Protocol for an exploratory, randomised, single-blind clinical trial of aerobic exercise to promote remyelination in multiple sclerosis.

INTRODUCTION: There is an urgent need for remyelinating therapies that restore function in people with multiple sclerosis (pwMS). Aerobic exercise is a promising remyelinating strategy because it promotes remyelination in animal models both independently and synergistically with medications. Here, in this study, we present an innovative, randomised, single-blind, clinical trial designed to explore: the relationship between demyelination and mobility (part 1), and if 24 weeks of aerobic exercise promotes remyelination in pwMS (part 2). METHODS AND ANALYSIS: Sedentary participants (n=60; aged 18-64 years) with stable MS will undergo a baseline visit with the following outcomes to assess associations between demyelination and mobility (part 1): spinal cord demyelination (somatosensory-evoked potentials, SSEPs), mobility (6-Minute Timed Walk, Timed 25-Foot Walk, Timed Up and Go, 9-Hole Peg Test) and patient-reported outcomes (PROs). After baseline testing, participants with significantly prolonged SSEP latency will advance to the clinical exercise trial (part 2) and will be randomised 1:1 to active or control conditions for 24 weeks. The active condition will be aerobic stationary cycling three times per week with graded virtual supervision. The control condition will be monthly virtual MS symptom education groups (six sessions). SSEP latency (remyelination endpoint), mobility outcomes and PROs will be measured at 12 and 24 weeks in all clinical trial participants. A subset of 11 active and 11 control participants will undergo a brain MRI with quantitative T1 myelin water fraction at baseline and 24 weeks (exploratory remyelination endpoint). ETHICS AND DISSEMINATION: Ethical approval was obtained from the Oregon Health & Science University Institutional Review Board (#21045). Dissemination of findings will include peer-reviewed publications, conference presentations and media releases. The proposed study will inform the feasibility, study design and sample size for a fully powered clinical trial of aerobic exercise to promote remyelination in pwMS. TRIAL REGISTRATION NUMBER: NCT04539002.

Essential Amino Acid Supplementation Mitigates Muscle Atrophy After Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Substantial muscle atrophy occurs after total knee arthroplasty (TKA), resulting in decreased strength and impaired mobility. We sought to determine whether perioperative supplementation with essential amino acids (EAA) would attenuate muscle atrophy following TKA and whether the supplements were safe for ingestion in an older surgical population. METHODS: We performed a double-blind, placebo-controlled, randomized trial of 39 adults (age range, 53 to 76 years) undergoing primary unilateral TKA who ingested 20 g of EAA (n = 19) or placebo (n = 20) twice daily for 7 days preoperatively and for 6 weeks postoperatively. At baseline and 6 weeks postoperatively, magnetic resonance imaging (MRI) scans were obtained to measure quadriceps and hamstrings muscle volume. Secondary outcomes included functional mobility and strength. Data on physical activity, diet, and patient-reported outcomes (Veterans RAND 12-Item Health Survey and Knee injury and Osteoarthritis Outcome Score) were collected. Safety was determined through blood tests evaluating blood urea nitrogen, creatinine, creatinine clearance, homocysteine, and renal and liver function. Laboratory values at baseline, on the day of surgery, and at 2 days, 2 weeks, and 6 weeks postoperatively were compared between treatment groups. Analysis of covariance models, with baseline values as covariates, were used to evaluate outcomes between treatment groups. P values were adjusted for multiple tests. RESULTS: Compared with baseline, the EAA group had significantly less decrease in mean quadriceps muscle volume compared with the placebo group in the involved leg (-8.5% ± 2.5% compared with -13.4% ± 1.9%; p = 0.033) and the contralateral leg (-1.5% ± 1.6% compared with -7.2% ± 1.4%; p = 0.014). The hamstrings also demonstrated a greater muscle-volume-sparing effect for the EAA group than for the placebo group in the involved leg (-7.4% ± 2.0% compared with -12.2% ± 1.4%; p = 0.036) and contralateral leg (-2.1% ± 1.3% compared with -7.5% ± 1.5%; p = 0.005). There were no differences between the groups in terms of functional measures or strength. Blood chemistry values varied significantly between assessments periods but did not statistically differ between groups. CONCLUSIONS: The results of the present study suggest that EAA supplementation is safe and reduces the loss of muscle volume in older adults recovering from TKA. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Empiric validation of a process for behavior change.

Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre- and post- intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change.

The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments) Study: Mixed Methods Longitudinal Findings.

The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments) Study is a worksite wellness team-based intervention among police and sheriff departments assessing the program's effectiveness to reduce occupational risks and unhealthy lifestyle behaviors. The SHIELD program focused on improving diet, physical activity, body weight and sleep, and reducing the effects of unhealthy stress and behaviors, such as tobacco and substance abuse. The SHIELD team-based health promotion program was found to be feasible and effective at 6 months in improving diet, sleep, stress, and overall quality of life of law enforcement department personnel. Both intervention and control groups were followed for 24 months, and we report those durability findings, along with qualitative group interview results that provide insight into the changes of the long-term outcomes. Long-term effects were observed for consumption of fruits and vegetables, and there was some evidence for effects on tobacco and alcohol use. Assessment of dietary habits, physical activity behaviors, weight loss maintenance, and substance use is rare more than 1 year following an intervention, and in general, initial positive changes do not persist in prior research. The SHIELD program was feasible, effective, and durable for improving dietary changes.

Healthy Team Healthy U: A Prospective Validation of an Evidence-Based Worksite Health Promotion and Wellness Platform.

OBJECTIVE: To evaluate the effects of a research-tested, team-based health promotion and wellness program combined with digital technologies and implemented in a diverse worksite setting among hospital, clinic, and university employees. METHODS: A prospective cohort study of employees completing biometrics and questionnaires before and after the initial 12-session wellness program and its 12-session booster, 1 year later. RESULTS: After both the initial intervention and booster, blood pressure and weight were reduced, with greater reductions among employees with pre-hypertension and hypertension and those with a body mass index ≥25. After both the initial intervention and booster, there was a significant increase in (1) daily intake of fruit and vegetable servings, (2) days/week of ≥30 min of exercise, (3) days/week of strength training, and (4) levels of moderately vigorous and vigorous daily physical activity. Self-reported indices of both depression and work-related stress were reduced, while participants reported increased happiness. Post booster, average sleep quality, and sleep duration increased among higher risk employees reporting ≤6 h of daily sleep. Employees reported receiving encouragement from co-workers to engage in healthful diet and physical activities, and exercised together more, and indicated that they would recommend the program to other employees. Longitudinal analysis revealed the durability of the initial intervention outcomes with further beneficial effects after the booster. CONCLUSION: A research tested, comprehensive team-based health promotion and wellness program, combined with digital technologies, improved employee health behaviors, mood, sleep, elements of co-worker cohesion, and biometrics among a diverse multi-site workforce. Positive program effects were durable, with enhanced results after the booster.

Effectiveness of total worker health interventions.

Total Worker Health (TWH) was introduced and the term was trademarked in 2011 by the National Institute for Occupational Safety and Health (NIOSH) to formally signal the expansion of traditional occupational safety and health (OSH) to include wellness and well-being. We searched PubMed, PsycINFO, and other databases using keywords TWH, health promotion, health protection, and variants for articles meeting the criteria of (a) employing both occupational safety and/or health (OSH, or health protection) and wellness and/or well-being (health promotion, or HP) in the same intervention study, and (b) reporting both OSH and HP outcomes. Only 17 published studies met these criteria. All but 1 of the 17 TWH interventions improved risk factors for injuries and/or chronic illnesses, and 4 improved 10 or more risk factors. Several TWH interventions reported sustained improvements for over a year, although only 1 is readily available for dissemination. These results suggest that TWH interventions that address both injuries and chronic diseases can improve workforce health effectively and more rapidly than the alternative of separately employing more narrowly focused programs to change the same outcomes in serial fashion. These 17 articles provide useful examples of how TWH interventions can be structured. The promise of simultaneous improvements in safety, health, and well-being leads to the call to pursue TWH research to identify and disseminate best practices.

The safety and health improvement: enhancing law enforcement departments study: feasibility and findings.

This randomized prospective trial aimed to assess the feasibility and efficacy of a team-based worksite health and safety intervention for law enforcement personnel. Four-hundred and eight subjects were enrolled and half were randomized to meet for weekly, peer-led sessions delivered from a scripted team-based health and safety curriculum. Curriculum addressed: exercise, nutrition, stress, sleep, body weight, injury, and other unhealthy lifestyle behaviors such as smoking and heavy alcohol use. Health and safety questionnaires administered before and after the intervention found significant improvements for increased fruit and vegetable consumption, overall healthy eating, increased sleep quantity and sleep quality, and reduced personal stress.

Understanding the durability of a fire department wellness program.

OBJECTIVES: To understand the influences associated with durability and diffusion of benefits of a fire service wellness program. METHODS: Qualitative assessment of group interviews. RESULTS: Five years following a controlled worksite wellness trial, behavioral improvements were durable and had diffused to control participants. These findings were associated with firefighters' team orientation, enacted healthy norms and competitiveness regarding the results of annual health assessments. The original intervention trial appeared to initiate individual change that coalesced into group effects. Secondary influences included increasing public awareness about health, newly hired younger firefighters, and a modicum of administrative support. Culture shift was achieved at the workplace. CONCLUSIONS: Although the fire service is a unique occupation, these findings suggest general strategies to achieve durable positive health change in other occupational settings.

Factors in adoption of a fire department wellness program: champ-and-chief model.

OBJECTIVE: To identify and evaluate determinants of fire departments' wellness program adoption. METHODS: The Promoting Healthy Lifestyles: Alternative Models' Effects fire service wellness program was offered for free to all medium-sized fire departments in Oregon and Washington. An invitation to participate was mailed to key fire department decision makers (chief, union president, and wellness officer). These key decision makers from 12 sites that adopted the program and 24 matched nonadopting sites were interviewed and results were analyzed to define adoption determinants. RESULTS: Three adoption requirements were identified: (1) mailer connection, (2) local firefighter wellness champion, and (3) willing fire chief, whereas a fourth set of organizational factors had little or no impact on adoption including previous and ongoing wellness activities, financial pressures, and resistance to change. CONCLUSIONS: Findings identified determinants of medium-sized fire service wellness program adoption.

Cherry juice targets antioxidant potential and pain relief.

Strenuous physical activity increases the risk of musculoskeletal injury and can induce muscle damage resulting in acute inflammation and decreased performance. The human body's natural response to injury results in inflammation-induced pain, swelling, and erythema. Among sports medicine physicians and athletic trainers, the mainstays of urgent treatment of soft tissue injury are rest, ice, compression, and elevation (RICE). In order to reduce pain and inflammation, anti-inflammatory agents such as non-steroidal anti-inflammatory drugs (NSAIDs) act on the multiple inflammatory pathways, which, although often very effective, can have undesirable side effects such as gastric ulceration and, infrequently, myocardial infarction and stroke. For centuries, natural anti-inflammatory compounds have been used to mediate the inflammatory process and often with fewer side effects. Tart cherries appear to possess similar effectiveness in treating the inflammatory reaction seen in both acute and chronic pain syndromes encountered among athletes and non-athletes with chronic inflammatory disease. This article reviews the antioxidant and anti-inflammatory effects of tart cherries on prevention, treatment, and recovery of soft tissue injury and pain.

Body mass index as a predictor of firefighter injury and workers' compensation claims.

OBJECTIVE: To determine the relationship between lifestyle variables including body mass index and filing a workers' compensation claim due to firefighter injury. METHODS: A cross-sectional evaluation of firefighter injury related to workers" compensation claims occurring 5 years after the original Promoting Healthy Lifestyles: Alternative Models' Effects study intervention. RESULTS: A logistic regression analysis for variables predicting filing a workers' compensation claim due to an injury was performed with a total of 433 participants. The odds of filing a compensation claim were almost 3 times higher for firefighters with a body mass index of more than 30 kg/m than firefighters with a normal body mass index (odds ratio, 2.89; P < 0.05). CONCLUSIONS: This study addresses a high-priority area of reducing firefighter injuries and workers' compensation claims. Maintaining a healthy body weight is important to reduce injury and workers' compensation claims among firefighters.

Worksite wellness program implementation: a model of translational effectiveness.

Occupational health promotion programs with documented efficacy have not penetrated worksites. Establishing an implementation model would allow focusing on mediating aspects to enhance installation and use of evidence-based occupational wellness interventions. The purpose of the study was to implement an established wellness program in fire departments and define predictors of program exposure/dose to outcomes to define a cross-sectional model of translational effectiveness. The study is a prospective observational study among 12 NW fire departments. Data were collected before and following installation, and findings were used to conduct mediation analysis and develop a translational effectiveness model. Worker age was examined for its impact. Leadership, scheduling/competing demands, and tailoring were confirmed as model components, while organizational climate was not a factor. The established model fit data well (χ (2)(9) = 25.57, CFI = 0.99, RMSEA = 0.05, SRMR = 0.03). Older firefighters, nearing retirement, appeared to have influences that both enhanced and hindered participation. Findings can inform implementation of worksite wellness in fire departments, and the prioritized influences and translational model can be validated and manipulated in these and other settings to more efficiently move health promotion science to service.

The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: testing mediating mechanisms.

This paper examines the mechanisms by which PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects), a health promotion intervention, improved healthy eating and exercise behavior among firefighters, a population at high risk for health problems due to occupational hazards. In a randomized trial, 397 firefighters participated in either the PHLAME team intervention with their work shift or a control condition. Intervention sessions taught benefits of a healthy diet and regular exercise, and sought to improve social norms and social support from coworkers for healthy behavior. At posttest, team intervention participants had increased their fruit and vegetable consumption as compared to control participants. An increase in knowledge of fruit and vegetable benefits and improved dietary coworker norms partially mediated these effects. Exercise habits and VO2 max were related to targeted mediators but were not significantly changed by the team intervention. Partial support was found for both the action and conceptual theories underlying the intervention. Our findings illustrate how an effective program's process can be deconstructed to understand the underpinnings of behavior change and refine interventions. Further, fire stations may improve the health of firefighters by emphasizing the benefits of healthy diet and exercise behaviors while also encouraging behavior change by coworkers as a whole.

Worksite health promotion in six varied US sites: beta testing as a needed translational step.

BACKGROUND: Dissemination of health promotion interventions generally has followed an efficacy, effectiveness to full scale paradigm, and most programs have failed to traverse that sequence. OBJECTIVE: Report national dissemination of a health promotion program and juxtapose sequential case study observations with the current technology transfer literature. DESIGN: Multiple department-level case studies using contact logs, transcribed interactions, augmented with field notes and validated by respondent review; at least two investigators independently generated site summaries, which were compared to formulate a final report. RESULTS: Adoption was facilitated with national partners and designing branded materials. Critical site influences included departmental features, local champions, and liaison relationships. Achieving distal reach and fidelity required sequential process and program revisions based on new findings at each site. CONCLUSIONS: Beta testing to redesign program elements and modify process steps appears to be a needed and often ignored translational step between efficacy and more widespread dissemination.

Review of the efficacy and tolerability of the diclofenac epolamine topical patch 1.3% in patients with acute pain due to soft tissue injuries.

BACKGROUND: The diclofenac epolamine topical patch 1.3% (DETP) was approved by the US Food and Drug Administration in January 2007 for the treatment of soft tissue injuries such as strains, sprains, and contusions, although it has been available for many years in >40 countries worldwide. OBJECTIVE: The aim of this study was to review the efficacy and tolerability of the DETP in relieving acute pain caused by soft tissue injuries. METHODS: The MEDLINE, Derwent Drug File, BIOSIS, and EMBASE databases were searched for literature published between 1984 and October 30, 2009, in any language, using the terms diclofenac epolamine patch, diclofenac hydroxyethylpyrrolidine patch, and FLECTOR Patch. Clinical studies of the efficacy and/or tolerability of the DETP in patients with acute pain due to soft tissue injuries or localized periarticular disorders were included. Efficacy studies that enrolled patients with other medical conditions were excluded, except for reports that focused on tolerability, which were included to supplement tolerability data. The bibliographies of included studies were reviewed manually for relevant articles based on inclusion and exclusion criteria, and the manufacturer was contacted for additional relevant postmarketing surveillance information and presentations from scientific meetings. RESULTS: The search identified 6 placebo-controlled clinical studies, 1 active-comparator-controlled clinical study, and 1 open-label comparator clinical study of the efficacy and tolerability of the DETP in patients with soft tissue injuries. Three studies reported on tolerability. Primary analyses among the 8 studies reported DETP-associated reductions in spontaneous pain from baseline, assessed using a visual analog scale, ranging from 26% to 88% on day 7 and 56% to 61% on day 14. The use of the DETP was associated with significantly greater reductions in pain scores compared with a placebo patch (2 studies) on day 7 (88% vs 74%; P = 0.001) and day 14 (56.5% vs 46.8%; P = 0.001) and compared with diclofenac diethylammonium topical gel (1 study) on day 14 (60.8% vs 40.8%; P < 0.001). With the use of the DETP, median time to pain resolution was 3 days less than with placebo (8.8 vs 12.4 days; P = 0.009). The prevalences of adverse events across the 11 studies were low (3.1%-14.0%) and not significantly different from those with placebo (5.8%-16.0%). The most commonly reported adverse events were cutaneous application-site reactions (pruritus, rash, and dermatitis) and gastrointestinal symptoms (nausea). CONCLUSION: Based on data from clinical studies and postmarketing experience, the DETP was associated with significant pain relief in patients with soft tissue injuries, with good tolerability.

Long-term effects of a worksite health promotion program for firefighters.

OBJECTIVE: To describe effects of 2 worksite health promotion programs for firefighters, both immediate outcomes and the long-term consequences for 4 years following the interventions. METHODS: At baseline, 599 firefighters were assessed, randomized by fire station to control and 2 different intervention conditions, and reevaluated with 6 annual follow-up measurements. RESULTS: Both a team-centered peer-taught curriculum and an individual motivational interviewing intervention demonstrated positive effects on BMI, with team effects on nutrition behavior and physical activity at one year. Most differences between intervention and control groups dissipated at later annual assessments. However, the trajectory of behaviors across time generally was positive for all groups, consistent with lasting effects and diffusion of program benefits across experimental groups within the worksites. CONCLUSIONS: Although one-year programmatic effects did not remain over time, the long-term pattern of behaviors suggested these worksites as a whole were healthier more than 3 years following the interventions.

Young women's anterior cruciate ligament injuries: an expanded model and prevention paradigm.

Anterior cruciate ligament (ACL) injuries among young female athletes occur at rates three- to eight-times greater than in male competitors and, in general, females experience more sports injuries than males, when balanced for activity and playing time. ACL injuries are a particular concern, as they result in immediate morbidity, high economic costs and may have long-term adverse effects. While several closely monitored ACL injury preventive programmes have been effective, those efforts have not been uniformly protective nor have they achieved widespread use. To date, ACL injury prevention has focused on neuromuscular and anatomical factors without including issues relating more broadly to the athlete. Coincident with greater female sport participation are other influences that may heighten their injury risk. We review those factors, including early single sport specialization, unhealthy dietary behaviours, chronic sleep deprivation and higher levels of fatigue, substance use and abuse, and psychological issues. We augment existing models of ACL injury with these additional dimensions. The proposed expanded injury model has implications for designing injury prevention programmes. High school athletic teams are natural settings for bonded youth and influential coaches to promote healthy lifestyles, as decisions that result in better athletes also promote healthy lifestyles. As an example of how sport teams could be vehicles to address an expanded injury model, we present an existing evidenced-based sport team-centered health promotion and harm reduction programme for female athletes. Widening the lens on factors influencing ACL injury expands the prevention paradigm to combine existing training with activities to promote psychological well-being and a healthy lifestyle. If developed and shown to be effective, those programmes might better reduce injuries and, in addition, provide life skills that would benefit young female athletes both on and off the playing field.

Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial.

BACKGROUND: Long distance running causes acute muscle damage resulting in inflammation and decreased force production. Endurance athletes use NSAIDs during competition to prevent or reduce pain, which carries the risk of adverse effects. Tart cherries, rich in antioxidant and anti-inflammatory properties, may have a protective effect to reduce muscle damage and pain during strenuous exercise. This study aimed to assess the effects of tart cherry juice as compared to a placebo cherry drink on pain among runners in a long distance relay race. METHODS: The design was a randomized, double blind, placebo controlled trial. Fifty-four healthy runners (36 male, 18 female; 35.8 +/- 9.6 yrs) ran an average of 26.3 +/- 2.5 km over a 24 hour period. Participants ingested 355 mL bottles of tart cherry juice or placebo cherry drink twice daily for 7 days prior to the event and on the day of the race. Participants assessed level of pain on a standard 100 mm Visual Analog Scale (VAS) at baseline, before the race, and after the race. RESULTS: While both groups reported increased pain after the race, the cherry juice group reported a significantly smaller increase in pain (12 +/- 18 mm) compared to the placebo group (37 +/- 20 mm) (p < .001). Participants in the cherry juice group were more willing to use the drink in the future (p < 0.001) and reported higher satisfaction with the pain reduction they attributed to the drink (p < 0.001). CONCLUSIONS: Ingesting tart cherry juice for 7 days prior to and during a strenuous running event can minimize post-run muscle pain.

Outcomes of a prospective trial of student-athlete drug testing: the Student Athlete Testing Using Random Notification (SATURN) study.

PURPOSE: To assess the effects of random drug and alcohol testing (DAT) among high school athletes. METHODS: This was a 2-year prospective randomized controlled study of a single cohort among five intervention high schools with a DAT policy and six schools with a deferred policy, serially assessed by voluntary, confidential questionnaires. DAT school athletes were at risk for random testing during the full academic year. Positive test results were reported to parents or guardians, with mandatory counseling. Indices of illicit drug use, with and without alcohol use, were assessed at the beginning and end of each school year for the past month and prior year. Potential mediating variables were evaluated. RESULTS: Student-athletes from intervention and control schools did not differ in past 1-month use of illicit drug or a combination of drug and alcohol use at any of the four follow-up periods. At the end of the initial school year and after 2 full school years, student-athletes at DAT schools reported less drug use during the past year (p < .01) compared to athletes at the deferred policy schools. Combining past year drug and alcohol use together, student-athletes at DAT schools reported less use at the second and third follow-up assessments (p < .05). Paradoxically, DAT athletes across all assessments reported less athletic competence (p < .001), less belief authorities were opposed to drug use (p < .01), and indicated greater risk-taking (p < .05). At the final assessment, DAT athletes believed less in testing benefits (p < .05) and less that testing was a reason not to use drugs (p < .01). CONCLUSIONS: No DAT deterrent effects were evident for past month use during any of four follow-up periods. Prior-year drug use was reduced in two of four follow-up self-reports, and a combination of drug and alcohol use was reduced at two assessments as well. Overall, drug testing was accompanied by an increase in some risk factors for future substance use. More research is needed before DAT is considered an effective deterrent for school-based athletes.

The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: outcomes of two models of behavior change.

OBJECTIVE: PHLAME's (Promoting Healthy Lifestyles: Alternative Models' Effects) objective was to assess and compare two means to promote healthy lifestyles. METHODS: Prospective trial among 599 firefighters randomized by station to 1) team-centered curriculum, 2) one-on-one motivational interviewing (MI), and 3) controls. Assessment included dietary behavior, physical activity, weight, and general well-being at baseline and 12 months. Program effects were determined using an analysis of covariance (ANCOVA) based approach, and models for relationships were evaluated with path analysis. RESULTS: Both interventions were acceptable and delivered with high fidelity. The team and MI programs increased fruit and vegetable consumption (P < 0.01 and 0.05, respectively) and general well-being (P < 0.01). Significantly less weight gain occurred in both (P < 0.05). A cross-sectional model was consistent with mediation differing between interventions. CONCLUSIONS: Both a team-centered and individual-oriented intervention promoted healthy behaviors. The scripted team curriculum is innovative, exportable, and may enlist influences not accessed with individual formats.