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kin 1070 Flashcards

1
Q

sport psychology

A

understanding sport behaviour, and improving sport performance

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2
Q

exercise psychology

A

understanding and measuring exercise and sedentary behaviour

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3
Q

health psychology

A

psychological consequences of exercise
using exercise to change health behaviours

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4
Q

rehabilitation psychology

A

psycholgical predictors of injury, interventions to reduce injury, and process of injury recovery

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5
Q

Conjunctive Moderator Variables in Vulnerability and Resiliency Research: Life Stress, Social Support and Coping Skills, and Adolescent Sport Injuries
by: Ronald E. Smith, Frank L Smoll, and John T. Ptacek
Method

A

250 Male and 201 female high school varsity athletes age from 14-19 years old. Participated in basketball, wrestling, or gymnastics at 13 seattle area high schools.obtained data from a total of 41 teams of the three sports

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6
Q

Conjunctive Moderator Variables in Vulnerability and Resiliency Research: Life Stress, Social Support and Coping Skills, and Adolescent Sport Injuries
by: Ronald E. Smith, Frank L Smoll, and John T. Ptacek
Take Home Message

A

Social Support and coping operate in a conjunctive manner to influence the relationship between life stress and subsequenet ahtletic injury in youth athletes.
Only athletes low in both coping and social support exhibiited a significiant stress-injury relation, and in that vulnerable subgroup, negative major life events predicted up to 22% of injury occurrence scores.

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7
Q

Conjunctive Moderator Variables in Vulnerability and Resiliency Research: Life Stress, Social Support and Coping Skills, and Adolescent Sport Injuries
by: Ronald E. Smith, Frank L Smoll, and John T. Ptacek
Implications

A

Most athletic injuries are influenced mained by physical and biomechanical factors, leaving less room to be accounted for by psychological factors.

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8
Q

Conjunctive Moderator Variables in Vulnerability and Resiliency Research: Life Stress, Social Support and Coping Skills, and Adolescent Sport Injuries
by: Ronald E. Smith, Frank L Smoll, and John T. Ptacek
Measures and Procedure

A

Each of the high schools, the athletes complete a series of questionnaires in a group setting in a week prior to the beginning of the sport season. The inventories included measures of recent life events, levels of social support experienced by the athlete, and self-perceived adequacy of psychological coping skills. Injury data were then collected over the course of the season.

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9
Q

Moderator variables

A

quatntitative variable that affects the nature, the direction or the strength of a relation between an independent or predictor variable and a dependent variable

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10
Q

Reducing Stress

A

In order to prevent injuries caused by stress, the intervention should focus on alteration of the cognitive appraisal of potentially stressful events and modifying the phsyiological and attentional aspects of the stress response.
Interventions may be used to directly influence the moeerator variables under coping resources and personality factors.

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11
Q

The effects of a stress Management Program on Injuries and Stress Levels
by: Gretchen Kerr, Judy Goss
Rationale

A

If athletes were taught to better manage or cope with their stress, would the occurrence of injury be reduced?

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12
Q

The effects of a stress Management Program on Injuries and Stress Levels
by: Gretchen Kerr, Judy Goss
Subjects

A

24 voluntter gymnasts who competed nationally and internationally, 16 males from the age of 16-25 and 8 females between the age of 14 and 18 years old.

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13
Q

The effects of a stress Management Program on Injuries and Stress Levels
by: Gretchen Kerr, Judy Goss
Design

A

2 arm randomized trial
Time period of study: Time 1 - preseason and pre-intervention measures (athletic stress): Time 2 - four months after Time 1 and represented mid-season: Time 3 - four months after time 2 and represented peak season (National Championships)
Dependent Measure: Injury occurrence- any physical harm, occuring as a reuslt of training or complete absence from training.
16 sessions delivered bi-weekly ove the 8 months, each session lasted 1 hour

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14
Q

The effects of a stress Management Program on Injuries and Stress Levels
by: Gretchen Kerr, Judy Goss
Injury Data

A

Each gymnasts had at least one injury over the 8-month period of study. 40% of the injuries interfered with trianing for two weeks or less, minor severity. 35% compromise training for 8 weeks or more, most of these injuries are chronic or overuse. They accept these injries as just the way things are. 3% of the injuries were major traumatic injuries such as fractures.

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15
Q

The effects of a stress Management Program on Injuries and Stress Levels
by: Gretchen Kerr, Judy Goss
Take Home Message

A

The incidence of injury can be reduced gymnasts when negative athletic stress is reduced

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16
Q

Evaluaton of the effects of psychological prevention interventions on sport injuries: A meta-analysis
by: U. Traneus, A.Ivarsson, U. Johnson
Objective

A

The purpose was to conduct a systematic review of published articles aiming to prevent sports injuries based on psychological intervention and to perform a meta-analysis of the effects in such interventions

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17
Q

Evaluaton of the effects of psychological prevention interventions on sport injuries: A meta-analysis
by: U. Traneus, A.Ivarsson, U. Johnson
Prospect and Projects

A

The electronic databases and suitable sport psychology journals were searched for published studies. OUt of 560 screened articles, 15 were potentially eligible articls. 7 of these articles with substantional informaiton in the papers or the authors were able to provide us with data after request were included.

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18
Q

Evaluaton of the effects of psychological prevention interventions on sport injuries: A meta-analysis
by: U. Traneus, A.Ivarsson, U. Johnson
Conclusion

A

Psychological injury prevention interventions have a large effect on reducing the number of injuries in sport poulation

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19
Q

Effects of Relaxation and Guided Imagery on Knee Strength, Reinjury Anxiety, and Pain following Anteriror Cruciate Ligament Reconstruction (ACL)
by: Deborah D. Cupal, Britton W. Brewer
Partcipants

A

30 patients who had completed ACL reconstructive surgery; no evidence of other acute lower extremity truama; expected to engage in a 6 month post-surgical rehab

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20
Q

Effects of Relaxation and Guided Imagery on Knee Strength, Reinjury Anxiety, and Pain following Anteriror Cruciate Ligament Reconstruction (ACL)
by: Deborah D. Cupal, Britton W. Brewer
Measures

A

Re-injury Anxiety: concern for re-injury reconstructed knee once normal physical activity is resumed
Pain: subjective experience of pain
Knee Strength: Cybex isokinetic dynamometer ( computing a ratio in foot pounds of performance on the injured knee to that of the uninjured knee)

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21
Q

Effects of Relaxation and Guided Imagery on Knee Strength, Reinjury Anxiety, and Pain following Anteriror Cruciate Ligament Reconstruction (ACL)
by: Deborah D. Cupal, Britton W. Brewer
Procedure

A

Participats were randomly assigned to either treatment, placebo, control conditions
Measure of re-injury anxiety and pain were assessed at 2 weeks and 24 post-surgery
Measures of knee strength were assessed 24 weeks post-surgery
Treatment group: 10 individual session of relaxation and guided imagery (session spaced two weeks apart over the 24 weeks) and normal course of physiotherapy
Placebo group: received attention, encouragement and support from the clinican at the sports medicine facility + normal course of physiotherapy
Contorl: followed a normal course of physiotherapy

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22
Q

Why does imagery work?

A

Psycholgoical mechanisms: personal control, motivation
Reduce stress -> better immune-inflmmatory response -> promotes tissue regeneration and repair

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23
Q

Effects of Relaxation and Guided Imagery on Knee Strength, Reinjury Anxiety, and Pain following Anteriror Cruciate Ligament Reconstruction (ACL)
by: Deborah D. Cupal, Britton W. Brewer
Take Home message

A

Psychological-based interventions can enhance functional and related cognitive outcomes during rehabilitation

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24
Q

Bandura’s Model

A

Modeled Act -> Attention -> Retention -> Production -> Motivation -> Response

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25
Q

Research and Applications of Modeling in Rehab Psychology

A

Settings
Modeling Interventions
Outcomes

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26
Q

Outcome Measures

A

Performance - adherence, outcome, errors, form
Cognitive and Affective Psychological Responses - anxiety, self-efficacy, mood, RPE

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27
Q

Types of Modeling Interventions

A

Mastery vs Coping Models
Imagery vs Modeling as a Vicarious Experience
Self-Modeling

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28
Q

Mastery Models

A

Demonstrate errorless perfromance
Verbalize Confidence
Demonstrate positive attitude
Verbalize low task difficulty

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29
Q

Coping Models

A

Display decreasing distress as they struggle with difficulties or threats
Demonstate strategies for dealing with different situations
voice progressively self-efficacious beliefs
Approach or achieve mastery

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30
Q

Kulik Mahler 1987

A

The exposure to postoperative sensations and events through a coping model better prepares the observer by providing accurate information on which cognitive appraisal of the situation can be made

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31
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Modeling as a tool

A

Powerful instructional tool for the acquisition of motor skills, psychological responses, and behavior change in physical activity contexts
Modeling combined with instruction in coping strategies is highly effective in producing positive outcomes for adults undergoing surgery or invasive medical procedures

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32
Q

Modeling

A

An area that has received limited attention in the realm of injury rehabilitation is modeling

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33
Q

Flint (1991)

A

Examined the role of coping models compared to no models on psychological factors and functional outcomes following a rehabilitation program for ACL among ten female basketball players.
Players were assigned to watch a coping model video of peers participating in rehabilitation from ACL surger.
The coping model video showed female athletes similar in age, basketball position, and type of injury progressing through the rehabilitation process to full recovery.

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34
Q

Flint 1991 Psychological Milestones

A

At 3 weeks post-srugery athletes who watched the modelling video had greater self-efficacy than the control gorup
At 2 months post surgery the intervention group had higher perceived athletic competence

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35
Q

Flint 1991 Limitations

A

Flint study had a modest sample size and hence was underpowered.
Modeling intervention was introduced postoperatively and did not provide an indication of its benefit preoperatively.

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36
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Purpose

A

To extend the work of Flint (1991) by investigating the effectiveness of a coping model intervention to improve psychological processes and fucntional outcomes pre- and post- ACLR

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37
Q

ACL Reconstruction

A

Population suitable for continued research, because ACL disruption is one of the more common sport-related injury and is associated with an extensive period of rehabilitation (6-9 months)
Opportunity to augment traditional programmes

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38
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Hypotheses

A

Athletes who received the coping modeling video intervention would report lower preoperative anxiety and perceptions of pain and would report reater elf-efficacy for rehabilitation compared to the non-intervention group
Participants in the intervention group would show greater improvements in functional milestones (ex. range of motion, and crutch use) than those in the non-intervention group.

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39
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Participants

A

72 partcipants scheduled for ACLR recruited
30 intervention, 28 control
15-53 years of age
68% were male

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40
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Psychoogical Measures

A

Perceptions of expected pain - baseline, pre operative
Perceptions of actual pain - baseline, predischarge and 2 weeks
Anxiety- participants rated levels of state anxiety, baseline, pre-operatively and pre-discharge
Self-efficacy- Partcipants rated their confidence to perform specific tasks over increasing duration and frequency
Walk with crutches (post-op)
Walk without crutches (post-op, 2 weeks)
Perform rehabilitation exercises (post-op, 2 and 6 weeks)

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41
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Functional Measures

A

International Knee Documentation Committee Form (IKDC)
Objective component (surgeon)- knee laxity, swelling ROM
Subjective component (patient)- symptoms, difficulty performing tasks)
Basline and 6-weeks
Range of Motion - baseline, 2 and 6 weeks using a goniometer, time walking without crutches (in days)

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42
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Procedure

A
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43
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Modeling Intervention

A

A DVD was developed
Presented interviews of individuals who had undergone ACL repair
Demonstrated and verbalised increasing confidence in dealing with the operation and rehabilitation programme
Detailed various stages of the post-operative rehabilitation process
It was expected that watching the video would permit individuals to pick up relevent cues and information particular to their own stage of progression (pre-op/post op)
This information would be processed, retained, and result in decreased anxiety, perceptions of pain and increased confidence to perform rehabilitation.

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44
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Observation

A

Intervention group - better walking self efficacy pre discharge, confidence in exercise pre discharge, expected pain lowered, crutch efficacy higher, less days walking with a crutch
Objective: IKDC score was a closer to 0 (better function)
Subjective: IKDC score was higher

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45
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Conclusions (Psychological Measures)

A

Preoperative anxiety, no effect
Perceptions of expected pain, positive effect
Perceptions of actual pain, no effect
Self-efficacy measures, early effect

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46
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Conclusions (Function)

A

Crutch walking, positive effect
IKDC, positive effect
ROM, no effect

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47
Q

Modeling and Rehabilitation Following Anterior Cruciate Ligament Reconstruction
by: Ralph MAddison, Harry Prapaessis, Mark Clatworthy
Future research

A

The use of interactive modeling techniques in specific rehabilitation exercsies.
Non-pharmacological pain-management techniques used during pain focusing (association and disassociation) and pain reduction (relaxation training, meditation) might be presented using a modeling format
Use of modelling techniques could be employed to alter psychological variables previously shown to affect adherence behavior (ex. motivation, intention and perceived behavioral control)

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48
Q

Placebo

A

The measurable, observable, or felt improvment in health not attributable to treatment
Psychological theory- belief in the treatment or a subjective feeling of improvement

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49
Q

Process of treatment theory

A

Placebos caue the release endogenous opiods, or endorphins, that reduce pain
showing attention, care, affection etc. to the pateint/subject triggers phsyical rreactions in the boyd which reduce stresss and promote healing

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50
Q

Fun facts about placebos

A

The placebo effect has been measure in thousands of medical experiment and many doctors regulary prescribe placebos, drug companeis must show that their new drug work better than a placebo before the drugs are approved
Placebos have been shown to affect a range of health conditions
The color and of a talbet can alter the strength of its placebo affect

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51
Q

Bruce Moseley: Power of Placebo

A

Compared rehab outcomes from real surgery vs. sham surgery.
No difference between knee surgery and sham surgery, no notable difference in regards to the ability to walk

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52
Q

Osteoarthritis

A

Breakdown of cartilage in joints and arthroscopic surgery damaged cartilage is scraped or flushed out

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53
Q

Systematic Review & Meta Analysis: Real vs. Placebo Surgery

A

What are the true effects of a placebo after sugery ( internal validity was measure qualitatively by curcial appraisal)
Risk assumed omplicationw ere not lower in placebo than the intervention group
No complications following sham sugery compared to actual surgery

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54
Q

Systematic Review & Meta Analysis: Real vs. Placebo Surgery
Methods

A

Followed PRISMA Statement guidelines
PRISM- document that structures and guidees how people report these kind of systematic review with meta analsysi component

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55
Q

Systematic Review & Meta Analysis: Real vs. Placebo Surgery
Summary

A

Placebo can be feasible and is valid methodological instrument for evaluation of the fficiency of surgical inerventions
Risk with placebo which should only be used if there is a necssity
Placebos are proven beneifical and very powerful

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56
Q

Who experiences depression

A

Affects about 121 million people
13% of Americans experience major depression over the course of their lifetime
Approximately 7% suffer a major depressive disorder in any given year
Fewere than 25% of those affected have access to effective treatment
Women experience depression more than men
Leading cause of disability as measured by eyars living with disability (YLD) and the fourth leading contributor to the global burden of disease

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57
Q

Mood

A

Specific short term feeling states or emotional tones which can be either postiive or negative

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58
Q

Anxiety

A

Unpleasant feeling state and physiological reaction that occurs when fear is provoked
Affective, physiological, cognitive, behavioural aspects, AROUSAL is key
trait vs state.

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59
Q

Depression

A

State that eventuates from a perception of an important loss or the threat of such a loss
Affective, phsyiological, cognitive, behavioural aspects, characterised by avoidance, withdrawal, diminished activity

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60
Q

Diagnosis Depression

A

No biological test currently available
Established 2 core and 9 other symptoms for depression (4 psychological and 5 physical)
A person must have at least 1 core symptom and 5 or more of the other symptoms present in the same two week period within the last month

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61
Q

Core depression symptoms

A

Depressed mood most of the day, nearly every day
Markedly diminished interested in pelasure in all, or almost all, activities most of the day, nearly every day

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62
Q

Other depression symptoms

A

Feeling guilty, hopeless, and worthless
Recurring suicidal thoughts
Having trouble sleeping, either too much or too little
Experiencing appetite/weight changes
Trouble concentrating
Feeling little energy or unexplained tiredness
Agitation or slowing down of body movement

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63
Q

Other types of depression

A

Bipolar disorder-alternating episodes of emotional highs (mania) and lows (depression)
Dysthmia - mild depression symptoms that last two years or longer
Postpartum depression - a type of depression that occurs in the mother after her baby is born
Season affective disorder (SAD) - amajor depression that occurs during season with low sunlight

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64
Q

Understanding depression: co-existing conditions

A

Anxiety disorders
Alcohol and/or substance abuse
Heart disease
Stroke
Cancer
HIV/AIDS
Diabetes
Parkinson’s disease

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65
Q

Beck Depression Inventory (Beck, Ward, Mendelson, Mock & Erbaugh, 1961)

A

Used to asses presence and intensity of depressive symptoms in psychiatric populations
Self report
21 items
Symtpoms & attitudes common to depression
Scored 0-3 for intensity
Summed to give total score
<10 none/minimal depression
10-18 mild/moderate depression
19-29 moderate/severe depression
30-63 severe depression

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66
Q

Center for Epidemiologic Studies Depression Scale (Radloff, 1977)

A

Used to asess presnece and intesity of depressive symtpoms in the general population
Self report
20 items
6 domains of symptoms
Scored 0-3
Summed to give total socre
>= 16 =depression

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67
Q

Hamilton Rating Scale for Depression (Hedlung & Vieweg, 1979)

A

Self Report
21 items
Scored 0-4
Depressed mood, feelings of guilt, suicide, insomnia, work and activites, psychomotor retardation, agitation, anxiety, libido, hypochrondiasis, loss of weight, insight, diurnal, paranoid, obsessional and compulsive symptoms

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68
Q

Causes of depression

A

not fully known
combination of genetics, biolgoic, and environmental, and personal factors at work

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69
Q

Seratonin

A

In some people who are severely depressed, receptors may be insensitive to seroonin, causing their response to its release to be inadequate. Message mgiht be weakend if the originating cell pumps out too little of the serotonin neurotransmitter or if an overly efficient reuptake mops up too much before the molecules have the chance to bind to the receptors on other neuros
Any of these system faults could signifcantly affect mood

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70
Q

Benefits of keeping serotonin working

A

Keeping serotonin at levels that allow communication between nerve cells strengthen circuits to the brain which regulate mood

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71
Q

Inflammation in the brain

A

Inflmmation is the body’s immune response to infection and trauma
One theory is that depressed patients may have been exposed to an infection or trauma, and their brain has yet to cool off from the experience

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72
Q

Brain Atrophy

A

Depression can be associated with the loss of volumen in parts of the brain, namely the hippocampus, which belongs to the limbic system, and is important in the consolidation of information from short-term memory to long-term memory. The most severe the depression, the greater the loss of brain volume

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73
Q

Mood-LInked Responses in Medial Prefrontal cortex Predict Relapse in Patients with Recurrent Unipolar Depression
by: Norman Farb, Adam Anderson, Richard Boch, Zindel Segal
Design and Results

A

Using MRI, reaeraches presented 16 formerly depressed patinets with sad movie clips while taking pictures of their brain activity.
Over the next year and 9 of the 16 patients relapsed into depression. The researchers compared the brain activity of relapsing patients against those who remained healthy and against another gorup of people who had never been depressed.
Relapsing patients showed more activity in a rontal region of the brain known as the medial prefrontal gyrus.
Responses in this front region were also linked to higher rumination scores, and the tendency to think obsessively about negative events

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74
Q

Mood-LInked Responses in Medial Prefrontal cortex Predict Relapse in Patients with Recurrent Unipolar Depression
by: Norman Farb, Adam Anderson, Richard Boch, Zindel Segal
Implications

A

For a person with ahistory of epression, using the frontal brain’s ability to analyze and interpret sadness may actually be an unhealthy reaction that can perpetuate the chronic cycle of depression

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75
Q

Neuroinflammation

A

PET scans use a radiopharmaceutical that binds (high or mixed affinity binding) to the translocator protein (TSPO) in microglia cells. Level of protein is increased in activated microglia cells = elevated translocator protein density

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76
Q

Microglia

A

Type of glial cell that are the residnet macrophages of the brain and spinal cord, and thus act as the first and main form of active immune defense in the central nervous system (CNS)

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77
Q

Macrophages

A

Type of white blood cell that engulfs and digests cellular debris, foreign substances, microbes

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78
Q

Setiawan Study: Translocator Protein Density
Design and Participants

A

Design: case-control
Participants: 20 patients with a major depressive episode (MDE) secondary to major depressive disorder and 20 healthy controls

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79
Q

Setiawan Study: Translocator Protein Density
Implications

A

Brain inflmmation, and more specifically microglia activation is implication in major depressive episode
Unable to determine whether the neuroinflammation occurs before depression or because of it
Suggests that treatments should be designed to reduce microglia activation in depressive patients

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80
Q

Depression and white matter of the brain

A

The CNS has two kinds of tissue: grey matter and white matter, grey matter, which has a pinkish-grey color in the living brain, contains the cell bodies, dendrites and axon terminals of neurons, so it is where all synapses are. White matter is made of axons connecting different parts of grey matter to each other
Depression has been shown to alter the strucutre of the brain’s white matter, and underpins brain function

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81
Q

Genetics depression

A

Depression tends to run in families, so researches believe that certain genes may be associated with developing it
If someone has a parent or sibling with major depression, that person probably has a 2 or 3 times greater risk o developing depression compared with the average persion

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82
Q

Genetics (Capsi et al. 2003)

A

Researchers at Wisconsin and Otago anayzed the type of 5-HTT gene carried by 847 adults (5-HTT gene helps regulat serotonin)
2 forms of the 5-HTT gene, the long and the short. An individual can inherit two copies of the long form, two fo the short, or one of each
Short version of 5-HTT is not as effective in controlling the serotonin flow as the long version
Researchers focused on subjects who had traumatic life events over a 5 year period
Patients with at least one copy of the short form of 5-HTT were moer at risk of depression

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83
Q

Health Psychology

A

Psychological consequences of treatment (exercsie)
Using treatment (exercise) to change other health behaviours

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84
Q

Distribution

A

Relates to the frequency and patterns of disease occurrence in a population

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85
Q

Prevalence

A

How often the disease occurs

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86
Q

Incidence/occurrence

A

Rate of new disease or health events

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87
Q

Epidemiological Research

A

Observational not experimental

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88
Q

Why is Epidemiological Research Important

A

Virtually the only way in which a quantitative understanding of the exposure-disease relationship can be obtained

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89
Q

Types of Epidemiologic Study Designs

A

Analytical, case control, cohort

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90
Q

Analytical Study Designs

A

Designed to test specific hypotheses regarding casual links between various exposures and mortality and incidence outcomes using purely observational methods

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91
Q

Analytical: cohort studies

A

Whatever the topic, a group of individuals is identified and watched to see what events befall them

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92
Q

Analytical: cohort studies

A

Disease rates in cohort studies are often expressed relative to “person years” of follow up
Person year represents 1 year of observation for one person during the follow up period

93
Q

Cohorot Analysis: Paffenbarger et al

A

At follow-up assessment 6-10 years later, it was determined that 572 men had experienced their first heart attack
Rates of fatal, non fatal, and all first heart attack were compared in each of the baseline physical activity exposure categories.

94
Q

Analytical: case-control studies

A

Often the gorup of individuals will have some disease, in which case the question will be directed at the causes of their diease.
Select a set of patients with a defining characteristic: a diagnosed disease
Characteristics of theses are compared with a control group similar in age, sex and background who do not have the disease
Sometimes called a retrospective study
These types of studies typically look for treatments which reduce event rates

95
Q

MET

A

metabolic equivalent, a unit used to estimate the metabolic cost of physical activity. The value of 1 MET is approxiamtely equal to a person’s resting energy ependiture

96
Q

Case- Control study: Bernstein et al

A

Investigated effect of physical activity exposure from adolescence through adulthood on the risk of breast cancer
Compared women with breast cancer to those without
Looked physical activity exposure retrospectively
Looked for treatment that reduced event rates
Women who exercise more than 3.8 hours a week were 58% reduced risk to breast cancer

97
Q

Kyu et al

A

Meta analysis and review on dosage associations between physical activity and chronic diseases
However, they mainly focused on leisure time physical activity
Total physical activity and chronic diseases relation was not well characterized

98
Q

Kyu et al
Chart

A

no matter what diseases all lines are quite different with how physical activity affects diseases
Each one of these diseases has its own unique and distinct pattern
Only similarity is that for ischaemic heart diseases and diabetes, the protective benefit seem to dissipate at 4000 MET mins per week
Most to Least Profound Benefits:
1.Ischaemic stroke and ischaemic heart disease (3000-2. 4000 MET mins a week)
3. Diabetes (4000 MET mins a week)
4. Colon cancer (3000 MET mins per week)
5.Breast cancer (some benefit throughout MET min per week the risk benefits are much greater for the others then breast cancers)

99
Q

Kyu et al
conclusions

A

Risks of these disease decrease with increasing level of total activity
Most health gains occur at relatviely lower levels of activity
Dose response focused on total physical activity

100
Q

Psychological Reaction to Injury

A

Injury-relevant processing - information about pain, extent of injury, how it happened, negative consequences
Emotional upheaval & reactive behaviour - agitation, emotional depletion, isolation, shock, disbelief, denial, self-pity
Positive outlook & coping - acceptance, coping efforts, optimism, relief with progress
Identity Loss
Fear & anxiety
Lack of Confidence
Performance decrements

101
Q

Stress

A

Substantial imbalance between demand and response capability
Under conditions where failure to meet demand has important consequences
Injry is a stressor
Rehab can be a stressor as well

102
Q

Stress and Injury Recovery

A

Most salient when recover < expectations
Period immediately post-injury characterized by greatest negative emotion
High stress may = poor adjustment

103
Q

Prehabilitation/ Prerehabilitation

A

Training/treatment in preparation for an anticipated stressor
CAn be physical, psychological, or both

104
Q

The Theory - Topp et al

A

Prehab patients have a boost before surgery
Boost is beneficial because they will be a drop post of minimum level of functional ability surgery but it won’t be as dramatic with prehab
Spend less time postoperative below minimum level of function

105
Q

Why does Prehab work

A

Train specific systems that will be affected by the stressor
build up a functional reserve to compensate for depletion by the stressor

106
Q

Chronic Conditions

A

Elective surgery or longer wait times for necessary surgery = larger prehab window

107
Q

Before Surgery

A

Condition continues to get worse
Patients become more sedentary
Treatment options have been exhausted

108
Q

After Surgery

A

Get mobile ASAP
Wound closure, prevent infection
Strength, independence, range of motion

109
Q

Sport Injury

A

Acute Injury
Shorter surgical wait time
Performance goals
Return to play timeline

110
Q

Chronic Condition

A

Gradual onset
Longer wait time
Daily living/health goals
No defined recovery timeline

111
Q

A systematic review and meta-analysis of randomised controlled trials
by: Wang
Overview

A

Does prehab for patients undergoing joint replacement surgery improve outcomes
Joint replacement surgery is one of the most successful medical interventions
Significant pain relief and improvement
Recovery is difficult and prolonged

112
Q

A systematic review and meta-analysis of randomised controlled trials
by: Wang
Study Design

A

Randomized control trials
Prehab vs Non-Prehab before surgery
Prehab — Physio supervised exercise
Non-Prehab — Normal Care

113
Q

A systematic review and meta-analysis of randomised controlled trials
by: Wang
Outcome measures

A

Function scores
Pain
Quality of life
Cost
Length of hospital stay

114
Q

A systematic review and meta-analysis of randomised controlled trials
by: Wang
Strengths/ Limitations

A

Strength - Converted outcomes into standardized measurement of WOMAC
Limitation - Compliance wasn’t reported and no physical measure of function

115
Q

A systematic review and meta-analysis of randomised controlled trials
by: Wang
Conclusion

A

Prehab slightly improve post-operative pain and function
Effects are too small andshort term to be clinically reliable
Did not influence outcomes of interest

116
Q

Anorexia Nervosa

A

A refusal to maintain body weight at or above a minimally normal weight for age and height
Intense fear of gaining weight or becoming fat, even though underweight.
distrubance in thew ay in which one’s body weight or shape is expereinced undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

117
Q

Physical symptoms of anorexia

A

severe weight loss
insomnia
dehydration
constipation
weakness and fatigue
dizziness and fainting
thinning and breaking hair
bluish tinge to the fingers
dry, yellowish skin
inability to tolerate cold
absense of menstruation
downy hair on the boyd, arms and face
arrhythmia

118
Q

Behavioral changes in anorexia

A

skipping melas
lying about how much food they’ve eaten
eating only low calorie foods
talking badly about their body
trying to hide their body with baggy clothes
avoiding situation that can involve eating in front of other people
extreme exercising

119
Q

Bullmia

A

Two different types of bulimia. The attempts to purge are used to differentiate them. The new edition of DSM-5 now refers to attempts to purge as “inappropriate compensatory behaviors”
Purging bullmia: vomitting after binge eating
Non-purging bulimia: fast or engage in extreeme exercise to prevent weight gain after a binge

120
Q

Physical symptoms of bulimia

A

Weight that increases and decrease in signficant amounts between 5-20 pounds in a week
chapped or cracked lips
bloodshot eyes
callouses, sores, or scares on the knuckles
mouth sensitivity
swollen lymph nodes

121
Q

Behaviorial changes bullimia

A

constantly worrying about weight or appearance
eating to the point of discomfort
going to the bathroom immediately after eating
exercising too much, especially after they’ve eaten a lot
restricitng calories or avoiding certain foods
not wanting to eat in front of others

122
Q

Emotional symptoms of anorexia and bullimia

A

Poor self esteem and body image
irritability agitation, or other mod changes
social isolation
depression
anxiety

123
Q

Eating disorder treatment approaches

A

Psychotherapy
Family approaches
Nutritional management
Medication

124
Q

Psychological mechanism Eating Disorder

A
125
Q

Eating Disorder (Kaye Strober, 1999 Eating Dis Rev)

A

Eating Disorder patients have abnormally high levels of serotonin
Controllling food intake lowers serotonin levels to make patients feel better

126
Q

Eating Disorders in Athletes

A

High levels of competitevenss, high emphasis on control, and perfectionist tendencies. Athletes may also represent a high-risk population for eating disroders becaue it is assumed they are exposed to body shape and weight pressures unique to sport.

127
Q

Prevalence of Eating Disorders in Elite Athletes is Higher than the general population
by: Sundgot-Borgen
Design

A

A 2 step study including self-reported questionnaire and clinical interview

128
Q

Prevalence of Eating Disorders in Elite Athletes is Higher than the general population
by: Sundgot-Borgen
Participants

A

The entire population of Norwegian male and female elite athletes was evaluated

129
Q

Prevalence of Eating Disorders in Elite Athletes is Higher than the general population
by: Sundgot-Borgen
Measurement

A

Followed DSM criteria for eating disorders

130
Q

Prevalence of Eating Disorders in Elite Athletes is Higher than the general population
by: Sundgot-Borgen
Results

A

More athletes had subclinical or clinical EDs. Females competing in aesthetic sports were at high risk. Males in antigrativation sports were a more risk

131
Q

Prevalence of Eating Disorders in Elite Athletes is Higher than the general population
by: Sundgot-Borgen
Conclusion

A

Prevalence of ED is higher in athletes than the controls, higher in females than males
More common in lean-dependant and weight-dependant sports

132
Q

Perfectionism and Eating Attitudes in Rowers: the moderating effects of body mass, weight, classification and gender
by: Haase and Prapevassis
Participants

A

496 New Zealand and Australian national rowers

133
Q

Perfectionism and Eating Attitudes in Rowers: the moderating effects of body mass, weight, classification and gender
by: Haase and Prapevassis
Measures

A

Positive and Negative Perfectionism Scale
Eating Attitudes Test
BMI

134
Q

Perfectionism and Eating Attitudes in Rowers: the moderating effects of body mass, weight, classification and gender
by: Haase and Prapevassis
Chart

A

As perfectionism socres go up so do eating attitude scores
Rowers who have a lower GMI ahve a lower strength of that relationship

135
Q

Perfectionism and Eating Attitudes in Rowers: the moderating effects of body mass, weight, classification and gender
by: Haase and Prapevassis
Conclusions

A

Negative Perfectionism is positviely related to EDs
Positive Perfectionism is unrelate to EDs
Body mass, weight classification and gender moderate relations between negative perfectionism and disturbed eating attitudes
Negative Perfectionsim- ED’s are maximised for lightweight female rowers with greater body mass

136
Q

Perfectionism and Eating Attitudes in Rowers: the moderating effects of body mass, weight, classification and gender
by: Haase and Prapevassis
Future Recommendations

A

Underlying mechanism for ocnjunctive moderator effect- need for control
Lack of relations between Positive Perfectionism and ED
Translation into psychopathology

137
Q

Sleep Patterns

A

As a person begins to fall asleep, his/her heart rate, respiration rate and body temperature decrease and alpha waves ( 8-13 cps) appear on an electreoncephalography EEG profile

138
Q

Non-REM sleep Stage 1

A

Semi conscious state characterised by further reduction in HR, irregularity in respiration, and muscle relaxation tha my atrigger involuntary twitching

139
Q

Non-REM sleep Stage 2

A

As body temperature continues to decrease the person enters stage 2 where EEG profile exhibits short bursts of rhytmical activity in the 13-16 cps range known as sleep spindles. Theses spindles mark the boundary between perceptions of semi-consciousness and sleep, because most people awaked after the appearance of spinkldes report that they have been asleep

140
Q

non-REM sleep Stage 3

A

with further loss of consciousness and the intial appearance of very slow brain waves (5-3 cps). No cosscious awarenss. slow wave sleep

141
Q

REM Sleep

A

Low voltage, mixed fequency EEG in conjunction with episodic REMs and low amplitude electromyography (EMG)
The most memorable and vivid dreams occur during REM sleep
REM sleep occurs in cycles of about 90-120 minutes through the night, and it accounts for up to 20-25% of total sleep time

142
Q

Meta Analysis by Kubitz et al.
Effect size

A

How much benefit does exercise have on sleep patterns vs no exercise
Strength association with IV and DV
How much total variability of the grouping or factor variable — how much exercise affects sleep variable

143
Q

Meta Analysis by Kubitz et al.
Findings

A

Effect size were small 0.2 to moderate 0.5 favouring exercise
Observed effect size may be somewhat conservative since exercise/sleep studies generally examine individuals without sleep difficulty
Exercise has the biggest impact on sleep when exercise has a longer duration and is completed earlier in the day

144
Q

Meta Analysis by Kubitz et al.
Exercise and Sleep

A

Dynamic/Aerobic exercise increase time to fall asleep and may result in less SWS if undertaken late in the day
Static exercise performed close to bedtime appears to decrease sleep latency and may increase SWS
Exercise may increase SWS only for already trailed (fit) individuals
Evidence that the time of day and the type of exercise are important moderators of the relationship between exercise and sleep patterns

145
Q

Systematic Review and Meta Analysis
by: Wu et al.
Background

A

Sleep disorders are on eof the most common difficulties facing older people
Conceptualized as a geritatric syndrome and include insomnai and other conditions
Common symptoms: difficulty falling asleep, noncturnal awakenings, etc.
Higher prevalence of sleep disorders,with rates of 25%-60% in elderly people, than in the general adult population
Sleep disorders can have a significant negative impact on mental and physical health

146
Q

Factors associated with poor sleep quality

A

As people age, sleep wake circadian rhythm and hormone secretions become less robust
Decreased health status
Psychiatric illness
Cognitive diorder status
Medication side effects
Psychological factors

147
Q

Conventional Treatment Options

A

Involve pharmacologic and psychological interventions
Pharmacological agents
Cognitive behavior therapy

148
Q

Meditatitve Movement Interventions (MMIs)

A

Evidenced based complementary and alternative mediceine (CAM) approaches are of interest and increasing popularity
MMIs: combine meditative focuse with movement
Defined as some form of movement or body positioning as well as focus on breathing with a cleared or calm state of mind
Ex. yoga, tai chi

149
Q

Systematic Review and Meta Analysis
by: Wu et al.
Findings

A

14 studies examined
Types of MMIs varied
Duration ranged form 12-24 weeks
Most studies included interventions lasting 60 minutes/session
Performed 3x a week

150
Q

Systematic Review and Meta Analysis
by: Wu et al.
Implications

A

MMIs can be beneficial for sleep quality in elderly people with sleep complaints
Effects were clinically relevant
Similar effects as seen with conventional interventions
Effectiveness is influenced by frequency

151
Q

Effect of exercise training on sleep apnea
by: Aiello et al.
Background

A

Obstructive sleep apnea (OSA) is commonly characterized by recurring upper airway obstruction during sleep
Common predisposing factors: gender (male), craniofacial anomalies and obesity
Treatment options: continuous positive airway pressure (CPAP)

152
Q

Apnea hypopne index (AHI)

A

Number of events per hour of sleep as measure of severity of OSA

153
Q

Effect of exercise training on sleep apnea
by: Aiello et al.
Purpose

A

To study the use of exercise as a management treatment for OSA in adults

154
Q

Effect of exercise training on sleep apnea
by: Aiello et al.
Findings

A

8 studies included
Supervised exercise programs were used in the majority of studies
2-6 monhs with a frequency of 2-7 days/week
Exercise was associated with a reduciton in API after treatment

155
Q

Effect of exercise training on sleep apnea
by: Aiello et al.
Implications

A

Exercise has an effect on reducing AHI and the underlying causes of OSA in patients with OSA
Consistent findings independent of different types, durations, and frequency of exercise ssions; CPAP usage; supervised vs. unsupervised

156
Q

Effect of exercise on sleep quality and insomnia in middle-aged women
by: Rubio Arias et al.
Background

A

Sleep distrubance is quite frequent in the general population
40-55% of middle aged womenmay show some degree of sleep disturbance
Insomnia is under recognized and undertreated
Exercise has been proposed as a non-pharmacological alternative

157
Q

Effect of exercise training on sleep apnea
by: Aiello et al.
Purpose

A

To assess the effets of short term programmed exercsie on sleep quality and insomnia in middle-aged women

158
Q

Effect of exercise training on sleep apnea
by: Aiello et al.
Findings

A

5 publications reported data from four RCTs on PE effects during 12-16 weeks on sleep quality and/or insomnia
Moderate PE = positive effect on sleep quality as compared to controls
Low levels of PE = no significant improvement on sleep quality
Low-moderate PE = no significant reduction in severity of insomnia

159
Q

Effect of exercise training on sleep apnea
by: Aiello et al.
implications

A

Porgrammed exercise improved sleep quality but had no signifcant effect on the severity of insomnia
current evidence should be interpreted with caution due to small # of studies

160
Q

Health hazards of smoking

A

Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obsturctive pulmonary disease (COPD), which includes emphysema and chronic bronchitis
Smoking is directly related for approximatey 90% of lung deaths and approximately 80-90% of COPD (emphysema and bronchitis) deaths

161
Q

Smoking and lung cancer

A

Smoking damages your lungs’ natural cleaning and repair system and traps cancer-causing chemicals in your lungs
Smoking chemicals mix together to form a sticky tar that lines the inside of your lungs
If the cilia are covered in tar, they can’t do their job properly, and germs, chemicals and dirt can stay in your lungs and cause disease-cancer.

162
Q

Smoking and COPD

A

Smoking permanently damages the alveoli in the lungs making it harder to breathe
Smoking damages the structure of the alveoli by making it less stretchy harder for lungs to take in oxygen and get rid of carbon dioxide
Leads to shortness of breath and feeling tired
Heart has to work harder to give your body the oxygen it needs
Over time this damage leades to COPD

163
Q

Smoking cessation

A

It is recognized in all Canadian health strategy documents that stopping smoking at any age is associate with clear health beneftis

164
Q

High recidivism rates

A

Failure rates amongst self-quitters have consistently been shown to be as high as 95-98%
Relapse after quitting is fast and common
Up to 70% of current smokers wish to quit or have made at least 1 quit attempt

165
Q

How Nicotine works

A

Within several seconds, about 1/4 of the nicotine has gone through the bloodstream straight to the brain
causes a rise in heart rate and in the rate of breathing
Nicotine stimulates nicotine acetylcholine receptors located in the ventral tegmental area
Leads to the release of dopamine in the nucleus accumbens, plays an important role

166
Q

Why quitting smoking is hard

A

Weight management, nicotine regulates metabolism
Psychological- helps control mood and stress
Habit and sensory - risky situations that trigger the urge to smoke
Risk factors - depression, history of alcohol or drug abuse, low SES, co morbidity

167
Q

Nicotine metabolism

A

NIcotine is metabolized to cotinine and cotinine is metabolized to 3-hydroxycotine by the lizer enzyme cyctochrome P450 2AG. The rate of nictoine metabolism has been found to predict smoking behavior.

168
Q

Why exercise can help quit smoking

A

Exercise has positive effects on mood
Exercise increase self-efficacy/coping
Exercise may be a competitive behavior o smoking and hence incompatible
Promotes healthy weight and may reduced post cessation weight concerns
Favorable effect on CVD risk profile

169
Q

Temporary Cessation with Exercise

A

Only one piece of exercise equipment, heart rate monitor, carbon monoxide monitor
Data in a missivle control is consisten for a treatment phase
Those in exercise condition show a drop in desire to smoke during exercise rises a bit after but remains lower than the control
Can help women with acute craving

170
Q

Improving ecological validity

A

A more realistic situation for a smoker attempting to quit: stressors are presented concurrently
1. temporary abstinence
2. demanding cognitive tasks and/r cue-elicited smoking stimuli
Unknown how exercise will affect cravings and time to first cigarette in this situation

171
Q

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors
by: Fong et al.
Overview

A

Collected data and asked participants to retain from smoking
Follow up- stress them again with a cognitive task
Gave money and would lose money every time they lit a cigarette

172
Q

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors
by: Fong et al.
Take Home Messages

A

First study to examine the effects of acute exercise following concurrent stressors
Reflects a more ecologically valid scenario when a smoker is attempting to quit
Exercise significantly decreased cravings following concurrent stressors
Exercise had no effect on ad lib smoking

173
Q

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors
by: Fong et al.
Other limitations

A

Included temporarily abstinent smokers rather than quitters
Severity of desire sy potoms may not correspond entirely with those felt when an individual is fully invested in a quit attempt
The effect of acute exercise on cravings and withdrawal during a pharacological based products is unknown

174
Q

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors
by: Fong et al.
Where does it leave us?

A

Exercise seems to work
Different from a fact acting losing or spray
Comibing the two could be worth while

175
Q

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors
by: Fong et al.
Mechanisms

A

Nicotine Replacement Therapy: All of the NRT products rely on systemic venous absorption and therefore do not achieve the rapid systemic arterial delivery as cigarettes

176
Q

The effect of acute exercise on cigarette cravings while using a nicotine lozenge
by: Tritter et al
Measures

A

Cigarette Cravings:
7 poin tlikert scale
Withdrawal Symptoms:
5 single items that are believed to be part of the nictone withdrawel syndrome, including depressed mood, irritability, restlessness, and poor concentration
5 point scale

177
Q

The effect of acute exercise on cigarette cravings while using a nicotine lozenge
by: Tritter et al
conclusion

A

Engaging in an acute bout of moderate intensity exercise while consuming a nicotine lozenge yields additive cigarette craving relief for recently quit smokers
When feasible one should use both treatments

178
Q

Acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation
by:Daniel et al.
Psychological Mechanism

A

Exercise serves as a distraction, idea that if a smoker redirects thier attention toward something else, the urge will pass, possible that it may play a small role early on in the exercise bout, but it sunlikely to have any effecs once the exercise stops
Alleviates affect/mood/feeling disturbances
Some evidence that exercise can reduce negative affect and enhance positive mood which in turn can reduce cravings

179
Q

Why does exercise reduce withdrawal and cravings?

A

Physiological explanations
Exercise mimics the effects of nicotine
Cortisol regulation

180
Q

Cortisol

A

Shown to drop during the first 2 weeks of abstinence, and low cortisol on the first day of abstinence has been associated with increased tobacco cravings and withdrawel symptoms
Acute exercise has been show to elevate corisol levels

181
Q

Acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation
by:Daniel et al.
Overall summary

A

Acute exercise produces craving reduction in temporary abstinent smokers

182
Q

Seminal work
by: Marcus et al
Design

A

Half the group attended a cessation program combined with a three times a week wellness program, and the other half attended a cessation program with supervised vigorous exercise three times a week
Asked to stop smoking at the end of week 4
Abstinence from smoking was bsed on self report which was verified by saliva cotinie and CO cut off points
Abstinence was measure 1 week after quit day (week 5), end of treatment (week 12), and 3 and 12 months later

183
Q

Seminal work
by: Marcus et al
Results

A

People in exercise had a higher continuous abstinence
Exerecise gained significantly less weight than control subjects among quitters
Quitters gained more weight than non quitters

184
Q

Seminal work
by: Marcus et al
Conclusion

A

adding exercise to a CBT cessation program has value
Marginal benefits of adding pharmacological agents, such as nicotine replacement therapy, deserves exploration

185
Q

Smoking behaviour and sensations during the pre-quit period of an exercise aided smoking cessation intervention
by: Jesus and Prapavessis
Participants

A

Female smokers, one year exercise + nicoerm quit smoking program to prevent smoking relapse and to maintain exercise

186
Q

Smoking behaviour and sensations during the pre-quit period of an exercise aided smoking cessation intervention
by: Jesus and Prapavessis
Smoking behaviour

A

Cigarette Consumption
Smoking topography- a thorough representation of the physical characterisitics of smoking behaviour

187
Q

Smoking behaviour and sensations during the pre-quit period of an exercise aided smoking cessation intervention
by: Jesus and Prapavessis
Cessation

A

Smoking sensation
Smoking satisfaction
psychological reward
Enjoyment of respiratory tract sensation
Craving reduction
Smoking Reduction

188
Q

Smoking behaviour and sensations during the pre-quit period of an exercise aided smoking cessation intervention
by: Jesus and Prapavessis
Results

A

Hardly any reductions in topography
Psychological - satisfaction of cigarettes that are being smoked are gradually declining

189
Q

Smoking behaviour and sensations during the pre-quit period of an exercise aided smoking cessation intervention
by: Jesus and Prapavessis
Conclusion

A

Female smokers who exercise prior to quit attempt are favourable to achieve cessation
People are putting themselves int he right place to do the right thing behaviourally and psychologically to properly quit

190
Q

How antidepressant works

A

Stem from how they affect certain brain circuits and the chemicals that pass along signals from one nerve cell to another in the brain

191
Q

Neurotransmitters

A

Serotonin
Dopamine
Norephinephrine

192
Q

Reuptake inhibitors

A

Process in which neurotransmitters are naturally absorbed back into the nerve cells in the brain
Reuptake inhibitors prevents this from happening- neurotransmitter tays at least temporarily in the gap between nerves (synapse)

193
Q

Front line antidepressants

A

Prozac
Zoloft
Celexa
Lexapro

194
Q

Intial severity and antidepressant benefits
Kirsch et al.
Background

A

Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accpted criteria for clinical significance
The efficacy of the antidepressants may also be depend on the severity of initial depression

195
Q

Placebo

A

Psychological theory - belief in the treatment or to a subjective feeling of improvement
The critical factor “is our beliefs about what’s going to happen to us”

196
Q

Intial severity and antidepressant benefits
Kirsch et al.
Purpose

A

To establish the relationof baseline severity and antidepressant efficacy using a relevant dataset of published and unpublished clinical trials

197
Q

Intial severity and antidepressant benefits
Kirsch et al.
Methods

A

Obtained data on all clinical trials submitted to the FDA for the licensing of the four new generation antidepressants for which full datasets were available
Meta analytic techniques to assess linear and quadratic effects of initial severity on improvement socres for drug and placebo groups and on drug-placebo difference scores.

198
Q

Intial severity and antidepressant benefits
Kirsch et al.
Results

A

Hamilton Rating Scale
9.6 Improvement in receiving the drug
7.8 Improvement in receiving the drug
Difference of 1.8 favouring drug over placebo
National institute for health and clinical excellence criteria of clinically relevant/significant a point difference should be —– At least a 3 point difference
1.8 Falls below the 3 point criteria that signifies there is a clinical significance
Standardized mean difference (0.5 to meet statistical significance) — Difference between drug and placebo is 0.32 (1.24 for drug & 0.92 for placebo)
Mean difference/Standardized difference —- How far ahead the treatment group is over the placebo

199
Q

Intial severity and antidepressant benefits
Kirsch et al.
Conclusions

A

Drug placebo differences increased as a function of initial severity, rising from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the very seerely depression category.
The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication

200
Q

Conclusion of the Cipriani study

A

All antidepressants were more efficacious than placebo in adults with MDD
Lingering questions: is it because of the active ingredient in the drug or that the placebo stops working as effectively?
All-cause attrition is only a crude proxy for tolerability can not determine the benefits and harms, especially harms that matter most to patiens

201
Q

Psychotherapy

A

The role of psychotherapy in treating clinical depression is to help the person develop good coping strategies for dealing with everyday stressors. In addition, it can encourange you to use your medications properly

202
Q

Interpersonal Therapy

A

Depression occurs within an interpersonal context and affects relationships and the roles of people within those relationships. by addressing interpersonal issues, interpersonal therapy for depression puts emphasis on the way symptoms are related to a person’s relationships, including family and peers

203
Q

Psychodynamic therapy

A

Designed to help patients explore the full range of their emotions, including feelings they may not be aware of. By making the unconscious elements of their life a part of their present experience, psychodynamic therapy helps people understand how their behavior and mood are affected by unresolved issues and unconscious feelings

204
Q

Cognitive Behavioral Therapy

A

At the heart of CBT is an assumption that a person’s mood is directly related to his or her patterns of htought. Negative, dysfunctional thinking affects a person’s mood, sense of self, behavior, and even physical state. The goal of cognitive behavioral therapy is to help a person learn to recognize negatie patterns of thought, evaluate their validity, and replace them with healthier ways of thinking

205
Q

Electroconvulsive Therapy

A

Brain stimulation techniques such as electroconvulsive therapy (ECT), for example, can be used to treat major depression that hasn’t responded to standard treatments

206
Q

Study
by. Lihua et al.

A

CAMH-Toronto
Ketamien is a fact acting anesthetic and pain killer
Has antidepressant properties

207
Q

How does ketamine work

A

different from other types of medications because theses types of treatments only last when the drugs in the system
Ketamine causes reaction in the cortex of the brain and enables brain connects to regrow
Gives patients the opportunity to create more positive thoughts and behaviour

208
Q

Cross-section studies: Yoshiuchi et al.

A

showed that daily step count and daily duration of moderate intensity PA were signifcantly and inversely correlated with depression

209
Q

Longitudinal studies: Paffenbarger et al

A

People with the highest energy profile were 28% less likely to develop depression

210
Q

Effects of exercise training on older patients with major depression
by: Blumenthal et al. 1999
Background

A

The extent to which exercise training may reduce depressive symptoms in older patients with MDD has not been systematically evaluated

211
Q

Effects of exercise training on older patients with major depression
by: Blumenthal et al. 1999
Objective

A

To assess the effectiveness of an aerobic exercise program compared to standard medication

212
Q

Effects of exercise training on older patients with major depression
by: Blumenthal et al. 1999
Methods

A

156 men and women with MDD randonmly assigned to : exercise, antidepressant medication
Treatment period: 16 weeks
Primary outcome: HAM-D and BDI

213
Q

Effects of exercise training on older patients with major depression
by: Blumenthal et al. 1999
Background
Results

A

Intervention group with exercise reduced CSD post inervention scores from baseline
those in ctonrol also reduced CES-D scores but not as much

214
Q

Effects of exercise training on older patients with major depression
by: Blumenthal et al. 1999
Conclusions

A

an exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. After 16 weeks of treatment exercise was equally effective in reducing dperession among patients with MDD

215
Q

Prenatal Depression

A

Affects up to 20% of all pregnancies
19% will continue to have depressive symptoms postpartum
Can negatively impact growing fetus: preterm birth, intrauterine growth restriction, early cessation of breastfeeding

216
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Treatment options

A

Pharmacological treatment options are often avoided
Most women go untreated
Recent literature has shown that exercise may prevent prenatal depression

217
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Statistically Significant Change

A

focus on statistical significance to discuss effectiveness of an intervntion
This means the change we are seeing is likely not due to chance
Not necessarily mean that it is clinically important

218
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Purpose

A

To determine if prenatal exercise during pregnancy can treat depression among women who enter pregnancy at risk for dperession
To determine if exercise can have a clinically reliable change on depression risk during pregnancy

219
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Methods: The intervention

A

Randomized Controlled Trial: Exercise Group and Standard Care Control Group
Group fitness class 3 times a week
Aerobic training and resistance exerecises
Baseline 9-12 weeks
Completion 36-38 weeks
At baseline and at the ened, completed the CES-D

220
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Methods: Current Study Data Collection

A

The original study includes all CES-D scores
For the current study, only women with baseline CES-D scores >= 16 were included
Compared baseline and post-intervention CES-D scores

221
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Methods: Calculating the cinically reliable change criteria

A

Population and tool specific
Equation accounts for the internal consistency and standard deviation for the current population
Standard error of difference = 3.6
Therefore the clinically reliable change criteria was 7.09

222
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Results

A

Prenantal exercise is both a statistical and clinically reliable treatment effect on depression risk
Prenatal exercise may be prescribed to treat women who enter pregnancy with depression risk
Exercise can increase the likelihood of achieving the clinically reliable threshold

223
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
Strengths

A

first study to calculate and apply clinically reliable change criteria for this population; calculation can be used for other outcomes
Included women with a CES-D score >= 16

224
Q

Physical activity and prenatal depression
by: Nagpal and Terrones
LImitations

A

Convenience sample used
Group dynamis not assessed

225
Q

An examination of potential mechanisms for exercise as a treatment for dperession
by. Foley, Prapavessis et al.
Procedure

A

Participants who satisfied all criteria were randomized into a 12 week aerobic exercise or stretching intervention
Attended session 3x per week for 30-40 minutes
Exercise group = moderate-intensity aerobic exercise at 40-70% of Heart Rate Reserve
Stretching group= mild-intensity stretching

226
Q

An examination of potential mechanisms for exercise as a treatment for dperession
by. Foley, Prapavessis et al.
Measures

A

Depression
Coping efficacy
Episodic memory
Cortisol
Cardiovascular fitness
Flexibility

227
Q

An examination of potential mechanisms for exercise as a treatment for dperession
by. Foley, Prapavessis et al.
Results

A

BDII — Decrease in depression in both groups, more pronounced in aerobic group (Exercise)
MADRAS — Decreased depression in both, more in the aerobic group (exercise)
Coping efficacy — Increased in both groups, coping efficacy is more in the stretching group
Un-cued recall (Memory retrieval) — Both groups improving but more in the aerobic (Exercise)
Cortisol — Decreasing in both groups at week 6, but stretching increases at week 12

228
Q

An examination of potential mechanisms for exercise as a treatment for dperession
by. Foley, Prapavessis et al.
Conclusions

A

Participants in the aerobic exercise group showed significant reductions in depression and significant improvements in coping efficacy and episodic memory
However, these benefits also occurred, albeit to a lesser extent in the stretching gorup

229
Q

An examination of potential mechanisms for exercise as a treatment for dperession
by. Foley, Prapavessis et al.
Take home message

A

Both aerobic exercise and stretching seem to be good reatments for depression with associated positive changes to coping efficacy, episodic emmory. Stress was only positively influenced by aerobic exercise

midterm (4 decks)

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