Interdisciplinary Weight Loss and Lifestyle Intervention for Daily Functioning and Psychiatric Symptoms in Obstructive Sleep Apnea: The INTERAPNEA Randomized Clinical Trial.

Objective: Impaired daily functioning and psychiatric symptoms are highly prevalent in obstructive sleep apnea (OSA); however, the effects of weight loss and lifestyle interventions on these symptoms remain uncertain. This study aimed to evaluate the efficacy of an interdisciplinary weight loss and lifestyle intervention on impaired functioning, psychological distress, anxiety, and depression among men with moderate-to-severe OSA and obesity.Methods: This study was a randomized clinical trial conducted from April 2019 to October 2020. Men aged 18-65 years with moderate-to-severe OSA and obesity were randomly assigned to usual care (continuous positive airway pressure) or an 8-week weight loss and lifestyle intervention. Primary outcomes were changes from baseline to intervention endpoint and 6 months after intervention in daily functioning (measured by the Functional Outcomes of Sleep Questionnaire [FOSQ]); psychological distress (evaluated through the General Health Questionnaire [GHQ]); and anxiety and depression symptoms (measured by the State-Trait Anxiety Inventory [STAI], State-Trait Depression Inventory [STDI], and Beck Depression Inventory [BDI]).Results: Eighty-nine participants underwent randomization (mean [± SD] age, 54 ± 8 years; mean apnea-hypopnea index, 41 ± 22 events/h); 49 were assigned to usual care and 40 to the intervention. As compared with usual care, the intervention group had greater improvements in daily functioning (mean between-group difference in FOSQ score, 2.3; 95% confidence interval, 1.5 to 3.2), psychological distress (GHQ score, -10.3; -15.3 to -5.1), state anxiety (STAI-State score, -7.0; -11.0 to -3.0), trait anxiety (STAI-Trait score, -6.1; -9.5 to -2.8), state depression (STDI-State score, -2.4; -4.3 to -0.4), trait depression (STDI-Trait score, -3.8; -5.6 to -2.1), and general depression (BDI score, -2.0; -3.2 to -0.8) at intervention endpoint. Similar changes were observed at 6 months after intervention.Conclusions: This study provides the first evidence suggesting that an interdisciplinary weight loss and lifestyle intervention improves OSA-related impaired daily functioning and psychiatric symptoms. These findings should be considered when evaluating the potential benefits of this behavioral approach for OSA.Trial Registration: ClinicalTrials.gov Identifier: NCT03851653.

Intervention and mediation effects of a community-based singing group on older adults' perceived physical and mental health: the Sing4Health randomized controlled trial.

ObjectiveTo examine short- and long-term effects of a group singing program on older adults' perceived physical and mental health levels, and also investigate subjective well-being (life satisfaction, positive/negative affect and hedonic balance), body balance and serum biomarkers (C-reactive protein and erythrocyte sedimentation rate) as putative mediating mechanisms, controlling for the cognitive status of the participants. Design: The randomized controlled trial included 149 participants (60 to 95 years), allocated to an immediate intervention group (IG) or a wait-list active control group (WLG). The intervention comprised 34 sessions of group singing during 4-months. Main outcome measures: Self-report measures of physical health, anxiety, stress, and depression. Blinded assessments were conducted at baseline, post-intervention (4 months) and follow-up (6 months). Results: Participants in the IG reported a lower decline in perceived physical health after the intervention, as compared to the WLG. These benefits were maintained at follow-up. Singing-related changes in physical and mental health outcomes were mediated via an increase in positive affect. Moderation results showed that participants with very low cognitive functioning reported more anxiety and depression symptoms after the intervention. Conclusions: These findings provide further understanding on the psychological and physical mechanisms and effects of group singing in older adults.

Sing4Health: protocol of a randomized controlled trial of the effects of a singing group intervention on the well-being, cognitive function and health of older adults.

BACKGROUND: Singing is a multimodal activity that requires physical, cognitive and psychosocial performance, with benefits to various domains of well-being and health in older adults. In recent years, research has increasingly studied group singing as an important cost-effective intervention to promote active and healthy aging. However, the specific factors responsible for these benefits need further experimental support, as most studies do not allow for causal inferences. This study responds to the need for further randomized controlled trials (RCT), with follow-up measurement, on the benefits of group singing in older adults from a low socioeconomic background. Also, while most studies often focus on specific outcome measure dimensions, in this study, the conjoint effect of several physical, psychosocial, psychoemotional and cognitive dimensions are analyzed, testing mediation effects of psychosocial and psychoemotional variables on the well-being and health of the participants. METHODS: We implement and measure the effects of a singing group program for older adults, with an RCT crossover design study, in a natural context, before and after the intervention and in a follow-up, 6 months after the intervention. PARTICIPANTS: 140 retired older adults (> 60 years) users of a social support institution, will be invited to participate in a singing group program and randomly allocated to an experimental (n = 70) and a control (n = 70) group, which will enroll in the regular activities proposed by the institution. The intervention consists of 34 bi-weekly group singing sessions, of 2 h each, for 4 months. Measures on social and emotional well-being, cognitive function, and health indicators (e.g., blood pressure, glycemia, cholesterol, c-reactive protein, sedimentation rate, respiratory function, body balance, sleep quality, medication intake, and health services attendance) will be collected. Interviews will be conducted on the motivation and perceived benefits of participation. DISCUSSION: Significant improvements are expected in the outcome measures in the experimental group after the intervention, validating singing groups as a cost-effective intervention for healthy aging. Psychosocial and psychoemotional variables are expected to be mediators of the effects of the program in the cognitive function, well-being and health of the participants. TRIAL REGISTRATION: NCT03985917 . Registered 14th June 2019 (retrospectively registered).

Needs satisfaction ffect on exercise emotional response: a serial mediation analysis with motivational regulations and exercise intensity

Abstract Regarding psychological responses to exercise, this study aimed to analyze the mediating effects of motivational regulations and intensity in the association between basic psychological needs satisfaction and emotional responses. This was a cross-sectional study of 495 health club members (M = 40.50 years; SD = 13.54); of these, 186 were women (37.6%) and 309 men (62.4%), with an average attendance of 2.61 sessions per week (SD=1.29). Self-determination theory motivational regulations and basic psychological needs (BPN), perceived exercise intensity, and emotional response were measured. Serial mediation procedures were followed to test the interactions of variables. Models with autonomous regulations predicted positive emotional responses. As for the negative emotional response, the models with external regulation presented the highest predictions for negative activation. Results indicate that BPN satisfaction is associated with better emotional response, partially explained by autonomous regulations and perceived exercise intensity. In externally regulated individuals, perceived exercise intensity appears to be important to sustain a better emotional response.

Managing paediatric obesity: a multidisciplinary intervention including peers in the therapeutic process.

BACKGROUND: Adolescent obesity epidemic is one of the major health priorities as it tracks into adult life. There is widespread need for new creative strategies and lifestyle programs. This study was designed to investigate the possible impact of including peers on the weight management program and assess the long-run adherence to behaviour change, with a potential positive impact on body mass index, body composition, and physical activity. Peer influence is major at this age and it is expected that adolescents will be better motivated and engaged in the behaviour changes when they are accompanied by their friends. METHODS/DESIGN: The study is a non-randomised, non-blinded controlled trial, including two groups: 1) Comparison group (n = 35), which will receive a 12 month standard treatment at the hospital setting plus a weekly interactive and physical activity session; 2) Experimental group (n = 99), which will receive the standardized treatment at the hospital plus a weekly session together with a peer of their choice. The sample size calculations for the primary outcomes showed that we will have power to detect effect sizes of 0.25. Measures include: a) Dual-energy x-ray absorptiometry (for body composition assessment); b) Anthropometric evaluations; c) Assessment of physical activity levels by accelerometers; d) Psychosocial mediators (motivation and peer support) assessed with a package of psychometric questionnaires; and e) Outcomes (quality of life and well-being). DISCUSSION: Adolescence is a crucial period for the development of a healthy lifestyle, especially among those who reach this age with an obesity condition. Obesity management programs directed to adolescents are often an adopted version of programs developed for children, most of them with a strong focus on the family, or an adopted version of adult programs, not recognizing the specificities of this age group. This study is designed taking into account the unique characteristics of this life-cycle stage, with the main objective of testing an innovative treatment for adolescent obesity. TRIAL REGISTRATION: This trial is registered in the clinicaltrials.gov with the number NCT02024061.

Short- and medium-term impact of a residential weight-loss camp for overweight adolescents.

INTRODUCTION: Management of adolescent obesity in clinical practice has been usually centered on the promotion of healthy eating and an active lifestyle, with a weak evidence base. In search of creative and more effective interventions, our objective was to evaluate the immediate and follow-up effectiveness of a residential camp program for obese adolescents. METHODS: A total of 28 obese adolescents (15 girls), mean age 13.3±1.7 years and body mass index (BMI) 30.3±5.4 kg/m2, who were attending a tertiary health unit, enrolled in a 2-week camp. The activities were prepared and supervised by different specialists. All adolescents were assessed for anthropometric and psychosocial variables including body image, self-esteem, quality of life and depressive symptoms. Evaluations were conducted on the first and last day of the camp and at 6 months' follow-up. The effect of treatment was analyzed using analysis of variance (ANOVA) mixed models. RESULTS: At the end of the camp, weight was reduced by -2.7±1.2%, BMI by -0.8±0.4 units and waist circumference by -2.8±9.8 cm. A reduction in depressive symptoms was identified, with greater reductions in BMI associated with a more significant improvement in depressive symptoms. At the 6 months' follow-up only girls maintained BMI reduction, with boys having increased their BMI. DISCUSSION: In the short-term the camp was effective in reducing BMI and improving depressive symptoms. Only girls were able to proceed with BMI reduction at 6 months. These gender differences should be further explored. Ongoing research is examining the maintenance of these improvements.