Yoga and Mental Well-being: A Qualitative Exploration of the Lived Experiences of Yoga Practitioners.

Context: Participation in yoga has increased dramatically amongst all demographic groups in recent decades. While studies have explored the physical and mental benefits of yoga, few have focused on the lived experiences of those practicing yoga and why they continue their involvement. Aims: The purpose of this study was to assess practitioners' views about the impact of yoga on mental well-being and explore how these benefits may support their continued practice. Settings and Design: Semi-structured interviews were conducted with 22 individuals, the majority identified as female (M age = 44.25, standard deviation = 11.80). The majority of participants were White (86.36%) and had practiced yoga for an average of 8-10 years (40.91%). Methods: A pragmatic qualitative approach was taken that included the adoption of a constructivist, narrative, meaning-making ontology, hermeneutic epistemology, and interpretivist axiology. Interviews were conducted on Zoom, recorded, and transcribed verbatim. Analysis Used: Interviews were coded independently by two team members following reflexive thematic analysis procedures. Results: Two major themes, structural and functional components, covered the five main subthemes that explained why yoga was beneficial for mental well-being and highlighted the self-sustaining nature of yoga practice: (1) the yoga environment, (2) personnel, (3) strengthening of mind and body during practice, (4) transfer of skills, and (5) giving back. The practitioners described how their yoga journeys supported their mental well-being and encouraged the long-term maintenance of their yoga practices. A conceptual model will be presented that incorporates the major themes and provides an explanation of why practitioners continue to practice yoga. Conclusions: This study provides insight into how yoga's mental well-being benefits affect adherence, and ultimately, informs our understanding of yoga as a self-sustaining practice.

Physical Activity Assessment and Promotion in Clinical Settings in the United States: A Scoping Review.

OBJECTIVE: The purpose of this scoping review was to systematically examine interventions that focused on physical activity assessment and promotion in clinical settings in the United States. DATA SOURCES: A literature search was performed in 6 major databases to extract published peer-reviewed studies from 2008 to 2019. INCLUSION AND EXCLUSION CRITERIA: Interventions with practicing health professionals in the United States who performed physical activity assessment and promotion with adult patients 18 years of age and older. Studies were excluded if they were published in non-English, observational or case study designs, or gray literature. DATA EXTRACTION: Studies were screened and coded based on the population, intervention, comparison, outcomes and study setting for scoping reviews (PRISMA-ScR) framework. Of 654 studies that were identified and screened for eligibility, 78 met eligibility criteria and were independently coded by two coders. DATA SYNTHESIS: Data were synthesized using qualitative and descriptive methods. RESULTS: Forty-three of the included studies were randomized controlled trials with a majority being delivered by physicians and nurses in primary care settings. Fifty-six studies reported statistically significant findings in outcome measures such as anthropometrics and chronic disease risk factors, with 17 demonstrating improvements in physical activity levels as a result of the interventions. CONCLUSION: The assessment and promotion of physical activity in clinical settings appears to be effective but warrants continued research.

A telephone-based guided imagery tobacco cessation intervention: results of a randomized feasibility trial.

BACKGROUND: Evidence supports the use of guided imagery for smoking cessation; however, scalable delivery methods are needed to make it a viable approach. Telephone-based tobacco quitlines are a standard of care, but reach is limited. Adding guided imagery to quitline services might increase reach by offering an alternative approach. PURPOSE: To develop and test the feasibility and potential impact of a guided imagery-based tobacco cessation intervention delivered using a quitline model. METHODS: Participants for this randomized feasibility trial were recruited statewide through a quitline or community-based methods. Participants were randomized to guided imagery Intervention Condition (IC) or active behavioral Control Condition (CC). After withdrawals, there were 105 participants (IC = 56; CC = 49). The IC consisted of six sessions in which participants created guided imagery audio files. The CC used a standard six-session behavioral protocol. Feasibility measures included recruitment rate, retention, and adherence to treatment. We also assessed 6-month quit rates and consumer satisfaction. RESULTS: Both the IC and CC protocols were feasible to deliver. We finalized protocols and materials for participants, coaches and study staff, and delivered the protocols with fidelity. We developed successful recruitment methods, and experienced high retention (6 months = 81.9%) and adherence (all sessions = 66.7%). Long-term quit rates (IC = 27.9%; CC = 38.1%) compared favorably to those of quitlines, and program satisfaction was high, suggesting that the protocols are acceptable to smokers and may contribute to smoking abstinence. CONCLUSIONS: The guided imagery intervention is feasible and promising, suggesting that a fully powered RCT to test the efficacy of the intervention is warranted. TRIAL REGISTRATION NUMBER: NCT02968381.

Preliminary investigation of interactive associations of sleep and pain with cognition in sedentary middle-aged and older adults.

STUDY OBJECTIVES: The objective of this study was to examine independent and interactive associations between self-reported sleep (sleep efficiency and total sleep time [TST]) and pain with cognition in sedentary middle-aged and older adults. METHODS: Seventy-five sedentary adults at least 50 years of age (Mage = 63.24, standard deviation = 8.87) completed 14 daily diaries measuring sleep and pain. Weekly average sleep efficiency, TST, and pain were computed. Participants also completed computerized cognitive tasks: Letter Series (reasoning), N-back (working memory), Symbol Digit Modalities Test (processing speed, attention), and Number Copy (processing speed). Multiple regression analyses were conducted to determine independent and interactive (with pain) associations of sleep efficiency and TST with cognition, controlling for age, education, and sex. RESULTS: Sleep efficiency and pain interacted in their associations with Letter Series performance and N-back difference scores (2-back minus 1-back). Specifically, higher sleep efficiency was associated with better reasoning and working memory in those with highest pain but not average or lowest pain. TST and pain also interacted in their associations with Letter Series performance. Specifically, longer TST associated with worse reasoning in those with lowest (not average or highest) pain. CONCLUSIONS: Preliminary results show that in sedentary middle-aged and older adults, pain and sleep interact in their associations with executive function tasks. Higher sleep efficiency may be associated with better reasoning and working memory in those with highest pain. Lower TST may be associated with better reasoning in those with lowest pain. Studies evaluating temporal associations between sleep, pain, and cognition are needed.

A Scoping Review of Sport-Based Health Promotion Interventions With Youth in Africa.

Africa has the highest rates of child mortality and diseases in the world. Research suggests that sport can be an effective way to enhance health knowledge and behaviors among at-risk youth in Africa. Scoping reviews explore both the breadth and depth of a research topic, which allows researchers to conduct a detailed analysis and synthesis of studies to understand how, why, and under what circumstances sport-based interventions are effective. The purpose of this scoping review was to specifically examine the study design, theoretical foundations, sample characteristics, measured and observed outcomes, intervention characteristics, and funding sources identified in previous studies that examined sport as a platform for health promotion with youth in Africa. A total of 916 articles were retrieved from 10 electronic bibliographic databases; 28 studies met the inclusion criteria. Of these, four were randomized controlled trials, while the remaining were open trials with pre-posttest assessments, both with comparison conditions and without. Only 10 studies included a theoretical framework to specifically inform the sport-based intervention implemented. Targeted health outcomes included knowledge and behaviors related to a myriad physical and mental health concerns, such as HIV, clean water use, vaccinations, physical activity, and fitness. Statistically significant improvements were observed in 82% of the studies examined. Our results suggest that sport-based interventions may be effective in improving health knowledge and behaviors among youth in Africa. Recommendations for future research, including methodology and the importance of global partnerships with nonprofit organizations, are discussed.

Anxiety and executive functions in mid-to-late life: the moderating role of sleep.

Objectives: The goal of the study was to examine the influence of sleep efficiency on the relationship between anxiety and executive functions.Method: Secondary data analyses of 82 community-dwelling middle-aged and older adults were performed (M age = 63.00, SD = 8.64). Anxiety was measured using the trait anxiety subscale of the State-Trait Anxiety Inventory. Sleep efficiency was measured using one-week of sleep diary data. Two executive functions, cognitive flexibility and inductive reasoning, were measured using the Trail-Making Test and Letter Series task, respectively. SPSS PROCESS macro software version 2 was used to assess the moderating role of sleep efficiency in the relationship between anxiety and executive functions.Results: Sleep significantly moderated the relationship between anxiety and inductive reasoning. Among middle-aged and older adults with high anxiety, those with good sleep efficiency displayed significantly better inductive reasoning than those with poor sleep efficiency after controlling for age, gender, and education (ΔR2 = .05, p = .017). Sleep efficiency did not significantly moderate the relationship between anxiety and cognitive flexibility.Conclusion: Sleep efficiency weakened the association between anxiety and inductive reasoning in middle-aged and older adults. Evidence from the study suggests better sleep may limit the negative effects of anxiety on executive functions in mid-to-late life. Further research is needed to elucidate the impact of anxiety and sleep on executive functions in clinical populations with anxiety.

A Scoping Review of Health Outcomes Examined in Randomized Controlled Trials Using Guided Imagery.

INTRODUCTION: Guided imagery involves the controlled visualization of detailed mental images. This integrative health technique is used for healing, health maintenance, or the treatment of specific conditions. Guided imagery is an integral part of mindfulness meditation, hypnosis, and various relaxation exercises. However, evidence to support the widespread use and dissemination of guided imagery interventions has been lacking. The purposes of this scoping review were to document the scope of health outcomes and disease processes examined by guided imagery researchers and the journal outlets where this work has been published. Secondary purposes were to review the efficacy of guided imagery, risk of bias from studies published in selected integrative health journals, and gain feedback from clinicians in a practiced-based research network (PBRN) about potential barriers for use in clinical settings. METHODS: Ten bibliographic databases were searched for randomized controlled trials (RCTs) published between 1960 and 2013 that included adult participants. Descriptive and analytic methods were employed to document the journal outlets, diseases, and health outcomes investigated. RESULTS: 320 RCTs that included more than 17,979 adult participants were reviewed. The published studies appeared in 216 peer-reviewed journals from diverse disciplines largely representing psychology, the sport sciences, rehabilitation, nursing, and medicine. Major outcomes observed were coping with pain, stroke recovery, anxiety, coping with stress, and sport skills. Practitioner feedback from the PBRN revealed some interest but skepticism and time constraints were discussed as barriers. CONCLUSIONS: Ongoing research and creative dissemination techniques are warranted.

Neonatal Abstinence Syndrome in West Virginia Substate Regions, 2007-2013.

PURPOSE: The opioid epidemic is a public health threat with consequences affecting newborns. Neonatal Abstinence Syndrome (NAS) is a constellation of withdrawal symptoms resulting primarily from in utero opioid exposure. The purpose of this study was to examine NAS and drug-specific trends in West Virginia (WV), where rurality-related issues are largely present. METHODS: The 2007-2013 WV Health Care Authority, Uniform Billing Data were analyzed for 119,605 newborn admissions with 1,974 NAS diagnoses. NAS (ICD9-CM 779.5) and exposure diagnostic codes for opioids, hallucinogens, and cocaine were utilized as incidence rate (IR) per 1,000 live births. FINDINGS: Between 2007 and 2013, NAS IR significantly increased from 7.74 to 31.56 per 1,000 live births per year (Z: -19.10, P < .0001). During this time period, opioid exposure increased (Z: -9.56, P < .0001), while cocaine exposure decreased (Z: 3.62, P = .0003). In 2013, the southeastern region of the state had the highest NAS IR of 48.76 per 1,000 live births. NAS infants were more likely to experience other clinical conditions, longer hospital stay, and be insured by Medicaid. CONCLUSIONS: Statewide NAS IR increased 4-fold over the study period, with rates over 3 times the national annual averages. This alarming trend is deleterious for the health of WV mother-child dyads and it strains the state's health care system. Therefore, WV has a unique need for prenatal public health drug treatment and prevention resources, specifically targeting the southeastern region. Further examination of maternal drug-specific trends and general underutilization of neonatal exposure ICD-9-CM codes is indicated.

Theoretical, Critical, and Practical Reflections on the Long-Term Maintenance of Health Behavior Change.

This commentary is in response to Joseph, Daniel, Thind, Benitez and Pekmezi (2014). They reviewed randomized controlled trials (RCTs) that included long-term follow-up assessments at least 6 months post-intervention. Their main purpose was to understand which theory or model used by researchers could help explain the long-term maintenance of health behaviors once the intervention was withdrawn in trials focused on physical activity, dietary behavior, and excessive alcohol consumption. Results showed that social cognitive theory (SCT) and transtheoretical model (TTM) were used most often and associated with long-term behavior change compared to self-determination theory (SDT), theory of planned behavior (TPB), or the social-ecological model (SEM). SDT showed encouraging findings while the evidence was unclear for the TPB and the SEM. Here it is argued that scientists should continually reflect on the utility of theory over time and the efforts by Joseph and colleagues should be commended. It is also useful to distinguish theories, which are more specified and offer more generalized statements, than models. Models, such as the TPB and SEM, have incorporated elements of other theories but are typically viewed as tools to characterize behavior. For instance, in 10 studies reviewed by Joseph and colleagues the SCT and TTM were used in an integrative manner. An example of an integrated model is presented that incorporates elements of SDT, TPB, and SCT in an effort to highlight how integrating elements from multiple theories may be useful.

Guided Imagery for Arthritis and Other Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials.

Many individuals suffering from arthritis and other rheumatic diseases (AORD) supplement pharmacologic treatments with psychosocial interventions. One promising approach, guided imagery, has been reported to have positive results in randomized controlled trials (RCTs) and is a highly scalable treatment for those with AORD. The main purpose of this study was to conduct a systematic review of RCTs that have examined the effects of guided imagery on pain, function, and other outcomes such as anxiety, depression, and quality of life in adults with AORD. Ten electronic bibliographic databases were searched for reports of RCTs published between 1960 and 2013. Selection criteria included adults with AORD who participated in RCTs that used guided imagery as a partial or sole intervention strategy. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Results were synthesized qualitatively. Seven studies representing 306 enrolled and 287 participants who completed the interventions met inclusion criteria. The average age of the participants was 62.9 years (standard deviation = 12.2). All interventions used guided imagery scripts that were delivered via audio technology. The interventions ranged from a one-time exposure to 16 weeks in duration. Risk of bias was low or unclear in all but one study. All studies reported statistically significant improvements in the observed outcomes. Guided imagery appears to be beneficial for adults with AORD. Future theory-based studies with cost-benefit analyses are warranted.

Intervention markers of physical activity maintenance in older adults.

OBJECTIVES: To identify intervention components that may promote longterm changes of physical activity among older adults in a behavioral theory-based physical activity trial. METHODS: Participants (N = 24; aged 65 ± 8.79 years) shared perceptions of intervention components at the end of the intervention and physical activity was assessed at 18 months. Mixed-methods analyses using a pragmatic content analysis of interview data were conducted. RESULTS: Active study participants (25%) cited more specific goals/actions to achieve goals and more social support from family/friends, and had significantly higher self-determined motivation mean scores at 18 months than insufficiently active study participants (75%). CONCLUSIONS: Specific goal-setting behaviors and social support from family/friends may be key elements of physical activity maintenance in older adults.

Energy flux: staying in energy balance at a high level is necessary to prevent weight gain for most people.

Energy flux, the rate of energy conversion from absorption to expenditure or storage, is a critical component of understanding weight management. Individuals who maintain body weight over time have common characteristics including a relatively high level of physical activity and minimal changes in body composition, muscle mass and metabolic rate. A higher state of energy flux resulting from high energy expenditure may provide for a greater 'sensitivity' between energy intake and expenditure. This sensitivity stabilizes body weight by enhancing reciprocal compensation among these components with changes in eating or activity. The energy balance framework suggests that a higher level of energy expenditure requires higher energy intake to maintain body mass. Maintaining energy balance at a higher caloric intake and expenditure should be a more successful long-term strategy for weight maintenance than reduced consumption or extreme caloric restriction at a low level of energy expenditure (a low energy flux) and improve intervention effectiveness for sustainable methods for body weight stability.

Exercise and sleep in community-dwelling older adults: evidence for a reciprocal relationship.

Exercise behaviour and sleep are both important health indicators that demonstrate significant decreases with age, and remain modifiable well into later life. The current investigation examined both the chronic and acute relationships between exercise behaviour and self-reported sleep in older adults through a secondary analysis of a clinical trial of a lifestyle intervention. Seventy-nine community-dwelling, initially sedentary, older adults (mean age = 63.58 years, SD = 8.66 years) completed daily home-based assessments of exercise behaviour and sleep using daily diary methodology. Assessments were collected weekly and continued for 18 consecutive weeks. Multilevel models revealed a small positive chronic (between-person mean-level) association between exercise and wake time after sleep onset, and a small positive acute (within-person, day-to-day) association between exercise and general sleep quality rating. The within-person exercise and general sleep quality rating relationship was found to be reciprocal (i.e. sleep quality also predicted subsequent exercise behaviour). As such, it appears exercise and sleep are dynamically related in older adults. Efforts to intervene on either sleep or exercise in late-life would be wise to take the other into account. Light exposure, temperature regulation and mood may be potential mechanisms of action through which exercise can impact sleep in older adults.

Cognitive Inconsistency and Practice-Related Learning in Older Adults.

The current study examined predictors of individual differences in the magnitude of practice-related improvements achieved by 87 older adults (meanage 63.52 years) over 18-weeks of cognitive practice. Cognitive inconsistency in both baseline trial-to-trial reaction times and week-to-week accuracy scores was included as predictors of practice-related gains in two measures of processing speed. Conditional growth models revealed that both reaction time and accuracy level and rate-of-change in functioning were related to inconsistency, even after controlling for mean-level, but that increased inconsistency was negatively associated with accuracy versus positively associated with reaction time improvement. Cognitive inconsistency may signal dysregulation in the ability to control cognitive performance or may be indicative of adaptive attempts at functioning.

Exploring behavioral markers of long-term physical activity maintenance: a case study of system identification modeling within a behavioral intervention.

Efficacious interventions to promote long-term maintenance of physical activity are not well understood. Engineers have developed methods to create dynamical system models for modeling idiographic (i.e., within-person) relationships within systems. In behavioral research, dynamical systems modeling may assist in decomposing intervention effects and identifying key behavioral patterns that may foster behavioral maintenance. The Active Adult Mentoring Program was a 16-week randomized controlled trial of a group-based, peer-delivered physical activity intervention targeting older adults. Time-intensive (i.e., daily) physical activity reports were collected throughout the intervention. We explored differential patterns of behavior among participants who received the active intervention (N = 34; 88% women, 64.1 ± 8.3 years of age) and either maintained 150 minutes/week of moderate to vigorous intensity physical activity (MVPA; n = 10) or did not (n = 24) at 18 months following the intervention period. We used dynamical systems modeling to explore whether key intervention components (i.e., self-monitoring, access to an exercise facility, behavioral initiation training, behavioral maintenance training) and theoretically plausible behavioral covariates (i.e., indoor vs. outdoor activity) predicted differential patterns of behavior among maintainers and nonmaintainers. We found that maintainers took longer to reach a steady-state of MVPA. At week 10 of the intervention, nonmaintainers began to drop whereas maintainers increased MVPA. Self-monitoring, behavioral initiation training, percentage of outdoor activity, and behavioral maintenance training, but not access to an exercise facility, were key variables that explained patterns of change among maintainers. Future studies should be conducted to systematically explore these concepts within a priori idiographic (i.e., N-of-1) experimental designs.

Exercise and quality of life in women with multiple sclerosis.

The purpose of this study was to evaluate perceptions of quality of life after a 4-month progressive resistance training program for individuals with multiple sclerosis (MS). A second purpose was to examine participants' views about factors that facilitated or impeded exercise behavior. Qualitative interviews were conducted with eight females (Mage = 49.86, SD = 6.94) with relapsing remitting MS. Audio-tape recorded interviews were transcribed verbatim and coded. Walking performance improved (M = 13.08%, SD = 7.11). All participants perceived improvements in muscular strength and endurance while six indicated improvements in walking endurance and performance in tasks of daily living. Social benefits of participation were discussed by seven participants including interactions in the exercise environment. We concluded that supervised resistance training may promote improvements in QOL for women with relapsing remitting MS.

Peer volunteers improve long-term maintenance of physical activity with older adults: a randomized controlled trial.

BACKGROUND: Using peer volunteers as delivery agents may improve translation of evidence-based physical activity promotion programs for older adults. This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior. METHODS: Participants were randomized to 2 16-week, group-based programs: (1) peer-delivered, theory-based support for physical activity behavior change; or (2) an intervention typically available in community settings (basic education, gym membership, and pedometer for self-monitoring), attention-matched with health education. Moderate-to-vigorous physical activity (MVPA) was assessed via daily self-report logs at baseline, at the end of the intervention (16 weeks), and at follow-up (18 months), with accelerometry validation (RT3) in a random subsample. RESULTS: Seven peer volunteers and 81 sedentary adults were recruited. Retention at the end of the trial was 85% and follow-up at 18 months was 61%. Using intent-to-treat analyses, at 16 weeks, both groups had similar significant improvements in MVPA. At 18 months, the group supplemented with peer support had significantly more MVPA. CONCLUSIONS: Trained peer volunteers may enhance long-term maintenance of physical activity gains from a community-based intervention. This approach has great potential to be adapted and delivered inexpensively in community settings.

The effect of guided relaxation and exercise imagery on self-reported leisure-time exercise behaviors in older adults.

The purpose of this study was to examine the effects of a 6-wk intervention that used guided relaxation and exercise imagery (GREI) to increase self-reported leisure-time exercise behavior among older adults. A total of 93 community-dwelling healthy older adults (age 70.38 ± 8.15 yr, 66 female) were randomly placed in either a placebo control group or an intervention group. The intervention group received instructions to listen to an audio compact disk (CD) containing a GREI program, and the placebo control group received an audio CD that contained 2 relaxation tracks and instructions to listen to music of their choice for 6 wk. Results revealed that listening to a GREI CD for 6 wk significantly increased self-reported leisure-time exercise behaviors (p = .03). Further exploration of GREI and its effects on other psychological variables related to perceived exercise behaviors may substantiate its effectiveness.