Browsing by Author "Nemati, Donya"
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Item Comparing exercise determinants between Black and White older adults with heart failure(Springer, 2023-09-30) Kaushal, Navin; Nemati, Donya; Mann-Krzisnik, Dylan; de la Colina , Adrián Noriega; Health Sciences, School of Health and Human SciencesBackground Heart Failure is a leading cause of mortality among older adults. Engaging in regular exercise at moderate-to-vigorous intensity has been shown to improve survival rates. Theory-informed methodologies have been recommended to promote exercise, but limited application of theoretical framework has been conducted for understanding racial disparities among older adults with heart failure. This study aimed to use the Health Belief Model to compare exercise behavior determinants between Black and White older adults diagnosed with heart failure. Methods The HF-ACTION Trial is a multi-site study designed to promote exercise among individuals with heart failure that randomized participants to an experimental (three months of group exercise sessions followed by home-based training) or control arm. The present study used structural equation modeling to test the change in Health Belief Model constructs and exercise behavior across 12 months among older adults. Results Participants (n = 671) were older adults, 72.28 (SD = 5.41) years old, (Black: n = 230; White, n = 441) diagnosed with heart failure and reduced ejection fraction. The model found perceived benefits, self-efficacy, perceived threats, and perceived barriers to predict exercise behavior among Black and White older adults. However, among these constructs, only perceived benefits and self-efficacy were facilitated via intervention for both races. Additionally, the intervention was effective for addressing perceived barriers to exercise only among White participants. Finally, the intervention did not result in a change of perceived threats for both races. Conclusions Among health belief model constructs, perceived threats and barriers were not facilitated for both races in the experimental arm, and the intervention did not resolve barriers among Black older adults. Racial differences need to be considered when designing interventions for clinical populations as future studies are warranted to address barriers to exercise among Black older adults with heart failure.Item Exercise Behavior Is Determined By Pandemic Distress And Task Burden Among Caregivers Of Older Adults(Oxford University Press, 2022) Nemati, Donya; Keith, NiCole; Kaushal, Navin; Medicine, School of MedicineBackground: Caregivers who have dependents with dementia are at a much higher risk of heart disease and mental illnesses compared with non-dementia caregivers. Consequently, these outcomes have been exacerbated by societal barriers that resulted from the pandemic. Engaging in regular physical activity at a moderate-to-vigorous level (MVPA) is beneficial for caregivers has it has been shown to prevent several adverse health outcomes. However, pandemic-related (COVID-19) distress likely worsened caregiver burden which in turn compromised their MVPA levels. The purpose of this study was to understand how caregiving burden impacts MVPA when accounting for physical activity determinants from an augmented Theory of Planned Behavior (TPB) model. Methods: Participants (n=127) were caregivers for older adults (65+) who have dementia. Participants completed measures of MVPA (behavior), TPB, pandemic-related distress (COVID Caregiver Risk Index) and burden scale for family caregivers. The study was investigated using a structural equation model. Results: Participants were 45.5 (SD=3.4) years old, 76.4% female. Attitudes (β=.22, p=.012) and perceived behavioral control (β=.19, p<.001) predicted intention. Attitudes and perceived behavioral control mediated the relationship between past behavior and intention (β=.17, p=.02). Covid distress predicted caregiver burden (β=.35, p<.001), and caregiver burden mediated the effects between distress and behavior (β=-.12, p=.01). Conclusions: Caregiver burden findings suggest that societal changes and demographic-specific burdens related to caregivers need to be considered for caregivers with dependents who have dementia. Taken together, exercise programs that focus on traditional behavioral determinants also need to include specific approaches to buffer caregiving burden experienced in this demographic.Item How and Why Patients Adhere to a Prescribed Cardiac Rehabilitation Program: A Longitudinal Phenomenological Study of Patients with Acute Coronary Syndrome(MDPI, 2022-01-28) Kaushal, Navin; Nemati, Donya; Gauthier-Bisaillon, Raphaëlle; Payer, Marie; Bérubé, Béatrice; Juneau, Martin; Bherer, Louis; Health Sciences, School of Health and Human SciencesBackground: Adherence to cardiac rehabilitation remains a challenge despite established evidence that engaging in regular exercise is a strong preventive measure to experiencing a second cardiac event. A recent study found a six-month cardiac rehabilitation program to be effective for facilitating regular exercise behavior among patients diagnosed with acute coronary syndrome. The purpose of this study was to conduct a phenomenological investigation using Colaizzi’s descriptive technique to understand mechanisms responsible for behavior change. Methods: Data were collected and analyzed among patients with acute coronary syndrome at a cardiac rehabilitation using semi-structured interviews that were conducted over the phone across three months. Conclusion: Thematic analysis of 15 semi-structured interviews resulted in 124 statements that were analyzed. The data yielded seven themes that included “motivation to follow prescribed exercise program”, “volitional decision”, “capability of performing exercise”, “connectedness to peers”, “planning”, “habit formation”, and “adopting healthy behaviors beyond exercise”. The emerged themes align with construct definitions of the self-determination theory, which include the three psychological needs (autonomy, competence, and relatedness), in addition to autonomous motivation, which represents internally driven reasons to participate in exercise. Planning and habit formation themes support contemporary research that identifies these constructs responsible for behavioral maintenance. While these themes help explain exercise participation, the final theme, adopting healthy behaviors beyond exercise, reflects the impact of the program on having a change towards a healthier lifestyle. The findings highlight the complexity of exercise behavior, and that long-term participation is likely explained by amalgamating the self-determination theory.Item Incorporating Exercise to Buffer Aversive Health Effects of Loneliness Among Older Adults in the Life Trial(Oxford University Press, 2024-12-31) Kaushal, Navin; Pemmasani, Deepishka; de la Colina, Adrian Noriega; Nemati, Donya; Health Sciences, School of Health and Human SciencesIntroduction: In 2023 the US Surgeon General announced an epidemic of loneliness and isolation. Prolonged loneliness among older adults has been shown to predict dementia and cardiovascular disease (CVD). However, exercise has been demonstrated to have preventive effects on CVD and cognitive health, but its effects on buffering these outcomes manifested from loneliness, or gender effects have not been investigated. This study aimed to test two moderated-mediation models to investigate if exercise moderates the relationship between loneliness and health outcomes. Methods: The Lifestyle Interventions and Independence for Elders (LIFE) Study is a randomized controlled trial (n=1,600) that assigned older adults (aged 65+) to either an intervention or control group. The present observational study analyzed participants in the control group. Measures included: exercise (accelerometry), loneliness (Center for Epidemiologic Studies Depression Scale [CES-D]), CVD risk (handgrip test), and cognitive health (global cognitive function). Model #14 from Hayes PROCESS Macro 4.0 in SPSS was used to analyze the data. Results: In both models, females experienced greater loneliness compared to males(β=.25, p<.001). The CVD risk model found Moderate-to-Vigorous Physical Activity (MVPA) to independently predicted handgrip strength(β=.11, p<.001), and interacted with loneliness to predict handgrip strength(β=.05, p=.03). The cognition model also found MVPA to independently predict cognition(β=.14, p<.001), and interacts with loneliness to predict cognition(β=.07, p=.03), and also demonstrate total moderated-mediation effects(β=.02, 95%CI.003 to.367). Conclusion: Exercise can buffer aversive cardiovascular risk and cognition from loneliness. Lonely older adults are a high-risk demographic that should be sought for enrolling in exercise programs.Item Massage perceptions and attitudes of undergraduate pre-professional health sciences students: a cross-sectional survey in one U.S. university(BMC, 2020-07-08) Munk, Niki; Church, Abby; Nemati, Donya; Zabel, Samantha; Comer, Amber R.; Health Sciences, School of Health and Rehabilitation SciencesBackground Attitudes and beliefs about massage therapy have been explored among health professionals and health profession students, but not for undergraduate preprofessional health sciences students. Methods This cross-sectional survey sought to determine pre-professional health students’ attitudes and perceptions toward massage therapy and determine the extent demographic variables such as age, gender, race, along with lifetime massage experience are associated with neutral/negative perceptions. Results N = 129 undergraduate students completed the Attitudes Toward Massage scale and 7 supplemental items pertaining to sexuality and therapist gender preference along with questions regarding lifetime massage utilization. Prevalence of massage therapy utilization was 35.6% (lifetime) and 18.6% (last 12-months). Overall, positive attitudes towards massage therapy was observed with participants reporting massage experience expressing more positive massage attitudes (lifetime; p = 0.0081, the past 12 months; p = 0.0311). Participants with no massage experience were more likely to report neutral/negative attitudes toward massage (p = 0.04). Men were more likely to prefer their massage therapist to be of the opposite sex (38.9%) compared to women (2.1%) (p = < 0.0001). Men were less confident than women in their concern of becoming sexually aroused during massage (p = 0.0001) and in the belief that massage is sexually arousing (p = 0.048). Both genders expressed comfort with female and/or male massage therapists, but if given a choice, both prefer a female massage therapist. Conclusions Undergraduate pre-professional health sciences students have generally positive attitudes towards massage therapy however more research is needed regarding implicit gender bias and/or preferences. This work should inform future research designs examining the impact of attitudes and beliefs on patient referrals to massage therapy.Item Massage Therapy as a Self-Management Strategy for Musculoskeletal Pain and Chronic Conditions: A Systematic Review of Feasibility and Scope(Mary Ann Liebert Inc., 2023-10-25) Nemati, Donya; Hinrichs, Rachel; Johnson, Alisa; Lauche, Romy; Munk, NikiBackground: Musculoskeletal pain and chronic conditions are associated with deteriorating pain, stress, anxiety, and health-related quality of life (HR-QOL). There is emerging evidence that performing massage therapy as self-management (MTSM) is a viable approach to alleviate these symptoms across various clinical populations. However, a significant gap remains on the effectiveness and limitation of MTSM usage as no systematic review has been conducted to comprehensively evaluate and synthesize the scope, feasibility, and efficacy of MTSM. This systematic review aimed to investigate the effect of MTSM on common symptoms of musculoskeletal and chronic conditions, followed by identifying characteristics of MTSM dosage, setting, and adherence for formulating themes. Methods: A systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, which involved searching seven electronic databases, including Medline (OVID), CINAHL (EBSCO), PEDro, Web of Science (Clarivate), PsycINFO (EBSCO), Google Scholar, and EMBASE (Elsevier) from inception to January 2023. Clinical studies were eligible if they included MTSM, and massage treatment was more than 50% of the intervention. The quality of studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Target variables were extracted, including study design, participants' characteristics, outcome measures, massage dosage (duration, frequency, and timing), training setting, provider of massage training, adherence to the MTSM intervention, comparator, and key findings. Results: A total of 17 studies were evaluated and included 770 participants (female: N = 606) with musculoskeletal pain or chronic conditions. The emerged themes for MTSM utilization consisted of arthritis pain (knee, n = 3; neck, n = 1, hand, n = 2), neck and back pain (n = 4), and stress and anxiety (n = 3). Prescribed self-administered massage duration ranged from a single session to a maximum of 8–12 weeks, where 4 weeks (n = 8) was the most commonly prescribed duration. Out of 11 studies that used MTSM as a solo modality, 7 studies (41.2%) showed significant improvement in the outcome measures such as chronic neck and back pain, stress or anxiety, fatigue, quality of sleep, and HR-QOL. In addition, health benefits, including anxiety, depression, pain intensity, and pain threshold, were observed in six studies (35.3%) where MTSM was applied as a coadjuvant modality, which was combined with therapist-applied massage and physiotherapy. Conclusions: These findings support that MTSM is a viable approach to enhance the benefit of therapist-applied massage or as a solo modality for symptom management of musculoskeletal pain and chronic conditions. The review provides suggestions for design improvement, such as reporting participants' adherence to the prescribed massage regimen, that would be informative for providing a robust understanding of the magnitude or the extent to which MTSM is effective. Future studies on MTSM intervention are encouraged to use a theoretical framework and validated measures for determining and facilitating treatment fidelity.Item National Institutes of Health Stroke Scale (NIHSS) scoring inconsistencies between neurologists and emergency room nurses(Frontiers, 2022) Comer, Amber R.; Templeton, Evan; Glidden, Michelle; Bartlett, Stephanie; D'Cruz, Lynn; Nemati, Donya; Zabel, Samantha; Slaven, James E.BACKGROUND: Little is known about the consistency of initial NIHSS scores between neurologists and RNs in clinical practice. METHODS: A cohort study of patients with a code stroke was conducted at an urban academic Primary Stroke Center in the Midwest between January 1, 2018, and December 31, 2019 to determine consistency in National Institutes of Health Stroke Scale Scores (NIHSS) between neurologists and registered nurses (RNs). RESULTS: Among the 438 patients included in this study 65.3% (n = 286) of neurologist-RN NIHSS scoring pairs had congruent scores. One-in-three, (34.7%, n = 152) of neurologist-RN NIHSS scoring pairs had a clinically meaningful scoring difference of two points or greater. Higher NIHSS (p ≤ 0.01) and aphasia (p ≤ 0.01) were each associated with incongruent scoring between neurologist and emergency room RN pairs. CONCLUSIONS: One-in-three initial NIHSS assessed by both a neurologist and RN had a clinically meaningful score difference between providers. More severe stroke, as indicated by a higher NIHSS was associated with scoring inconsistency between neurologist-RN pairs. Subjective scoring measures, especially those involving a patient having aphasia, was associated with greater score incongruency. Score differences may be attributed to differences in NIHSS training requirements between neurologists and RNs.Item Physical Activity Profile and Preference Among Older Adult Patients With Cancer: A Cross-Sectional Study(Oxford University Press, 2023-12-21) Nemati, Donya; Ballinger, Tarah; Medicine, School of MedicinePhysical activity (PA) is beneficial for older adults (OAs) with cancer by improving physical function, mental health, and lowering the risk of recurrence in some cancer types. However, limited knowledge on OAs preferences may impede effective interventions. This study aimed to identify the PA profiles and preferences of OAs (age≥ 65) compared to younger adult (YA;18-64 years old) cancer patients. Data were collected from 372 adult patients with non-metastatic cancers visiting Indiana University Simon Comprehensive Cancer Center between July 2020-June 2021. Patients completed a cross-sectional survey comprising disease characteristics, PA habits, and PA preferences. A total of 132 OA patients (age 71 ± 5.2 years) were predominantly male (56.1%) and Caucasian (92.4%). Of these, 33.8% reported a decrease in PA after their cancer diagnosis. Fatigue (22%) and lack of motivation (16%) were the most reported PA barriers. While 43% of patients received exercise recommendations from their oncologists, 75% of those did not receive specific guidance. The majority of OAs preferred home-based workouts (65.9%) and exercise motivation packages (52.7%) over exercising at a cancer center facility (26%). Compared to YA patients (n=237), a smaller percentage of OAs (26.5% vs. 38.4%: p<.05) believed that PA could reduce the risk of cancer recurrence, and time constraints were less of a barrier for OAs (7.6% vs. 21.5%: p<.05). A home-based PA program that is supported with motivation packages may appeal to OAs with cancer. These findings are informative for designing tailored PA programs that suit the interests and preferences of OA patients with cancer.Item The Impact of the Life Trial on Cardiovascular Health: Racial Disparities in Lifestyle Factor Improvement(Oxford University Press, 2024-12-31) Nemati, Donya; Pemmasani, Deepishka; Lavangu, Vaishali; Kaushal, Navin; Health Sciences, School of Health and Human SciencesIntroduction. Cardiovascular disease is the leading cause of death among older adults. The American Heart Association promotes the lifestyle 8 (LE8) for cardiovascular disease prevention which includes healthy levels of exercise, sleep, smoking, BMI, blood pressure, nutrition (sodium), triglycerides and glucose levels. Exercise alone can improve most of these factors. The purpose of this study was to test if an exercise program can improve LE8 and identify racial (Black vs. White) differences. Methods. The LIFE Study is a randomized controlled trial that randomized 1,600 older adults (age 65+) to an intervention or control group (health-education program). The intervention included one-hour on-site exercise program twice per week with additional prescription of home-based exercise. LE8 measures included: exercise (accelerometers), sleep (Pittsburg-Sleep-Quality-Index), smoking (self-report). Blood samples measured glucose, triglycerides, and sodium, and on-site assessments measured blood pressure and BMI. Data was collected every six months for two years. STATA 18.0 was used to conduct multilevel modeling for each LE8 outcome. Results. A series of multilevel models revealed significant TimeXGroupXRace interaction effects for greater exercise(β=.12, p=.006), better sleep(β=.20, p=.04), lower BMI(β=.58, p<.001) and triglycerides(β=.38, p<.001) only among White participants in the intervention arm at the fifth timepoint. Sodium(β=.13, p=.04), glucose(β=.09, p=.04), and blood pressure(β=.20, p=.04) were higher in Black participants with no time or group interaction. Smoking was nonsignificant Conclusion. The LIFE trial demonstrated improvement in some LE8 factors, and several racial health disparities. There is a need to understand biopsychosocial determinants that contribute to racial disparities to ensure that all participants benefit equally.