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PubMed2004

The HIV Medication Self-Reported Nonadherence Reasons (SNAR) Index and its underlying psychological dimensions.

The purpose of this paper is to report on the construction of the HIV Medication Self-Reported Nonadherence Reasons (SNAR) index and its psychological correlates. Data were derived from a sample of 193 Swedish HIV-seropositive women and men receiving antiretroviral medications. Participants who reported dosing and/or scheduling and/or dietary instructions nonadherence in the past 7 days were presented with a modified AACTG list of 18 reasons for nonadherence. From these data, two conceptually and statistically independent factors were obtained, which accounted for 39% of the variance in the data. These factors were used as the basis for constructing two composite measures composing the SNAR index: the Medication concerns scale and the Routine disruption scale. The Medication concerns scale correlated significantly to suboptimal dose and scheduling adherence and Routine disruption scale with poorer dietary instructions adherence. Psychological distress was the best predictor of the SNAR index. The SNAR index has a clearly interpretable factor structure that allows the derived scales to be useful as multi-item measures of self-reported reasons for nonadherence to HIV antiretroviral medications. The psychological factors found to be associated with the index may imply a number of mental-health-related interventions to improve adherence, which deserve further exploration.

Adaptation, Psychological↗

PubMed1998

Estrogen profiles in postmenopausal African-American women in a wheat bran fiber intervention study.

High dietary fiber intake has been hypothesized to lower blood estrogen concentrations, an effect thought to be beneficial for decreasing breast cancer risk. This study investigated the association between dietary supplementation of wheat bran and circulating estrogen levels in postmenopausal African-American women participating in a community intervention trial. Seventeen postmenopausal women (aged 63 +/- 1.6 yr) participated in the study. Nutritional status was assessed and blood and 24-hour urine samples were collected before and after five to six weeks of daily supplementation of the diet with 35 g of wheat bran cereal (11.6 g insoluble dietary fiber) marked with 28 mg of riboflavin. Riboflavin confirmed that all postmenopausal participants adhered to the intervention protocol. Nine of the 17 postmenopausal women were taking some form of estrogen replacement therapy (PM-ERT). Baseline hormone levels in the PM-ERT group did not significantly change after the dietary intervention. Estradiol (96.8 +/- 20.3 vs. 113.8 +/- 23.3 pg/ml), androstenedione (0.47 +/- 0.06 vs. 0.45 +/- 0.06 ng/ml), and sex hormone-binding globulin (SHBG, 107 +/- 13.5 vs. 106.6 +/- 13.3 nmol/l) levels remained constant. In the eight postmenopausal women who were not receiving exogenous hormones (PM), wheat bran consumption was not associated with predicted decreased levels of estradiol (25.7 +/- 2.7 vs. 31.0 +/- 1.9 pg/ml), estrone (38.3 +/- 10.1 vs. 39.3 +/- 10.6 pg/ml), and androstenedione (0.78 +/- 0.08 vs. 0.68 +/- 0.11 ng/ml) or with increased concentrations of SHBG (35.2 +/- 6.4 vs. 34.8 +/- 6.5 nmol/l). Participants receiving ERT had baseline and postintervention levels of estradiol and SHBG significantly higher and androstenedione significantly lower than those not receiving ERT. No association between wheat bran supplementation and hormone levels was found in PM or PM-ERT African-American participants. These results in postmenopausal women are in contrast to findings of earlier studies in premenopausal women indicating that wheat bran fiber decreases serum sex hormones. Estrogen levels in postmenopausal women are only 5-10% of those in premenopausal women; therefore, a high wheat bran fiber diet alone may not be sufficient to depress these low levels even further.

Aged↗

PubMed2006

Rational Prescribing in Primary care (RaPP): process evaluation of an intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs.

BACKGROUND: A randomised trial of a multifaceted intervention for improving adherence to clinical practice guidelines for the pharmacological management of hypertension and hypercholesterolemia increased prescribing of thiazides, but detected no impact on the use of cardiovascular risk assessment tools or achievement of treatment targets. We carried out a predominantly quantitative process evaluation to help explain and interpret the trial-findings. METHODS: Several data-sources were used including: questionnaires completed by pharmacists immediately after educational outreach visits, semi-structured interviews with physicians subjected to the intervention, and data extracted from their electronic medical records. Multivariate regression analyses were conducted to explore the association between possible explanatory variables and the observed variation across practices for the three main outcomes. RESULTS: The attendance rate during the educational sessions in each practice was high; few problems were reported, and the physicians were perceived as being largely supportive of the recommendations we promoted, except for some scepticism regarding the use of thiazides as first-line antihypertensive medication. Multivariate regression models could explain only a small part of the observed variation across practices and across trial-outcomes, and key factors that might explain the observed variation in adherence to the recommendations across practices were not identified. CONCLUSION: This study did not provide compelling explanations for the trial results. Possible reasons for this include a lack of statistical power and failure to include potential explanatory variables in our analyses, particularly organisational factors. More use of qualitative research methods in the course of the trial could have improved our understanding.

Journal Article↗

PubMed2026

Effect of a pharmacist-led mHealth app on adherence, quality of life, and glycaemic control in diabetes: A multicentre RCT.

AIMS: To evaluate whether CareAide®, a pharmacist-driven mHealth application, improves medication adherence, health-related quality of life (HRQoL), and glycaemic control in diabetes mellitus using structural equation modelling. METHODS: Pre-specified secondary analysis of the type 2 diabetes mellitus cohort from a 6-month multicentre open-label randomised controlled trial (N = 663) across three Malaysian hospitals. Adherence was assessed by MMAS-8 (subjective) and Proportion of Days Covered (PDC; pharmacy-verified). HRQoL was measured by AQoL-6D and EQ-5D-5 L. Structural equation modelling (SEM), Necessary Condition Analysis, and Importance-Performance Map Analysis (cIPMA) were applied. RESULTS: CareAide® produced large adherence gains (MMAS-8: 7.31 vs 5.55, d = 1.64; PDC ≥ 80%: 81.6% vs 33.0%; both p < 0.001). Early 3-month adherence was the strongest predictor of sustained 6-month adherence in both models (β std = 0.567 and 0.688; p < 0.001). AQoL-6D utility improved significantly (0.669 vs 0.618; d = 0.353, p < 0.001), driven by coping (d = 0.447) and relationships (d = 0.254) domains. HRQoL did not mediate adherence; gains were a direct independent benefit. The intervention effect on HbA1c was not statistically significant in the PDC-based SEM model (β =  - 0.333, p = 0.065); a group difference was, however, supported by baseline-adjusted ANCOVA (β =  - 0.41%, p = 0.002), and the complete-case comparison was non-significant (p = 0.153), so glycaemic findings warrant cautious interpretation. cIPMA identified the intervention as the primary optimisation target. CONCLUSIONS: CareAide® significantly improves medication adherence and psychosocial quality of life. Evidence for glycaemic benefit came from baseline-adjusted analysis (ANCOVA), though findings should be interpreted with caution given incomplete HbA1c data at one site. The first three months are the most critical period for pharmacist support. In this dataset, PDC appeared more sensitive than MMAS-8 to the HbA1c signal within 6 months, but this finding requires confirmation in longer studies with more complete HbA1c data. TRIAL REGISTRATION: ClinicalTrials.gov NCT06068309.

Aged↗

PubMedDate not supplied

Is stress management training a useful addition to physician advice and nicotine replacement therapy during smoking cessation in women? Results of a randomized trial.

PURPOSE: To determine whether a stress management (SM) program could improve cessation rates when added to usual care (UC) among women attempting to quit smoking. DESIGN: Randomized controlled trial conducted during a 12-month period. SETTING: Smoking cessation clinics located within two tertiary care centers in Ottawa, Ontario. SUBJECTS: A total of 332 women smokers 19 years or older who smoked 10 or more cigarettes per day were recruited via advertisements. INTERVENTION. Either UC (physician advice and nicotine replacement therapy) or UC plus an eight-session group SM training program (coping skills development relevant to smoking-specific and generic stressors). MEASURES: Point prevalence abstinence 2 and 12 months after study intake. A secondary outcome of interest was change in perceived stress during the intervention period. RESULTS: On an intent-to-treat basis, the addition of SM to UC had no incremental effect on 2- or 12-month abstinence rates. Abstinence rates at 2 months were 26.2% vs. 31.7% in the UC and SM groups, respectively (p = .59). At 12 months, the rates were 18.5% vs. 20.7% (p = .86). When quit rates were compared including only participants who demonstrated adequate adherence to the intervention protocol, there was a significant difference between the UC and SM groups at 2 months (34.9% vs. 48.7%; adjusted odds ratio, 1.88; 95% confidence interval, 1.04-3.42; p = .04) but not at 12 months (23.0% vs. 28.2%; adjusted odds ratio, 1.24; 95% confidence interval, .64-2.41; p = .53). There was a significant reduction in perceived stress from preintervention to postintervention; however, this decrease was not moderated by group assignment. CONCLUSION: The addition of SM in our setting neither increased abstinence rates nor reduced perceived stress over and above UC in women motivated to quit smoking. Poor attendance at the SM intervention undermined its effectiveness.

Adult↗

PubMed1985

Health beliefs and compliance with alcoholism treatment.

This study examined the health beliefs and attitudes of patients seen in an alcoholism treatment clinic and investigated the relationship between these beliefs and attitudes and patient compliance as defined by length of time in treatment contact. Results showed that health beliefs and attitudes measured at the onset of treatment were predictive of patient adherence to treatment. Elements of the Health Belief Model found to be strongly associated with compliance included patients' perceived severity of their drinking problem, their expectations of improvement by remaining in treatment, and their levels of satisfaction with aspects of the doctor-patient relationship during the initial visit. The Health Belief Model offers a fruitful approach to understanding patients' compliance with alcoholism treatment and indicates possible areas for intervention to improve adherence.

Alcoholism↗

PubMed2005

Hemodynamic responses to a community-based Tai Chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death among older adults worldwide, including Europe, Asia, and North America. In the United States (US), CVD is also the leading cause of death among Asian-Americans. Physical activity has been shown to reduce CVD risk factors. Reduction in blood pressure (BP) in response to Tai Chi (TC) exercise in persons with CVD risk factors have been reported, though not in ethnic Chinese living in the US. AIM: Hemodynamic responses to a 12-week community-based TC exercise intervention among ethnic Chinese with CVD risk factors were examined. METHODS: Quasi-experimental design. Ethnic Chinese > 45 years old with at least 1 major CVD risk factor, living in the San Francisco Bay Area, attended a TC intervention three times a week for 12 weeks. A 2-min step-in-place test assessed aerobic endurance. BP and heart rate were measured at rest, and within 1-min after the step-test. Data were collected at baseline, 6 and 12 weeks. RESULTS: A total of 39 subjects (69% women), 66 +/- 8.3 years old, with hypertension (92%), hypercholesteremia (49%), and/or diabetes (21%), and 1 current smoker participated. Adherence to the intervention was high (87%). Subjects were sedentary at baseline, though had a statistically significant improvement in aerobic endurance over-time (eta2 = 0.39). At baseline, the average BP at rest was 150/86, while BP in response to the step-test was 178/99. Clinically and statistically significant reductions in BP at rest (131/77), and in response to the step-test (164/82) were found over 12 weeks of TC (p < 0.01). No significant change in heart rate was observed. CONCLUSIONS: This innovative, culturally relevant, community-based 12-week TC exercise intervention, appealed to Chinese adults with CVD risk factors, with significant reductions in BP and improvement in aerobic endurance. Given the number of persons estimated to have HTN and other CVD risk factors, the identification of new approaches to improve health, combined with risk factor reduction is needed. This is particularly important, given the rise in HTN among adults in the US and the associated public health burden of HTN. TC has the potential to reduce expenditures associated with CVD by facilitating a lifestyle that promotes physical activity, while remaining a low-tech, low-cost alternative to exercise.

Adult↗

PubMed2000

Assessment of psychological factors associated with adherence to medication regimens among adult patients with asthma.

Nonadherence with asthma medications is a significant problem associated with unnecessary functional limitations. The development of measures to assess psychological factors important to adherence with medication regimens among adult patients with asthma is described in the present report. The results indicated that the reliability and validity of the newly designed measures were adequate. Patients that did not perceive a need to take their medications as prescribed or those already taking their medications as prescribed had better pulmonary function. The results are discussed in terms of their implications for future studies, such as motivational interventions to enhance adherence with asthma medications.

Administration, Inhalation↗

PubMed2000

Is exercise effective treatment for osteoarthritis of the knee?

OBJECTIVE: To review and determine the effectiveness of exercise treatment in osteoarthritis of the knee. METHODS: A computerised literature search of Medline was carried out searching between June 1966 and January 2000. RESULTS: Twenty three randomised controlled trials were identified from the literature. Only three trials were sufficiently powered. Small to moderate beneficial effects of exercise treatment were found for pain, small beneficial effects on disability outcome measures, and moderate to great beneficial effects were observed according to patient global assessment of effect. It was not possible to obtain evidence on the content of exercise interventions, as studies were hampered by lack of attention to proper concealment, reporting of adverse effects, and long term effects of exercise treatment. The lack of standard outcomes measures is also noted. CONCLUSIONS: The available evidence indicates beneficial short term effects of exercise treatment in patients with osteoarthritis of the knee. However, the number of available studies is limited, and more research is needed to expand this recommendation. Specifically, additional trials should provide information on adherence, home based interventions, interaction with pharmacological treatments, functional outcomes measures relevant to exercise treatment in these patients, and long term effects. At present, doctors should recommend exercise to all patients with mild/moderate disease. Further study should be encouraged and exercise should be continued to be recommended as a mainstay of non-pharmacological treatment of osteoarthritis of the knee.

Exercise Therapy↗

PubMed2005

Who are the sedentary people in Israel? A public health indicator.

BACKGROUND: Increasing physical activity and thereby reducing a sedentary lifestyle can lower the risk of chronic diseases. Raising the population's involvement in physical activity is a major challenge for public health and healthcare services. OBJECTIVES: To identify subpopulations with a sedentary lifestyle and low levels of adherence to physical activity recommendations. METHODS: The Israel Center for Disease Control performed two national surveys during 2002-2003, interviewing 7,307 Jewish Israelis and 1,826 Arab Israelis over age 21. Respondents were asked if they engaged in physical activity lasting at least 20 consecutive minutes, and if so how frequently: less than once a week, once or twice a week, nearly every day or every day. RESULTS: Arab respondents were less physically active than Jewish respondents after adjusting for gender, age, level of religiosity, marital status, education, self-reported health, smoking, body mass index, and type of survey. Multiple logistic regression analysis run separately for Jews and Arabs found a more sedentary lifestyle, in both groups, among women, the less educated, those who were married and those with poor subjective health. Among Jews, younger age, increased religiosity, smoking and high BMI were associated with a sedentary lifestyle. CONCLUSIONS: The Jewish population is in need of more targeted and specific interventions for lower adhering subpopulations, such as women, the less educated and those with other risk factors. In the Arab population a more thorough understanding of the benefits of physical activity is needed; however, it seems that a general intervention is required to decrease the prevalence of a sedentary lifestyle all round.

Adult↗

PubMed2003

Measurement, correlates, and health outcomes of medication adherence among seniors.

OBJECTIVE: To provide a comprehensive review of the literature on the measurement, correlates, and health outcomes of medication adherence among community-dwelling older adults. DATA SOURCES: Searches of MEDLINE, PubMed, and International Pharmaceutical Abstracts databases for English-language literature (1966-December 2002) were conducted using one or more of the following terms: elderly, adherence/nonadherence, compliance/noncompliance, medication/drug, methodology/measurement, and hospitalization. STUDY SELECTION AND DATA EXTRACTION: From the above search, studies of medication adherence in community-dwelling seniors were selected for review along with relevant publications from the reference lists of articles identified in the initial database search. DATA SYNTHESIS: Although several methods are available for the assessment of adherence, accurate measurement continues to be difficult. The available evidence suggests that polypharmacy and poor patient-healthcare provider relationships (including the use of multiple providers) may be major determinants of nonadherence among older persons, with the impact of most sociodemographic factors being negligible. There is little consensus regarding other determinants of nonadherence. Relatively few high-quality investigations have examined the associations between nonadherence and subsequent health outcomes. Available data provide some support for increased health risks with nonadherence. However, interventions to improve adherence have seldom demonstrated positive effects on health outcomes. CONCLUSIONS: There are few empirical data to support a simple systematic descriptor of the nonadherent patient. The inconsistencies across studies may be attributable, in part, to the inherent difficulties involved in the measurement of a behavioral risk factor such as nonadherence. Future research in this area would be strengthened by incorporation of detailed assessments of patient-reported reasons for nonadherence, the appropriateness of drug regimens, and the effect of nonadherence on health outcomes.

Activities of Daily Living↗

PubMed2003

Factors affecting patient adherence to highly active antiretroviral therapy.

OBJECTIVE: To determine the clinical and demographic variables related to adherence to highly active antiretroviral therapy (HAART) in patients treated in our hospital and identify the characteristics of nonadherent patients. METHODS: Outpatients receiving treatment with HAART (n = 283) were asked about variables related to adherence and to complete the APGAR (family support), State-Trait Anxiety questionnaire (STAI) (emotional situation), and IAS (social support) questionnaires. Patients were classified in 2 groups depending on whether adherence was > or =95% or <95%. Adherence was defined as the percentage of dosage forms prescribed that were obtained by the patient at the hospital pharmacy. A multivariate analysis was created to analyze how each significant variable affected adherence. RESULTS: Our data showed significant nonadherence for patients with the following factors: low level of education, unemployed, emotional situation, and abuse of substances including intravenous drugs. All significant variables were included in a logistic regression model to optimize the results. This model considered 4 variables: age (95% CI 0.89 to 0.99), number of antiretroviral drugs (95% CI 1.05 to 2.11), STAI Anxiety/Trait test (95% CI 2.02 to 6.02), and abuse of drugs (95% CI 1.20 to 3.95). CONCLUSIONS: We recommended special intervention to reinforce adherence for younger patients, patients taking a high number of antiretroviral drugs, those who have a history of intravenous drug use, and those with high anxiety status.

Adult↗

PubMed1994

Factors affecting physician adherence to breast cancer screening guidelines.

A one-group, meta-analytic design was used to assess survey results published between the years of 1985 and 1990 that measured adherence to the breast cancer screening guidelines by U.S. primary care physicians. The purpose of this analysis was twofold: 1) to systematically synthesize current literature to determine why primary care physicians do not adhere to the prescribed breast cancer screening guidelines; and 2) to determine what strategies and interventions would be most effective in increasing adherence to the guidelines. Factors associated with nonadherence to guidelines included cost concerns, patient worry and refusal, radiation risk, and lack of confidence in performing a clinical breast examination. Five factors were associated with increased adherence to guidelines. Effective interventions must address the specific concerns of physicians by specialty to mitigate barriers to adherence. Generic interventions with a single focus are not likely to achieve their intended effects.

Adult↗

PubMed2002

Antipsychotic medication adherence: is there a difference between typical and atypical agents?

OBJECTIVE: Pharmacy refill records were used to compare medication adherence in outpatient veterans receiving typical versus atypical antipsychotic medications. METHOD: Consecutive patients meeting selection criteria and receiving prescriptions for haloperidol (N=57), perphenazine (N=60), risperidone (N=80), olanzapine (N=63), and quetiapine (N=28) over a 3-month period were identified from a computerized database. The hospital policy at the time of this study required failure in trials of at least two typical antipsychotics before initiation of an atypical agent. Patients' adherence with the antipsychotic regimen was calculated by analyzing refill records for up to 12 months. The cumulative mean gap ratio (the number of days when medication was unavailable in relation to the total number of days) and the compliant fill rate (the number of prescription fills indicating adherence in relation to the total number of prescription fills) at 6 and 12 months were calculated. RESULTS: Adherence rates at 6 and 12 months were moderately higher in patients who received atypical antipsychotics than in those who received typical agents. Cumulative mean gap ratios were 23.2% for typical and 14.1% for atypical antipsychotics at 12 months; thus, patients who received typical agents were without medication for an average of 7 days per month, compared with 4 days per month for those who received atypical agents. At 12 months, compliant fill rates were 50.1% for typical and 54.9% for atypical antipsychotics. CONCLUSIONS: Interventions to improve adherence are warranted even for patients who receive atypical antipsychotic medications.

Adult↗

PubMed1994

Enhancing exercise adherence in middle-aged males and females.

BACKGROUND: Perceptions of personal efficacy have been consistently identified as being determinants of exercise adherence in asymptomatic, rehabilitative, younger, and older populations. The present study incorporated a randomized control design in an effort to examine the effects of an efficacy-based intervention in enhancing exercise adherence in a large sample (N = 114) of formerly sedentary middle-aged males and females. METHODS: Subjects randomly assigned to an exercise plus intervention group or an exercise plus attentional control group participated in a 5-month long walking program led by trained personnel. Exercise behavior (frequency, miles walked, duration) were assessed on a continuous basis and self-efficacy was measured at 1, 2, and 4 months. RESULTS: Repeated measures multivariate analyses revealed a significant treatment effect with subjects in the intervention group exercising more frequently, for longer duration, and walking greater distances over the course of the program. Path analysis indicated that the effect of the treatment on adherence was direct rather than through self-efficacy as hypothesized. Self-efficacy was, however, a significant predictor of exercise behavior in the early and middle stages of the exercise program but not during the last month. CONCLUSIONS: An intervention program designed to maximize information pertaining to participants' capabilities appears to have had a reasonable effect on reducing attrition in middle-aged males and females and self-efficacy was a significant predictor of exercise frequency over time. Further research efforts are required to tease out those cognitive factors that might underlie any effects of interventions in exercise adherence.

Attitude to Health↗

PubMed1977

Comparative effects of physical training and diet in normalizing serum lipids in men with Type IV hyperlipoproteinemia.

The effect of milk physical training (PT) (group A), Type IV hyperlipoproteinemia (HLP) diet (group B), and PT plus Type IV HLP diet on serum lipids (group C) in 46 men with Type IV HLP was studied. Significant reductions in mean triglyceride (TG) levels from 163, 229, 196, to 136, 145, 116 mg/100 ml serum were found for groups A, B, and C, respectively. Following six weeks of intervention, cholesterol levels also dropped for all groups with the greatest reductions occurring in groups B and C. Minimal weight losses were found for all groups while groups A and C displayed significant reductions in body fatness, but both of these changes appeared independent of lipid reductions. It was concluded that either mild PT or HLP diet or both are effective means of lowering TG levels in Type IV HLP individuals. Furthermore, it appears that patients need to participate regularly in formal programs in order to maintain adherence to these interventions.

Adult↗

PubMedDate not supplied

Simplified therapy with zidovudine, lamivudine, and abacavir for very nonadherent, treatment-failing patients.

OBJECTIVE: To assess the effectiveness of a simplified therapy for very nonadherent patients who had previously failed with HAART. METHOD: We performed a prospective open-label study of antiretroviral-experienced patients. Dosing schedule comprised (co-formulated) zidovudine, lamivudine, and abacavir bid. Eligible patients had to have plasma HIV RNA >5000 copies/mL, previous therapy, and very poor adherence to the medication regimen. RESULTS: Eighty-five patients were included (mean viral load, 4.4 log/mL; mean CD4, 240 cells/mL; IDUs, 78%; methadone maintenance program, 42%; AIDS, 28%). Number of previous therapies: one, 53%; two, 28%; three or more, 19%. In the intent-to-treat analysis at 1 year, 38 patients (44.7%) achieved viral load below 500 copies/mL. Adherence greater than 90% of prescribed drugs was reported in 49% of patients, adverse events were reported in 17.6%, mortality in 6%, and lost to follow-up in 26%. The factors associated with virologic failure were nonadherence (odds ratio [OR], 4.4; 95% CI 1.5-12.3), baseline CD4 cell count <200 cells/mL (OR, 3.4; 95% CI 1.3-8.9; p =.01), and more than one previous treatment (OR, 2.7; 95% CI 1.1-6.9). CONCLUSION: Regarding previously very nonadherent patients, this simplified combination therapy containing three NRTIs obtained satisfactory results in ART-experienced patients. However, more aggressive interventions to enhance adherence are needed to improve results.

Adult↗

PubMed2002

Physical training improves insulin resistance syndrome markers in obese adolescents.

INTRODUCTION: The purpose of this study was to test the hypothesis that physical training (PT), especially high-intensity PT, would have a favorable effect on components of the insulin resistance syndrome (IRS) in obese adolescents. METHODS: Obese 13- to 16-yr-olds (N = 80) were randomly assigned to one of the following 8-month interventions; 1) lifestyle education (LSE)-alone every 2 wk, 2) LSE+moderate-intensity PT, and 3) LSE+high-intensity PT. PT was offered 5 d x wk(-1). Plasma triacylglycerol (TAG), total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), very low-density lipoprotein cholesterol (VLDLC), low-density lipoprotein cholesterol (LDLC), low-density lipoprotein (low density lipoprotein (LDL)) particle size, apolipoproteins AI and B, glucose, insulin, and blood pressure were measured with standardized methods. RESULTS: The intent-to-treat analyses for all subjects who completed pre- and post-tests regardless of their adherence to the interventions showed that the LSE+high-intensity PT group had more favorable changes than the LSE-alone group in TAG level (P = 0.012), TC/HDLC (P = 0.013), and diastolic blood pressure (P = 0.031). For efficacy analyses, all PT subjects who attended at least 2 d x wk(-1) (40%) were combined into one group (LSE+PT) and compared with the LSE-alone group. These two-group analyses showed significant interactions (P < 0.001) between baseline values and group membership for deltaTAG, deltaVLDLC, and deltaTC/HDLC, such that subjects who had the least favorable baseline values showed the most beneficial impact of the PT. Of particular interest was a favorable effect of the PT on LDL particle size. CONCLUSION: PT, especially high-intensity PT, had a favorable effect on several IRS markers in obese adolescents.

Absorptiometry, Photon↗