The Go-VAR (Veterans Active Recovery): An Adjunctive, Exercise-Based Intervention for Veterans Recovering from Substance Use Disorders.

Substance use disorders (SUD) are prevalent among veterans, and the relapse rate is estimated at ≥60% within one year of treatment. Exercise's broad health benefits make it an appealing adjunctive component to interventions preventing relapse among individuals with SUDs. After conducting formative research, we designed and conducted the Go-VAR! (Veterans Active Recovery) pilot study to examine the feasibility and acceptability of a multi-component exercise-based intervention for veterans seeking SUD treatment through the outpatient Alcohol & Drug Treatment Program (ADTP) at the VA San Diego Healthcare System (VASDHS). Participants (N = 15; mean age = 45 [SD = 9.7]; 13% Hispanic, 60% White) from the La Jolla VASDHS outpatient ADTP were enrolled in this 12-week one-arm pilot study. Feasibility and acceptability were established: 70% of participants attended weekly psychoeducation groups, wore their Fitbit Charge HR, increased their weekly physical activity, and used their study-provided YMCA memberships, group exercise training sessions, and Fit4Me personal training program. Lower use of both alcohol and drugs were reported at the end of the study (p < .0001). Significant increases in daily steps as measured by the Fitbit HR and improvements in measures of physical fitness were also achieved (p < .05). Future work should focus on potential integration within the VA system.

Optimal Bowel Cleansing for Colonoscopy in the Elderly Patient.

Colonoscopy is an important diagnostic and screening tool for colorectal cancer detection and prevention, and adequate bowel preparation is critical for successful colonoscopy. Complications related to colonoscopy, either directly or indirectly related to the procedure, are increased in elderly patients, and the risks and benefits of colonoscopy procedures need to be carefully considered in these patients. Recent studies have shown that 4 L polyethylene glycol with a split preparation is safe and effective for elderly patients, and is the preferred preparation for patients with medical comorbidities. Preparations containing sodium phosphate are generally not recommended for the elderly because of increased renal complications. In addition, a low-residue diet may aid in tolerance and willingness to undergo the procedure compared with a clear liquid diet, with comparable bowel preparation adequacy. Risk factors for inadequate bowel preparations include poor adherence to split preparation instructions or volume of solution ingested, and certain patient-related medications and comorbidities, such as diabetes, elevated body mass index, and antidepressant or narcotic use. Methods for achieving safe and adequate bowel preparations in the elderly include clear instructions, reminder calls, and case management for potential confounding patient-related factors.