Annual review of nursing research最新文献

Engaging in regular physical activity is a key component for maintaining a healthy weight and preventing overweight and obesity. Obesity continues to be a concern globally, especially for women, and women are less physically active than men. This systematic review examined current research on physical activity interventions designed for healthy community dwelling women and assessed the effects of those interventions on physical activity and body composition. Three author-developed data collection tools were used to extract and examine study variables. For studies with suitable data, effect sizes were obtained. The initial search identified 1,406 titles published between 2000 and 2012, of which 40 randomized clinical trials met inclusion criteria. Of these 40 studies, 16 had a physical activity intervention that did not have a diet component and 24 had a physical activity intervention along with a diet component. The overall weighted mean effect was d = .21, 95% CI [0.06, 0.36] for physical activity outcomes (n = 18 studies) and d = -.16, 95% CI [-0.22, -0.09] for body composition outcomes (n = 24 studies). Both physical activity interventions without and with a diet component were effective in promoting physical activity and improving body composition. Physical activity interventions without a diet component were more effective than physical activity interventions with a diet component at promoting physical activity. The most effective interventions need to be adapted for dissemination into practice.

Poorly controlled HIV infection and antiretroviral therapy, especially the use of protease inhibitors, are among the causes that contribute to the development of cardiovascular disease in people living with HIV (PLWH). Poor lifestyle choices (smoking, lack of physical activity, poor diet) and individual factors such as high stress, physical or emotional trauma, depression, and so forth contribute to the overall risk of developing cardiovascular disease. The purpose of this review was to critically evaluate the more recent aerobic and resistance exercise studies and their impact on cardiovascular and metabolic risk factors in PLWH.

There are an estimated 13.7 million cancer survivors in the United States. Persistent and late effects of cancer therapy have contributed to an increased risk for co-morbid illness and higher all-cause mortality. Physical exercise is a targeted rehabilitative intervention following cancer therapy and a health promotion risk reduction intervention for patients as they transition into survivorship. This chapter provides a brief overview of the research on exercise and cancer survivor outcomes with a specific focus on randomized controlled trials (RCT) on the effects of exercise on body composition and bone health. There were 17 RCT trials that were identified with body composition outcomes. There was no change in weight in 16/17 trials, 4 reported decreases in percent fat mass and 2 reported increases in lean mass. Eight exercise trials were identified with bone outcomes, two of which had pharmacologic comparison arms. These trials demonstrated preservation of bone in the intervention group compared with loss in the usual care or placebo control group. The majority of trials were with breast cancer survivors, the largest survivor group. Many are overweight or obese at diagnosis; weight gain continues to increase after therapy; and treatment is associated with bone loss. The findings of the 25 trials reviewed suggest that exercise maintains weight and bone mass in a high risk population. However, differences in design, measurement of body composition and bone mass and lack of targeted exercise to the specific outcomes warrants additional research to improve the quality of life for survivors.

Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease (CVD) which is considered the leading cause of morbidity and mortality in this cohort of patients. Additional independent risk factors for poor health outcomes among many include diabetes, physical inactivity and physical dysfunction. Physical inactivity partly contributes to the accelerated deterioration of physical function in people in all stages of CKD, to levels that significantly impact on clinically and patient important outcomes such as morbidity, employment, quality of life (QoL) and ultimately survival. Ongoing research aims to determine the effectiveness and impact of exercise rehabilitation on reducing/managing the risk of CVD, alleviating physical function limitations, preventing disability and enhancing QoL. Current research also aims to elucidate the mechanisms via which exercise therapy may contribute to clinically relevant benefits.

Physical activities provide women a way to improve their health and intervene in disease processes during pregnancy. This chapter briefly describes pathophysiological models and then examines current research on the effects of physical activity on prevention and treatment of gestational diabetes and preeclampsia. The chapter then reviews cognitive behavioral theories and current literature on the effects of behavioral interventions on physical activity in pregnancy. The literature helps to explain the pathophysiological mechanisms through which physical activity mediates disease processes and the behavioral interventions through which physical activity can be introduced and sustained during pregnancy. Throughout the chapter, both pathophysiological models and behavioral theories are viewed as part of a socioecologic model that encompasses pregnancy and physical activity.

People with chronic obstructive pulmonary disease (COPD) are very sedentary and this contributes to their health problems. The aim of this systematic review was to examine the effects of interventions designed to increase physical activity (PA) in people with COPD. Studies were included when PA was the primary outcome and measured objectively. Six databases were searched and 15 studies with a total of 761 subjects were identified that met inclusion criteria. Nine of the studies were quasi-experimental (QE) and six were randomized controlled trials (RCT). Interventions included pulmonary rehabilitation (n = 7), exercise only (n = 2), behavioral only (n = 2) and a combination of both behavioral and pulmonary rehabilitation/exercise interventions (n = 4). Methodological quality was evaluated using the Downs and Black checklist. The quality of the pulmonary rehabilitation studies was the lowest with a fair rating and the quality of exercise only studies was the highest with a good rating. Eight of the 15 studies demonstrated statistically significant increases in PA: two pulmonary rehabilitation (QE = 2), two exercise only (RCT = 2), two behavioral only (RCT = 1, QE = 1), and two combined behavioral and pulmonary rehabilitation/exercise (RCT = 2). The magnitude of increase was modest in all but one study; and in many studies the increase in PA was not clinically meaningful. Longer interventions demonstrated a higher success rate and only three studies examined longer term effects of the interventions. Existing interventions are promising, but the small number of randomized controlled trials makes it difficult to draw conclusion. Further research is needed to identify a range of interventions that are effective and could be used to promote PA in people with COPD.

The study of fever has provided important models in understanding the cells, chemical messengers, and anatomic structures that are involved in inflammation and thermoregulation as a result of infection, stress, or trauma. After contact with a pathogen or an inflammatory stimulus, cells are activated to produce endogenous pyrogens called cytokines. Cytokine functions include a cascade of nonspecific immune responses by target leukocytes and reticuloendothelial cells inducing the synthesis of acute phase proteins by the liver, direct pyrogenic activities via the supraoptic nuclei and the hypothalamus to increase the thermoregulatory set-point (and, thus, induce fever), and a wide spectrum of additional immune effects.

Overweight and obesity in youth with type 1 diabetes (T1D) is now prevalent and accounts for significant health consequences, including cardiovascular complications and dual diagnosis of type 2 diabetes. Physical activity and lifestyle are modifiable and play an important role in the prevention and management of excessive weight, but it is unclear how these factors relate to overweight and obese youth with T1D. Thus, a systematic review was conducted to examine how physical activity, sedentary behavior, sleep, and diet are related to overweight/obesity in youth with T1D. Seven observational and intervention studies published between 1990 and 2013 were included in the review. Prevalence of overweight ranged from 12.5% to 33.3%. Overweight in youth with T1D was associated with infrequent napping, increased screen time, and skipping breakfast and dinner but was not related to time engaged in physical activity. Weight-related interventions indicated modest weight loss along with improved glycemic control. In light of this review, there is a need for high quality research that examines all levels of activity in youth with T1D to identify lifestyle modification targets for weight prevention and management.

Despite the known benefits of physical activity for older adults, adherence to regular physical activity recommendations is poor. Less than half of adults in this country meet physical activity recommendations with reasons for lack of adherence including such things as access, motivation, pain, fear, comorbidities, among others. To overcome these challenges, function-focused care was developed. Function-focused care is a philosophy of care that focuses on evaluating the older adult's underlying capability with regard to function and physical activity and helping him or her optimize and maintain physical function and ability and continually increase time spent in physical activity. Examples of function-focused care include such things as using verbal cues during bathing, so the older individual performs the tasks rather than the caregiver bathing the individual; walking a resident or patient to the bathroom rather than using a urinal, or taking a resident to an exercise class. There are now over 20 studies supporting the benefits of function-focused care approaches across all settings and different types of patient groups (i.e, those with mild versus moderate-to-severe cognitive impairment). The approaches for implementation of function-focused care have also been well supported and have moved beyond establishing effectiveness to considering dissemination and implementation of this approach into real world clinical settings. The process of dissemination and implementation has likewise been articulated and supported, and ongoing work needs to continue in this venue across all care settings.