Effect of Experiential Competency-Based Interprofessional Education on Pre-Professional Undergraduate Students: A Pilot Study.

The purpose of this pilot study was to evaluate the effectiveness of an interdisciplinary faculty team-led competency-based interprofessional undergraduate course for health and human services pre-professional students. Today's complex health and social problems require inter-professional knowledge and skills. Most interprofessional education occurs in graduate-level healthcare programs. Students graduating from health and allied health professions at the undergraduate level are ill prepared to work on interprofessional teams. Using a quasi-experimental design, this study examined the impact of an innovative experiential course on interprofessional competencies. Eleven undergraduate students in human services, public health, and nursing participated in the course. Students and faculty completed a modified Interprofessional Education Collaborative Competency Survey after each simulation and results were compared. At the end of the semester, each student also responded to open-ended prompts describing their reflections pertaining to team experiences. The results of this study indicate that an undergraduate course can increase students' interprofessional competencies, and that group dynamics influence how students view their skill levels. Consistent with other studies on this topic, students' self-ratings on the survey were mostly higher than those completed by faculty members. Educators need to process group dynamics (e.g., storming, norming) and individual styles of work regularly throughout the semester in order to maximize students' development of interprofessional competencies. Pre-professional students should be provided interprofessional learning opportunities to improve their competencies for addressing complex health and social challenges.

Effects of Instructional Physical Activity Courses on Overall Physical Activity and Mood in University Students.

PURPOSE: The aim of this research was to assess the association between university-based instructional physical activity (PA) courses and changes in overall PA levels and negative mood and their interrelations. The study also sought to determine the amount of change in PA required to significantly improve mood in course enrollees. METHOD: Participants were university students initially completing PA below the level recommended for health who were either presently enrolled in an elective instructional PA course (treatment group, n = 52, 69% female) or not presently enrolled in such a course (comparison group, n = 32, 69% female). Validated surveys assessed volumes of PA completed per week and overall negative mood from baseline to course end. Mediation analyses assessed group effects on mood through PA changes and reciprocal relations between PA and mood changes. RESULTS: There was a significantly greater increase in PA and significantly more reduction in negative mood in the treatment group. Change in PA completely mediated the relationship between group and change in negative mood, and change in mood completely mediated the relationship between group and PA. These findings indicated a reciprocal, mutually reinforcing relationship between changes in PA and mood. An increase in PA of at least 2 days/week was associated with a significant reduction in negative mood, with no greater effect for more increase. CONCLUSIONS: Results provided an improved understanding of the effects of university-based instructional PA courses and how they might be leveraged to improve students' mental health and possibly contribute to their academic success.

Weight Loss and the Prevention of Weight Regain: Evaluation of a Treatment Model of Exercise Self-Regulation Generalizing to Controlled Eating.

CONTEXT: For decades, behavioral weight-loss treatments have been unsuccessful beyond the short term. Development and testing of innovative, theoretically based methods that depart from current failed practices is a priority for behavioral medicine. OBJECTIVE: To evaluate a new, theory-based protocol in which exercise support methods are employed to facilitate improvements in psychosocial predictors of controlled eating and sustained weight loss. METHODS: Women with obesity were randomized into either a comparison treatment that incorporated a print manual plus telephone follow-ups (n = 55) or an experimental treatment of The Coach Approach exercise-support protocol followed after 2 months by group nutrition sessions focused on generalizing self-regulatory skills from an exercise support to a controlled eating context (n = 55). Repeated-measures analysis of variance contrasted group changes in weight, physical activity, fruit and vegetable intake, mood, and exercise- and eating-related self-regulation and self-efficacy over 24 months. Regression analyses determined salient interrelations of change scores over both the weight-loss phase (baseline-month 6) and weight-loss maintenance phase (month 6-month 24). RESULTS: Improvements in all psychological measures, physical activity, and fruit and vegetable intake were significantly greater in the experimental group where a mean weight loss of 5.7 kg (6.1% of initial body weight) occurred at month 6, and was largely maintained at a loss of 5.1 kg (5.4%) through the full 24 months of the study. After establishing temporal intervals for changes in self-regulation, self-efficacy, and mood that best predicted improvements in physical activity and eating, a consolidated multiple mediation model suggested that change in self-regulation best predicted weight loss, whereas change in self-efficacy best predicted maintenance of lost weight. CONCLUSIONS: Because for most participants loss of weight remained greater than that required for health benefits, and costs for treatment administration were comparatively low, the experimental protocol was considered successful. After sufficient replication, physician referral and applications within health promotion and wellness settings should be considered.

Bi-Directional Relationship Between Self-Regulation and Improved Eating: Temporal Associations With Exercise, Reduced Fatigue, and Weight Loss.

Severely obese men and women (body mass index ≥ 35 ≤ 55 kg/m(2); M(age) = 44.8 years, SD = 9.3) were randomly assigned to a 6-month physical activity support treatment paired with either nutrition education (n = 83) or cognitive-behavioral nutrition (n = 82) methods for weight loss. Both groups had significant improvements in physical activity, fatigue, self-regulation for eating, and fruit and vegetable intake. Compared to those in the nutrition education group, participants in the behavioral group demonstrated greater overall increases in fruit and vegetable intake and physical activity. These group differences were associated with changes that occurred after Month 3. Increased physical activity predicted reduced fatigue, ß = -.19, p =.01. A reciprocal relationship between the mediators of that relationship, which were changes in self-regulation and fruit and vegetable intake, was identified. There was significantly greater weight loss over six months in the behavioral nutrition group when contrasted with the nutrition education group. Self-regulation for eating and fruit and vegetable intake were significant predictors of weight loss over both three and six months. Findings enabled a better understanding of psychosocial effects on temporal aspects of weight loss and may lead to more effective behavioral treatments for weight loss.

Carry-over of self-regulation for physical activity to self-regulating eating in women with morbid obesity.

Poor outcomes from behavioral treatments of severe obesity have led to a dependence on invasive medical interventions, including surgery for morbidly obese individuals. Improved methods to self-regulate eating will be required to reduce obesity. The use of self-regulation methods for completing physical activity may carry over to increased self-regulation for eating through improved feelings of competence (self-efficacy) and mood. The study recruited women (Meanage = 43 years) with morbid obesity (MeanBMI = 44 kg/m(2)) to participate in 26 weeks of cognitive-behavioral support of physical activity paired with either nutrition education (n = 51) or cognitive-behavioral nutrition (n = 51) methods. Data collected were from 2011 and 2012. Significant improvements in self-regulation for physical activity, self-regulation for eating, overall mood, and self-efficacy for eating, with greater improvement in self-regulation for eating, were observed in the cognitive-behavioral nutrition group. Changes in mood and self-efficacy for eating significantly mediated the relationship between changes in self-regulation for physical activity and self-regulation for eating. When subscales of overall mood and self-efficacy were entered into separate regression equations as mediators, the only significant mediators were vigor, and controlling eating when socially pressured and when increased cues to overeat were present.

Pilot testing a cognitive-behavioral protocol on psychosocial predictors of exercise, nutrition, weight, and body satisfaction changes in a college-level health-related fitness course.

OBJECTIVE: Small-scale pilot testing of supplementing a required college health-related fitness course with a cognitive-behavioral exercise-support protocol (The Coach Approach). PARTICIPANTS: Three classes were randomly assigned to Usual processes (n = 32), Coach Approach-supplemented: Mid-size Groups (n = 32), and Coach Approach-supplemented: Small Groups (n = 34) conditions. METHODS: Repeated-measures analyses of variance (ANOVAs) assessed overall and between-class changes in the behavioral/physiological factors of exercise, fruit/vegetable intake, and body mass index (BMI); and the psychosocial factors of self-regulation, exercise self-efficacy, mood, and body satisfaction. Dependent t tests evaluated within-class changes. Multiple regression analyses tested prediction of exercise by changes in self-regulation, self-efficacy, and mood. RESULTS: Significant improvements in self-regulation and fruit/vegetable intake were found in all classes. The Coach Approach-supplemented classes demonstrated significant increases in exercise. Significant improvements in BMI, self-efficacy, and body satisfaction were found in only The Coach Approach-supplemented: Small Groups class. Psychosocial changes predicted increased exercise. Self-regulation was the strongest contributor. CONCLUSIONS: Overall, results were positive and warrant more comprehensive testing.

Reciprocal effects of exercise and nutrition treatment-induced weight loss with improved body image and physical self-concept.

Improvements in self-image and mood are often reported as outcomes of obesity interventions. However, they may also concurrently influence weight loss, suggesting a reciprocal effect. Although previously reported for overweight women, such relationships were untested in morbidly obese women whose psychosocial responses to treatment may be different, and health-risks greater. Women (N = 161, Meanage = 42 years) with morbid obesity (MeanBMI = 45.1 kg/m(2)) participated in a 6-month, behaviorally based physical activity and nutrition treatment. Significant within-group improvements in weight-loss behaviors (physical activity and eating), weight, body satisfaction, physical self-concept, and depression were found. After controlling for age, mediation analyses indicated that, as a result of the treatment, weight loss was both an outcome and mediator of improvements in body-areas satisfaction and physical self-concept (reciprocal effects), but not depression. Results replicated findings from women with lower degrees of overweight, and suggested that weight-loss treatments emphasize changes in self-perception.

Behavioural support of a proposed neurocognitive connection between physical activity and improved eating behaviour in obese women.

PROBLEM: An explanation of the association between physical activity and improved eating behaviours has recently been posited via the effect of physical activity on executive functions of the brain resulting in a reduction in the hedonic drive to overeat. Decomposition and clarification of embedded relationship through a behavioural/psychological framework was sought. METHODS: Changes in theory-based psychosocial factors over 26 weeks were tested with 134 severely obese women (age 41.7±10.4 years) initiating a physical activity support treatment. Mediation and reciprocal effects analyses incorporating these changes were then computed. RESULTS: Significant improvements in mood, self-regulation for eating, and self-efficacy for controlled eating were found. Emanating from mood change, a reciprocal relationship between changes in the self-regulation and self-efficacy measures was found. Thus, each factor reinforced the other's change. CONCLUSION: Findings suggest a convergence of neurocognitively and behaviourally based explanations of the relations of physical activity and controlled eating. Implications for behavioural weight-loss theory and treatments were suggested.

Reciprocal effects of treatment-induced increases in exercise and improved eating, and their psychosocial correlates, in obese adults seeking weight loss: a field-based trial.

BACKGROUND: A better understanding of interrelations of exercise and improved eating, and their psychosocial correlates of self-efficacy, mood, and self-regulation, may be useful for the architecture of improved weight loss treatments. Theory-based research within field settings, with samples possessing high probabilities of health risks, might enable rapid application of useful findings. METHODS: Adult volunteers with severe obesity (body mass index [BMI] 35-50 kg/m²; age = 43.0 ± 9.5 y; 83% female) were randomly assigned to six monthly cognitive-behavioral exercise support sessions paired with either group-based nutrition education (n = 145) or cognitive behavioral methods applied to improved eating (n = 149). After specification of mediation models using a bias-corrected bootstrapping procedure, a series of reciprocal effects analyses assessed: a) the reciprocal effects of changes in exercise and fruit and vegetable intake, resulting from the treatments, b) the reciprocal effects of changes in the three psychosocial variables tested (i.e. self-efficacy, mood, and self-regulation) and fruit and vegetable change, resulting from change in exercise volume, and c) the reciprocal effects of changes in the three psychosocial variables and exercise change, resulting from change in fruit and vegetable intake. RESULTS: Mediation analyses suggested a reciprocal effect between changes in exercise volume and fruit and vegetable intake. After inclusion of psychosocial variables, also found were reciprocal effects between change in fruit and vegetable intake and change in mood, self-efficacy for controlled eating, and self-regulation for eating; and change in exercise volume and change in mood and exercise-related self-regulation. CONCLUSION: Findings had implications for behavioral weight-loss theory and treatment. Specifically, results suggested that treatments should focus upon, and leverage, the transfer effects from each of the primary weight-loss behaviors (exercise and healthy eating) to the other. Findings on psychosocial correlates of these behavioral processes may also have practical applications.