Exercise professional education, qualifications, and certifications: a content analysis of job postings in the United States.

Introduction: Growth in the field of clinical exercise science and the potential impacts on overall health and wellbeing have driven the need for qualified, clinically trained, exercise professionals. And yet, it is not well understood what specific credentials employers are seeking when hiring exercise professionals. Purpose: The purpose of the study was to examine the qualification requirements for professionals seeking employment in exercise science, exercise physiology, kinesiology or equivalent fields. Methods: Search platforms Indeed.com and USAJobs.gov were examined within a two week period in 2022. Search terms included "Exercise Physiology", "Exercise Science", "Exercise Professional", "Exercise Prescription", "Exercise Specialist", and "Kinesiology". Results: A total of n = 739 jobs were retrieved and n = 615 jobs were included: Exercise Science (n = 227), Kinesiology (n = 210), Exercise Physiology (n = 91), Exercise specialist (n = 53), and Exercise prescription (n = 32). Over 70% of the jobs analyzed required a bachelor's degree with the remainder requiring various levels of education. The primary certification required was personal trainer (n = 94), followed by strength and conditioning specialist (n = 33), clinical exercise physiologist (n = 26), group exercise (n = 17), exercise specialist (n = 10), and exercise physiologist (n = 5). Four job focus areas were determined: academic teaching and research, general fitness and worksite wellness, athletic performance and rehabilitation, clinical exercise specialist all with varying levels of degree and certification requirements. Discussion: Job postings related to exercise related professions are varied across the United States with wide-ranging education, credentialing and certification requirements. These findings indicate the timely need for outreach to employers to highlight changing credentialing requirements due to evolving accreditation standards.

Nutrition Interventions on Muscle-Related Components of Sarcopenia in Females: A Systematic Review of Randomized Controlled Trials.

Sarcopenia is a skeletal muscle disease categorized by low muscle strength, muscle quantity or quality, and physical performance. Sarcopenia etiology is multifaceted, and while resistance training is widely agreed upon for prevention and treatment, disease progression is also highly related to poor diet. The incidence of sarcopenia appears sex-specific and may be increased in females, which is problematic because dietary quality is often altered later in life, particularly after menopause. Identifying effective nutrition or supplementation interventions could be an important strategy to delay sarcopenia and related comorbidities in this vulnerable population. This systematic review examined randomized controlled trials (RCTs) of nutrition strategies on muscle-related components of sarcopenia in middle-aged and older females. A protocol was registered (PROSPERO CRD42022382943) and a systematic search of MEDLINE and CINAHL was undertaken. RCTs from 2013 to 2023 that assessed nutrition-only interventions on muscle mass, muscle strength, and physical function in female participants were included. Fourteen RCTs were included based on selection criteria. Study designs and interventions were heterogeneous in supplementation type and amount, age, and duration. Six RCTs reported beneficial effects of protein, Vitamin D, Vitamin D and Magnesium (Mg), and fish oil on muscle protein synthesis, muscle strength, and/or muscle function. Eight studies that examined various protein interventions, VitD alone, Mg alone, and dairy derivatives did not demonstrate any effect. Exercise appeared to modulate results in several studies. Nutrition interventions alone are likely to have a limited but positive effect on muscle-related components of sarcopenia in females. Current evidence suggests that a combination of dietary intervention and exercise is likely to be key to preventing and treating sarcopenia in middle aged and older females and there is a need for well-designed nutrition based studies in this population.

Protocol: Can coronary artery calcium score identified on thoracic planning CT scans be used and actioned to identify cancer survivors at high risk of cardiac events: A feasibility study in cancer survivors undergoing radiotherapy in Australia.

INTRODUCTION: A coronary artery calcium (CAC) CT scan can identify calcified plaque and predict risk of future cardiac events. Cancer survivors undergoing thoracic radiotherapy routinely undergo a planning CT scan, which presents a unique opportunity to use already obtained medical imaging to identify those at the highest risk of cardiac events. While radiation therapy is an important modality for many cancer treatments, radiation dose to the heart in thoracic radiotherapy leads to cardiotoxicity and may accelerate pre-existing atherosclerosis. The primary aims of this study are to investigate the feasibility of using CAC scores calculated on thoracic radiotherapy planning CT scans to identify a subset of cancer survivors at an increased risk of future cardiac events, and to establish and evaluate a referral pathway for assessment and management in a cardio-oncology clinic. An optional substudy aims to investigate using abdominal aortic calcification (AAC) as a practical, low-radiation alternative to CAC to evaluate and monitor vascular health. METHODS AND ANALYSIS: This is an observational, prospective study in a minimum of 100 cancer survivors commencing radiotherapy. Participants will have CAC scored from thoracic radiotherapy planning CT scans. Those identified as high risk (CAC score>0) will be referred to a cardio-oncology clinic. Feasibility, determined by adherence to the recommended pathway, and impact on quality of life and anxiety measured via questionnaire, will be assessed. Participants in Western Australia will be invited to participate in a 12-month observational pilot substudy, investigating lifestyle behaviours and the use of a dual-energy X-ray absorptiometry machine to measure musculoskeletal health and AAC. ETHICS AND DISSEMINATION: Ethics approval has been obtained from St Vincent's Hospital, Sydney (Project number 2021/ETH11847), GenesisCare and Edith Cowan University (2022-03326-DALLAVIA). Study results will be reported in peer-reviewed academic journals, at scientific conferences, and at clinical forums, irrespective of the results observed. TRIAL REGISTRATION NUMBER: ACTRN12621001343897.

Impact of vascular screening interventions on perceived threat, efficacy beliefs and behavioural intentions: a systematic narrative review.

Health-related behaviours contribute to the global burden of cardiovascular disease (CVD). Cardiovascular imaging can be used to screen asymptomatic individuals for increased risk of CVD to enable earlier interventions to promote health-related behaviours to prevent or reduce CVD risk. Some theories of behaviour and behaviour change assume that engagement in a given behaviour is a function of individual threat appraisals, beliefs regarding the performance of behaviour, self-efficacy for performing the desired behaviour and/or dispositions to act (e.g. behavioural intentions). To date, little is known about the impact of cardiovascular imaging interventions on these constructs. This article summarises evidence related to perceived threat, efficacy beliefs, and behavioural intentions after CVD screening. We identified 10 studies (2 RCTs and 8 non-randomised studies, n = 2498) through a combination of screening citations from published systematic reviews and meta-analyses and searching electronic databases. Of these, 7 measured behavioural intentions and perceived susceptibility and 3 measured efficacy beliefs. Findings showed largely encouraging effects of screening interventions on bolstering self-efficacy beliefs and strengthening behavioural intentions. Imaging results that suggest the presence of coronary or carotid artery disease also increased perceived susceptibility to CVD. However, the review also identified some gaps in the literature, such as a lack of guiding theoretical frameworks and assessments of critical determinants of health-related behaviours. By carefully considering the key issues highlighted in this review, we can make significant strides towards reducing CVD risks and improving population health.

This systematic narrative review sought to comprehensively report evidence related to individual responses to cardiovascular screening interventions. Theoretically, the study builds upon theories based on the cognitive perspective (e.g. Health Belief Model, Protection Motivation Theory), which supports the examination of individual perceptions of negative health-related outcomes or health risk, beliefs regarding the performance of a behaviour or outcome expectancies (e.g. perceived benefits of behavioural performance), personal control or capacity to perform a behaviour and/or willingness to invest the effort to engage in behaviour after behavioural intervention delivery. These concepts are considered key predictors of health-related behaviours and have been examined in several public health interventions. Using a variety of search strategies, studies that reported outcomes of interest were identified. Some studies showed that cardiovascular screening interventions may help people form the desired intention to engage in health-related behaviours. We also observed (largely) encouraging effects of cardiovascular screening interventions on individual confidence to engage in health-related behaviours and understanding of personal health risks. However, we identified some limitations in the design, delivery and outcomes assessed in the studies included. For future research, key recommendations to inform the design and delivery of health behaviour interventions are provided.

Looking back: a review of policy implications for exercise oncology.

The evidence to support the benefits of exercise for people living with and beyond cancer is robust. Still, exercise oncology interventions in the United States are only eligible for coverage by third-party payers within the restrictions of cancer rehabilitation settings. Without expanded coverage, access will remain highly inequitable, tending toward the most well-resourced. This article describes the pathway to third-party coverage for 3 programs that address a chronic disease and utilize exercise professionals: the Diabetes Prevention Program, Supervised Exercise Training for Peripheral Artery Disease, and Cancer Rehabilitation. Lessons learned will be applied toward expanding third-party coverage for exercise oncology programming.

Key takeaways for knowledge expansion of early-career scientists conducting Transdisciplinary Research in Energetics and Cancer (TREC): a report from the TREC Training Workshop 2022.

The overall goal of the annual Transdisciplinary Research in Energetics and Cancer (TREC) Training Workshop is to provide transdisciplinary training for scientists in energetics and cancer and clinical care. The 2022 Workshop included 27 early-to-mid career investigators (trainees) pursuing diverse TREC research areas in basic, clinical, and population sciences. The 2022 trainees participated in a gallery walk, an interactive qualitative program evaluation method, to summarize key takeaways related to program objectives. Writing groups were formed and collaborated on this summary of the 5 key takeaways from the TREC Workshop. The 2022 TREC Workshop provided a targeted and unique networking opportunity that facilitated meaningful collaborative work addressing research and clinical needs in energetics and cancer. This report summarizes the 2022 TREC Workshop's key takeaways and future directions for innovative transdisciplinary energetics and cancer research.

Running Marathons in High School: A 5-Year Review of Injury in a Structured Training Program.

OBJECTIVE: The aim in this study was to quantify the number, nature, and severity of injuries sustained by male and female high school students who took part in a running training program that culminated in the completion of a half or full marathon. DESIGN: This study is a retrospective clinical audit. METHODS: Injury reports from high school students (grades 9-12) who participated in a half or full marathon 30-week progressive training program comprising four training days per week (three running days and one cross-training day) were reviewed. The number of runners completing a marathon, together with the number, nature, severity of injuries, and treatment types, as reported to the program physiotherapist, were the main outcome measures. RESULTS: Program completion was 96% (n = 448/469). Of all participants, 186 (39.6%) were injured, with 14 withdrawing from the program due to injury. For those who completed a marathon, 172 (38%) reported 205 musculoskeletal injuries (age of injured runners: 16.3 ± 1.1 years; 88 girls (51.2%) and 84 boys (48.8%)). More than half (n = 113, 55.1%) of the reported injuries were soft tissue injuries. Most injuries were localized to the lower leg (n = 88, 42.9%) and were of a minor nature (n = 181, 90%), requiring only 1-2 treatments. CONCLUSIONS: There was a low number of relatively minor injuries for high school participants taking part in a graduated and supervised marathon training program. The injury definition was conservative (i.e., any attendance to physiotherapist) and the relative severity of injuries was minor (i.e., requiring 1-2 treatment sessions). Overall, these results do not support a need to restrict high school students from taking part in marathon running, though continued emphasis on graduated program development and close supervision of young participants is recommended.

Provision of non-invasive coronary and carotid vascular imaging results on changes in diet and physical activity in asymptomatic adults: A scoping review.

Background: Although a healthy diet and physical activity have been shown to prevent or delay cardiovascular disease (CVD) hospitalizations and deaths, most adults do not meet current guidelines. Provision of coronary artery calcification (CAC) and carotid ultrasound (CUS) imaging results may motivate beneficial lifestyle changes. We scoped the existing literature for studies providing non-invasive vascular imaging results and reporting diet, physical activity, and/or anthropometric measures to identify knowledge gaps and opportunities for further research. Methods: A systematic search was performed across three electronic databases, in line with PRISMA ScR guidelines and Arksey and O'Malley's scoping review framework. Results: Twenty studies (thirteen observational and seven randomized controlled trials) examining the impact of provision of CAC/CUS imaging results on diet and/or physical activity behaviors were included. Nearly half the studies did not clearly state whether participants received dietary and physical activity advice along with vascular imaging results, and these were secondary outcomes in most studies, with data assessment and reporting being inconsistent. Conclusion: Well-designed clinical trials with consistent and clear messaging based on detailed subjective and objective measures of diet and physical activity are needed to determine whether this approach may stimulate long-term dietary and physical activity change.

Building the plane while it's flying: implementation lessons from integrating a co-located exercise clinic into oncology care.

BACKGROUND: Despite its therapeutic role during cancer treatment, exercise is not routinely integrated into care and implementation efforts are largely absent from the literature. The aim of this study was to evaluate a strategy to integrate the workflow of a co-located exercise clinic into routine care within a private oncology setting in two clinics in the metropolitan region of Western Australia. METHODS: This prospective evaluation utilised a mixed methods approach to summarise lessons learned during the implementation of an integrated exercise workflow and supporting implementation plan. Data collection was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Reports detailing utilisation of the exercise service and its referral pathways, as well as patient surveys and meeting minutes documenting the implementation process informed the evaluation. RESULTS: The co-located exercise service achieved integration into routine care within the clinical oncology setting. Patient utilisation was near capacity (reach) and 100% of clinicians referred to the service during the 13-month evaluation period (adoption). Moreover, ongoing adaptations were made to improve the program (implementation) and workflows were integrated into standard operating practices at the clinic (maintenance). The workflow performed as intended for ~70% of exercise participants (effectiveness); however, gaps were identified in utilisation of the workflow by both patients and clinicians. CONCLUSION: Integration of exercise into standard oncology care is possible, but it requires the ongoing commitment of multiple stakeholders across an organisation. The integrated workflow and supporting implementation plan greatly improved utilisation of the co-located exercise service, demonstrating the importance of targeted implementation planning. However, challenges regarding workflow fidelity within and across sites limited its success highlighting the complexities inherent in integrating exercise into clinical oncology care in a real-world setting.

Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review.

PURPOSE: While calls have been made for exercise to become standard practice in oncology, barriers to implementation in real-world settings are not well described. This systematic scoping review aimed to comprehensively describe barriers impeding integration of exercise into routine oncology care within healthcare systems. METHODS: A systematic literature search was conducted across six electronic databases (since 2010) to identify barriers to implementing exercise into real-world settings. An ecological framework was used to classify barriers according to their respective level within the healthcare system. RESULTS: A total of 1,376 results were retrieved; 50 articles describing implementation barriers in real-world exercise oncology settings were reviewed. Two hundred and forty-three barriers were identified across all levels of the healthcare system. Nearly 40% of barriers existed at the organizational level (n = 93). Lack of structures to support exercise integration and absence of staff/resources to facilitate its delivery were the most common issues reported. Despite the frequency of barriers at the organizational level, organizational stakeholders were largely absent from the research. CONCLUSIONS: Implementing exercise into routine cancer care is hindered by a web of interrelated barriers across all levels of the healthcare system. Organizational barriers are central to most issues. Future work should take an interdisciplinary approach to explore best practices for overcoming implementation barriers, with organizations as a central focus. IMPLICATIONS FOR CANCER SURVIVORS: This blueprint of implementation barriers highlights critical issues that need to be overcome to ensure people with cancer have access to the therapeutic benefits of exercise during treatment and beyond.

We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology.

BACKGROUND: Exercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate research into practice; however, implementation barriers have limited their success in part because successful translation of exercise oncology research into practice requires context-specific implementation plans. The aim of this study was to employ the implementation mapping protocol to develop an implementation plan to support programming of a co-located exercise clinic and cancer treatment center. METHODS: The Implementation Mapping protocol, which consists of five specific iterative tasks, was used. A stakeholder advisory group advised throughout the process. RESULTS: A comprehensive needs assessment was used to identify the organization's general manager as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified. The theoretical domains framework was used to identify likely determinants of change, which informed the selection of eight individual implementation strategies across the individual and organizational levels. Finally, an evaluation plan was developed which will be used to measure the success of the implementation plan in the project's next phase. CONCLUSION: The Implementation Mapping protocol provided a roadmap to guide development of a comprehensive implementation plan that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to development of the plan.

Safety, Effectiveness, and Uptake of Exercise Medicine Integrated Within a Cancer Care Center.

OBJECTIVES: The aim of this study was to evaluate the safety, effectiveness, and acceptability of an exercise clinic co-located within a cancer treatment center to identify best practices for integrating exercise medicine into cancer care. DATA SOURCES: Two-hundred thirty-seven patients were referred to the exercise clinic and completed self-report health and demographic questionnaires. Further assessments were conducted at baseline on 67 patients and following completion of the exercise program by 46 patients. Endpoints included muscular strength, physical function, cardiorespiratory fitness, body composition, quality of life, and fatigue scores. Adverse events were tracked throughout exercise participation to evaluate program safety. CONCLUSION: Exercise programming co-located and aligned with cancer treatment in a real-world clinical setting appears to be safe with only four minor exercise-related adverse events. Effectiveness was demonstrated by all physical performance (2.9%-9.5%), strength (7.4%-27.6%), and balance (10.1%) improving and some patients reported outcomes exhibiting modest but clinically relevant benefit. Importantly, no outcomes including fatigue worsened even though the patients were undergoing radiation and/or chemotherapy. Assessment of patient physical and self-reported outcomes should be co-located where they receive oncological treatment and/or exercise medicine to increase uptake of this aspect of the service. Future work should incorporate and describe program and implementation design to help identify best practices in exercise oncology programming. IMPLICATIONS FOR NURSING PRACTICE: Nurses are a primary driver of exercise among patients receiving treatment for cancer. Their regular patient interactions offer a practical opportunity to collect and record important exercise-related information from patients. As organizations look to develop plans to implement exercise into standard practice, input from nurses is critical to ensure program feasibility.

If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework.

OBJECTIVE: Employ the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the effectiveness of a co-located exercise clinic model in increasing access to exercise for people undergoing cancer treatment in a private clinic in Western Australia. METHODS: This retrospective evaluation utilised a mixed-method approach to gather feedback from key stakeholder groups involved with the exercise clinic. Questionnaires and workout summary sheets were gathered from 237 exercise clinic participants over the 50-month evaluation period. These were supplemented by survey results from 119 patients who received cancer treatment at the facility, and semi-structured interviews from seven radiation oncologists, eight nurses, and three accredited exercise physiologists involved with the exercise clinic. RESULTS: The co-located clinic demonstrated positive outcomes related to effectiveness and adoption. Participant feedback indicated satisfaction with the exercise programming (effectiveness), and clinicians were receptive to referring patients to the clinic (adoption). However, no clear implementation or maintenance plan was employed and overall reach (12%) remained suboptimal throughout the evaluation period. CONCLUSION: Co-locating an exercise clinic into a treatment facility does not in itself overcome the logistical challenges of providing integrated exercise services to people during cancer treatment. To enhance its utilisation, an implementation plan needs to accompany the intervention.

Bridging the gap between clinicians and fitness professionals: a challenge to implementing exercise as medicine.

OBJECTIVE: Health clubs (HC) and personal trainers (PT) are traditional outlets for the promotion of physical activity (PA) and exercise programming. As physicians are increasingly being called on to write exercise prescriptions for their patients, this study sought to investigate the level of integration between the healthcare and fitness systems. DESIGN: An internet study was designed with five domains to understand physicians': (1) overall perception of HC, (2) appropriateness and recommendation of HC and PT to their patients, (3) attitude regarding specific aspects of HC, (4) support of patient participation in HC sponsored exercise and (5) elements of HC that physicians would like to know for referral. METHODS: An electronic survey was sent to members of two mailing lists of primary care and sports medicine specialty physicians during 2011-2012. RESULTS: On a Likert scale of 1-10 412 physicians reported being familiar with HC (8.9±2.1), indicated a favourable view of HC (7.9±2.2), and believe HC to be an appropriate venue for their patients (7.5±2.3). However, physicians only recommend HC to 41%±28% of their patients and PT for only 21%±21.6% of patients. Physicians ranked expense and convenience as the most problematic elements of HC (8.1±2.1 and 6.3±2.5, respectively). 72% of physicians indicated cost as most concerning when recommending a specific HC. CONCLUSION: HC and PT are a significant implementation system for the promotion of physical activity, yet physicians are concerned with several elements of HC and are not adequately relying on this partnership to promote physical activity to their patients.

Practice patterns, counseling and promotion of physical activity by sports medicine physicians.

OBJECTIVES: This study examined sports medicine physicians with an established interest in physical activity to investigate attitudes surrounding exercise, physical activity and patient-counseling behavior. The degree to which physicians' personal knowledge of physical activity and related resources, involvement with common activities, and perceived barriers were assessed. DESIGN: An internet survey was designed in four domains: (1) counseling behavior, (2) tools and resources, (3) appropriateness of common physical activities for patients and (4) barriers. METHODS: The survey was sent to 3570 members of two electronic mailing lists - Institute of Lifestyle Medicine, Boston, MA and The American College of Sports Medicine. Surveys were emailed during 2011-2012 and analyzed in 2013-2014. Each survey contained 39 questions. RESULTS: The response rate of the surveys was 16%. Of 412 physicians, 74% regularly recommended physical activity, 66% talked about exercise with patients, and 49% included as a vital sign. Only 26% of physicians provided a written exercise prescription. ACSM's Exercise is Medicine® (37%) was the most popular resource. Walking, followed by aerobic activity, strength training and cycling were the most recommended forms of activity and were associated with physicians' personal experiences. The most potent inhibitor was time. CONCLUSIONS: Physicians with an interest in exercise and physical activity recognize the importance of recommending and counseling patients on exercise and physical activity. Physician counseling was associated with personal familiarity with physical activity. Increasing knowledge and experience with exercise, physical activity and counseling behavior is an important component to encourage physical activity assessment and promotion by sports medicine physicians.

Physical activity counseling in medical school education: a systematic review.

BACKGROUND: Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. METHODS: The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students' awareness of benefits of PA, change in students' attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. RESULTS: Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students' attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students' personal PA behaviors. CONCLUSIONS: Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.

Identifying whole grain foods: a comparison of different approaches for selecting more healthful whole grain products.

OBJECTIVE: Eating whole grains (WG) is recommended for health, but multiple conflicting definitions exist for identifying whole grain (WG) products, limiting the ability of consumers and organizations to select such products. We investigated how five recommended WG criteria relate to healthfulness and price of grain products. DESIGN: We categorized grain products by different WG criteria including: the industry-sponsored Whole Grain stamp (WG-Stamp); WG as the first ingredient (WG-first); WG as the first ingredient without added sugars (WG-first-no-added-sugars); the word 'whole' before any grain in the ingredients ('whole'-anywhere); and a content of total carbohydrate to fibre of ≤10:1 (10:1-ratio). We investigated associations of each criterion with health-related characteristics including fibre, sugars, sodium, energy, trans-fats and price. SETTING: Two major grocery store chains. SUBJECTS: Five hundred and forty-five grain products. RESULTS: Each WG criterion identified products with higher fibre than products considered non-WG; the 10:1-ratio exhibited the largest differences (+3·15 g/serving, P < 0·0001). Products achieving the 10:1-ratio also contained lower sugar (−1·28 g/serving, P = 0·01), sodium (−15·4 mg/serving, P = 0·04) and likelihood of trans-fats (OR = 0·14, P < 0·0001), without energy differences. WG-first-no-added-sugars performed similarly, but identified many fewer products as WG and also not a lower likelihood of containing trans-fats. The WG-Stamp, WG-first and 'whole'-anywhere criteria identified products with a lower likelihood of trans-fats, but also significantly more sugars and energy (P < 0·05 each). Products meeting the WG-Stamp or 10:1-ratio criterion were more expensive than products that did not (+$US 0·04/serving, P = 0·009 and +$US 0·05/serving, P = 0·003, respectively). CONCLUSIONS: Among proposed WG criteria, the 10:1-ratio identified the most healthful WG products. Other criteria performed less well, including the industry-supported WG-Stamp which identified products with higher fibre and lower trans-fats, but also higher sugars and energy. These findings inform efforts by consumers, organizations and policy makers to identify healthful WG products.

The impact of lifestyle medicine continuing education on provider knowledge, attitudes, and counseling behaviors.

BACKGROUND: There is a need for effective continuing medical education (CME) programs to increase healthcare providers' knowledge and skills in lifestyle medicine so that healthcare providers are better equipped to assist patients in adopting and maintaining healthier lifestyle behaviors. AIMS: To evaluate the impact of five live face-to-face CME programs in lifestyle medicine on providers' barriers, knowledge, confidence, and professional counseling behaviors. METHODS: 200 participants completed researcher-generated surveys before and 90 days after each CME program. Paired t-tests measured significant changes for all outcome variables, and regression analyses assessed predictors of these changes. RESULTS: Barriers that were targeted during the programs, i.e. lack of knowledge/skills, lack of materials, and perceived poor patient compliance showed highly significant improvement. Participants also reported significant changes in knowledge, confidence, and counseling behaviors in the areas of exercise and stress management. Some improvements occurred in areas that the CME programs did not target as much, i.e. nutrition, smoking, and weight management. The greatest predictor of change was the baseline level of scores. Those participants who could most benefit from change did show the largest improvements. CONCLUSIONS: Live CME programs can be effective in educating healthcare providers about topics within the rapidly expanding field of lifestyle medicine.

The exercise prescription: a tool to improve physical activity.

The current epidemic of sedentary behavior is a serious public health issue that requires the attention of the medical community. Although the benefits of physical activity are well established, research indicates that Americans are not heeding the message, and new strategies are warranted to bring about change in this arena. The health care community can and should play a key role in this movement. Patients respect their physicians as credible sources of information and look to them for health-related guidance. Unfortunately, many physicians are not talking to their patients about physical activity and are missing a unique opportunity to raise awareness about its benefits. Exercise needs to be discussed as a serious form of treatment, similar to medication, and should be thoughtfully prescribed to every patient. Physicians need to be familiar with the level of exercise necessary to achieve health benefits as defined by the Physical Activity Guidelines for Americans. Furthermore, they should be competent in their ability to identify a patient's level of risk for starting or increasing exercise and provide guidance on the frequency, intensity, time, and type of activity necessary to safely elicit maximal health benefits. These basic competencies can be easily understood by physicians and incorporated into their practices. Resources have been established to help support physicians in this process. Physiatrists are uniquely positioned to lead the effort for change in this area because they are well-established proponents of exercise and are trained to prescribe therapeutic exercise to address the complex medical issues of their patients. This skill-set should be used for every patient in an effort to reduce the widespread prevalence of the "chronic disease" physical inactivity.