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Millstein, Rachel

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Millstein

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Rachel

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Millstein, Rachel

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2015 - 20182

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Author's Publications: search.filters.isAuthorOfPublication.96116050-0c75-4ce1-866d-b0cfd0af8d0e

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    Cluster randomized controlled trial of a multilevel physical activity intervention for older adults
    (BioMed Central, 2018) Kerr, Jacqueline; Rosenberg, Dori; Millstein, Rachel; Bolling, Khalisa; Crist, Katie; Takemoto, Michelle; Godbole, Suneeta; Moran, Kevin; Natarajan, Loki; Castro-Sweet, Cynthia; Buchner, David
    Background: Older adults are the least active population group. Interventions in residential settings may support a multi-level approach to behavior change. Methods: In a cluster randomized control trial, 11 San Diego retirement communities were assigned to a physical activity (PA) intervention or a healthy aging attention control condition. Participants were 307 adults over 65 years old. The multilevel PA intervention was delivered with the assistance of peer leaders, who were trained older adult from the retirement communities. Intervention components included individual counseling & self-monitoring with pedometers, group education sessions, group walks, community advocacy and pedestrian community change projects. Intervention condition by time interactions were tested using generalized mixed effects regressions. The primary outcomes was accelerometer measured physical activity. Secondary outcomes were blood pressure and objectively measured physical functioning. Results: Over 70% of the sample were 80 years or older. PA significantly increased in the intervention condition (56 min of moderate-vigorous PA per week; 119 min of light PA) compared with the control condition and remained significantly higher across the 12 month study. Men and participants under 84 years old benefited most from the intervention. There was a significant decrease in systolic (p < .007) and diastolic (p < .02) blood pressure at 6 months. Physical functioning improved but the changes were not statistically significant. Conclusions: Intervention fidelity was high demonstrating feasibility. Changes in PA and blood pressure achieved were comparable to other studies with much younger participants. Men, in particular, avoided a year-long decline in PA. Trial registration clincialtrials.gov Identifier: NCT01155011. Electronic supplementary material The online version of this article (10.1186/s12966-018-0658-4) contains supplementary material, which is available to authorized users.
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    Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development
    (Hindawi Publishing Corporation, 2015) Huffman, Jeff C.; DuBois, Christina M.; Millstein, Rachel; Celano, Christopher; Wexler, Deborah
    Most patients with type 2 diabetes (T2D) have suboptimal adherence to recommended diet, physical activity, and/or medication. Current approaches to improve health behaviors in T2D have been variably effective, and successful interventions are often complex and intensive. It is therefore vital to develop interventions that are simple, well-accepted, and applicable to a wide range of patients who suffer from T2D. One approach may be to boost positive psychological states, such as positive affect or optimism, as these constructs have been prospectively and independently linked to improvements in health behaviors. Positive psychology (PP) interventions, which utilize systematic exercises to increase optimism, well-being, and positive affect, consistently increase positive states and are easily delivered to patients with chronic illnesses. However, to our knowledge, PP interventions have not been formally tested in T2D. In this paper, we review a theoretical model for the use of PP interventions to target health behaviors in T2D, describe the structure and content of a PP intervention for T2D patients, and describe baseline data from a single-arm proof-of-concept (N = 15) intervention study in T2D patients with or without depression. We also discuss how PP interventions could be combined with motivational interviewing (MI) interventions to provide a blended psychological-behavioral approach.