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Objective: Facilitated self‐management interventions have the potential to enhance resilience and well‐being. We examined whether resilience is a mediator of improving physical and psychological symptoms for people with systemic sclerosis (SSc) who participated in a 12‐week online peer‐led symptom management intervention. Methods: We conducted a secondary data analysis from a randomized control trial comparing a peer health‐coached intervention to a waitlist control. Participants completed the Connor‐Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy‐Fatigue scale, and the Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms at the baseline and at weeks 6 and 12. Linear mixed effect regression models were used to assess the effect of intervention on changes in resilience. Causal mediation analyses were conducted to examine whether changes in resilience at week 12 mediated intervention effects on changes in fatigue, pain interference, and depressive symptoms at week 12. Results: One hundred and seventy‐three eligible participants were enrolled. Participants in the intervention group reported improvements in resilience (P < 0.001). These changes in resilience mediated the intervention effects on fatigue with indirect effect of −1.41 (95% confidence interval [CI] −2.41 to −0.41), pain interference of −0.86 (95% CI −1.65 to −0.08), and depressive symptoms of −1.99 (95% CI −3.16 to −0.81). Conclusion: For participants in the intervention who had positive improvements in their physical and psychological symptoms, increased resilience was a mechanism for these improvements. These findings support the importance of addressing resilience to improve symptoms in similar SSc interventions. [ABSTRACT FROM AUTHOR]

Purpose: Fitness education is essential for children's health, but determining the effectiveness of instruction related to health-related fitness is difficult. The present study developed and confirmed the validity of a 20-item scale, adapted from the School Health Index (Centers for Diseases Control and Prevention [CDC], 2014), to evaluate the success of fitness education portion of the Presidential Youth Fitness Program (PYFP) across a sample of 785 teachers. Method: The initial subset (n = 373) represented 353 schools and was used for conducting an exploratory factor analysis. The second subset (n = 412) representing 404 schools, was used to conduct the confirmatory factor analysis. Teachers self-assessed their perceived degree of implementation of fitness education (full, partial, under development, not in place) within their school (i.e., teachers helped students set fitness goals). Results: An initial exploratory factor analysis revealed that the Fitness Education Index questions clustered into six factors. A subsequent confirmatory factor analysis conducted using Mplus concluded the six-factor solution was a good fit (CFI = 0.90, TLI = 0.88, RMSEA = 0.08, SRMR = 0.06). Conclusion: This scale is a valid measure of a school's readiness to initiate and track progress toward the full implementation of fitness education.

Objectives People with SSc often experience fatigue, which significantly affects daily life functioning and quality of life. We aimed to explore participants' experiences of a peer health–coached resilience-building energy management to enhance well-being (RENEW) intervention on symptoms and well-being and to use mixed methods to compare how SSc duration influenced the experiences of participants who had clinically significant fatigue improvement vs those who did not. Methods Semi-structured interviews were conducted with 21 participants from the parent clinical trial randomized to the RENEW intervention. Data were analysed using the rigorous and accelerated data reduction technique combined with thematic content analysis. A mixed methods approach used a joint display to identify themes related to the impact of SSc duration on fatigue improvement status. Participants were categorized into short/improvement, short/limited improvement, long/improvement, and long/limited improvement. Results Our team generated four themes: participant and peer health–coach relationship, physical and psychological well-being improvement, need for a tailored approach and easy program access through technology. Mixed methods analysis revealed that, regardless of SSc duration, participants with improved fatigue reported increasing self-awareness of SSc-related symptoms and learning coping strategies to manage fatigue. Participants in the short/improvement group reported preferences for slower pacing of the program and pairing with a coach with similar symptom severity. Participants in the long/limited improvement group sought SSc-specific symptom management information. Conclusion Incorporating peer health coaches and technology is beneficial for self-management interventions for people with SSc. Future tailoring of RENEW based on SSc duration and symptom severity is needed. Clinical trial registration number clinicatrials.gov , NCT04908943. [ABSTRACT FROM AUTHOR]

Objective: Supported self‐management interventions for individuals with systemic sclerosis (SSc) are needed. We examined the effects of a 12‐week resilience‐building energy management program (called RENEW) for fatigue and other patient‐reported outcomes. Methods: Participants, who had physician‐diagnosed SSc, moderate to severe fatigue, and were ≥18 years old, were randomly assigned to RENEW or waitlist control in a 2:1 ratio. The RENEW intervention included an educational website/application plus nine virtual peer‐led health coaching sessions. The primary outcome was change in the Functional Assessment of Chronic Illness Therapy‐Fatigue scale. Secondary outcomes were change in Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms and Connor‐Davidson Resilience Scale. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. Multiple imputation was conducted; linear mixed models were used to assess group differences. A three‐way interaction with group, time, and SSc duration was examined in each model. Results: Among 173 participants (mean ± SD age 54.5 ± 11.7 years; 93% female, 85% White), 47% had diffuse cutaneous SSc; 57% were ≤5 years from diagnosis. At 12 weeks, compared to controls, RENEW participants had a clinically meaningful fatigue improvement (β = −4.7; 95% confidence interval −6.7 to −2.7; P < 0.001) and improvement in all secondary outcomes. Among RENEW participants, individuals with shorter disease duration had greater improvements in fatigue at 12 weeks. Conclusion: An mHealth supported self‐management intervention improved fatigue and other outcomes, particularly in newly diagnosed patients. This program may be broadly scalable for SSc symptom management. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore what non-pharmacological interventions have been examined for individuals with antiphospholipid syndrome (APS). Methods: We conducted a systematic literature search of the databases PubMed, Embase, Scopus, Web of Science, CINAHL, and ClinicalTrials.gov from 1983–Feb. 2023. Our scoping review included studies that examined non-pharmacological interventions for individuals with APS using patient-reported outcome measures. We excluded studies that reported physiological outcomes only. Results: The review yielded one case study on the safety and efficacy of an exercise program for a 15-year-old male with secondary APS using physiological and patient-reported outcome measures. Despite the lack of evidence of non-pharmacological interventions for individuals with APS, one excluded study reported that individuals with APS want guidance about physical activity and exercise. We also found several types of potentially relevant non-pharmacological interventions for individuals with lupus, a disease that often co-occurs with APS. Conclusions: Non-pharmacological interventions may offer a solution for addressing some non-thrombotic or non-obstetric APS symptoms, such as neurological, physical, and cognitive symptoms that are not well-controlled by anticoagulation. Due to the unique risks associated with APS, research is needed to determine the safety and efficacy of non-pharmacological interventions, particularly those involving exercise. Adopting a comprehensive, multidisciplinary approach to managing patients with APS and involving rehabilitation professionals, who are experts in the design and delivery of non-pharmacological interventions, may provide a foundation for developing and testing novel interventions that improve health outcomes while also fulfilling unmet needs reported by patients. [ABSTRACT FROM AUTHOR]

Objectives Symptoms of people who have SSc are heterogeneous and difficult to address clinically. Because diverse symptoms often co-occur and may share common underlying mechanisms, identifying symptoms that cluster together may better target treatment approaches. We sought to identify and characterize patient subgroups based on symptom experience. Methods An exploratory hierarchical agglomerative cluster analysis was conducted to identify subgroups from a large SSc cohort from a single US academic medical centre. Patient-reported symptoms of pain interference, fatigue, sleep disturbance, dyspnoea, depression and anxiety were used for clustering. A multivariate analysis of variance (MANOVA) was used to examine the relative contribution of each variable across subgroups. Analyses of variance were performed to determine participant characteristics based on subgroup assignment. Presence of symptom clusters were tallied within subgroup. Results Participants (n  = 587; 84% female, 41% diffuse cutaneous subtype, 59% early disease) divided into three subgroups via cluster analysis based on symptom severity: (i) no/minimal, (ii) mild, and (iii) moderate. Participants in mild and moderate symptoms subgroups had similar disease severity, but different symptom presentation. In the mild symptoms subgroup, pain, fatigue and sleep disturbance was the main symptom cluster. Participants in the moderate symptoms subgroup were characterized by co-occurring pain, fatigue, sleep disturbance, depression and anxiety. Conclusion Identification of distinct symptom clusters, particularly among SSc patients who experience mild and moderate symptoms, suggests potential differences in treatment approach and in mechanisms underlying symptom experience that require further study. [ABSTRACT FROM AUTHOR]

Many women do not engage in regular physical activity and women's physical activity declines over the life cycle. The present study examines the association of regular leisure-time physical activity with affective experience among 881 middle-aged and older women from the National Survey of Midlife Development in the United States. In multiple linear regression and structural equation analyses, a higher level of leisure-time physical activity was related to more high-arousal and low-arousal positive affect and less high-arousal and low-arousal negative affect. Appreciating positive affective responses associated with physical activity can help to motivate women to engage in regular leisure-time physical activity. [ABSTRACT FROM AUTHOR]

Background: Women with disabilities, a health disparities group, are choosing to become parents, but it is unclear the extent to which they face related disparities regarding key health promotion behaviors associated with perinatal outcomes. Men's health behaviors may also directly or indirectly influence these outcomes. The purpose of this study was to compare the preconception health behaviors of reproductiveage women and men with mobility-related disabilities to their non-disabled counterparts to better understand areas for improving health promotion in this population. Methods: We used Texas Behavioral Risk Factor Surveillance System (BRFSS) data for 2013 and 2015 among a subsample of women (non-pregnant) and men age 18-44 years (N = 7,108). Physical disability categorization was based on whether mobility-related disability (MRD) was reported. Health behaviors examined were current smoking status, meeting aerobic physical activity (PA) and muscle strengthening guidelines, and dark green vegetable intake. In addition to frequencies and percentages, logistic regression analyses were used to examine associations between MRD and health behaviors separately for women and men. Results: After adjusting for covariates, women with MRD had higher odds of smoking (odds ratio [OR] = 1.77, 95% confidence interval [CI]: 1.03-3.04), not meeting aerobic PA guidelines (OR = 1.82, 95% CI: 1.13-2.92), and having lower dark green vegetable intakes (OR = 1.61, 95% CI: 1.01-2.56). Men with MRD had reduced odds of having lower dark green vegetable intake (OR = 0.50, 95% CI: 0.28-0.88). Conclusion: Women of reproductive age who have MRD face increased odds of smoking, being less physically active, and having lower dark green vegetable intake compared with nondisabled women. These areas require increased attention in health promotion programs targeting preconception health of women with MRD. [ABSTRACT FROM AUTHOR]

Physical activity carries immediate and long-term benefits for middle-aged and older women; however, physical activity decreases in adulthood and aging in women. In this study, the authors investigate the relation of health behaviors, health attitudes, and health appraisals to leisure-time physical activity among middle-aged and older women in a cross-sectional analysis of the second wave of the Study of Midlife Development in the United States (MIDUS2) conducted during the period from 2004 to 2006. The sample consisted of 829 women, ranging in age from 40 to 75 years of age (Mean = 56 years). In multiple logistic regression analyses, controlling for socio-demographic factors and functional restrictions, most of the psychosocial variables examined showed unique associations with physical activity, including health behaviors of having a routine checkup and not smoking, health attitudes involving commitment to health and valuing physical fitness and strength, and the health appraisal that one’s health is better compared to others of the same age. Older women (aged 61–75 years) were less active, but reported greater health commitment than middle-aged women (aged 40–60 years). Neither health commitment nor any other psychosocial variable interacted with age in relation to physical activity. Understanding characteristics of middle-aged and older women who are physically active is essential in tailoring interventions to this population. [ABSTRACT FROM PUBLISHER]

Impaired upper extremity (UE) function has limited activities of daily living in people with systemic sclerosis (SSc). Exergaming, a combination of gaming and exercises, could be a novel way to improve UE exercise engagement. The objective of this study was to examine the usability of exergaming and to investigate participant experiences after exergaming among people with SSc. Both quantitative and qualitative data were collected. Participants completed questionnaires regarding the usability of exergaming. Semi-structured interviews were conducted directly after exergaming. Descriptive statistics and thematic content analysis were performed. Twenty participants with SSc participated. Exergaming was highly acceptable with a good System Usability Scale score (M = 71.6 ± 9.9). Participants described exergaming as motivating with potential physical and nonphysical benefits. Although results were generally positive, participants expressed some barriers and temporary side effects of using exergaming and needs for improvement. This work stands to inform future exergaming interventions in people with SSc.