and responsiveness to change.ResultsAll patient groups reported more fatigue than the general population (range = 0.2–1.29 standard deviation worse). The four clinical groups with pretreatment baseline data experienced significant improvement in fatigue at follow-up (effect size range = 0.25–0.91). Individuals reporting better overall health usually experienced larger fatigue changes than those reporting worse overall health.ConclusionThe results support the PROMIS fatigue measures's responsiveness to change in six different chronic conditions. In addition, these results support the ability of the PROMIS fatigue measures to compare differences in fatigue across a range of chronic conditions, thereby enabling comparative effectiveness research.     

Influence of adapted sports on quality of life and life satisfaction in sport participants and non-sport participants with physical disabilities

BackgroundThe lack of controlled trials in the relationship between participation in adapted sports, and quality of life (QoL) and life satisfaction in people with physical disabilities encouraged us to consider conducting this study.ObjectiveThe aim of this study was to compare the QoL and life satisfaction scores between people with physical disabilities who participated in adapted sports and those who did not participate in any adapted sports.MethodsThis cross-sectional controlled study included 60 individuals with physical disabilities (paraplegia and amputee). Participants were divided into two groups based on sports participation and non-sports participation. Group one included 30 disabled elite athletes who participated in adapted sports. The control group included 30 disabled individuals not involved in any adapted sports. We compared scores on the World Health Organization Quality-of-Life Scale (WHOQoL-BREF) and the Satisfaction With Life Scale (SWLS) between the two groups. Participation in the community and QoL was examined as a reflection of participant’s priority on sports participation.ResultsWe found that WHOQoL-BREF physical, psychological, and social domain scores were significantly higher in group one than in the control group (p < 0.05), whereas environment domain scores were similar (p = 0.13). Moreover, SWLS scores were significantly higher in group one than in the control group (p < 0.05).ConclusionsThese results showed that people with physical disabilities who participated in adapted sports had significantly higher QoL and life satisfaction scores compared to people with physical disabilities not involved in any adapted sports.     

The Impact of Subclinical Hypothyroidism on the Quality of Life During Pregnancy: Mapping 5-Level Version of EQ-5D and ThyPRO-39

ObjectivesTo describe how subclinical hypothyroidism (SubHypo) influences the quality of life (QoL) during pregnancy.MethodsIn primary data collection (NCT04167423), thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibodies, generic quality of life (QoL; 5-level version of EQ-5D [EQ-5D-5L]), and disease-specific QoL (ThyPRO-39) were measured among pregnant women. SubHypo during each trimester was defined according to the 2014 European Thyroid Association guidelines (TSH > 2.5, 3.0, and 3.5 IU/L, respectively; with normal FT4). Path analysis described relationships and tested mediation. Linear ordinary least squares, beta, tobit, and two-part regressions were used to map ThyPRO-39 and EQ-5D-5L. Alternative SubHypo definition was tested in sensitivity analysis.ResultsA total of 253 women at 14 sites (31 ± 5 years old, 15 ± 6 weeks pregnant) completed the questionnaires. Sixty-one (26%) had SubHypo and differed from 174 (74%) euthyroid women in smoking history (61% vs 41%), primiparity (62% vs 43%) and TSH level (4.1 ± 1.4 vs 1.5 ± 0.7 mIU/L, P < .001). EQ-5D-5L utility in SubHypo (0.89 ± 0.12) was lower than that in euthyroid (0.92 ± 0.11; P = .028) even after adjustment (difference −0.04, P = .033), whereas ocular (P = .001, ThyPRO-39), cognitive symptoms (P = .043), anxiety (P < .0001), and the composite score were higher. The impact of SubHypo on utility was mediated by anxiety. Results were confirmed by sensitivity analysis. Final mapping equation (ordinary least squares) includes goiter symptoms, anxiety, upset stomach, composite score (ThyPRO-39), FT4 levels, and week of pregnancy (determination coefficient 0.36).ConclusionThis is the first QoL mapping of SubHypo during pregnancy and the first evidence that SubHypo is associated with a negative impact on QoL. The effect is mediated by anxiety. EQ-5D-5L utilities can be generated based on ThyPRO-39 scores collected in pregnant euthyroid and patients with SubHypo.     

Correlates of sleep disturbance in Veterans with traumatic brain injury and chronic pain: A cross-sectional study

BackgroundFew studies have investigated sleep in Veterans with comorbid traumatic brain injury (TBI) and chronic pain.ObjectiveTo describe mood and cognitive correlates with sleep disturbance in a sample of Veterans with both TBI and chronic pain.Research methodCross-sectional, correlational analyses were completed using baseline data from a randomized controlled trial comparing psychosocial treatments for pain in Veterans with TBI. Enrollment occurred between July 2015 and January 2017. Self-report measures of hours slept, insomnia severity, depression and PTSD symptoms were collected along with a brief neuropsychological assessment.ResultsParticipants (n = 221) were an average age of 37.2 years (SD = 8.2) and mostly male (89%). Participants reported sleeping an average of 4.9 h a night (SD = 1.4) with an average Insomnia Severity Index (ISI) score of 17.4 (SD = 5.4) suggesting moderate insomnia symptoms. Fewer hours slept was associated with higher depression scores (r = ?0.28, p < 0.001) and slower processing speed (r = 0.23, p < 0.001). Increasing insomnia severity was associated with greater depression (r = 0.57, p < 0.001) and PTSD symptoms (r = 0.44, p < 0.001), and slower processing speed (r = ?0.22, p < 0.001).ConclusionsThe average ISI score was above the clinical cut off for insomnia diagnosis. Results suggest that those with more severe insomnia symptoms report higher depression and PTSD symptoms as well as exhibit slower processing speed. Improving sleep in this population may be important for improving outcome following TBI.     

An exploratory investigation of purging disorder

ObjectivePurging Disorder (PD) is an understudied pattern of behaviors within the Eating Disorder Not Otherwise Specified (EDNOS) category. Such categorization may suggest that PD is not clinically significant as other eating disorders. However, evidence has suggested that PD is associated with significant impairments in psychosocial functioning and well-being. Despite the apparent clinical significance of PD, it remains to be determined if PD is distinct from other clinically significant eating disorders. The present study sought to assess the phenomenology, clinical significance, and distinctiveness of PD.MethodGroup scores on measures of eating pathology, body image disturbance, and psychological correlates were compared using MANOVA among a female undergraduate sample (N = 94) meeting diagnostic criteria for PD (n = 20), Bulimia Nervosa (BN; n = 35), restrained eating (n = 18), and healthy controls (n = 21).ResultsOverall, results indicated the PD group reported less severe symptoms than BN but more severe symptoms than controls. The PD and restraint groups were similar on most variables (including subjective binge behavior), with the exception of perfectionism and hunger.DiscussionFindings support the conceptualization of PD as existing along a spectrum of bulimic spectrum disorders rather than as a distinct diagnostic category.     

Validation of handgrip strength and endurance as a measure of physical function and quality of life in healthy subjects and patients

ObjectiveHandgrip strength (HGS) is often used as a bedside measurement of muscle function in the hospital setting. The aim of this study was to investigate the extent to which HGS, endurance, and work (force during endurance × time) are related to physical function as measured by mobility and physical activity (PA) in young, healthy volunteers. Further, the relations between HGS, mobility, PA and quality of life (QoL) in patients were investigated.MethodsNinety-two healthy subjects (45% men, mean age 30 y) and 45 patients (56% men, mean age 55 y) were assessed for HGS, handgrip endurance, and handgrip work, mobility (timed up-and-go test), and PA (Baecke questionnaire or Bouchard activity diary). The patients were further assessed for QoL (SF-36).ResultsThere was a correlation between HGS and mobility in healthy subjects (r = ?0.31, P = 0.0028) and patients (r = ?0.59, P < 0.0001). Further, HGS and mobility were related to physical and mental component summary scores of QoL in patients. There was also a relation between HGS and PA in healthy female subjects and male patients.ConclusionHandgrip strength is a valid measurement of mobility and QoL in patients and of PA in healthy female subjects and male patients. Handgrip endurance and work were not found to be valid measurements of mobility and PA in healthy subjects or of QoL in patients.     

Relationship between initial symptoms and prognosis of patients with Covid-19

ObjectiveAims to describe the initial symptoms most related to the prognosis of Covid-19.DesignThis is a retrospective cross sectional, quantitative, data analyzed study.SiteThis study was made in the family medicine centers (n = 82) of Çorlu district of Tekirda? province, in Turkey.ParticipantsThe study included patients (n = 1.506) who had a positive PCR test for Covid-19 from March to September 2020. And we asked them their initial symptoms which bring them to the family medicine centers before the test.Main measurementsThe participants’ age, gender, presence of chronic disease, and initial symptoms which they come to a healthcare facility were evaluated. These variables were analyzed in terms of length of hospital stay, intensive care unit admission and mortality rates.ResultsThe most common initial symptom in Covid-19 patients was cough. The presence of a chronic disease, the shortness of breath, malaise, the loss of smell and taste, and vomiting were found to be associated with an increased mortality rate. Advanced age, the presence of cough, malaise, the loss of smell and taste, and vomiting as the initial symptoms were found to have increased the likelihood of being admitted to the intensive care unit.ConclusionsThe authors advise placing more attention on the initial symptoms of cough, malaise, the loss of smell and taste and vomiting in Covid-19 patients. Because these symptoms are related with severe prognosis indicators.     

Moderate lead exposure and elementary school end-of-grade examination performance

PurposeThis study investigated the association between moderate lead poisoning in early childhood with performance on a comprehensive set of end-of-grade examinations at the elementary school level in two urban school districts.MethodsChildren born between 1996 and 2000 who resided in Milwaukee or Racine, WI, with a record of a blood lead test before the age of 3 years were considered for the analysis. Children were defined as exposed (blood lead level ≥10 and <20 μg/dL) or not exposed (BLL < 5 μg/dL). Parents of eligible children were mailed surveys to consent to participation and elicit information on potential confounders. On consent, children were matched to educational records for fourth grade Wisconsin Knowledge and Concepts Examinations. Seemingly unrelated regression was used to evaluate the relation between scaled scores on all sections of the examination (math, reading, language arts, science, and social studies) with exposure status, controlling for demographics, social status indicators, health indicators, and district-based poverty indicators.ResultsA total of 1133 families responded to the survey and consented to have educational records released; 43% of children were considered exposed. After controlling for demographic and socioeconomic covariates, lead exposure was associated with significantly lower scores in all sections of the Wisconsin Knowledge and Concepts Examinations (range: science, β = ?5.21, P = .01; reading, β = ?8.91, P = .003). Children who were black, had a parent with less than a high-school education, and were classified by parents as having less than excellent health had significantly lower performance on all examination components.ConclusionsChildren with moderate lead poisoning in early childhood performed significantly lower on all components of elementary school end-of-grade examinations compared with unexposed children. Household level social status and childhood health indicators partially explain decreased examination scores.     

Whose quality of life is it anyway? Discrepancies between youth and parent health-related quality of life ratings in type 1 and type 2 diabetes

Purpose

Health-related quality of life (HRQOL) is a critical diabetes outcome, yet differences between youth and parent-proxy ratings can make interpretation difficult. This study aims to explore potential differences between self- and parent-reports of Pediatric Quality of Life Inventory (PedsQL) scores from youth with type 1 (T1D) or type 2 diabetes (T2D) and to evaluate associations between discrepancies, PedsQL scores, and glycemic control (HbA1c).

Methods

Youth and parents in the SEARCH for Diabetes in Youth Study (T1D: age 5–18, n = 3402; T2D: age 8–18, n = 353) completed the PedsQL Generic and Diabetes Modules, and youth provided a blood sample to assess HbA1c. Discrepancies (youth minus parent PedsQL ratings) were calculated and examined by age and diabetes type, and associations with youth PedsQL scores and HbA1c were evaluated.

Results

Discrepancies existed between youth and parent-proxy reports of generic and diabetes PedsQL scores in T1D and T2D (all p values < 0.01). Higher (more favorable) ratings were reported by youth except for those 5–7-years old, where parents’ scores were higher. When parent-proxy scores were higher, discrepancies were largest when the child reported low PedsQL scores. Higher HbA1c was associated with larger discrepancies (youth scores higher) for adolescents with T1D.

Conclusions

Discrepant PedsQL ratings suggest that parents may often underestimate youths’ HRQOL except in the youngest children. Although examining both reports is optimal, the youth report should be prioritized, particularly for young children with T1D and for adolescents with either T1D or T2D.

     

Stress,Lifestyle, and Quality of Life in Midlife and Older Australian Women: Results From the Stress and the Health of Women Study

BackgroundChronic psychological stress may pose a serious threat to health, although the mechanisms are not fully understood. This study examines the impact of stress on modifiable lifestyle factors, depressive symptoms, health-related quality of life (HRQOL) and chronic illness in older Australian women.MethodsCross-sectional data were collected from a random sample of 181 older adults aged 60 to 70 years from rural and urban areas of South-East Queensland, Australia. We used structural equation modelling to examine associations between stress, modifiable lifestyle factors, HRQOL, and chronic illness.FindingsParameter estimates show that older women who reported life stressors where they felt helpless and feared for their life (high-magnitude stressors) also reported higher body mass index (p = .03) and more chronic illness (p < .01). In contrast, duration of exposure to life stressors was associated with higher depressive symptom scores (Center for Epidemiologic Studies Depression Scale; p = .02) and sleep disturbance scores (p < .01).ConclusionsOur findings support the link between traumatic personal histories (exposure to high-magnitude stressors) and unhealthy lifestyle factors. Findings highlight the need for more research on how stress reduction, a healthy lifestyle, and positive coping strategies can be used to reduce the effects of high-magnitude stress on HRQOL and chronic illness.     

The barriers to participation in leisure time physical activities among Iranian women with severe mental illness: A qualitative study

Background and objectivesSedentary behavior and physical inactivity are known risk factors for poor health and increased mortality in patients with severe mental illness. Identifying the barriers to participation in leisure-time physical activities among these patients can be helpful in planning effective interventions aimed at increasing activity level. Prior to the present study, the barriers experienced by female patients in Iran were unknown.Materials and methodsThis was a qualitative study using conventional content analysis. Participants were 32 women with severe mental illness who were hospitalized at women's psychiatric wards of Farabi Teaching Hospital in Kermanshah, Iran, from September 2015 to March 2016. Data were collected through four focus group discussion sessions and were then analyzed.ResultsParticipants had a mean age of 42 (SD = 7.8) and an active diagnosis of schizoaffective disorder (n = 10), schizophrenia (n = 8), a chronic bipolar disorder (n = 8), or major depression disorder (n = 6). Two main barrier categories emerged: Personal experience of disease and Non-supportive context. Within the former, stigma of disease, signs and symptoms of disease, and medication side effects were the constituent subcategories. Non-supportive context subcategories consisted of family, cultural, environmental, and medical staff barriers that influenced non-participation in leisure-time physical activities.ConclusionIranian women with severe mental illness face a number of barriers to participation in leisure-time physical activities including the stigma, symptoms, and treatment of mental illness; and contextual barriers such as family expectations, societal perceptions, environmental factors, and lack of medical staff support. It is recommended that providers consider these factors when developing therapeutic plans for similar patient populations.     

The effects of 60 minutes of supervised weekly walking (in a single vs. 3–5 session format) on depressive symptoms among older women: Findings from a pilot randomized trial

ObjectiveTo investigate the effects of training frequency on psychological benefits resulting from a walking program among older women with subsyndromal depression.MethodsAll participants were randomly assigned to a 4-week-long self-paced walking program including one (G₁) or three to five (G_3–5) weekly training sessions. They completed the Geriatric Depression Scale (GDS) as a measure of depressive symptoms during the intervention and one month later.ResultsUsing statistics for small-n designs, it appeared that, at the end of the program, a significantly greater proportion of women in G_3–5 reported GDS values below the cutoff score of 10 (i.e., indicative of the absence of any depressive symptoms) compared to women in G₁ (5 of 6 vs. 1 of 6; Φ² = 0.48; p < .05). The GDS scores after treatment were significantly lower than baseline scores in both groups (Z = 2.20; p < .03, and Z = 1.99; p < .05 respectively), but the mean decrease of depressive symptoms was significantly larger in G_3-5 (48.9%) than in G₁ (22.7%).ConclusionBreaking 60 min of weekly walking into shorter periods on 3–5 days a week appears to be more effective to alleviate depressive symptoms in older women with subsyndromal depression.