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Purpose: To determine the effects of dietary nitrate supplementation, in the form of red spinach extract (RSE), on adaptations to offseason training in collegiate athletes. Methods: Sixteen Division I male baseball athletes (20.5 ± 1.7y, 90.4 ± 0.5 kg) enrolled in this study and were randomized into a RSE (n = 8) or placebo (n = 8; PL) group. Athletes completed an 11-week resistance training program during the offseason, which consisted of 2-3 workouts per week of upper and lower-body exercises and baseball-specific training. Athletes consumed a RSE (2 g; 180 mg nitrate) or PL supplement daily for the entire offseason training program. Pre and post-training, all athletes underwent one-repetition maximum (1RM) strength testing for the bench press and completed a Wingate anaerobic cycle test (WAnT). Body composition analysis was completed via a 4-compartment model, as well as muscle thickness (MT) measurement of the rectus femoris (RF) and vastus lateralis (VL) via ultrasonography. Resting heart rate and blood pressure (BP) were also obtained. Separate repeated measures analyses of variance were used to analyze all data. Results: Significant (p ≤ 0.05) main effects for time were observed for improved bench 1RM, fat-free mass, body fat percentage, RF MT, and VL MT. No significant group x time interactions (p > 0.05) were found for any measure of performance, body composition, or cardiovascular health. However, a trend for improved peak power in the WAnT was observed (p = 0.095; η2=0.200). Conclusions: These data suggest that daily RSE supplementation had no effect on performance, body composition, or cardiovascular measures in male Division I baseball players following offseason training. [ABSTRACT FROM AUTHOR]

Background: In the United States, more than 6 million adults live with Alzheimer disease (AD) that affects 1 out of every 3 older adults. Although there is no cure for AD currently, lifestyle-based interventions aimed at slowing the rate of cognitive decline or delaying the onset of AD have shown promising results. However, most studies primarily focus on older adults (>55 years) and use in-person interventions. Objective: The aim of this study is to determine the effects of a 2-year digital lifestyle intervention on AD risk among at-risk middle-aged and older adults (45-75 years) compared with a health education control. Methods: The lifestyle intervention consists of a digitally delivered, personalized health coaching program that directly targets the modifiable risk factors for AD. The primary outcome measure is AD risk as determined by the Australian National University-Alzheimer Disease Risk Index; secondary outcome measures are functional fitness, blood biomarkers (inflammation, glucose, cholesterol, and triglycerides), and cognitive function (Repeatable Battery for the Assessment of Neuropsychological Status and Neurotrack Cognitive Battery). Screening commenced in January 2021 and was completed in June 2021. Results: Baseline characteristics indicate no difference between the intervention and control groups for AD risk (mean -1.68, SD 7.31; P=.90). Conclusions: The intervention in the Digital, Cognitive, Multi-domain Alzheimer Risk Velocity is uniquely designed to reduce the risk of AD through a web-based health coaching experience that addresses the modifiable lifestyle-based risk factors. [ABSTRACT FROM AUTHOR]

Aim: PREPARE‐ABC is a pragmatic multicentre randomised controlled trial including an internal pilot designed to assess the clinical and cost‐effectiveness of pre‐ and postoperative exercise in relation to short‐ and longer‐term postoperative recovery outcomes in colorectal cancer patients undergoing surgical resection. Here, we report on internal pilot phase data for the first 200 patients randomised to the trial, which included prespecified stop‐go criteria used to inform the decision to progress to the fully powered trial by the funder. Methods: Eligible and consenting patients are randomly assigned (1:1:1) to hospital‐supervised exercise, home‐supported exercise or treatment as usual (TAU). Randomisation is concealed but clinical teams providing treatment and participants are unmasked. Primary outcomes are 30‐day morbidity (Clavien‐Dindo) and 12‐month health‐related quality of life (Medical Outcomes Study Health Questionnaire). Here, we present findings from the prespecified pilot phase which assessed feasibility of site set up, recruitment, adherence and acceptability of trial processes to patients and site staff. Results: Between 9 November 2016 and 18 May 2018, 18 sites were set up, with 200 patients randomised to either hospital‐supervised exercise (68), home‐supported exercise (69) or treatment as usual (TAU) (63). Across the groups, 19 patients did not proceed to surgery or withdrew and 52% experienced a complication. Over half of the participants (57%) in the hospital‐supervised group attended ≥6 preoperative sessions and 50% attended ≥5 monthly postoperative exercise "booster sessions". In the home‐supported group, 70% patients engaged with ≥2 telephone support sessions in the preoperative phase and 80% engaged in ≥5 monthly telephone support "booster sessions". Adverse events were reported by 22 patients and three patients reported a serious adverse event. The majority of complications were Clavien‐Dindo grades 1–2; however, 16 patients experienced one or more Clavien‐Dindo grade 3–4 complication(s). Conclusions: Results of the internal pilot phase confirm the feasibility of site set‐up and patient recruitment, representativeness of the sample population and adequate adherence to hospital‐supervised and home‐supported exercise. On the basis of these positive results, progression to the fully‐powered trial was authorised by the funder. [ABSTRACT FROM AUTHOR]

Background: A colorectal resection is standard treatment for patients with colorectal cancer (CRC). However, the procedure results in significant post-operative mortality and reduced quality of life. Maximising pre-operative cardiopulmonary fitness could improve post-surgical outcomes. PREPARE-ABC is a multi-centre, three-armed, randomised controlled trial investigating the effects of exercise interventions, with motivational support on short and longer-term recovery outcomes in CRC patients undergoing major lower-gastrointestinal surgery. The trial included an internal pilot phase with parallel process evaluation. The aim of the process evaluation was to optimise intervention implementation for the main trial.Methods: Mixed methods process evaluation conducted in 14 UK hospitals between November 2016 and March 2018. Data included a site profile questionnaire and telephone scoping interview with hospital staff, 34 qualitative observations of standard care and 14 observations of intervention delivery, 13 semi-structured interviews with healthcare professionals (HCPs) and 28 semi-structured interviews with patients. Data analysis focused on describing intervention delivery within each arm, assessing fidelity, acceptability and how variation in delivery was linked to contextual characteristics.Results: Standard care exercise advice was typically limited to maintaining current activity levels, and with lead-in time to surgery affecting whether any exercise advice was provided. Variation in HCP capacity affected the ability of colorectal units to deploy staff to deliver the intervention. Patients' exercise history and motivation prior to surgery influenced HCP perceptions and delivery of the motivational components. Observations indicated a high level of fidelity to delivery of the exercise interventions. All but one of the 28 interviewed patients reported increasing exercise levels as a result of receiving the intervention, with most finding them motivational and greatly valuing the enhanced level of social support (versus standard care) provided by staff.Conclusion: Hospital-supervised and home-based exercise interventions were highly acceptable for most patients undergoing surgery for CRC. Delivery of pre- and post-operative exercise within the CRC care pathway is feasible but systematic planning of capacity and resources is required to optimise implementation. [ABSTRACT FROM AUTHOR]

Background: Exercise programmes can increase cardiopulmonary reserve and functional capacity prior to surgery and can improve clinical, functional and survival outcomes after a colorectal cancer diagnosis. However, the impact of pre‐ and postoperative exercise on postoperative recovery outcomes and longer‐term health‐related quality of life are unknown; thus, there is a need for high‐quality randomized controlled trials. Method: SupPoRtive Exercise Programmes for Accelerating REcovery after major Abdominal Cancer surgery (PREPARE‐ABC) is a three‐arm multicentre randomized controlled trial with internal pilot. The primary objective is to assess the effects of pre‐ and postoperative exercise on surgical outcomes and longer‐term health‐related quality of life in cancer patients undergoing colorectal resection. The aim of PREPARE‐ABC is to randomize 1146 patients at the individual level (1:1:1) to hospital‐supervised exercise, home‐supported exercise or treatment as usual. The primary outcomes are short‐term (30‐day) morbidity, assessed using the Clavien–Dindo classification, and longer‐term health‐related quality of life, assessed using the Medical Outcomes Study Health Questionnaire (36‐item Short‐Form Survey [SF‐36]). Secondary outcomes include cardiopulmonary fitness, physical activity behaviour change, psychological health status and cost‐effectiveness. A process evaluation of intervention delivery and usual care also will be undertaken. Discussion: This is the first UK‐based definitive randomized controlled trial to investigate the effects of pre‐ and postoperative exercise on short‐term postoperative health outcomes and longer‐term health‐related quality of life in colorectal cancer patients. The trial will yield robust clinical and cost‐effectiveness data to underpin clinical guidance on how exercise programmes should be implemented in the routine management of patients undergoing major colorectal cancer surgery. [ABSTRACT FROM AUTHOR]

Background: Generalized anxiety disorder (GAD) is one of the most common mental disorders among university students; however, many students go untreated due to treatment costs, stigma concerns, and limited access to trained mental health professionals. These barriers are heightened in universities in India, where there are scant mental health care services and severe stigma surrounding help seeking. Objective: To evaluate the feasibility, acceptability, and efficacy of Internet-based, or "online," cognitive behavioral therapy (CBT)-based unguided and guided self-help interventions (using the programs GAD Online and Lantern, respectively) to reduce GAD symptoms in students with clinical and subthreshold GAD and, ultimately, reduce the prevalence and incidence of GAD among the student population. Methods: Students will be recruited via 3 colleges in Hyderabad, India, and referred for a campus-wide online screening. Self-report data will be collected entirely online. A total of 300 qualifying students will be randomized in a 1:1:1 ratio to receive GAD Online, Lantern, or to be in a wait-list control condition, stratified by clinical and subthreshold GAD symptomatology. Students will complete a postintervention assessment after 3 months and a follow-up assessment 6 months later, at which point students in the wait-list control condition will receive one of the programs. The primary outcome is GAD symptom severity at 3 months postintervention. Secondary outcomes include GAD caseness at 9 months, other anxiety and depression symptoms, self-efficacy, and functional measures (eg, sleep, social functioning) at 3 and 9 months, respectively. Primary analyses will be differences between each of the intervention groups and the wait-list control group, analyzed on an intention-to-treat (ITT) basis using mixed-design ANOVA. Results: The study commenced in February 2015. The sample was recruited over a 3-week period at each college. The trial is expected to end in December 2015. Conclusions: This trial will be the first to evaluate the use of Internet-based CBT programs compared with a wait-list control group for the treatment of GAD among students in Indian universities. If effective, these programs have the potential to reduce the mental health care treatment gap by providing readily accessible, private, and cost-effective evidence-based care to students with GAD who do not currently receive the treatment they need. Trial Registration: ClinicalTrials.gov NCT02410265 http://clinicaltrials.gov/ct2/show/NCT02410265 (Archived by WebCite at http://www.webcitation.org/6ddqH6Rbt). [ABSTRACT FROM AUTHOR]

OBJECTIVE. This study examined the efficacy of an Internet-facilitated intervention for weight maintenance and binge eating in adolescents. METHODS. A total of 105 adolescent male and female high school students at risk for overweight (mean age: 15.1 ± 1.0 years) were randomly assigned to a 16-week online intervention, StudentBodies2-BED (n = 52), or the wait-list control group (n = 53). RESULTS. Participants in the StudentBodies2-BED group had significantly lower BMI z scores and BMI from baseline assessment to follow-up assessment, compared with the wait-list control group. In addition, significant reductions in objective binge episodes and subjective binge episodes from baseline assessment to posttreatment assessment and from baseline assessment to follow-up assessment were observed among StudentBodies2-BED participants. The StudentBodies2-BED group also reported significantly reduced weight and shape concerns from posttreatment assessment to follow-up assessment and from baseline assessment to follow-up assessment. Participants in the StudentBodies2-BED group who engaged in objective overeating or binge eating episodes at baseline assessment experienced a significantly greater reduction in BMI at follow-up assessment, compared with the wait-list control group. CONCLUSIONS. Results suggest that an Internet-facilitated intervention is moderately effective in short-term weight loss and weight maintenance and yields a large reduction in binge eating. This study also demonstrates that weight management and reduction of eating disorder psychopathological features can be achieved simultaneously by using an easily disseminated, Internet-facilitated program. [ABSTRACT FROM AUTHOR]

Learning to compute with fractions is a major challenge for many students and especially for students with disabilities (SWD). Phase 1 of this study employed a randomized pretest–posttest comparison design to test the effects of two versions of formative assessment combined with an instructional program called Fractions at Work. In one condition, teachers used technology-assisted prompts to assess student performance and remediate errors. In the comparison condition, teachers gave students the same items for assessing progress but used their own methods of reteaching. Results indicated no difference between the two methods. However, pretest-to-posttest gain scores were significantly higher on all three measures regardless of type of formative assessment, and students maintained much of what they had learned. Phase 2 examined issues related to instructional dosage. Students who received additional weeks of instruction scored significantly higher than students who went back to their business-as-usual curriculum. [ABSTRACT FROM AUTHOR]