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Chronic lung disease is associated with increased psychological distress (especially anxiety and depression) and neuropsychological impairments (primarily in flexible problem-solving and information-sequencing), which decrease quality of life, disease management, and survival. This review summarizes current data regarding the prevalence of neuropsychiatric disorders, the assessment tools commonly used to measure and monitor neuropsychiatric symptoms, the effect of pulmonary rehabilitation on neuropsychiatric symptoms, the mechanisms by which exercise rehabilitation may influence neuropsychiatric functioning, and the clinical implications of the data. [ABSTRACT FROM AUTHOR]

This study evaluated the utility of the psychosocial vulnerability model for understanding the hostility-coronary heart disease (CHD) relationship among college students at risk for CHD. Interrelationships of cognitive, affective, and behavioral hostility with structural and functional social support were examined. College undergraduates with a parental history of CHD (n = 121) and a control group of 125 students with no CHD family history completed measures of hostility and social support. Among women, a significant negative correlation was found between affective-experiential hostility and functional support. Among men, a significant negative correlation was observed between cognitive-experiential hostility and structural support. Path analyses revealed a significant positive effect of expressive hostility on functional s\upport for CHD-negative men and CHD-positive women. CHD family history was not associated with hostility or family environment. CHD-positive participants reported less support satisfaction than did CHD-negative participants. Thus, results indicated qualified support for the psychosocial vulnerability model of the hostility-CHD relationship. [ABSTRACT FROM AUTHOR]

Twenty-seven adults (10 men, 17 women) with chronic pulmonary disease participated in a 30-day rehabilitation program including aerobic exercise, education, and stress management. Mean age of the sample was 55.5 + or - 15.8 years (Range: 27-83 years). Subjects underwent assessments of physiological functioning, neuropsychological functioning, and psychological well-being before (Time 1) and after (Time 2) the exercise program. Using a median age split, the sample was divided into older adult (mean age = 68.6 + or - 9.2) and middle-aged (mean age = 43.4 + or - 9.5) groups, and data were analyzed by multivariate analysis of variance, with age as a between subjects factor. The exercise intervention had no significant effect on indicators of pulmonary function, but both age groups achieved significant gains in cardiopulmonary endurance. Middle-aged subjects functioned at a higher level than older adult subjects at both times of measurement, and middle-aged subjects achieved significantly greater gains in walking distance than older adults. Both groups reported fewer symptoms of psychological distress (depression and anxiety) following the exercise program. The middle-aged subjects performed better than the older adult subjects on timed neuropsychological tests, but both groups improved significantly at Time 2. Although age differences were found in physiological and neuropsychological status in this sample of mildly-to-moderately impaired pulmonary patients, exercise outcomes in psychological well-being and neuropsychological functioning were not differentially associated with age. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pulmonary rehabilitation has become a standard of care for patients with chronic lung diseases. This document provides a systematic, evidence-based review of the pulmonary rehabilitation literature that updates the 1997 guidelines published by the American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation. METHODS: The guideline panel reviewed evidence tables, which were prepared by the ACCP Clinical Research Analyst, that were based on a systematic review of published literature from 1996 to 2004. This guideline updates the previous recommendations and also examines new areas of research relevant to pulmonary rehabilitation. Recommendations were developed by consensus and rated according to the ACCP guideline grading system. RESULTS: The new evidence strengthens the previous recommendations supporting the benefits of lower and upper extremity exercise training and improvements in dyspnea and health-related quality-of-life outcomes of pulmonary rehabilitation. Additional evidence supports improvements in health-care utilization and psychosocial outcomes. There are few additional data about survival. Some new evidence indicates that longer term rehabilitation, maintenance strategies following rehabilitation, and the incorporation of education and strength training in pulmonary rehabilitation are beneficial. Current evidence does not support the routine use of inspiratory muscle training, anabolic drugs, or nutritional supplementation in pulmonary rehabilitation. Evidence does support the use of supplemental oxygen therapy for patients with severe hypoxemia at rest or with exercise. Noninvasive ventilation may be helpful for selected patients with advanced COPD. Finally, pulmonary rehabilitation appears to benefit patients with chronic lung diseases other than COPD. CONCLUSIONS: There is substantial new evidence that pulmonary rehabilitation is beneficial for patients with COPD and other chronic lung diseases. Several areas of research provide opportunities for future research that can advance the field and make rehabilitative treatment available to many more eligible patients in need. [ABSTRACT FROM AUTHOR]

Previous studies have found cognitive deficits in patients with impaired pulmonary function, and recent data from healthy older adults suggest an association of pulmonary function with cognitive function. This 6-year longitudinal study evaluated genetic and environmental sources of covariation in the association of pulmonary function and cognitive performance. The sample included 222 Swedish twin pairs (60% women) with a mean age of 62.3 (+/- 7.7) years (age range: 40-84). Hierarchical multiple regression analyses, controlling for the effects of age, gender, and height, were employed to predict performance on cognitive tests of fluid intelligence (Digit Symbol, Block Design, Digit Span-Backward) and crystallized intelligence (Information) from forced expiratory volume in one second (FEV1). Bivariate cross-twin correlations were used to evaluate the contribution of genetic and environmental factors in the association of pulmonary function and cognitive performance. Results indicated that FEV1 predicted performance on tests of fluid intelligence but not crystallized intelligence at the initial assessment and at the 6-year follow-up. Cross-twin correlational analyses indicated that genetic effects accounted for a greater share of the association of pulmonary function and cognitive performance than environmental effects, but environment also accounted for a substantial share of the covariance. [ABSTRACT FROM AUTHOR]

Objective: The goal of this follow-up to a randomized proof-of-concept study was to determine if targeting body shape concern (BSC) has a clinically significant impact on long-term weight change among adult women of higher body weight with BSC. A secondary aim was to observe the maintenance of body image improvements during follow-up., Method: In the original 4-week trial, women were randomized to behavioral weight loss recommendations alone (control; n = 15) or combined with the evidence-based body project intervention (n = 17). All participants were directed to continue monitoring diet and exercise through Week 8. The current analysis focused on follow-up data collected on weight, BSC, internalized weight bias, internalized thin ideal, and body appreciation at 8 weeks, 6 months, and 12 months. Percent weight change was calculated from baseline and compared against clinical milestones of -2.5% and -5%. An intent-to-treat approach was used for individuals lost to follow-up (n = 11)., Results: Body project participants achieved the clinically significant target of -2.5% weight loss by 12 months. Control participants did not reach the milestone and regained lost weight at 12 months. Neither condition reached the 5% clinical target. Both groups experienced improved body image, but body project participants maintained a greater magnitude of improvement in all measures except internalized thin ideal at 12 months., Conclusion: The current study provides preliminary evidence that targeting BSC among women with BSC who want to lose weight may improve long-term weight loss. Further intervention development and testing are warranted., Public Significance: The results of this study suggest that targeting negative body image among adult women with high BSC might be a pathway to improve long-term weight loss in behavioral weight management. This is aligned with precision medicine priorities to optimize weight-related health care., (© 2023 Wiley Periodicals LLC.)

Purpose: To determine whether preoperative psychological status before outpatient knee surgery is influenced by athletic status, symptom chronicity, or prior surgical history., Methods: International Knee Documentation Committee subjective scores (IKDC-S), Tegner Activity Scale scores, and Marx Activity Rating Scale scores were collected. Psychological and pain surveys included the McGill pain scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia 11, Patient Health Questionnaire 9, Perceived Stress Scale, New General Self-Efficacy Scale, and Life Orientation Test-Revised for optimism. Linear regression was used to determine the effects of athlete status, symptom chronicity (>6 months or ≤6 months), and history of prior surgery on preoperative knee function, pain, and psychological status after matching for age, sex, and surgical procedure., Results: In total, 497 knee surgery patients (247 athletes, 250 nonathletes) completed a preoperative electronic survey. All patients were age 14 years and older and had knee pathology requiring surgical treatment. Athletes were younger than nonathletes on average (mean [SD], 27.7 [11.4] vs 41.6 [13.5] years; P < .001). The most frequently reported level of play among athletes was intramural or recreational (n = 110, 44.5%). Athletes had higher preoperative IKDC-S scores (mean [SE], 2.5 [1.0] points higher; P = .015) and lower McGill pain scores compared to nonathletes (mean [SE] 2.0 [0.85] points lower; P = .017). After matching for age, sex, athlete status, prior surgery, and procedure type, having chronic symptoms resulted in higher preoperative IKDC-S (P < .001), pain catastrophizing (P < .001), and kinesiophobia scores (P = .044)., Conclusions: Athletes demonstrate no difference in symptom/pain and function scores preoperatively when compared to nonathletes of similar age, sex, and knee pathology, as well as no difference in multiple psychological distress outcomes measures. Patients with chronic symptoms have more pain catastrophizing and kinesiophobia, while those who have had prior knee surgeries have slightly higher preoperative McGill pain score., Level of Evidence: Level III, cross-sectional analysis of prospective cohort study data., (Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Abstract: Higher body mass and obesity are associated with bodily pain, and rates of chronic pain increase among older adults. Most past studies are cross-sectional, precluding determination of the temporal relationship between body mass and pain. A longitudinal study of body mass and pain among middle-aged adults found that higher body mass index (BMI) led to greater lower back pain. No longitudinal study of BMI and pain has been conducted among adults older than 70 years. This study used dual change score models to determine the directional relationship between BMI and bodily pain in a sample of middle-aged and older adults. Participants (n = 1889) from the Swedish Twin Registry (baseline age range 40-93 years) completed at least 1 nurse assessment of BMI and self-report ratings of pain interference and joint pain. Pain interference was not associated with BMI, but joint pain was analyzed in univariate and bivariate models, with dual change score models modeling the relationship of BMI and joint pain across age, both independently and as part of bivariate relationships. The results indicated a reciprocal relationship between BMI and joint pain, but joint pain generally led to changes in BMI. In addition, the relationship changed with age, until approximately age 80 years, increasing joint pain contributed to higher BMI, but after that time increasing joint pain contributed to lower BMI. In addition, sex differences in the relationship between BMI and pain appeared after age 70 years. Thus, joint pain contributes to changes in BMI among middle-aged and older adults, but the relationship may change by age and sex., (Copyright © 2022 International Association for the Study of Pain.)

Background: Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers., Objective: This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences., Methods: We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI., Results: Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient -668, 95% CI -1157 to -180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient -517, 95% CI -1188 to -11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day., Conclusions: In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity., Trial Registration: PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=143012., (©Alexander Hodkinson, Evangelos Kontopantelis, Salwa S Zghebi, Christos Grigoroglou, Brian McMillan, Harm van Marwijk, Peter Bower, Dialechti Tsimpida, Charles F Emery, Mark R Burge, Hunter Esmiol, Margaret E Cupples, Mark A Tully, Kaberi Dasgupta, Stella S Daskalopoulou, Alexandra B Cooke, Ayorinde F Fayehun, Julie Houle, Paul Poirier, Thomas Yates, Joseph Henson, Derek R Anderson, Elisabeth B Grey, Maria Panagioti. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.08.2022.)

Background: Breast cancer survivors face a number of physical health threats including cardiovascular disease, the leading cause of death among breast cancer survivors. Low heart rate variability (HRV) represents one well-established risk factor for poor cardiovascular health. Among physically healthy adults and breast cancer survivors, distress disorders may contribute to lower HRV, enhancing morbidity and mortality. This study examined how a distress disorder history altered survivors' HRV trajectories during and after an experimental stressor., Methods: Breast cancer survivors (n = 178; mean age = 51.22) who finished treatment for stages 0-IIIa cancer within the past two years completed a diagnostic interview assessing lifetime presence of psychological disorders. They also participated in a Trier Social Stress Test (TSST). HRV data provided information on survivors' cardiovascular responses at baseline, during the TSST, and during recovery. HRV recovery data at 45 min and 120 min post-TSST was also collected. Survivors also completed questionnaires before and after the TSST assessing task performance, stress levels, ability to cope, and hopelessness. Covariates included body mass index, age, cancer stage, cardiovascular medications, exercise, menopause status, fatigue, current depressive and anxiety symptoms, and physical comorbidities., Results: Women with a distress disorder history had significantly lower HRV before, during, and after the TSST compared to women without such a history. Survivors with distress disorders found the TSST to be more threatening, and reported feeling less control over their performance than those without distress disorders., Conclusions: Breast cancer survivors with a distress disorder history may have lower autonomic flexibility before, during, and after stress exposure. Distress disorder histories also heighten several stress-related risk perceptions leading up to and following the TSST. These findings highlight distress disorder histories as a unique correlate of poorer cardiovascular function among survivors., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: We evaluated the risk factors for pain catastrophizing, kinesiophobia, and elevated depressive symptoms among patients undergoing high-grade cartilage defect surgery. We hypothesized that cartilage patients would demonstrate high scores on pain catastrophizing, kinesiophobia, and depression testing prior to surgery., Methods: Two hundred and ten patients undergoing surgery for high-grade cartilage defects (56% chondroplasty, 36% microfracture, 22% autologous chondrocyte implantation) completed a preoperative survey before undergoing surgery. Outcome scores assessed were: International Knee Documentation Committee-Symptom (IKDC-S) score, Tegner activity score, Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK-11), and Patient Health Questionnaire depression scale (PHQ-9). Multivariate logistic regression was used to determine what pre-operative factors predicted pain catastrophizing, kinesiophobia, and elevated depressive symptoms., Results: The mean pre-operative Tegner score was 5.8 (SD 2.4) and IKDC-S score was 44.7 (SD 11.1). Prior to surgery, 19% had abnormal pain catastrophizing (PCS ≥ 20 points), 14.4% had moderate-severe depression (PHQ ≥ 10), and 49.0% had high kinesiophobia (TSK-11 ≥ 25). Lower pre-operative Tegner scores predicted moderate-severe depressive symptoms (per point decrease, OR 1.36, 95% CI 1.06, 1.76; p = 0.008). Predictors of elevated pain catastrophizing were lower pre-operative IKDC-S scores (per 5-point decrease, OR 1.28, 95% CI 1.08, 1.51; p = 0.002) and symptom duration >6 months (OR 2.20 CI 1.14, 4.32; p = 0.02). A lower pre-operative IKDC-S score (per 5-point decrease, OR 1.17, CI 1.03, 1.33; p = 0.02) predicted elevated kinesiophobia., Conclusion: Low self-reported function, low activity level and symptom duration greater than six months are associated with poor preoperative psychological status., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Context: It is unknown how specific coping strategies are associated with the short-term outcomes among athletes following knee surgery., Objective: 1) To determine whether specific coping strategies are associated with satisfaction, return to sport, self-reported knee function, or kinesiophobia following sports-related knee surgery. 2) To determine whether these associations vary by age, sex, or surgical procedure., Study Design: Case series., Methods: Athletes (n=184 total; n=104 men, n=80 women; n=38 age <20 years, n=35 age 20-25, n=36 age 26-31, n=36 age 32-40, n=39 age >40) who underwent outpatient knee surgery were enrolled from a single center. Utilization of specific coping strategies (self-distraction, use of emotional or instrumental support, venting, positive reframing, and acceptance) was assessed pre-operatively with the Brief-COPE inventory. Relationship between coping strategies and post-operative satisfaction, return to sport, International Knee Documentation Committee-subjective (IKDC-S) and Tampa Scale for Kinesiophobia scores at median 10.7 months follow-up were determined with consideration for age, sex, and surgical procedure., Results: Return to prior level of sport was 72%, and satisfaction was 86%. Most coping strategies had age-specific utilization rates; positive reframing was utilized least frequently in ages <20 years. Satisfaction increased with greater positive reframing among ages <20 years and decreased with greater self-distraction among men. Return to sport was higher with greater positive reframing in ages <32 years. No coping strategies predicted IKDC-S scores. Greater positive reframing correlated with lower kinesiophobia in ages <20 years. Greater instrumental support correlated with lower kinesiophobia in ages >40 years. No other coping strategies were associated with outcomes. Surgical procedure was not related to association between coping strategies and outcomes., Conclusion: Coping strategies have age-specific associations with outcomes after knee surgery in athletes. Positive reframing is infrequently utilized in younger athletes. Greater use of positive reframing in this group may improve satisfaction, return to sport, and lower fear of re-injury.

Background and Objectives: Individuals with social anxiety disorder show pronounced perceptual biases in social contexts, such as being hypervigilant to threat and discounting positive social cues. Parasympathetic activity influences responses to the social environment and may underlie these biases. This study examined the associations among social anxiety symptoms, heart rate variability (HRV), and vocal emotion recognition., Design and Method: Female undergraduate students ( N =  124) self-reported their social anxiety symptoms using the Social Anxiety Disorder Dimensional Scale and completed a computerized vocal emotion recognition task using stimuli from the Ryerson Audio-Visual Database of Emotional Speech and Song stimulus set. HRV was measured at baseline and during the emotion recognition task., Results: Women with more social anxiety symptoms had higher emotion recognition accuracy ( p =  .021) and rated positive stimuli as less intense ( p =  .032). Additionally, although those with greater social anxiety symptoms did not have lower resting HRV ( p =  .459), they did have lower task HRV ( p =  .026), which mediated their lower positivity bias and greater recognition accuracy., Conclusions: A parasympathetically-mediated positivity bias may indicate or facilitate normal social functioning in women. Additionally, HRV during a symptom- or disorder-relevant task may predict task performance and reveal parasympathetic differences that are not found at baseline.

We sought to determine whether individual coping strategies and optimism are associated with satisfaction after sports-related knee surgery at the time of rehabilitation completion and whether the association between coping strategies/optimism and satisfaction varies by surgical procedure or length of rehabilitation. A total of 104 recreational and competitive athletes who underwent knee surgery completed preoperative assessments for intrinsic optimism using the revised Life Orientation Test and coping strategies using the brief Coping Orientations to the Problem Experience inventory. Postoperative assessments at completion of rehabilitation (mean: 5.5-month follow-up.; maximum: 15 months) included satisfaction with surgery, return to prior level of sport, and International Knee Documentation Committee (IKDC-S) symptom scores. Eighty-one percent were satisfied after completion of rehabilitation with a 68% return to prior level of sport. Irrespective of surgical procedure or length of rehabilitation ( p  > 0.25, all comparisons), greater reliance on others for emotional support as a coping mechanism increased risk of dissatisfaction after surgery (per point: odds ratio [OR]: 1.75; confidence interval [CI]: 1.13-2.92; p  = 0.01), whereas greater use of positive reframing as a coping mechanism was protective (per point: OR: 0.43; CI: 0.21-0.82; p  = 0.009). Intrinsic optimism was not predictive of postoperative satisfaction ( p  = 0.71). Satisfied patients had mean 13.5 points higher IKDC-S scores at follow-up than unsatisfied patients ( p  = 0.001). Patients who returned to prior level of sport had significantly higher satisfaction scores than patients who had not. Irrespective of surgical procedure or length of rehabilitation, use of positive reframing and reliance on others for emotional support are positive and negative predictors, respectively, of satisfaction after sports-related knee surgery. Preoperative optimism is not predictive of postoperative satisfaction., Competing Interests: D. C. F. reports personal fees from Depuy Mitek, Smith & Nephew, Vericel, Ceterix Orthopaedics, Conmed, Histogenics Corp., Moximed Inc., and Zimmer Biomet, outside the submitted work. D. C. F. is a consultant for Smith & Nephew, DePuy Mitek, and Zimmer., (Thieme. All rights reserved.)

Objectives: Body fat, measured with body mass index (BMI), and obesity are associated with depressive symptoms. Among younger adults there is stronger evidence of obesity leading to depressive symptoms than of depressive symptoms leading to obesity, but the temporal relationship is unknown among older adults. This study utilized dual-change-score models (DCSMs) to determine the directional relationship between body mass and depressive symptoms among older adults., Method: Participants (n = 1,743) from the Swedish Twin Registry (baseline age range 50-96 years) completed at least one assessment of BMI (nurse measurement of height and weight) and the Center for Epidemiologic Studies-Depression scale (CESD). More than half the sample completed 3 or more assessments, scheduled at intervals of 2-4 years. DCSMs modeled the relationship of BMI and CESD across age, both independently and as part of bivariate relationships., Results: Depressive symptoms contributed to subsequent changes in BMI after age 70, while BMI contributed to subsequent changes in depressive symptoms after age 82. Thus, there is a reciprocal relationship that may change with age. The effect was more pronounced for women., Discussion: The association of BMI and depressive symptoms is bidirectional among older adults, and it appears to be affected by both age and sex., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To determine whether pain perceptions and coping strategies are predictive of the following outcomes after knee surgery in athletes: (1) return to similar level of sport, (2) improvement in symptoms, and (3) improvement in kinesiophobia., Design: Prospective cohort study., Methods: 101 athletes (52 men, 49 women; mean age 32.7years) at mean 12.1months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPQ), Pain Catastrophizing Scale (PCS), Pain Coping Measure (PCM), and the brief COPE subscales of acceptance, denial, positive reframing, and use of instrumental support. Adjustment was performed for length of follow-up, symptom duration, surgical history, age, activity level, and surgical procedure., Results: Rate of return to similar level of sport was 73%; severe pain catastrophizers (PCS >36 points) had increased odds of not returning to similar level of sport (OR 11.3 CI 1.51, 236; p=0.02) whereas COPE-use of instrumental support was protective (per point increase: 0.72 CI 0.54, 0.94; p=0.02). Problem-focused coping positively correlated with improvement in IKDC-S scores (beta 0.032 SE 0.010; p=0.001). Improvement in kinesiophobia after surgery was less likely with higher pre-operative perceived pain frequency (OR 0.23 CI 0.06, 0.71; p=0.009) and higher COPE-denial scores (OR 0.43 CI 0.21, 0.88; p=0.02)., Conclusions: Among athletes undergoing knee surgery, severe pain catastrophizing is negatively associated with return to similar level of sport. Instrumental support and problem-focused coping strategies are associated with improved outcomes. High preoperative pain scores are negatively associated with improvement in kinesiophobia after rehabilitation., (Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Purpose: Cardiac rehabilitation (CR) session attendance and rates of completion remain suboptimal. Greater distress (ie, depression and anxiety) has been associated with both better and poorer adherence. Will to live (ie, desire, determination and effort to survive) has been associated with survival among cardiac patients and thus may be relevant for CR adherence. It was hypothesized that depression and anxiety would be negatively associated with adherence, and that will to live would moderate these relationships., Methods: Sixty patients (mean age = 56.9 ± 10.8 yr; 38 males) entering outpatient CR completed self-report measures of will to live (Wish to Prolong Life Questionnaire) and distress (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were performed to predict CR session attendance (%) and program completion (yes/no) from depression and anxiety, as well as the interaction of those variables with will to live., Results: Neither depression nor anxiety was associated with CR adherence (Ps > .33). However, there was a significant interaction of will to live with anxiety in predicting attendance (β= -0.31, P = .03, Model R = .19, P = .01), reflecting that anxiety predicted lower attendance only among patients reporting greater will to live., Conclusions: These data help clarify the complex relationship between distress and CR adherence. Findings suggest that higher anxiety is associated with poorer adherence, but only in combination with greater motivation for living. Patients higher in anxiety and will to live may benefit from additional strategies to make actionable behavioral change in the context of CR.

Background: Insomnia is prevalent among patients with heart failure (HF) and is associated with reduced physical and mental functioning, including possible exacerbation of cognitive deficits., Objectives: This study evaluated the effects of Brief Behavioral Treatment for Insomnia (BBTI) on insomnia and related factors among HF patients., Methods: Twenty-three HF patients with insomnia (70% women; 65% white; M age  = 55.7 ± 11.3 years; NYHA Class II = 70%) were randomized to a behavioral intervention (BI; n = 12) or sleep monitoring (SM; n = 11) group. Sleep, cognitive functioning, quality of life, distress, self-care, and functional status were assessed pre- and post-intervention., Results: BI participants experienced reduced insomnia and increased sleep quality and efficiency, with 58% demonstrating clinically meaningful improvements in insomnia and 25% achieving remission of insomnia symptoms. Depression and anxiety also improved in BI participants., Conclusions: BBTI was tolerated well within this symptom-limited patient population and was associated with reduced symptoms of insomnia and distress., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Pain is prevalent among individuals with overweight or obesity but few studies have examined the mechanism linking pain with excess body weight. Because there is evidence that social and physical pain may be processed through similar physiological mechanisms, weight-stigma may potentiate the experience of physical pain through shared neuroanatomical pathways. This study evaluated the relationship between perceived weight stigma and self-reported bodily pain in a sample of overweight and obese adult women. Sixty-one women with a body mass index (BMI) between 25-35 completed self-report questionnaires assessing perceived stigma, internalized weight stigma, and self-reported pain. Height and weight were measured and participants completed a demographic and health history questionnaire. Hierarchical regression analyses were utilized to predict self-reported pain from perceived stigma, adjusting for demographic variables associated with self-reported pain as well as pain-related conditions. Perceived stigma was associated with pain F(6, 54)=6.10, p<.001) as was internalized stigma. Perceived stigma mediated the relationship between BMI and bodily pain among individuals with a BMI in the overweight range but not among individuals with a BMI in the obese range. Weight-related stigma among women with overweight or obesity appears to be associated with greater experience of physical pain. These results underscore the need to evaluate multiple mechanisms that might explain the relationship between bodily pain and body weight and to determine how the relationship may vary across different subgroups of individuals.

Background: Greater general disease knowledge predicts better patient-reported outcomes (PROs) among congenital heart disease (CHD) survivors, but higher illness uncertainty is associated with elevated emotional distress and poorer well-being among patients with chronic disease., Objectives: This study explored the relationship of illness uncertainty and disease knowledge with emotional distress and health-related quality of life (HRQoL) among patients with CHD., Methods: Individuals with CHD (N = 169, ages 15-39) completed self-report measures of disease knowledge (general and risk-related), illness uncertainty, depressive and anxiety symptoms, and HRQoL. Pearson correlations and regressions analyses were utilized., Results: Greater risk-related knowledge was associated with greater anxiety (b = .41, p = .03, 95% CI = [.04, .77]) and poorer emotional HRQoL (b = -.53, p = .03, 95% CI = [-1.02, -.05]) when illness uncertainty was higher., Conclusion: When individuals with CHD feel uncertain about their disease course and outcomes, knowledge about future cardiovascular risks may result in higher levels of distress., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: This proof-of-concept study was designed to replicate the effects of the empirically-supported Body Project intervention on body dissatisfaction when combined with behavioral recommendations for weight loss among women with overweight or obesity., Method: Women with overweight or obesity who reported body dissatisfaction and a desire to lose weight were randomized to one of two 4-week treatment conditions. Individuals assigned to the standard group (n = 15) were directed to track diet and activity level daily. Body project (n = 17) participants tracked daily diet and activity, in addition to attending four weekly, group-based body project intervention sessions. Body mass index, body dissatisfaction, body appreciation, and internalization of thin ideal and weight stigma were evaluated before and after the treatment period., Results: Feasibility data suggest the Body Project can be implemented with this novel sample. Preliminary estimates suggest greater effects on body appreciation in the Body Project group than in the standard group (ES = 0.43), but no group effects for other body image variables., Conclusions: With minor modifications, the Body Project was successfully implemented among women with overweight or obesity. The effect on body appreciation is encouraging and worthy of further investigation. Modification to the intervention may be necessary to enhance treatment effects on other body image variables., (© 2018 Wiley Periodicals, Inc.)

Objective: Studies of sex differences in heart rate variability (HRV) typically have not accounted for the influence of family history (FH) of cardiovascular disease (CVD). This study evaluated sex differences in HRV response to speech stress among men and women (age range 30-49 years) with and without a documented FH of CVD., Methods: Participants were 77 adults (mean age = 39.8 ± 6.2 years; range: 30-49 years; 52% female) with positive FH (FH+, n = 32) and negative FH (FH-, n = 45) of CVD, verified with relatives of participants. Cardiac activity for all participants was recorded via electrocardiogram during a standardized speech stress task with three phases: 5-minute rest, 5-minute speech, and 5-minute recovery. Outcomes included time domain and frequency domain indicators of HRV and heart rate (HR) at rest and during stress. Data were analyzed with repeated measures analysis of variance, with sex and FH as between subject variables and time/phase as a within subject variable., Results: Women exhibited higher HR than did men and greater HR reactivity in response to the speech stress. However, women also exhibited greater HRV in both the time and frequency domains. FH+ women generally exhibited elevated HRV, despite the elevated risk of CVD associated with FH+., Conclusions: Although women participants exhibited higher HR at rest and during stress, women (both FH+ and FH-) also exhibited elevated HRV reactivity, reflecting greater autonomic control. Thus, enhanced autonomic function observed in prior studies of HRV among women is also evident among FH+ women during a standardized stress task., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: Although walk tests are frequently used in cardiac rehabilitation (CR), no prior study has evaluated the capacity of these measures to predict peak oxygen uptake during exercise testing ((Equation is included in full-text article.)O2peak). This study evaluated the interrelationship of objective measures of exercise performance (walk and exercise testing) among patients entering CR as well as a novel measure of functional status assessment for use in CR., Methods: Forty-nine patients (33 males) referred to an outpatient CR program were evaluated with objective measures of ambulatory functional status (peak oxygen uptake [(Equation is included in full-text article.)O2peak], 6-minute walk test [6MWT], and 60-ft walk test [60ftWT])., Results: All measures of functional status were moderately to highly intercorrelated (r values from 0.50 to 0.88; P values < .05). The relationship among measures differed by sex, but not by age or diagnosis. Among men, results were generally consistent with the full sample. Among women, the magnitude of correlations was generally lower and there was no relationship between (Equation is included in full-text article.)O2peak and other measures., Conclusions: Measures of functional status, including (Equation is included in full-text article.)O2peak, 6MWT, and 60ftWT, were highly correlated among CR patients, suggesting the plausibility of using them interchangeably to fit the needs of the patient and testing environment. Among women, walk tests may not be appropriate substitutes for (Equation is included in full-text article.)O2peak. Because of the brevity of the 60ftWT, it may be particularly useful for measuring functional status in patients with greater symptoms and those with comorbidities limiting walking.

Dual-process models of health behavior posit that implicit and explicit attitudes independently drive healthy behaviors. Prior evidence indicates that implicit attitudes may be related to weekly physical activity (PA) levels, but the extent to which self-regulation attenuates this link remains unknown. This study examined the associations between implicit attitudes and self-reported PA during leisure time among 150 highly active young adults and evaluated the extent to which effortful control (one aspect of self-regulation) moderated this relationship. Results indicated that implicit attitudes toward exercise were unrelated to average workout length among individuals with higher effortful control. However, those with lower effortful control and more negative implicit attitudes reported shorter average exercise sessions compared with those with more positive attitudes. Implicit and explicit attitudes were unrelated to total weekly PA. A combination of poorer self-regulation and negative implicit attitudes may leave individuals vulnerable to mental and physical health consequences of low PA.

The objective of the present study was to compare a group-mediated cognitive behavioral (GMCB) physical activity intervention with traditional exercise therapy (TRAD) upon select social cognitive outcomes in sedentary knee osteoarthritis (knee OA) patients. A total of 80 patients (mean age = 63.5 years; 84% women) were recruited using clinic and community-based strategies to a 12-month, single-blind, two-arm, randomized controlled trial. Mobility-related self-efficacy, self-regulatory self-efficacy (SRSE), and satisfaction with physical function (SPF) were assessed at baseline, 3, and 12 months. Results of intent-to-treat 2 (Treatment: GMCB and TRAD) × 2 (Time: 3 and 12 month) analyses of covariance yielded significantly greater increases in SRSE and SPF (P < 0.01) relative to TRAD. Partial correlations revealed that changes in SRSE and SPF were significantly related (P < 0.05) to improvements in physical activity and mobility at 3 and 12-months. The GMCB intervention yielded more favorable effects on important social cognitive outcomes than TRAD; these effects were related to improvements in physical activity and mobility.

Prior studies have documented an association of obesity with chronic pain, but the mechanism explaining the association remains unknown. This study evaluated the degree to which dietary intake of foods with anti-inflammatory effects mediates the relationship of body fat to body pain. Ninety-eight community-residing healthy adults (60% women; mean age = 43.2 ± 15.3 years; range: 20-78 years) participated in a home-based study of home environment, food-related behaviors, health, and adiposity. During a 3-hour home visit evaluation, 3 measures of body fat were collected, including height and weight for calculation of body mass index (BMI). Participants also completed a 24-hour food recall interview and self-report measures of bodily pain (BP; BP subscale from the Medical Outcomes Study Short Form-36) and psychological distress (Hospital Anxiety and Depression Scale). Quality of dietary intake was rated using the Healthy Eating Index-2010. Mediation models were conducted with the PROCESS macro in SAS 9.3. Mean BMI was consistent with obesity (30.4 ± 7.8; range: 18.2-53.3), and BP values (73.2 ± 22.1; range: 0-100) and dietary intake quality (59.4 ± 15.5; range: 26.8-88.1) were consistent with population norms. Modeling in PROCESS revealed that Healthy Eating Index-2010 scores mediated the relationship between BMI and BP (bindirect = -0.34, 95% confidence interval = -0.68 to -0.13). The mediation model remained significant when controlling for biomechanical factors (arthritis/joint pain), medication use, psychological distress, age, and education, and models remained significant using the other 2 body fat measures. Thus, the data indicate that dietary intake of foods with anti-inflammatory effects mediates the relationship of body fat to body pain in healthy men and women.

Purpose: Patients with a diagnosis of cardiac disease are often asked to make significant lifestyle changes, but they may experience difficulty initiating and maintaining lifestyle changes, especially when engaging in experiential avoidance (EA), the tendency to push away unpleasant emotions and sensations. This study examined the relationship between EA, psychological functioning, cardiac-quality of life (cardiac-QOL), program adherence, and cardiopulmonary endurance among patients entering an outpatient cardiac rehabilitation (CR) program., Methods: Patients completed study questionnaires pre-CR, including 2 measures of EA (general and cardiac-specific), and assessments of psychological functioning and cardiac-QOL. Adherence was calculated as the proportion of insurance-approved CR sessions attended. Thirty participants completed stress testing pre-CR and post-CR., Results: Forty-seven patients completed the questionnaires. General EA was associated with greater depression (r = 0.73, P < .001), anxiety (r = 0.56, P < .001), and stress (r = 0.65, P < .001) and lower cardiac-QOL (r =-0.69, P < .001). In addition, when controlling for the influence of general EA, greater cardiac-specific EA was associated with depression ([INCREMENT]R = 0.05, P = .01), anxiety ([INCREMENT]R = 0.18, P < .001), and poorer cardiac-QOL ([INCREMENT]R = 0.04, P = .04). However, lower cardiac-specific EA predicted greater increases in cardiopulmonary endurance ((Equation is included in full-text article.)O2peak) during the CR program (b =-0.18, P = .002; [INCREMENT]adjusted R = 0.07). Experiential avoidance was not associated with adherence., Conclusions: Lower EA is associated with better psychological well-being among patients entering a CR program and with better exercise outcomes. Strategies for reducing EA may be important to consider in future clinical studies.

Repressive coping has been associated with elevated risk of disease and negative health outcomes in past studies. Although a prior study of healthy men found that repression was associated with lower body mass index (BMI), no study has examined repressive coping among obese individuals. This study examined the relationship of repressive coping with BMI and obesity-relevant psychosocial factors among 104 overweight and obese participants in a behavioral weight management program. Participants completed questionnaires assessing repressive coping, stigmatization, psychological distress, and quality of life. BMI was objectively measured. Repressors reported lower stigmatization, anxiety, and depression as well as higher emotional and weight-related quality of life. Repressors and non-repressors had equivalent BMI and reported similar impairment in physical quality of life, but stigmatization moderated the relationship between repressive coping and physical quality of life (b=0.31, p=0.039), reflecting better physical quality of life among non-repressors with lower stigmatization. Obese individuals who engage in repressive coping may tend to underreport psychological symptoms, social difficulties, and impairments in quality of life. Higher physical quality of life among non-repressors with lower stigmatization may reflect a combined influence of coping and social processes in physical quality of life among obese individuals., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To examine the prognostic value of select biobehavioral factors in patients with chronic obstructive pulmonary disease (COPD) in a secondary analysis of participants from the INSPIRE-II trial., Methods: Three hundred twenty-six outpatients with COPD underwent assessments of pulmonary function, physical activity, body mass index, inflammation, pulmonary symptoms, depression, and pulmonary quality of life and were followed up for up to 5.4 years for subsequent clinical events. The prognostic value of each biobehavioral factor, considered individually and combined, also was examined in the context of existing Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 risk stratification., Results: Sixty-nine individuals experienced a hospitalization or died over a mean follow-up period of 2.4 (interquartile range = 1.6) years. GOLD classification was associated with an increased risk of clinical events (hazard ratio [HR] = 2.72 [95% confidence interval = 1.63-4.54], per stage); 6-minute walk (HR = 0.50 [0.34-0.73] per 500 ft), total steps (HR = 0.82 [0.71-0.94] per 1000 steps), high-sensitivity C-reactive protein (HR = 1.44 [1.01-2.06] per 4.5 mg/l), depression (HR = 1.12 [1.01-1.25] per 4 points), and pulmonary quality of life (HR = 1.73 [1.14-2.63] per 25 points) were each predictive over and above the GOLD assessment. However, only GOLD group and 6-minute walk were predictive of all-cause mortality and COPD hospitalization when all biobehavioral variables were included together in a multivariable model., Conclusions: Biobehavioral factors provide added prognostic information over and above measures of COPD severity in predicting adverse events in patients with COPD.

Background/objectives: Prior research indicates that features of the home environment (for example, televisions, exercise equipment) may be associated with obesity, but no prior study has examined objective features of the home food environment (for example, location of food) in combination with behavioral (for example, food purchasing), psychological (for example, self-efficacy) and social factors among obese adults. This study identified factors associated with obesity status from measures of home environment, food purchasing behavior, eating behavior and psychosocial functioning., Subjects/methods: One hundred community-residing obese (mean body mass index (BMI)=36.8, s.e.=0.60) and nonobese (mean BMI=23.7, s.e.=0.57) adults (mean age=42.7, s.e.=1.50; range=20-78 years) completed an observational study with 2-h home interview/assessment and 2-week follow-up evaluation of food purchases and physical activity. Data were analyzed with analysis of variance and logistic regression, controlling for sex., Results: Univariate analyses revealed that homes of obese individuals had less healthy food available than homes of nonobese (F(1,97)=6.49, P=0.012), with food distributed across a greater number of highly visible locations (F(1,96)=6.20, P=0.01). Although there was no group difference in household income or size, obese individuals reported greater food insecurity (F(1,97)=9.70, P<0.001), more reliance on fast food (F(1,97)=7.63, P=0.01) and more long-term food storage capacity in number of refrigerators (F(1,97)=3.79, P=0.05) and freezers (F(1,97)=5.11, P=0.03). Obese individuals also reported greater depressive symptoms (F(1,97)=10.41, P=0.002) and lower ability to control eating in various situations (F(1,97)=20.62, P<0.001). Multiple logistic regression revealed that obesity status was associated with lower self-esteem (odds ratio (OR) 0.58, P=0.011), less healthy food consumption (OR 0.94, P=0.048) and more food available in the home (OR 1.04, P=0.036)., Conclusions: The overall pattern of results reflected that home food environment and psychosocial functioning of obese individuals differed in meaningful ways from that of nonobese individuals. In particular, lower self-esteem may be an important psychosocial aspect of obesity, especially in the context of greater food consumption and food storage/availability.

Objectives: Cancer survivors often report cognitive problems. Furthermore, decreases in physical activity typically occur over the course of cancer treatment. Although physical activity benefits cognitive function in noncancer populations, evidence linking physical activity to cognitive function in cancer survivors is limited. In our recent randomized controlled trial, breast cancer survivors who received a yoga intervention had lower fatigue and inflammation following the trial compared with a wait list control group. This secondary analysis of the parent trial addressed yoga's impact on cognitive complaints., Methods: Posttreatment stage 0-IIIA breast cancer survivors (n = 200) were randomized to a 12-week, twice-weekly Hatha yoga intervention or a wait list control group. Participants reported cognitive complaints using the Breast Cancer Prevention Trial Cognitive Problems Scale at baseline, immediately postintervention, and 3-month follow-up., Results: Cognitive complaints did not differ significantly between groups immediately postintervention (p = 0.250). However, at 3-month follow-up, yoga participants' Breast Cancer Prevention Trial Cognitive Problems Scale scores were an average of 23% lower than wait list participants' scores (p = 0.003). These group differences in cognitive complaints remained after controlling for psychological distress, fatigue, and sleep quality. Consistent with the primary results, those who practiced yoga more frequently reported significantly fewer cognitive problems at 3-month follow-up than those who practiced less frequently (p < 0.001)., Conclusions: These findings suggest that yoga can effectively reduce breast cancer survivors' cognitive complaints and prompt further research on mind-body and physical activity interventions for improving cancer-related cognitive problems., (Copyright © 2014 John Wiley & Sons, Ltd.)

Rationale: The 2011 combined Global Initiative for Chronic Obstructive Lung Disease (GOLD) assessment incorporates symptoms, exacerbation history, and spirometry in discriminating risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Six-minute-walk distance (6MWD) and accelerometry also have been used to assess disease severity in COPD. The association between these measures and the risks of hospitalization and mortality in the context of GOLD 2011 is unknown., Objectives: To describe changes in exercise tolerance and physical activity over time in patients with COPD and to test the hypothesis that lower baseline 6MWD or accelerometry step count is associated with increased risk of COPD-related hospitalization or all-cause mortality, independent of GOLD 2011 group., Methods: Physical function and medical outcomes were prospectively assessed in 326 patients with moderate to severe COPD in INSPIRE-II, a randomized controlled trial of a coping skills training intervention. Cox models were used to determine if GOLD 2011 group, 6MWD, or accelerometry steps were associated with risk of COPD-related hospitalization or all-cause mortality., Measurements and Main Results: Physical function declined over time in GOLD group D but remained stable in groups A, B, and C. GOLD classification was associated with time to death or first COPD-related hospitalization. Baseline 6MWD was more strongly associated with time to death or first COPD-related hospitalization (hazard ratio, 0.50 [95% confidence interval, 0.34, 0.73] per 150 m, P=0.0003) than GOLD 2011 classification. A similar relationship was observed for accelerometry steps (hazard ratio, 0.80 [95% confidence interval, 0.70, 0.92] per 1,000 steps, P=0.002)., Conclusions: Exercise tolerance and daily physical activity are important predictors of hospitalization and mortality in COPD, independent of GOLD 2011 classification. Physical function may represent a modifiable risk factor that warrants increased attention as a target for interventions to improve clinically meaningful outcomes in COPD.

Objective: Mindfulness training has been incorporated increasingly into weight loss programs to facilitate dietary and physical activity changes. This systematic review of studies using mindfulness-based programs for weight loss evaluated study methodologies with the goal of determining the current evidence in support of mindfulness interventions for weight loss., Methods: Published studies of mindfulness-based interventions for weight loss were identified through systematic review including a comprehensive search of online databases. Studies were reviewed and graded according to methodological strengths and weaknesses., Results: A total of 19 studies, including 13 randomized controlled trials and 6 observational studies, evaluated the effects of mindfulness-based interventions on weight among individuals attempting weight loss. Twelve of the studies were published in peer-reviewed journals and seven were unpublished dissertations. Among the eight randomized controlled trials published in peer-reviewed journals, six documented significant weight loss among participants in the mindfulness condition, one reported no significant change, and one failed to report body mass index at program completion. None of the studies documented a relationship between changes in mindfulness and weight loss., Conclusion: Significant weight loss was documented among participants in mindfulness interventions for 13 of the 19 studies identified for review. However, studies do not clarify the degree to which changes in mindfulness are a mechanism responsible for weight loss in mindfulness interventions. Methodological weaknesses and variability across studies limit the strength of the evidence. Further research is needed to document and evaluate the psychological, behavioral, and biological mechanisms involved in the relationship between mindfulness and weight loss.

Background: Despite increased life expectancy among patients with cystic fibrosis (CF), few studies have examined coping among adolescents and young adults with CF. Previous research suggests that stigma associated with chronic disease is related to worse physical and psychological health, but optimism may be protective. This study examined stigma and optimism among patients with CF., Methods: Seventy-two patients with CF (ages 14 to 25) completed a self-report questionnaire assessing stigma, distress, CF-specific quality of life (QoL), and optimism. Objective health data were recorded from patient medical records., Results: Greater stigma was associated with lower pulmonary function, QoL, and optimism. Stigma was positively correlated with distress. Optimism moderated the relationship between stigma and anxiety (p<0.001), and between stigma and emotional functioning (p<0.01)., Conclusions: Stigma is related to worse lung function and psychological health in patients with CF, but higher levels of optimism may act as a protective factor., (Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Objective: Cardiac rehabilitation (CR) is routinely prescribed for patients with cardiovascular disease (CVD), but data indicate that 20% to 50% of patients do not adhere to CR. Studies have focused on the impact of depression on CR adherence, but results have been equivocal. Irrational health beliefs are related to adherence among diabetes patients, but have not been examined among cardiac patients. This study examined depression and irrational health beliefs as predictors of CR adherence., Method: Sixty-one participants (30% female; mean age = 59.9 ± 11.8; 72% Caucasian), recruited at the outset of an outpatient CR program, completed a baseline questionnaire including measures of depression and irrational health beliefs. CR adherence was defined as the percentage of CR exercise sessions completed. Pearson correlations and analysis of variance determined demographic factors related to adherence. Hierarchical regression analyses examined irrational health beliefs and depression as predictors of CR adherence., Results: Older age (p < .05) and higher income (p < .05) were associated with better CR adherence, but CR adherence was lower among African Americans than Caucasians (p < .01). Depression was not related to adherence (p = .78), but irrational health beliefs predicted CR adherence, after controlling for race/ethnicity, income, and age (β = -.290, ΔR² = .074, ΔF[1,55] = 5.50, p < .05)., Conclusions: Irrational health beliefs predicted CR adherence but depression did not. Thus, poorer adherence to CR was associated with endorsing beliefs that are not based in medical evidence.

Objective: Chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality and reduced quality of life (QoL). Novel interventions are needed to improve outcomes in COPD patients. The present study assessed the effects of a telephone-based coping skills intervention on psychological and somatic QoL and on the combined medical end point of COPD-related hospitalizations and all-cause mortality., Methods: We conducted a dual-site, randomized clinical trial with assessments at baseline and after 16 weeks of treatment. The study population comprised 326 outpatients with COPD aged 38 to 81 years, randomized to coping skills training (CST) or to COPD education (COPD-ED). Patients completed a battery of QoL instruments, pulmonary function tests, and functional measures and were followed up for up to 4.4 years to assess medical outcomes., Results: The CST group exhibited greater improvements in psychological QoL compared with controls (p = .001), including less depression (Cohen d = 0.22 [95% confidence interval, or CI = 0.08-0.36]) and anxiety (d = 0.17 [95% CI = 0.02-0.33]), and better overall mental health (d = 0.17 [95% CI = 0.03-0.32]), emotional role functioning (d = 0.29 [95% CI = 0.10-0.48]), vitality (d = 0.27 [95% CI = 0.11, 0.42]), and social functioning (d = 0.21 [95% CI = 0.03-0.38]). A significant baseline psychological QoL by treatment group interaction revealed that CST with lower QoL at baseline achieved even greater improvements in psychological QoL compared with COPD-ED. CST participants also exhibited greater improvements in somatic QoL (p = .042), including greater improvements in pulmonary QoL (d = 0.13 [95% CI = 0.01-0.24]), less fatigue (d = 0.34 [95% CI = 0.18-0.50]), and less shortness of breath (d = 0.11 [95% CI = -0.01 to 0.23]) and greater improvement in distance walked on the Six-Minute Walk test (d = 0.09 [95% CI = 0.01-0.16]). However, there was no significant difference in risk of time to COPD-related hospitalization or all-cause mortality between CST (34 events) and COPD-ED (32 events; p = 0.430)., Conclusions: A telehealth CST intervention produced clinically meaningful improvements in QoL and functional capacity, but no overall improvement in risk of COPD-related hospitalization and all-cause mortality., Trial Registration: clinicaltrials.gov Identifier: NCT00736268.

Objective: Stressful events enhance risk for weight gain and adiposity. Ghrelin and leptin, two hormones that are implicated in appetite regulation, may link stressful events to weight gain; a number of rodent studies suggest that stressors increase ghrelin production. The present study investigated the links among daily stressors, ghrelin and leptin, and dietary intake in humans., Method: Women (n=50) completed three study appointments that were scheduled at least 2 weeks apart. At each visit, women arrived fasting and ate a standardized breakfast and lunch. Blood samples were collected 45min after each meal. Women completed a self-report version of the Daily Inventory of Stressful Events (DISE) at each appointment. Two composites were created from the DISE data, reflecting the number of stressors that did and did not involve interpersonal tension., Results: Women who experienced more stressors involving interpersonal tension had higher ghrelin and lower leptin levels than those who experienced fewer interpersonal stressors. Furthermore, women who experienced more interpersonal stressors had a diet that was higher in calories, fat, carbohydrates, protein, sugar, sodium, and fiber, and marginally higher in cholesterol, vegetables (but not fruits), vitamin A, and vitamin C. Stressors that did not involve interpersonal tension were unrelated to ghrelin and leptin levels or any of the dietary components examined., Conclusions: These data suggest that ghrelin and leptin may link daily interpersonal stressors to weight gain and obesity., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To compare the effects of a group-mediated cognitive behavioral exercise intervention (GMCB) with traditional center-based exercise therapy (TRAD) on objectively assessed levels of physical activity (PA) and mobility in sedentary patients with knee osteoarthritis (OA)., Methods: The Improving Maintenance of Physical Activity in Knee Osteoarthritis Trial-Pilot (IMPACT-P) was a 12-month, 2-arm, single-blind, randomized controlled pilot study designed to compare the effects of GMCB and TRAD on 80 sedentary patients with knee OA with self-reported difficulty in daily activities [mean age 63.5 yrs, 84% women, mean body mass index (BMI) 32.7 kg/m(2)]. Objective assessments of PA (LIFECORDER Plus Accelerometer) and mobility (400-m walk) were obtained at baseline, 3 months, and 12 months by study personnel blinded to participants' treatment assignment., Results: Intent to treat 2 (treatment: GMCB and TRAD) × 2 (time: 3 mos and 12 mos) analyses of covariance of controlling for baseline, age, sex, and BMI-adjusted change in the outcomes demonstrated that the GMCB intervention yielded significantly greater increases in PA (p < 0.01) and a nonsignificant yet more favorable improvement in mobility (p = 0.09) relative to TRAD. Partial correlation analyses also revealed that change in PA was significantly correlated with the 400-m walk performance at 3-month (r = -0.51, p < 0.01) and 12-month (r = -0.40, p < 0.01) followup assessments., Conclusion: Findings from the IMPACT-P trial suggest that the GMCB treatment resulted in significantly greater improvement in PA and nonsignificant yet more favorable change in mobility relative to TRAD.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that interdisciplinary health care professionals providing pulmonary rehabilitation services need to have certain core competencies. This statement updates the previous clinical competency guidelines for pulmonary rehabilitation professionals, and it complements the AACVPR's Guidelines for Pulmonary Rehabilitation Programs. These competencies provide a common core of 13 professional and clinical competencies inclusive of multiple academic and clinical disciplines. The core competencies include patient assessment and management; dyspnea assessment and management; oxygen assessment, management, and titration; collaborative self-management; adherence; medication and therapeutics; non-chronic obstructive pulmonary diseases; exercise testing; exercise training; psychosocial management; tobacco cessation; emergency responses for patient and program personnel; and universal standard precautions.