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Crozier A, Watson PM, Graves LE, George KP, Richardson D, Naylor L, Green DJ, Rosenberg M, Jones H. Insights and recommendations into service model structure, staff roles and qualifications in a UK cancer specific clinical exercise service: a multi-method qualitative study. Disabil Rehabil 2023:1-13. [PMID: 37341512 DOI: 10.1080/09638288.2023.2225879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE Clinical exercise delivery in the United Kingdom is disparate in terms of service structure, staff roles and qualifications, therefore it is difficult to evaluate and compare across services. Our aim was to explore, in a purposely selected cancer exercise service that was recognised as effective; (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective services, and (iii) to identify existing challenges from staff and service user perspectives. METHODS The Consolidated Framework for Implementation Research was used as an overarching guide to review the Prehab4Cancer service. Exercise specialists and service user perspectives were explored using a multi-method approach (online semi-structured interviews, online focus group and in-person observation) and data triangulation. RESULTS Exercise specialists were educated to a minimum of undergraduate degree level with extensive cancer-specific knowledge and skills, equivalent to that of a Registration Council for Exercise Physiologist (RCCP) Clinical Exercise Physiologist. Workplace experience was essential for exercise specialist development in behaviour change and communications skills. CONCLUSIONS Staff should be educated to a level comparable with the standards for registered RCCP Clinical Exercise Physiologists, which includes workplace experience to develop knowledge, skills and competencies in real-world settings.
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Affiliation(s)
- Anthony Crozier
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Paula M Watson
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lee E Graves
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith P George
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Richardson
- School of Human and Behavioural Sciences, Bangor University, North Wales, UK
| | - Louise Naylor
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Daniel J Green
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Michael Rosenberg
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Helen Jones
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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2
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Cowley ES, Foweather L, Watson PM, Belton S, Thompson A, Thijssen D, Wagenmakers AJM. What Happened in 'The HERizon Project'?-Process Evaluation of a Multi-Arm Remote Physical Activity Intervention for Adolescent Girls. Int J Environ Res Public Health 2022; 19:966. [PMID: 35055786 PMCID: PMC8775378 DOI: 10.3390/ijerph19020966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
This mixed-methods process evaluation examines the reach, recruitment, fidelity, adherence, acceptability, mechanisms of impact, and context of remote 12-week physical activity (PA) interventions for adolescent girls named The HERizon Project. The study was comprised of four arms-a PA programme group, a behaviour change support group, a combined group, and a comparison group. Data sources included intervention deliverer and participant logbooks (100 and 71% respective response rates, respectively), exit surveys (72% response rate), and semi-structured focus groups/interviews conducted with a random subsample of participants from each of the intervention arms (n = 34). All intervention deliverers received standardised training and successfully completed pre-intervention competency tasks. Based on self-report logs, 99% of mentors adhered to the call guide, and 100% of calls and live workouts were offered. Participant adherence and intervention receipt were also high for all intervention arms. Participants were generally satisfied with the intervention components; however, improvements were recommended for the online social media community within the PA programme and combined intervention arms. Autonomy, sense of accomplishment, accountability, and routine were identified as factors facilitating participant willingness to adhere to the intervention across all intervention arms. Future remote interventions should consider structured group facilitation to encourage a genuine sense of community among participants.
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Affiliation(s)
- Emma S. Cowley
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK; (E.S.C.); (L.F.); (P.M.W.)
| | - Lawrence Foweather
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK; (E.S.C.); (L.F.); (P.M.W.)
| | - Paula M. Watson
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK; (E.S.C.); (L.F.); (P.M.W.)
| | - Sarahjane Belton
- School of Health and Human Performance, Dublin City University, D09 NA55 Dublin, Ireland;
| | - Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK;
| | - Dick Thijssen
- Radboud Institute of Health Sciences, Department of Physiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Anton J. M. Wagenmakers
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK; (E.S.C.); (L.F.); (P.M.W.)
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3
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Jones H, George KP, Scott A, Buckley JP, Watson PM, Oxborough DL, Thijssen DH, Graves LEF, Whyte GP, McGregor G, Naylor LH, Rosenberg M, Askew CD, Green DJ. Charter to establish clinical exercise physiology as a recognised allied health profession in the UK: a call to action. BMJ Open Sport Exerc Med 2021; 7:e001158. [PMID: 34631147 PMCID: PMC8458347 DOI: 10.1136/bmjsem-2021-001158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
The UK population is growing, ageing and becoming increasingly inactive and unfit. Personalised and targeted exercise interventions are beneficial for ageing and the management of chronic and complex conditions. Increasing the uptake of effective exercise and physical activity (PA) interventions is vital to support a healthier society and decrease healthcare costs. Current strategies for exercise and PA at a population level mostly involve self-directed exercise pathways, delivered largely via the fitness industry. Even for those who opt-in and manage to achieve the current recommendations regarding minimum PA, this generic ‘one-size-fits-all’ approach often fails to demonstrate meaningful physiological and health benefits. Personalised exercise prescription and appropriate exercise testing, monitoring and progression of interventions for individuals with chronic disease should be provided by appropriately trained and recognised exercise healthcare professionals, educated in the cognate disciplines of exercise science (eg, physiology, biomechanics, motor control, psychology). This workforce has operated for >20 years in the Australian public and private healthcare systems. Accredited exercise physiologists (AEPs) are recognised allied health professionals, with demonstrable health and economic benefits. AEPs have knowledge of the risks and benefits of distinct forms of exercise, skills in the personalised prescription and optimal delivery of exercise, and competencies to support sustained PA behavioural change, based on the established scientific evidence. In this charter, we propose a road map for the training, accreditation and promotion of a clinical exercise physiology profession in the UK.
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Affiliation(s)
- Helen Jones
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Andrew Scott
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - John P Buckley
- Centre for Active Living, University Centre Shrewsbury, University of Chester, Shrewsbury, UK
| | - Paula M Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Dick H Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Radboud Institute for Health Sciences, Radboud University Medical Centre, Radboud, The Netherlands
| | - Lee E F Graves
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Greg P Whyte
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Gordon McGregor
- University of Coventry, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Louise H Naylor
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Rosenberg
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher D Askew
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Western Australia, Australia
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4
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Oliver EJ, Buckley BJ, Dodd-Reynolds C, Downey J, Hanson CL, Henderson H, Hawkins J, Steele J, Wade M, Watson PM. Where next for the design, delivery and evaluation of community-based physical activity prescription? Emerging lessons from the United Kingdom. Appl Physiol Nutr Metab 2021; 46:1430-1434. [PMID: 34324824 DOI: 10.1139/apnm-2021-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite widespread use, community-based physical activity prescription is controversial. Data limitations have resulted in a lack of clarity about what works, under what circumstances, and for whom, reflected in conservative policy recommendations. In this commentary we challenge a predominantly negative discourse, using contemporary research to highlight promising findings and 'lessons learnt' for design, delivery, and evaluation. In doing so, we argue for the importance of a more nuanced approach to future commissioning and evaluation. Contribution: • Amalgamating learning from multiple research teams to create recommendations for advancing physical activity prescription.
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Affiliation(s)
- Emily J Oliver
- Durham University, 3057, Sport and Exercise Sciences, 42 Old Elvet, Durham, Durham, United Kingdom of Great Britain and Northern Ireland, DH1 3LE;
| | - Benjamin Jr Buckley
- University of Liverpool, 4591, Liverpool Centre for Cardiovascular Science, Liverpool, Merseyside, United Kingdom of Great Britain and Northern Ireland;
| | - Caroline Dodd-Reynolds
- Durham University, 3057, Sport and Exercise Sciences, Durham, United Kingdom of Great Britain and Northern Ireland;
| | - John Downey
- Plymouth Marjon University, 6629, Plymouth, Devon, United Kingdom of Great Britain and Northern Ireland;
| | - Coral L Hanson
- Edinburgh Napier University, 3121, Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland;
| | - Hannah Henderson
- University of Lincoln, 4547, Lincoln, Lincolnshire, United Kingdom of Great Britain and Northern Ireland;
| | - Jemma Hawkins
- Cardiff University, 2112, Cardiff, South Glamorgan, United Kingdom of Great Britain and Northern Ireland;
| | - James Steele
- Solent University, 7422, Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Matthew Wade
- ukactive Research Institute, 569080, London, United Kingdom of Great Britain and Northern Ireland;
| | - Paula M Watson
- Liverpool John Moores University, 4589, Liverpool, Merseyside, United Kingdom of Great Britain and Northern Ireland;
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5
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Watson PM, McKinnon A, Santino N, Bassett-Gunter RL, Calleja M, Josse AR. Integrating needs-supportive delivery into a laboratory-based randomised controlled trial for adolescent girls with overweight and obesity: Theoretical underpinning and 12-week psychological outcomes. J Sports Sci 2021; 39:2434-2443. [PMID: 34157957 DOI: 10.1080/02640414.2021.1939948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
When designing efficacy trials, researchers have a responsibility to "do no harm" and to "do good". Given the psychological vulnerability of adolescent girls with overweight and obesity, it is important to consider the implications of participating in weight-related research studies. We investigated psychological outcomes from a 12-week laboratory-based randomised controlled trial aimed at improving body composition and bone health in adolescent girls with overweight and obesity. Sixty-three participants were randomised to three groups (Recommended dairy diet plus exercise (RDa, n = 24); Low dairy diet plus exercise (LDa, n = 25); no-intervention control (n = 14)). Self-Determination Theory-informed strategies were applied in both intervention groups to foster motivation and enhance psychological wellbeing. Motivation, perceived competence and self-perceptions were measured at 0 and 12 weeks. Fifty-four participants (24 RDa, 23 LDa, 7 Control) provided complete psychological data. There were no between group differences in 0- to 12-week change in motivation, perceived competence or global self-worth. Both intervention groups showed significant improvements in physical self-worth (p = 0.001), body satisfaction (p = 0.002) and perceived physical conditioning (p = 0.002), compared with the control group. A theory-informed, laboratory-based diet and exercise intervention produced favourable psychological outcomes for adolescent girls with overweight and obesity.
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Affiliation(s)
- Paula M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Amanda McKinnon
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Nicholas Santino
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | | | - Melissa Calleja
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, Canada
| | - Andrea R Josse
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada.,Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, Canada
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6
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Birtwistle SB, Jones I, Murphy R, Gee I, Watson PM. "Do what you can with a happy heart": a longitudinal study of patient and family members' lived experiences of physical activity post-myocardial infarction. Disabil Rehabil 2021; 44:3661-3670. [PMID: 33646893 DOI: 10.1080/09638288.2021.1878560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Physical activity (PA) post-myocardial infarction (MI) can reduce risk of reoccurrence and mortality. Yet uptake of PA through cardiac rehabilitation (CR) is poor, and little is known about the long-term PA behaviour of cardiac patients. This study aimed to explore the lived experiences of patients' engagement with PA post-MI, together with the experiences of their family. METHODS Longitudinal interviews with six family-dyads were conducted which drew on interpretative phenomenology to understand the lived experiences of PA for post-MI patients and family members. RESULTS Participants described a journey that involved leaving "normality" (doing what PA they wanted and when) and transitioning to a new "normality" (being active within post-MI parameters). This journey was expressed through feelings of "I can't do what I was doing before," "finding my way," and "accepting this way". CONCLUSION The role of family within the patient's journey was complex, with PA identity, beliefs, and fear of MI re-occurrence influencing PA support both positively and negatively. PA engagement post-MI is a dynamic and interactive process within which the family can have an important influence.IMPLICATIONS FOR REHABILITATIONThe process of (re-)engaging in physical activity post-myocardial infarction involves a complex journey towards acceptance of a new "normality".Family play an important role in regulating and supporting patients' physical activity during the rehabilitation process.Promoting positive health beliefs and helping families understand what, how and when patients should be physically active may optimise the rehabilitation journey for post-myocardial infarction patients.
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Affiliation(s)
- Sarah B Birtwistle
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Ian Jones
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Rebecca Murphy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Ivan Gee
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Paula M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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7
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Birtwistle SB, Jones I, Murphy R, Gee I, Watson PM. Family support for physical activity post‐myocardial infarction: A qualitative study exploring the perceptions of cardiac rehabilitation practitioners. Nurs Health Sci 2021; 23:227-236. [DOI: 10.1111/nhs.12806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/12/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Ian Jones
- School of Nursing and Allied Health Liverpool John Moores University Liverpool UK
- Liverpool Centre for Cardiovascular Science Liverpool John Moores University Liverpool UK
| | - Rebecca Murphy
- Physical Activity Exchange Liverpool John Moores University Liverpool UK
| | - Ivan Gee
- Public Health Institute, Liverpool John Moores University Liverpool UK
| | - Paula M. Watson
- Physical Activity Exchange Liverpool John Moores University Liverpool UK
- Liverpool Centre for Cardiovascular Science Liverpool John Moores University Liverpool UK
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8
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Cowley ES, Watson PM, Foweather L, Belton S, Mansfield C, Whitcomb-Khan G, Cacciatore I, Thompson A, Thijssen D, Wagenmakers AJM. Formative Evaluation of a Home-Based Physical Activity Intervention for Adolescent Girls-The HERizon Project: A Randomised Controlled Trial. Children (Basel) 2021; 8:76. [PMID: 33499174 PMCID: PMC7911217 DOI: 10.3390/children8020076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This is a formative evaluation study of the HERizon Project, a home-based multi-component physical activity (PA) intervention for adolescent girls in the UK and Ireland. Although not intended, this study coincided with the initial COVID-19 lockdown restrictions. METHODS A total of 42 female participants, aged 13 to 16 years old (mean = 14.2, SD = 1.1), were randomly allocated to: (i) the HERizon group (n = 22) or (ii) the wait-list control group (n = 20). Participants in the six-week HERizon group were asked to complete three PA sessions each week and engage in weekly behaviour change support video calls. The primary outcome measure was self-reported habitual PA. Secondary outcomes measures included cardiorespiratory fitness (20 m shuttle run), muscular strength (standing long jump), muscular endurance (push up test), and psychosocial outcomes (Perceived Competence Scale, Body Appreciation Scale, Self-Esteem Questionnaire, Behavioural Regulation in Exercise Questionnaire). Quantitative and qualitative process evaluation data were also collected. Outcome measures were assessed at baseline and after the six-week intervention. RESULTS There was no significant change in habitual PA between groups (LMM group*time interaction: p = 0.767). The HERizon group had significantly increased cardiorespiratory fitness (p = 0.001), muscular endurance (p = 0.022), intrinsic motivation (p = 0.037), and body appreciation (p < 0.003) in comparison to the wait-list control group. All participants in the intervention group completed the intervention and compliance to the intervention was high (participants completed 18 ± 2 sessions). CONCLUSIONS Although no change in PA was observed, HERizon resulted in improved physical fitness and psychosocial outcomes. These preliminary findings, alongside positive findings for feasibility and acceptability, highlight potential benefits from the home-based intervention, thus further investigation is warranted.
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Affiliation(s)
- Emma S. Cowley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
| | - Paula M. Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
| | - Lawrence Foweather
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
| | - Sarahjane Belton
- School of Health and Human Performance, Dublin City University, D09 Y5NO Dublin, Ireland;
| | - Chiara Mansfield
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
| | - Gabriella Whitcomb-Khan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
| | - Isabella Cacciatore
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
| | - Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK;
| | - Dick Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Anton J. M. Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Room 1.22 Tom Reilly Building, Byrom Street Campus, Liverpool L3 5AF, UK; (E.S.C.); (P.M.W.); (L.F.); (C.M.); (G.W.-K.); (I.C.); (D.T.)
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9
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Crozier A, Porcellato L, Buckley BJR, Watson PM. Facilitators and challenges in delivering a peer-support physical activity intervention for older adults: a qualitative study with multiple stakeholders. BMC Public Health 2020; 20:1904. [PMID: 33308176 PMCID: PMC7733256 DOI: 10.1186/s12889-020-09990-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Involving peer volunteers in intervention delivery can provide social support and improve adherence. Whilst such interventions have the potential to reduce physical activity (PA) intervention costs, little is known about the process of delivering them in practice. This qualitative study explored the facilitators and challenges of delivering a peer-support PA intervention for older adults, with a view to making recommendations for the delivery of future interventions. METHODS Data were collected via (7) semi-structured interviews and a focus group with stakeholders involved in a peer-support PA intervention for older adults in a large city in the North-West of England. Participants included local authority staff (n = 3), peer volunteers (n = 2) and service users (n = 7). Audio data were transcribed verbatim and thematically coded to identify perceived facilitators and challenges. RESULTS Facilitators to delivery included social interaction, community referral pathways, suitable facilities, peer volunteers and high-quality instructors. Challenges surrounded inconsistent practice, staff capacity, safety and accountability, and awareness raising. CONCLUSIONS Peer volunteers can provide an additional support mechanism alongside qualified instructors for increasing social interaction within PA interventions. For optimal intervention delivery, consideration needs to be given to equipment and space, safety and accountability and consistency of practice.
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Affiliation(s)
- Anthony Crozier
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lorna Porcellato
- Faculty of health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Benjamin J. R. Buckley
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Paula M. Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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10
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Buckley BJR, Finnie SJ, Murphy RC, Watson PM. "You've Got to Pick Your Battles": A Mixed-Methods Investigation of Physical Activity Counselling and Referral within General Practice. Int J Environ Res Public Health 2020; 17:ijerph17207428. [PMID: 33053911 PMCID: PMC7650624 DOI: 10.3390/ijerph17207428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022]
Abstract
One in four people say they would be more active if advised by a general practitioner (GP), yet 72% of GPs do not discuss physical activity (PA) with patients and 80% of GPs are unaware of the PA guidelines. The aim of this study was therefore to investigate GP perspectives on PA counselling and referral and interpret these within the context of the socio-ecological model (SEM). Fifty-six GPs completed an online survey to investigate factors influencing PA counselling and referral. Semi-structured interviews were then conducted with seven GPs to explore topics in more depth. Interview data were analysed thematically and mapped to the SEM. GPs were more likely to discuss PA with patients if they were physically active themselves (p = 0.004). Influences on PA counselling and referral were identified at the policy (provision of education, priority), organisational (feedback, e-referral), interpersonal (PA as everybody’s business, patient factors) and intrapersonal (knowledge, GP PA levels) levels of the SEM. Multi-level strategies are required to help GPs promote PA and make use of exercise referral schemes, including making PA a strategic priority, introducing systems for feedback from referrals, and involving other members of the care team in PA counselling and referral.
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Affiliation(s)
- Benjamin J. R. Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L7 8TX, UK
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (R.C.M.); (P.M.W.)
- Correspondence:
| | - Stephanie J. Finnie
- Emergency Department, Royal Liverpool University Hospital, Liverpool L7 8XP, UK;
| | - Rebecca C. Murphy
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (R.C.M.); (P.M.W.)
| | - Paula M. Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (R.C.M.); (P.M.W.)
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11
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Buckley BJ, Thijssen DH, Murphy RC, Graves LE, Cochrane M, Gillison F, Crone D, Wilson PM, Whyte G, Watson PM. Pragmatic evaluation of a coproduced physical activity referral scheme: a UK quasi-experimental study. BMJ Open 2020; 10:e034580. [PMID: 33004383 PMCID: PMC7534707 DOI: 10.1136/bmjopen-2019-034580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES UK exercise referral schemes (ERSs) have been criticised for focusing too much on exercise prescription and not enough on sustainable physical activity (PA) behaviour change. Previously, a theoretically grounded intervention (coproduced PA referral scheme, Co-PARS) was coproduced to support long-term PA behaviour change in individuals with health conditions. The purpose of this study was to investigate the effectiveness of Co-PARS compared with a usual care ERS and no treatment for increasing cardiorespiratory fitness. DESIGN A three-arm quasi-experimental trial. SETTING Two leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control. PARTICIPANTS 68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment. INTERVENTION 16-weeks of PA behaviour change support delivered at 4, 8, 12 and 18 weeks, in addition to the usual care 12-week leisure centre access. OUTCOME MEASURES Cardiorespiratory fitness, vascular health, PA and mental well-being were measured at baseline, 12 weeks and 6 months (PA and mental well-being only). Fitness centre engagement (co-PARS and usual care) and behaviour change consultation attendance (co-PARS) were assessed. Following an intention-to-treat approach, repeated-measures linear mixed models were used to explore intervention effects. RESULTS Significant improvements in cardiorespiratory fitness (p=0.002) and vascular health (p=0.002) were found in co-PARS compared with usual care and no-treatment at 12 weeks. No significant changes in PA or well-being at 12 weeks or 6 months were noted. Intervention engagement was higher in co-PARS than usual care, though this was not statistically significant. CONCLUSION A coproduced PA behaviour change intervention led to promising improvements in cardiorespiratory and vascular health at 12 weeks, despite no effect for PA levels at 12 weeks or 6 months. TRIAL REGISTRATION NUMBER NCT03490747.
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Affiliation(s)
- Benjamin Jr Buckley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Dick Hj Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rebecca C Murphy
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lee Ef Graves
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Madeleine Cochrane
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Philip M Wilson
- Department of Kinesiology, Brock University, Saint Catharines, Ontario, Canada
| | - Greg Whyte
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Paula M Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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12
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Watson PM, Dugdill L, Pickering K, Hargreaves J, Staniford LJ, Owen S, Murphy RC, Knowles ZR, Johnson LJ, Cable NT. Distinguishing factors that influence attendance and behaviour change in family-based treatment of childhood obesity: A qualitative study. Br J Health Psychol 2020; 26:67-89. [PMID: 32710510 DOI: 10.1111/bjhp.12456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 06/13/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family-based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)). DESIGN Focus groups with children and parents/carers as part of a broader mixed-methods evaluation. METHODS Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change. RESULTS Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non-judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non-attending significant others. CONCLUSIONS Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family's change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention.
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Affiliation(s)
- Paula M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Lindsey Dugdill
- Formerly School of Health Sciences, University of Salford, Salford, UK
| | - Katie Pickering
- Physical Activity, Wellbeing, and Public Health Research Group, Academy of Sport and Physical Activity, Sheffield Hallam University, UK
| | | | - Leanne J Staniford
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | - Stephanie Owen
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Rebecca C Murphy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Zoe R Knowles
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Laura J Johnson
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - N Timothy Cable
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
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13
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Rudd JR, Crotti M, Fitton-Davies K, O’Callaghan L, Bardid F, Utesch T, Roberts S, Boddy LM, Cronin CJ, Knowles Z, Foulkes J, Watson PM, Pesce C, Button C, Lubans DR, Buszard T, Walsh B, Foweather L. Skill Acquisition Methods Fostering Physical Literacy in Early-Physical Education (SAMPLE-PE): Rationale and Study Protocol for a Cluster Randomized Controlled Trial in 5-6-Year-Old Children From Deprived Areas of North West England. Front Psychol 2020; 11:1228. [PMID: 32625143 PMCID: PMC7311787 DOI: 10.3389/fpsyg.2020.01228] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/11/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is a need for interdisciplinary research to better understand how pedagogical approaches in primary physical education (PE) can support the linked development of physical, cognitive and affective aspects of physical literacy and physical activity behaviors in young children living in deprived areas. The Skill Acquisition Methods fostering Physical Literacy in Early-Physical Education (SAMPLE-PE) study aims to examine the efficacy of two different pedagogies for PE, underpinned by theories of motor learning, to foster physical literacy. METHODS SAMPLE-PE will be evaluated through a cluster-randomized controlled trial targeting 5-6 year old children from schools located in areas of high deprivation in Merseyside, North-West England. Schools will be randomly allocated to one of three conditions: Linear Pedagogy, Non-linear Pedagogy, or Control. Non-linear and Linear Pedagogy intervention primary schools will receive a PE curriculum delivered by trained coaches over 15 weeks, while control schools will follow their usual practice. Data will be collected at baseline (T0), immediately post-intervention (T1), and 6 months after the intervention has finished (T2). Children's movement competence is the primary outcome in this trial. Secondary outcomes include physical activity, perceived competence, motivation, executive functions, and self-regulation. An extensive process evaluation will also examine implementation factors such as intervention context, reach, dose, fidelity and acceptability. DISCUSSION The SAMPLE-PE project will enable better understanding surrounding how to operationalise physical literacy through enrichment of PE practices in early PE. The study will provide robust scientific evidence regarding the efficacy of underpinning PE pedagogy with theories of motor learning to promote the development of physical literacy. TRIAL REGISTRATION Retrospectively registered on 5th September 2018 at ClinicalTrials.gov, a resource provided by the U.S. National Library of Medicine (Identifier: NCT03551366).
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Affiliation(s)
- James R. Rudd
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Institute for Health and Sport, Footscray Park Campus, Victoria University, Melbourne, VIC, Australia
| | - Matteo Crotti
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Katie Fitton-Davies
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Laura O’Callaghan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Farid Bardid
- School of Education, University of Strathclyde, Glasgow, United Kingdom
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Till Utesch
- Institute for Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Simon Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynne M. Boddy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Colum J. Cronin
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Zoe Knowles
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jonathan Foulkes
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Paula M. Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Caterina Pesce
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - David Revalds Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, The University of Newcastle, Callaghan, NSW, Australia
| | - Tim Buszard
- Institute for Health and Sport, Footscray Park Campus, Victoria University, Melbourne, VIC, Australia
| | - Barbara Walsh
- School of Sport Leisure and Nutrition, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lawrence Foweather
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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14
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Cochrane M, Watson PM, Timpson H, Haycox A, Collins B, Jones L, Martin A, Graves LEF. Systematic review of the methods used in economic evaluations of targeted physical activity and sedentary behaviour interventions. Soc Sci Med 2019; 232:156-167. [PMID: 31100696 DOI: 10.1016/j.socscimed.2019.04.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/04/2019] [Accepted: 04/26/2019] [Indexed: 01/22/2023]
Abstract
The burden of noncommunicable diseases (NCD) on health systems worldwide is substantial. Physical inactivity and sedentary behaviour are major risk factors for NCD. Previous attempts to understand the value for money of preventative interventions targeting physically inactive individuals have proved to be challenging due to key methodological challenges associated with the conduct of economic evaluations in public health. A systematic review was carried out across six databases (Medline, SPORTSDiscus, EconLit, PsychINFO, NHS EED, HTA) along with supplementary searches. The review examines how economic evaluations published between 2009-March 2017 have addressed methodological challenges with the aim of bringing to light examples of good practice for future studies. Fifteen economic evaluations from four high-income countries were retrieved; there is a dearth of studies targeting sedentary behaviour as an independent risk factor from physical activity. Comparability of studies from the healthcare and societal perspectives were limited due to analysts' choice in cost categories, valuation technique and time horizon differing substantially. The scarcity of and inconsistencies across economic evaluations for these two behaviours have exposed a mismatch between calls for more preventative action to tackle NCD and the lack of information available on how resources may be optimally allocated in practice. Consequently, this paper offers a table of recommendations on how future studies can be improved.
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Affiliation(s)
- M Cochrane
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 5 Primrose Hill, Liverpool, L3 2EX, UK.
| | - P M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 5 Primrose Hill, Liverpool, L3 2EX, UK
| | - H Timpson
- Public Health Institute, Faculty of Health, Education and Community, Liverpool John Moores University, 3rd Floor, Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - A Haycox
- (c)Management School, University of Liverpool, Chatham Street, Liverpool, L69 7ZH, UK
| | - B Collins
- Department of Public Health and Policy, University of Liverpool, Waterhouse Building, Block B, 2nd Floor Liverpool, L69 3BX, UK
| | - L Jones
- (c)Management School, University of Liverpool, Chatham Street, Liverpool, L69 7ZH, UK
| | - A Martin
- Department of Public Health and Policy, University of Liverpool, Waterhouse Building, Block B, 2nd Floor Liverpool, L69 3BX, UK; HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, WA4 4FS, UK
| | - L E F Graves
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 5 Primrose Hill, Liverpool, L3 2EX, UK
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15
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Schneider J, Malinowski P, Watson PM, Lattimore P. The role of mindfulness in physical activity: a systematic review. Obes Rev 2019; 20:448-463. [PMID: 30468299 DOI: 10.1111/obr.12795] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 02/05/2023]
Abstract
Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness-based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the evidence for the potential of mindfulness-based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross-sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness-physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness-based interventions (n = 20) suggested positive between-subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow-up. Mindfulness-based interventions were more likely to be successful if they were physical activity-specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness-physical activity relationship reliably.
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Affiliation(s)
- J Schneider
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P Malinowski
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P M Watson
- Research Institute for Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P Lattimore
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
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16
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Birtwistle SB, Ashcroft G, Murphy R, Gee I, Poole H, Watson PM. Factors influencing patient uptake of an exercise referral scheme: a qualitative study. Health Educ Res 2019; 34:113-127. [PMID: 30307496 DOI: 10.1093/her/cyy038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/21/2018] [Indexed: 06/08/2023]
Abstract
Exercise referral schemes aim to increase physical activity amongst inactive individuals with or at risk of long-term health conditions. Yet many patients referred to these schemes (by health professionals) fail to take up the exercise opportunities on offer. Understanding factors influencing uptake to exercise referral schemes may help improve future attendance. Using the Socio-Ecological Model as a framework, this qualitative study aimed to explore factors influencing uptake to an exercise referral scheme based in the North West of England. Semi-structured interviews were conducted with referred patients (n = 38) about their reasons for referral, interactions with referring health professionals, events following referral and ideas to improve future uptake. Data were analysed thematically and mapped onto the constructs of the Socio-Ecological Model. Factors reported to influence uptake included intrapersonal (past PA experiences, motivation, competing priorities), interpersonal (scheme explanations, support) and organizational influences (scheme promotion, communication between service, cost). Whilst several intrapersonal-level factors influenced patient decisions to uptake the exercise referral scheme, modifiable interpersonal and organizational factors were identified as potential targets for intervention. Recommendations are made for improving awareness of exercise referral schemes and for enhancing communication between referring practitioners, patients and referral scheme staff.
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Affiliation(s)
- S B Birtwistle
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - G Ashcroft
- School of Natural Sciences and Psychology, Liverpool John Moores University, UK
| | - R Murphy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - I Gee
- Public Health Institute, Liverpool John Moores University, UK
| | - H Poole
- School of Natural Sciences and Psychology, Liverpool John Moores University, UK
| | - P M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
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17
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Divine A, Watson PM, Baker S, Hall CR. Facebook, relatedness and exercise motivation in university students: A mixed methods investigation. Computers in Human Behavior 2019. [DOI: 10.1016/j.chb.2018.09.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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18
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Buckley BJR, Thijssen DHJ, Murphy RC, Graves LEF, Whyte G, Gillison FB, Crone D, Wilson PM, Watson PM. Making a move in exercise referral: co-development of a physical activity referral scheme. J Public Health (Oxf) 2018; 40:e586-e593. [DOI: 10.1093/pubmed/fdy072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- B J R Buckley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - D H J Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen GA, Netherlands
| | - R C Murphy
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - L E F Graves
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - G Whyte
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - F B Gillison
- Department for Health, University of Bath, Bath, UK
| | - D Crone
- School of Health and Social Care, University of Gloucestershire, Gloucester, UK
| | - P M Wilson
- Behavioural Health Sciences Research Lab, Department of Kinesiology, Brock University, Ontario, Canada
| | - P M Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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19
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Bradbury D, Chisholm A, Watson PM, Bundy C, Bradbury N, Birtwistle S. Barriers and facilitators to health care professionals discussing child weight with parents: A meta-synthesis of qualitative studies. Br J Health Psychol 2018; 23:701-722. [PMID: 29700900 PMCID: PMC6099303 DOI: 10.1111/bjhp.12312] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/13/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Childhood obesity is one of the most serious global public health challenges. However, obesity and its consequences are largely preventable. As parents play an important role in their children's weight-related behaviours, good communication between parents and health care professionals (HCPs) is essential. This systematic review provides a meta-synthesis of qualitative studies exploring the barriers and facilitators experienced by HCPs when discussing child weight with parents. METHODS Searches were conducted using the following databases: MEDLINE (OVID), Psych INFO (OVID), EMBASE (OVID), Web of Knowledge and CINAHL. Thirteen full-text qualitative studies published in English language journals since 1985 were included. Included studies collected data from HCPs (e.g., nurses, doctors, dieticians, psychologists, and clinical managers) concerning their experiences of discussing child weight-related issues with parents. An inductive thematic analysis was employed to synthesize findings. FINDINGS Emerging subthemes were categorized using a socio-ecological framework into intra/interpersonal factors, organizational factors, and societal factors. Perceived barriers and facilitators most commonly related to intra/interpersonal level factors, that is, relating to staff factors, parental factors, or professional-parent interactions. HCPs also attributed a number of barriers, but not facilitators, at the organizational and societal levels. CONCLUSION The findings of this review may help to inform the development of future weight-related communication interventions. Whilst intra/interpersonal interventions may go some way to improving health care practice, it is crucial that all stakeholders consider the wider organizational and societal context in which these interactions take place. Statement of contribution What is already known on the subject? Childhood obesity is one of the United Kingdom's most serious current public health challenges. Health care professionals are in a prime position to identify child weight issues during routine consultations. However, they often feel unable or unequipped to raise the topic and provide information on child weight management. What does this study add? To our knowledge, this is the first review to synthesize barriers and facilitators to discussing child weight. This review interprets key barriers and facilitators in the context of the socio-ecological model. Supports the development of interventions matched to the appropriate level of the socio-economic model.
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Affiliation(s)
- Daisy Bradbury
- Physical Activity ExchangeResearch Institute for Sport and Exercise SciencesLiverpool John Moores UniversityUK
| | | | - Paula M. Watson
- Physical Activity ExchangeResearch Institute for Sport and Exercise SciencesLiverpool John Moores UniversityUK
| | | | | | - Sarah Birtwistle
- Physical Activity ExchangeResearch Institute for Sport and Exercise SciencesLiverpool John Moores UniversityUK
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20
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Domville MS, Watson PM, Richardson DJ, Graves LEF. Educator perspectives on factors influencing children’s school-based physical activity. Health Promot Int 2018; 34:931-940. [DOI: 10.1093/heapro/day041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Summary
Formative research is an important first step in the design and development of children’s school-based physical activity (PA) interventions. Exploration of educator [headteacher and physical education (PE)-co-ordinator] perceptions toward the promotion of school-based PA, including PE delivery has however been limited. This study took a socio-ecological approach to explore the barriers and facilitators of children’s school-based PA from the perspective of school educators. Interviews were conducted with headteachers (n = 4), PE-co-ordinators (n = 4) and a deputy headteacher (n = 1) and data thematically analysed using Nvivo software (version 10). Findings suggested that, at an organizational level headteachers were the predominant driving force in the promotion of PA opportunities, yet institutional barriers including low priority for PA and PE were perceived to negate delivery. At an interpersonal level, strategies to increase the delivery of school-based PA were developed, however poor teacher-coach relationships and significant others reduced PA promotion opportunities. Child PA was further negated through intrapersonal factors, including lack of PE-specific teacher training and varying teacher interest in PA and sport. To increase primary school children’s school-based PA, barriers and facilitators at the organizational, interpersonal and intrapersonal level must be considered and targeted and researchers and schools should work in partnership to develop future interventions.
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Affiliation(s)
- Matthew S Domville
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Paula M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Dave J Richardson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Lee E F Graves
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
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Abstract
School entry provides an opportune moment for health professionals to intervene with children who are overweight, yet identification and management of childhood obesity presents challenges in practice. This multi-method qualitative study explored the experiences of 26 school health professionals in addressing childhood obesity at school entry. Methods included semi-structured interviews with service managers (n = 3); focus groups with school nurses (n = 12) and child health practitioners (n = 6); and open-ended questionnaires with school nurses (n = 4) and child health practitioners (n = 1) who were unable to attend the focus groups. A thematic analysis revealed agreement between service managers, school nurses and child health practitioners. Whilst it was felt school health professionals have an important role to play in managing childhood obesity, efforts to address child weight were limited by a lack of capacity, lack of clear protocols, challenges of engaging parents and insufficient training in childhood obesity and related lifestyle issues. School health policymakers need to recognize childhood obesity as a serious public health issue, allocate appropriate resources to nurse training and development and ensure clear pathways are established to ensure consistency of care.
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Affiliation(s)
- Gillian L Turner
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Stephanie Owen
- Betsi Cadwaladr University Health Board, Caia Park Centre, Wrexham, Wales, UK
| | - Paula M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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22
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Watson PM, Dugdill L, Pickering K, Owen S, Hargreaves J, Staniford LJ, Murphy RC, Knowles Z, Cable NT. Service evaluation of the GOALS family-based childhood obesity treatment intervention during the first 3 years of implementation. BMJ Open 2015; 5:e006519. [PMID: 25652799 PMCID: PMC4322210 DOI: 10.1136/bmjopen-2014-006519] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To evaluate the impact of the GOALS (Getting Our Active Lifestyles Started) family-based childhood obesity treatment intervention during the first 3 years of implementation. DESIGN Single-group repeated measures with qualitative questionnaires. SETTING Community venues in a socioeconomically deprived, urban location in the North-West of England. PARTICIPANTS 70 overweight or obese children (mean age 10.5 years, 46% boys) and their parents/carers who completed GOALS between September 2006 and March 2009. INTERVENTIONS GOALS was a childhood obesity treatment intervention that drew on social cognitive theory to promote whole family lifestyle change. Sessions covered physical activity (PA), diet and behaviour change over 18 2 h weekly group sessions (lasting approximately 6 months). A Template for Intervention Description and Replication (TIDieR) checklist of intervention components is provided. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was child body mass index (BMI) z-score, collected at baseline, post-intervention and 12 months. Secondary outcome measures were child self-perceptions, parent/carer BMI and qualitative changes in family diet and PA (parent/carer questionnaire). RESULTS Child BMI z-score reduced by 0.07 from baseline to post-intervention (p<0.001) and was maintained at 12 months (p<0.05). There was no change in parent/carer BMI or child self-perceptions, other than an increase in perceived social acceptance from baseline to post-intervention (p<0.05). Parents/carers reported positive changes to family PA and dietary behaviours after completing GOALS. CONCLUSIONS GOALS completion was associated with small improvements in child BMI z-score and improved family PA and dietary behaviours. Several intervention modifications were necessary during the implementation period and it is suggested childhood obesity treatment interventions need time to embed before a definitive evaluation is conducted. Researchers are urged to use the TIDieR checklist to ensure transparent reporting of interventions and facilitate the translation of evidence to practice.
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Affiliation(s)
- Paula M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lindsey Dugdill
- School of Health Sciences, University of Salford, Salford, UK
| | - Katie Pickering
- Carnegie Faculty, Fairfax Hall, Leeds Beckett University, Leeds, UK
| | | | | | | | - Rebecca C Murphy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Zoe Knowles
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - N Timothy Cable
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Aspire Academy, Qatar
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Camp ER, Wang C, Little EC, Watson PM, Pirollo KF, Rait A, Cole DJ, Chang EH, Watson DK. Transferrin receptor targeting nanomedicine delivering wild-type p53 gene sensitizes pancreatic cancer to gemcitabine therapy. Cancer Gene Ther 2013; 20:222-8. [PMID: 23470564 DOI: 10.1038/cgt.2013.9] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To overcome gene therapy barriers such as low transfection efficiency and nonspecific delivery, liposomal nanoparticles targeted by a single-chain antibody fragment to the transferrin receptor (TfRscFv) delivering wild-type (wt) human p53 (SGT-53) were developed for tumor-specific targeting. We hypothesize that SGT-53 in combination with gemcitabine will demonstrate enhanced therapeutic benefit in an in vivo metastatic pancreatic cancer model. Intrasplenic injection of 1 × 10(6) Panc02 murine pancreatic cancer cells was used to generate in vivo hepatic metastatic tumors. Nanoparticle localization was assessed by tail vein injection of TfRscFv with fluorescently labeled oligonucleotides (6-carboxyfluorescein phosphoramidite (6FAM) ODN) imaged by Xenogen IVIS 200 scan. SGT-53 (equivalent to 30 μg of p53 intravenously) and gemcitabine (20 mg/kg intraperitoneally) alone and in combination were administered biweekly and compared with untreated mice. Survival was determined by blinded daily assessment of morbidity. Human wtp53 expression and transferrin levels in the tumors were assessed by western blot analysis. Tumor burden was quantified by liver weight. Xenogen imaging demonstrated tumor-specific uptake of TfRscFv-6FAM ODN. Exogenous human wtp53 protein was detected in the SGT-53-treated tumors compared with control. Compared with untreated mice with metastatic tumors demonstrating median survival of 20 days, SGT-53, gemcitabine and the combination demonstrated improved median survival of 29, 30 and 37 days, respectively. The combination treatment prolonged median survival when compared with single drug treatment and decreased tumor burden. The tumor targeting liposomal-based SGT-53 nanoparticle is capable of sensitizing pancreatic cancer to conventional chemotherapy in pancreatic cancer models. This approach has the potential to be translated into a new, more effective therapy for pancreatic cancer. Further optimization is ongoing, moving towards a Phase 1B/2 clinical trial.
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Affiliation(s)
- E R Camp
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
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24
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Watson PM, Dugdill L, Pickering K, Bostock S, Hargreaves J, Staniford L, Cable NT. A whole family approach to childhood obesity management (GOALS): Relationship between adult and child BMI change. Ann Hum Biol 2011; 38:445-52. [DOI: 10.3109/03014460.2011.590531] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Paula M. Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lindsey Dugdill
- College of Health and Social Care, University of Salford, Salford, UK
| | - Katie Pickering
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Stephanie Bostock
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jackie Hargreaves
- Physical Activity, Sport and Exercise Sciences, Leeds Metropolitan University, Leeds, UK
| | - Leanne Staniford
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Nigel T. Cable
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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25
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Watson PM. Idiosyncratic reaction to enrofloxacin in cats. Vet Rec 2002; 150:556. [PMID: 12019545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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26
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Commins SP, Watson PM, Frampton IC, Gettys TW. Leptin selectively reduces white adipose tissue in mice via a UCP1-dependent mechanism in brown adipose tissue. Am J Physiol Endocrinol Metab 2001; 280:E372-7. [PMID: 11158943 DOI: 10.1152/ajpendo.2001.280.2.e372] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We tested the hypothesis that leptin, in addition to reducing body fat by restraining food intake, reduces body fat through a peripheral mechanism requiring uncoupling protein 1 (UCP1). Leptin was administered to wild-type (WT) mice and mice with a targeted disruption of the UCP1 gene (UCP1 deficient), while vehicle-injected control animals of each genotype were pair-fed to each leptin-treated group. Leptin reduced the size of white adipose tissue (WAT) depots in WT mice but not in UCP1-deficient animals. This was accompanied by a threefold increase in the amount of UCP1 protein and mRNA in the brown adipose tissue (BAT) of WT mice. Leptin also increased UCP2 mRNA in WAT of both WT and UCP1-deficient mice but increased UCP2 and UCP3 mRNA only in BAT from UCP1-deficient mice. These results indicate that leptin reduces WAT through a peripheral mechanism requiring the presence of UCP1, with little or no involvement of UCP2 or UCP3.
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Affiliation(s)
- S P Commins
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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27
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Commins SP, Watson PM, Levin N, Beiler RJ, Gettys TW. Central leptin regulates the UCP1 and ob genes in brown and white adipose tissue via different beta-adrenoceptor subtypes. J Biol Chem 2000; 275:33059-67. [PMID: 10938091 DOI: 10.1074/jbc.m006328200] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The three known subtypes of beta-adrenoreceptors (beta(1)-AR, beta(2)-AR, and beta(3)-AR) are differentially expressed in brown and white adipose tissue and mediate peripheral responses to central modulation of sympathetic outflow by leptin. To assess the relative roles of the beta-AR subtypes in mediating leptin's effects on adipocyte gene expression, mice with a targeted disruption of the beta(3)-adrenoreceptor gene (beta(3)-AR KO) were treated with vehicle or the beta(1)/beta(2)-AR selective antagonist, propranolol (20 microgram/g body weight/day) prior to intracerebroventricular (ICV) injections of leptin (0.1 microgram/g body weight/day). Leptin produced a 3-fold increase in UCP1 mRNA in brown adipose tissue of wild type (FVB/NJ) and beta(3)-AR KO mice. The response was unaltered by propranolol in wild type mice, but was completely blocked by this antagonist in beta(3)-AR KO mice. In contrast, ICV leptin had no effect on leptin mRNA in either epididymal or retroperitoneal white adipose tissue (WAT) from beta(3)-AR KOs. Moreover, propranolol did not block the ability of exogenous leptin to reduce leptin mRNA in either WAT depot site of wild type mice. These results demonstrate that the beta(3)-AR is required for leptin-mediated regulation of ob mRNA expression in WAT, but is interchangeable with the beta(1)/beta(2)-ARs in mediating leptin's effect on UCP1 mRNA expression in brown adipose tissue.
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MESH Headings
- Adipose Tissue/metabolism
- Adipose Tissue, Brown/metabolism
- Adrenergic beta-Antagonists/pharmacology
- Animals
- Carrier Proteins/genetics
- Cell Membrane/drug effects
- Cell Membrane/physiology
- Cerebral Ventricles/drug effects
- Cerebral Ventricles/physiology
- Gene Expression Regulation/physiology
- Imidazoles/pharmacology
- Injections, Intraventricular
- Ion Channels
- Leptin/administration & dosage
- Leptin/genetics
- Leptin/pharmacology
- Male
- Membrane Proteins/genetics
- Mice
- Mice, Inbred C57BL
- Mice, Inbred Strains
- Mice, Knockout
- Mitochondrial Proteins
- Propanolamines/pharmacology
- Propranolol/pharmacology
- RNA, Messenger/genetics
- Receptors, Adrenergic, beta-3/deficiency
- Receptors, Adrenergic, beta-3/genetics
- Receptors, Adrenergic, beta-3/physiology
- Receptors, Leptin
- Transcription, Genetic
- Uncoupling Protein 1
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Affiliation(s)
- S P Commins
- Departments of Medicine and Biochemistry and Molecular Biology, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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28
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Watson PM, Commins SP, Beiler RJ, Hatcher HC, Gettys TW. Differential regulation of leptin expression and function in A/J vs. C57BL/6J mice during diet-induced obesity. Am J Physiol Endocrinol Metab 2000; 279:E356-65. [PMID: 10913036 DOI: 10.1152/ajpendo.2000.279.2.e356] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Obesity-resistant (A/J) and obesity-prone (C57BL/6J) mice were weaned onto low-fat (LF) or high-fat (HF) diets and studied after 2, 10, and 16 wk. Despite consuming the same amount of food, A/J mice on the HF diet deposited less carcass lipid and gained less weight than C57BL/6J mice over the course of the study. Leptin mRNA was increased in white adipose tissue (WAT) in both strains on the HF diet but to significantly higher levels in A/J compared with C57BL/6J mice. Uncoupling protein 1 (UCP1) and UCP2 mRNA were induced by the HF diet in brown adipose tissue (BAT) and WAT of A/J mice, respectively, but not in C57BL/6J mice. UCP1 mRNA was also significantly higher in retroperitoneal WAT of A/J compared with C57BL/6J mice. The ability of A/J mice to resist diet-induced obesity is associated with a strain-specific increase in leptin, UCP1, and UCP2 expression in adipose tissue. The findings indicate that the HF diet does not compromise leptin-dependent regulation of adipocyte gene expression in A/J mice and suggest that maintenance of leptin responsiveness confers resistance to diet-induced obesity.
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Affiliation(s)
- P M Watson
- Departments of Medicine and Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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29
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Commins SP, Marsh DJ, Thomas SA, Watson PM, Padgett MA, Palmiter R, Gettys TW. Norepinephrine is required for leptin effects on gene expression in brown and white adipose tissue. Endocrinology 1999; 140:4772-8. [PMID: 10499537 DOI: 10.1210/endo.140.10.7043] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Exogenous leptin enhances energy utilization in ob/ob mice by binding its hypothalamic receptor and selectively increasing peripheral fat oxidation. Leptin also increases uncoupling protein 1 (UCP1) expression in brown adipose tissue (BAT), but the neurotransmitter that mediates this effect has not been established. The present experiments sought to determine whether leptin regulates UCP1 expression in BAT and its own expression in white adipose tissue (WAT) through the long or short forms of leptin receptor and modulation of norepinephrine release. Mice lacking dopamine beta-hydroxylase (Dbh-/-), the enzyme responsible for synthesizing norepinephrine and epinephrine from dopamine, were treated with leptin (20 microg/g body weight/day) for 3 days before they were euthanized. UCP1 messenger RNA (mRNA) and protein expression were 5-fold higher in BAT from control (Dbh+/-) compared with Dbh-/- mice. Leptin produced a 4-fold increase in UCP1 mRNA levels in Dbh+/- mice but had no effect on UCP1 expression in Dbh-/-. The beta3-adrenergic agonist, CL-316,243 increased UCP1 expression and established that BAT from both groups of mice was capable of responding to beta-adrenergic stimulation. Similarly, exogenous leptin reduced leptin mRNA in WAT from Dbh+/- but not Dbh-/- mice. In separate experiments, leptin produced comparable reductions in food intake in both Dbh+/- and Dbh-/- mice, illustrating that norepinephrine is not required for leptin's effect on food intake. Lastly, db/db mice lacking the long form of the leptin receptor failed to increase UCP1 mRNA in response to exogenous leptin but increased UCP1 mRNA in response to CL-316,243. These studies establish that norepinephrine is required for leptin to regulate its own expression in WAT and UCP1 expression in BAT and indicate that these effects are likely mediated through the centrally expressed long form of the leptin receptor.
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Affiliation(s)
- S P Commins
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston 29425, USA
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30
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Abstract
Deposition of excess body fat occurs when energy intake chronically exceeds energy expenditure. In ob/ob mice, the absence of leptin affects both components of the energy balance equation, and the mice become morbidly obese after weaning. Treatment of ob/ob mice with exogenous leptin reduces body weight by decreasing food intake and stimulating energy utilization, but even when saline- and leptin-injected ob/ob mice are pair-fed, mice receiving leptin lose significantly more weight. Therefore, the purpose of the present study was to test the hypotheses that uncoupling protein-1 (UCP1) expression is reduced in adipose tissue from ob/ob mice and is restored by treatment with exogenous leptin. Lean and ob/ob mice (5-6 weeks old) were housed at 23 C and treated with leptin (20 microg/g BW x day) for 3 days before they were killed. Compared with levels in lean littermates, UCP1 messenger RNA (mRNA) and protein levels were lower in brown adipose tissue (BAT) and retroperitoneal white adipose tissue (WAT) from ob/ob mice. Treatment of ob/ob mice with leptin reduced body weight and produced a 4- to 5-fold increase in UCP1 mRNA levels in both interscapular BAT and retroperitoneal WAT. The increases in UCP1 mRNA were accompanied by comparable increases in UCP1 protein in mitochondrial preparations from each tissue. Given that the sole known function of UCP1 is to uncouple oxidative phosphorylation, the present results are consistent with the conclusion that leptin stimulates energy utilization in ob/ob mice by increasing thermogenic activity and capacity (UCP1). In addition, the present results suggest that decreased UCP1 expression in BAT and WAT of ob/ob mice is in part responsible for their increased metabolic efficiency and propensity to become obese.
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Affiliation(s)
- S P Commins
- Department of Medicine, Medical University of South Carolina, Charleston 29425, USA
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31
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Watson PM, Bell GD, Webster CM, Fitzgerald RA. Fluoroquinolone susceptibility of S typhimurium DT104. Vet Rec 1998; 142:374. [PMID: 9587203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Gettys TW, Watson PM, Taylor IL, Collins S. RU-486 (Mifepristone) ameliorates diabetes but does not correct deficient beta-adrenergic signalling in adipocytes from mature C57BL/6J-ob/ob mice. Int J Obes (Lond) 1997; 21:865-73. [PMID: 9347404 DOI: 10.1038/sj.ijo.0800479] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the role of hypercorticism in the development of compromised beta-adrenergic signalling in adipocytes of mature C57BL/6J-ob/ob mice. DESIGN AND EXPERIMENTAL UNITS: Mature male ob/ob mice and their lean littermates were treated with vehicle or the specific glucocorticoid receptor (GR) antagonist, RU-486 (30 mg/kg bw/d) for 21 d. MEASUREMENTS Blood glucose, serum insulin, adipocyte Glut-4 expression, adipocyte Gs alpha expression, adenylylcyclase activation by beta-adrenergic receptor (beta-AR) agonists in adipocyte membranes and mRNA levels for beta 1-, beta 2- and beta 3-adrenergic receptor subtypes in adipocytes. RESULTS RU-486 reduced blood glucose levels in ob/ob mice to levels that were not different from lean mice. RU-486 also reduced serum insulin by approximately 50% in ob/ob mice, but failed to restore depressed Gs alpha or GLUT-4 expression in adipocytes of ob/ob mice. RU-486 produced a two-fold increase in beta 3-AR mRNA in ob/ob mice and a small but significant improvement in isoprenaline-mediated adenylylcyclase activation. CONCLUSIONS The present results indicate that glucocorticoid antagonism ameliorates diabetic symptoms of the mature ob/ob mouse, but does not lessen their obesity or fully reverse deficient expression and function of components of the adipocyte beta-adrenergic signalling cascade.
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MESH Headings
- Adenylyl Cyclases/drug effects
- Adenylyl Cyclases/metabolism
- Adipose Tissue/cytology
- Adipose Tissue/metabolism
- Adrenergic beta-Agonists/pharmacology
- Animals
- Blood Glucose/metabolism
- Blotting, Northern
- Blotting, Western
- Colforsin/pharmacology
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/metabolism
- Dose-Response Relationship, Drug
- Enzyme Activation/drug effects
- Ethanolamines/pharmacology
- GTP-Binding Protein alpha Subunits, Gs/metabolism
- Glucose Transporter Type 4
- Hormone Antagonists/pharmacology
- Insulin/blood
- Isoproterenol/pharmacology
- Male
- Mice
- Mice, Inbred C57BL
- Mifepristone/pharmacology
- Monosaccharide Transport Proteins/metabolism
- Muscle Proteins
- Phenotype
- Receptors, Adrenergic, beta/drug effects
- Receptors, Glucocorticoid/antagonists & inhibitors
- Signal Transduction/drug effects
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Affiliation(s)
- T W Gettys
- Department of Medicine, Medical University of South Carolina, Charleston 29425, USA
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33
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Gettys TW, Watson PM, Seger L, Padgett M, Taylor IL. Adrenalectomy after weaning restores beta3-adrenergic receptor expression in white adipocytes from C57BL/6J-ob/ob mice. Endocrinology 1997; 138:2697-704. [PMID: 9202206 DOI: 10.1210/endo.138.7.5283] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The role of hypercorticism in the development of compromised beta-adrenergic signaling in adipose tissue was assessed in ob/ob mice adrenalectomized at 4 weeks of age and studied 1 and 3 weeks thereafter. Adrenalectomy prevented the rapid increase in body weight and fat deposition between 4 and 5 weeks of age in ob/ob mice and produced a phenotype indistinguishable from that of lean mice. However, adrenalectomized ob/ob mice became intermediate between lean and ob/ob mice by 7 weeks of age. Adipocyte beta3-adrenergic receptor (AR) messenger RNA levels were similar between lean and adrenalectomized ob/ob mice at both time points and were 4- to 8-fold higher than messenger RNA levels in ob/ob mice. As judged by maximal activation of adenylyl cyclase by a beta3-AR-selective agonist, adrenalectomy also restored functional activity of the beta3-AR to levels above or equivalent to those seen in lean mice at both time points. The present results suggest that development of hypercorticism at or before weaning in ob/ob mice represses expression of the beta3-AR and prevents the normal postweaning development of this signaling system in the adipocyte.
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MESH Headings
- Adipocytes/metabolism
- Adrenal Glands/physiology
- Adrenalectomy
- Adrenergic beta-Agonists/pharmacology
- Adrenergic beta-Antagonists/pharmacology
- Animals
- Binding Sites
- Binding, Competitive
- Cyclic AMP/pharmacology
- Dioxoles/pharmacology
- Epinephrine/pharmacology
- Imidazoles/pharmacology
- Mice
- Mice, Inbred C57BL
- Mice, Obese
- RNA, Messenger/metabolism
- Receptors, Adrenergic, beta/genetics
- Receptors, Adrenergic, beta/metabolism
- Receptors, Adrenergic, beta-3
- Ribonucleases/metabolism
- Signal Transduction
- Stereoisomerism
- Weaning
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Affiliation(s)
- T W Gettys
- Department of Medicine, Medical University of South Carolina, Charleston 29425, USA.
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Abstract
Various model systems have been used to study the expression of the recently cloned ob gene, leptin. Here we report that freshly isolated rat white adipocytes incubated with insulin release leptin in a rapid and concentration-dependent manner (EC50 of 0.221 +/- .075 nM). Insulin-stimulated leptin release could be detected as early as 30 min and a maximal 2-3 fold effect was produced by 10 nM insulin. The effect of insulin was completely blocked by simultaneous activation of cAMP-dependent protein kinase. Using the activation of lipolysis as an index of cAMP-dependent protein kinase activity, we show that inhibition of leptin release by norepinephrine or the selective beta 3-adrenergic receptor agonist, CL316,243, occurred in parallel to activation of cAMP-dependent protein kinase. In addition, beta 1- and beta 2-adrenergic receptor antagonists did not impair the ability of norepinephrine or CL316,243 to inhibit leptin release from the adipocytes. These findings suggest that the beta 3-adrenergic receptor plays a central role in regulating the release of leptin from the adipocyte.
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Affiliation(s)
- T W Gettys
- Department of Medicine, Medical University of South Carolina, Charleston 29425, USA
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35
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Rhodes VA, Watson PM, McDaniel RW, Hanson BM, Johnson MH. Expectation and occurrence of postchemotherapy side effects: nausea and vomiting. Cancer Pract 1995; 3:247-53. [PMID: 7620490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although nausea and vomiting are among the most disruptive chemotherapy side effects, little is known about patients' expectations before therapy and their experience after chemotherapy. A stratified sample of 329 subjects on nine chemotherapy regimens were asked to list their expected symptoms and level of distress. The patients listed a total of 524 responses and 28 different symptoms. This paper focuses on the symptoms of nausea and vomiting. A statistically significant relationship (P = 0.015) was found between the patients' expectations of symptom experience and their expectations of symptom distress. No significant relationship was found between the expectation of the symptom and the actual symptom experience. These findings support the need for educational interventions that provide hopeful but realistic expectations of the unknown events for patients with cancer.
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Abstract
Continuous tight junctions between vascular endothelial cells, the principal anatomical basis for the blood-brain barrier, have been investigated functionally and morphologically but their molecular components have not been defined. This communication reports that the protein ZO-1, a specific constituent of epithelial tight junctions, is found in human and rat brain vasculature. ZO-1-positive immunocytochemical staining forms a tightly banded pattern outlining individual endothelial cells in blood vessels of the human cerebral cortex. Rat brain exhibits a similar staining of blood vessels as well as ZO-1-positive staining around individual epithelial cells of the choroid plexus. The antiserum used for immunocytochemistry recognizes a protein of about 200 kDa in rat brain microvessels by Western blot. These findings indicate that ZO-1 is located at the interendothelial junctions of brain vasculature, implicating its importance as a component of the blood-brain barrier.
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38
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Watson PM. Blood transfusion debate. Prof Nurse 1989; 5:95-6. [PMID: 2594799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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39
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Cooper PE, Watson PM. Discontinuation of redwater treatments. Vet Rec 1989; 124:643. [PMID: 2773215 DOI: 10.1136/vr.124.24.643-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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40
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41
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Rhodes VA, Watson PM, Hanson BM. Patients' descriptions of the influence of tiredness and weakness on self-care abilities. Cancer Nurs 1988; 11:186-94. [PMID: 3401854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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42
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Nauert LB, Leach KM, Watson PM. Finding the productivity standard in your acuity system. J Nurs Adm 1988; 18:25-30. [PMID: 3339455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
What is a realistic patient workload for nurses to handle on a given shift? Should the workload vary from shift-to-shift and nurse-to-nurse? This article describes how (1) the authors identified the standard inherent in their patient classification system; (2) the system is used to establish department workload standards; (3) managers comply with the established standard; and (4) nursing costs are affected when compliance with the standard is not achieved.
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Affiliation(s)
- L B Nauert
- Division of Nursing, University of Missouri-Columbia Hospital
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