Dissemination of the Look AHEAD intensive lifestyle intervention in the United States Air Force: study rationale, design and methods. Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Psychosocial interventions for people with dementia: An overview and commentary on recent developments Functional outcomes of instrumented posterior lumbar interbody fusion in active-duty US servicemen: a comparison with nonoperative management. A comprehensive weight-loss program for soldiers. Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews The social experiences of cancer patients under treatment: a comparative study. Weight Loss Intervention for Breast Cancer Survivors: A Systematic Review Weight change following US military service Risk Factors for Lower Extremity Tendinopathies in Military Personnel A randomized controlled trial of a leg orthosis versus traditional treatment for soldiers with shin splints: a pilot study. Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Predictive ability of social cognitive theory in exercise research: an integrated literature review. Smoking cessation in military personnel. Predictors of short-term work-related disability among active duty US Navy personnel: a cohort study in patients with acute and subacute low back pain. Smokeless tobacco cessation in military personnel: a randomized controlled trial. Results from an Online Computer-Tailored Weight Management Intervention for Overweight Adults: Randomized Controlled Trial Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Obesity Intervention During a Work Health Promotion: The Obesity Intervention Program of the German Military Forces A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel
BACKGROUND Despite an increase in overweight and obesity similar to the civilian population , there have been few r and omized controlled trials examining behavioral weight management interventions in the military setting s. PURPOSE This paper describes the design , intervention development and analysis plan of the Fit Blue study , a r and omized controlled behavioral weight loss trial taking place in the United States Air Force . DESIGN This study compares two adapted versions of the efficacious Look AHEAD Intensive Lifestyle Intervention ( ILI ) , a counselor-initiated condition and a self-paced condition . Also described are the unique steps required when conducting military-based health promotion research and adaptations made to the Look AHEAD intervention to accommo date the military environment . CONCLUSIONS To our knowledge , this is the first translation of the Look AHEAD ILI in the military setting and one of the first translations of the ILI in general . If successful , this intervention could be disseminated to the entire U.S. Military as this project is design ed to overcome the barriers and utilize the facilitators for weight loss that are unique to a military population . Programs vali date d in military population s can have a major public health impact given that with 1.4 million active duty personnel , the Department of Defense is the nation 's largest employer . However , while this intervention is design ed for a military population and there are unique aspects of the military that may enhance weight loss interventions , the diversity of the study population should help inform obesity efforts in both civilian and military setting Background The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace . We conducted a systematic review to ( i ) examine the effectiveness of workplace-based diet and /or physical activity interventions aim ed at healthcare professionals and to ( ii ) identify and describe key components of effective interventions . Seven electronic data bases were systematic ally search ed . Results Thirteen r and omised controlled trials met the inclusion criteria , of which seven had data available for meta- analysis . Where meta- analysis was possible , studies were grouped according to length of follow-up ( < 12 months and ≥12 months ) and behavioural target ( diet only , physical activity only or diet and physical activity ) , with outcome data pooled using a weighted r and om effects model . Nine studies reported statistically significant ( between-group ) differences . Four studies reported being informed by a behaviour change theory . Meta- analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight ( −3.95 Kg , [ 95 % CI −4.96 to- 2.95 Kg ] ) than controls up to 12 months follow up . Conclusions Workplace diet and /or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous . To improve the evidence base , we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning , activities of daily living , behaviour and mood of people with dementia . Our aim here is to provide an up-to- date overview of research into psychosocial interventions and their impact on psychosocial outcomes . We focused on r and omised controlled trials , controlled studies and review s published between October 2008 and August 2015 , since the earlier review . The search of PsychInfo , Medline and the Cochrane data base of systematic review s yielded 61 relevant articles , organised into four themes echoing key phases of the care pathway : Living at home with dementia ( five review s , eight studies ) , carer interventions ( three review s , four studies ) , interventions in residential care ( 16 review s , 12 studies ) and end-of-life care ( three review s , two studies ) , along with an additional group spanning community and institutional setting s ( six review s , two studies ) . Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes ;  physical therapies , cognitive training and modified cognitive behaviour therapy also had a range of benefits . There was more limited evidence of positive benefits for people with dementia through interventions with family carers . Thirty-two articles focused on the management of ‘ behavioural symptoms ’ through a range of interventions all of which had some evidence of benefit . Also a range of multi-component and specific interventions had benefits for cognitive , emotional and behavioural well-being of people with dementia in residential setting s , as well as for quality of life . Overall , interventions tended to be short term with impact only measured in the short term . We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care . Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia BACKGROUND CONTEXT The existing literature lacks a functional outcome study addressing instrumented posterior lumbar fusion surgery in physically active patients . Furthermore , results of operative versus nonoperative treatment in these patients are not clear . PURPOSE To evaluate patient-assessed function , pain , and satisfaction and military job performance between servicemen treated operatively and nonoperatively . STUDY DESIGN / SETTING This is a nonr and omized analysis of consecutive active-duty military servicemen treated either operatively or nonoperatively for chronic back pain and single-level lumbar disc degeneration with emphasis on functional outcomes . PATIENT SAMPLE Active-duty US servicemen with chronic low back pain . OUTCOME MEASURES / METHODS : Twenty-nine consecutive active-duty US servicemen were treated for chronic back pain and single-level lumbar disc degeneration by the same surgeon at a military spine facility . Fifteen were treated with instrumented posterior lumbar interbody fusion ( PLIF )  , and 14 refused  surgery  and chose to be treated nonoperatively with spinal extensor muscle-strengthening exercise , medications , and restricted duty . The average follow-up time was 14 months ( range , 6 to 24 months ) . All servicemen completed a functional outcome question naire American Academy of Orthopedic Surgeons/Scoliosis Research Society ( AAOS/SRS ) with emphasis on pre- and posttreatment function , pain , and satisfaction . The two groups were also compared using military job performance parameters . RESULTS Four of 14 ( 28 % ) of the servicemen treated nonoperatively ultimately received a disability discharge from the military for back pain , another 5 of 14 ( 36 % ) remained on permanent duty-restriction profiles , and only 5 of 14 ( 36 % ) returned to full , unrestricted military duty . In the PLIF group , 12 of 15 soldiers ( 80 % ) were able to return to full duty , only 3 of 15 ( 20 % ) remained on permanent restrictive duty-limitation profiles , and 0 of 15 ( 0 % ) received a disability discharge from the military for back pain . Twelve of 15 ( 80 % ) of the PLIF group and 8 of 14 ( 57 % ) of the group treated nonoperatively were physically able to complete the posttreatment physical fitness test . No difference was observed between premorbid and posttreatment physical training ( PT ) test scores in either group . However , scores for patient-assessed posttreatment pain , function , and satisfaction were significantly higher in the PLIF group . Soldiers who were able to return to full military duty did so at an average of 2 months for the group treated nonoperatively ( n = 5 ) and 4 months for the PLIF group ( n = 12 ) . Complications in the PLIF group included dural tear ( n = 2 ) , unilateral transient lower extremity paresthesia ( n = 1 ) , and wound seroma requiring reoperation ( n = 1 ) . CONCLUSIONS In this nonr and omized study of 29 active-duty US servicemen with chronic low back pain and single-level lumbar disc degeneration , instrumented PLIF surgery was associated with a high rate of return to full military duty . Servicemen treated with this technique were less likely to receive a back pain disability discharge or a permanent physical limitation profile when compared with servicemen who chose to be treated nonoperatively . Outcomes with respect to postreatment pain , function , and satisfaction were higher in patients treated with instrumented PLIF and were excellent in servicemen who were able to return to full duty regardless of treatment A weight-loss treatment program for active duty military personnel is discussed and evaluated . The Fat Loss and Exercise Program at U.S. Army Hospital , Bremerhaven , Germany , consisted of a 3-week inpatient treatment program and 6 months of weekly outpatient follow-up . The program combined a multidisciplinary team approach to the treatment of obesity -- psychology , internal medicine , nursing , nutrition care , and physical therapy . Patients showed a significant weight and body fat loss [ F(2,90 ) = 52.91 and 65.85 , p < 0.001 , respectively ] from the initiation of treatment ( mean = 205.9 pounds , 28.91 % ) to the end of the inpatient program ( mean = 192.8 pounds , 25.97 % ) with maintenance over 6 months ( mean = 190.4 pounds , 25.03 % ) . Changes in cholesterol levels by treatment phase are also discussed . Results demonstrate positive increases in high-density lipoprotein at each phase . These results support a comprehensive , multidisciplinary inpatient treatment of obesity within the military Background The evidence that higher levels of physical activity and /or lower levels of physical inactivity are associated with beneficial health-related outcomes stems mainly from observational studies . Findings from these studies often differ from r and omised controlled trials and systematic review s currently demonstrate mixed results , due partly to heterogeneity in physical activity interventions , method ologies used and population s studied . As a result , translation into clinical practice has been difficult . It is therefore essential that an overview is carried out to compare and contrast systematic review s , and to identify those physical activity interventions that are the most effective in preventing and /or treating major chronic disease . This protocol has been registered on PROSPERO 2013 : CRD42013003523 . Methods We will carry out an overview of Cochrane systematic review s. We will search the Cochrane Data base of Systematic Review s for systematic review s of r and omised controlled trials that have a primary focus on disease-related outcomes . We will restrict review s to those in selected major chronic diseases . Two authors will independently screen search outputs , select studies , extract data and assess the quality of included review s using the assessment of multiple systematic review s tool ; all discrepancies will be resolved by discussing and reaching a consensus , or by arbitration with a third author . The data extraction form will summarise key information from each review , including details of the population ( s ) ( for example , disease condition ) , the context ( for example , prevention , treatment or management ) , the participants , the intervention(s ) , the comparison(s ) and the outcomes . The primary outcomes of interest are the prevention of chronic disease and /or improved outcomes , in the treatment or management of chronic disease . These outcomes will be summarised and presented for individual chronic diseases ( for example , any change in blood pressure in hypertension or glucose control in diabetes ) . Secondary outcomes of interest are to describe the structure and delivery of physical activity interventions  across chronic disease conditions and adverse events associated with physical activity . Discussion We anticipate that our results could inform research ers , guideline groups and policymakers of the most efficacious physical activity interventions in preventing and /or managing major chronic disease As part of a larger study on the quality of life of cancer patients under treatment , the positive and negative experiences in social interaction  have been examined as compared to those of a  control group ( non patients , n = 201 ) . Two patient groups were included : 109 patients who had recently undergone surgery and 108 patients receiving chemotherapy .  The respondents returned a mailed question naire . Contrary to the assumptions based on a review from the literature , cancer patients appear to have more positive and fewer negative social experiences than a r and om sample from the ' normal ' population . Even under more severe medical circumstances ( a poor prognosis or heavy chemotherapy , a large number of chemotherapy cycles , poor progress after surgery ) the poorer the patients , medically speaking , the more help and support they perceive . The results of this study do not support the idea of stigmatization . The personality characteristics , neuroticism and self-esteem are especially important for the having of positive and negative experiences in social interaction . Positive social experiences show a relationship with self-esteem and negative social experiences show a relationship with neuroticism To determine the effectiveness of weight loss intervention for breast cancer survivors . From October 2012 until March 2013 , Pubmed was search ed for weight loss intervention trials that reported body weight or weight loss as a primary outcome . Fifteen of these studies are included in this review . Of the 15 studies included , 14 result ed in statistically significant weight loss and 10 obtained clinical ly meaningful weight loss of ≥5 % from baseline . Evidence was provided of the feasibility of using several methods of weight loss intervention ( telephone , in person , individual , group ) . Successful intervention used a comprehensive approach , with dietary , physical activity , and behavior modification components . Weight loss improved cardiovascular risk factors and markers of glucose homeostasis . However , there is insufficient evidence to identify the components of this intervention that led to successful weight loss , or to determine the weight loss necessary to affect biomarkers linked to breast cancer prognosis . The small number of r and omized controlled trials shared several limitations , including small study sample sizes and lack of follow-up beyond 6 months . Intervention with longer follow-up revealed weight regain , showing the importance of considering strategies to promote long-term weight maintenance . Weight loss intervention for breast cancer survivors can lead to statistically significant and clinical ly meaningful weight loss , but the limited number of interventional studies , small sample sizes , and short duration of follow-up in many studies limit our ability to draw conclusions regarding the most efficacious weight-loss intervention after a breast cancer diagnosis . The findings to date are encouraging , but research on the effect of weight loss on breast cancer recurrence and mortality , and on prevention of weight gain for women newly diagnosed with breast cancer , is needed Background : Although overweight and obesity are less prevalent among active-duty military personnel compared with similar persons not serving in the military , no such differences have been observed between veterans and non-veterans . Objectives : To assess the magnitude of weight changes before , concurrent with and following discharge from the military , relative to weight during service , and to determine the demographic , service-related and psychological characteristics associated with clinical ly important weight gain among those who were discharged from military service during follow-up . Methods : Eligible Millennium Cohort Study participants ( n=38 686 ) completed the  question naires  approximately every 3 years ( 2001 , 2004 and 2007 ) that were used to estimate annual weight changes , as well as the percentage experiencing clinical ly important weight gain , defined as ⩾10 % . Analyses were stratified by sex . Results : Weight gain was greatest around the time of discharge from service and in the 3 years before discharge ( 1.0–1.3 kg per year ) , while it was nearly half as much during service ( 0.6–0.7 kg per year ) and ⩾3 years after service ended ( 0.7 kg per year ) . Consequently , 6-year weight gain was over 2 kg greater in those who were discharged compared with those who remained in the military during follow-up ( 5.7 vs 3.5 kg in men ; 6.3 vs 4.0 kg in women ) . In those who were discharged , younger age , less education , being overweight at baseline , being in the active-duty component ( vs Reserve/National Guard ) and having experienced deployment with combat exposures ( vs non-deployment ) were associated with increased risks of clinical ly important weight gain . Conclusions : This study provides the first prospect ively collected evidence for an increased rate of weight gain around the time of military discharge that may explain previously reported higher rates of obesity in veterans , and identifies characteristics of higher-risk groups . Discharge from military service presents a window of risk and opportunity to prevent unhealthy weight gain in military personnel and veterans Background : Overuse injuries have a significant impact on United States military service members , but research to date has been limited in its ability to assess occupational and behavioral risk factors . Hypothesis/ Purpose : To prospect ively identify risk factors for the development of lower extremity tendinopathy and plantar fasciitis in United States military personnel . Study Design : Descriptive epidemiology study . Methods : Baseline data from the Millennium Cohort Study , a long-term observational cohort of military personnel , were utilized . Service members were enrolled in the cohort in 2001 , 2004 , and 2007 . A total of 80,106 active-duty personnel were followed over 1 year for the development of patellar tendinopathy , Achilles tendinopathy , and plantar fasciitis . Regression analyses were used to estimate significant associations between each tendinopathy , plantar fasciitis , and demographic , behavioral , and occupational characteristics . Results : Using medical records , 450 cases of Achilles tendinitis , 584 cases of patellar tendinopathy , and 1228 cases of plantar fasciitis were identified . Recent deployment was associated with an increased risk for developing plantar fasciitis ( adjusted odds ratio [ AOR ] , 1.27 ; 95 % confidence interval [ CI ] , 1.04 - 1.56 ) . Moderate weekly alcohol consumption was marginally associated with an increased risk for Achilles tendinopathy ( AOR , 1.33 ; 95 % CI , 1.00 - 1.76 ) . Overweight or obese individuals were more likely to develop Achilles tendinopathy and plantar fasciitis . Conclusion : Lower extremity tendinopathies and plantar fasciitis are common among military service members , and this study identified several modifiable risk factors for their occurrence . These potential risk factors could serve as the focus for future preventive and intervention studies Diagnosis and management strategies for shin splints in active duty military population s closely resemble those in civilian athletic population s. There is a paucity of evidence supporting the use of many of these interventions . The purpose of this study was to present data on the Shin Saver orthosis as a treatment for  shin splints in an active duty military population and to review current condition management . Twenty-five subjects diagnosed with shin splints by a U.S. Army physical therapist were r and omly assigned to a shin orthosis treatment group or a control group . There was no significant difference between treatment and control groups in days to finish a 0.5-mile run pain free . Visual analog scales for pain at intake versus after 1 week of relative rest revealed no significant improvement in symptoms in either group . Current best- practice guidelines support a treatment program of rest , cryotherapy , and a graduated walk-to-run program Background Worldwide in 2000 , 10 % of children aged five to 17 years were reported as being overweight with an additional 2‐3 % being obese . Overweight and obesity in childhood can adversely impact on both physical and psychological health . The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake , decreased levels of physical activity and greater time spent in sedentary pursuits . A large number of environmental and cultural factors have also been identified as contributing to the problem . Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long‐term . However , the importance of family‐based treatment that combines diet , physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review . It has also been suggested that interventions offered in the community setting may help overcome barriers to participation , by making programs more accessible and allowing the targeting of specific sub‐groups of the population . Objectives The objective of this review was to identify the effectiveness of parent‐centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weight‐related outcomes of children . Inclusion criteria Types of participants This review considered studies that included free‐living children of pre‐school , primary and secondary school age and /or their parents/guardians aged > 18 years . Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component , to target eating and /or exercise behaviors for the prevention or treatment of obesity , and child weight status reported . Types of studies All intervention studies were included in the review including : r and omized controlled trials ( RCTs ) ; non‐r and omized controlled trials , longitudinal studies , cohort ( both retrospective and prospect i ve ) , case control and time series studies which had been conducted in a community setting . Types of outcomes This review considered studies that included overweight/obesity related outcomes , eating behavior outcomes , physical activity behaviour outcomes , and sedentary behavior outcomes and constructs . Search strategy A literature search of community‐based parent‐centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic data bases dating from 1975 to April 2009 . Method ological quality Studies were critically appraised for method ological quality using st and ardized tools . Data collection Data was extracted by one review er using a st and ardized data extraction form developed by the research ers and checked for accuracy and consistency by a second review er . Data synthesis Data in relation to setting , methodology , intervention components and effect on weight , dietary intake and physical activity was extracted , and described in a narrative synthesis . Where possible a meta‐ analysis was undertaken . Results Of the home‐based interventions , five of nine studies reported statistically significant changes in anthropometric outcomes post intervention . Of the 10 studies in the before and after school care setting , seven reported a significant decrease in a weight‐related outcome post intervention , with only one reporting an increase . Conclusions Results from the review support the after‐school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs . Implication s for practice At this stage , interventions to support parents should target the after‐school environment as opposed to being conducted in the home , summer camps , leisure centers or churches . Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use . Implication s for research Future studies of high quality are needed across the full range of community setting s. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after‐school setting , further studies in this area using similar method ologies to those already published will facilitate future meta‐analyses in this area The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood . Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal . Social Cognitive Theory ( SCT ) as presented by B and ura ( 1986 , 1997 ) appears to have strong promise as a guide to underst and ing physical activity behaviors and developing clinical ly relevant interventions to promote the initiation and maintenance of physical activity . This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance . Following review for quality and adequacy , published research during the years 1990 - 1998 contained 27 studies that examined the relationship between the construct of SCT , self-efficacy  , and physical activity .  All of the descriptive studies found a statistically significant relationship between self-efficacy and exercise behavior . Intervention studies demonstrated that participation in an exercise program promoted self-efficacy , and that programs design ed to increase outcome expectations and self-efficacy significantly increased exercise behavior . Due to the central ity of self-efficacy in many of the social psychological theories that help explain the attitude-intention-behavior triad , a strong need remains to design interventions to maximize its usefulness . Clear , generalizable , systematic and theoretically comprehensive , r and omized , controlled studies are needed to underst and the usefulness of the construct Tobacco use is the single most important preventable cause of death in military personnel . The purpose of this r and omized clinical trial was to evaluate the effectiveness of two behavioral interventions when added to nicotine-replacement therapy on smoking cessation .  The sample of 512 included 52 % active duty military , 29 % family , 11 % retirees , and 8 % Department of Defense civilians . There was a main effect of compliance at the end of the program ( EOP ) ; 69 % of those who attended 75 % of the classes were abstinent from tobacco ; regression analysis found the more intensive program to be twice as effective at EOP and at 3 months , an outcome not continued at 6 months . The longer , more intensive V and erbilt University Medical Center program was significantly more effective at helping the civilian portion of the population ( 85 % versus 60 % in the American Cancer Society program ) but not the active duty participants BACKGROUND CONTEXT Musculoskeletal disorders of the spine in the US military account for the single largest proportion of the absence of sickness causes leading to early termination . We explored if selected psychological and physical factors were associated with poor outcome after episodes of low back pain ( LBP ) . PURPOSE To identify clinical , demographic , and psychological factors predictive of work duty status after a complaint of LBP . STUDY DESIGN A prospect i ve clinical cohort of US Navy personnel treated for LBP . PATIENT SAMPLE Eligible cases were active duty US Navy or Marine Corps personnel presenting to an emergency clinic or primary care clinic with a complaint of LBP , where the index episode of LBP was no more than 12 weeks duration before enrollment . OUTCOME MEASURES The subject 's work status ( full duty , light duty , sick in quarters [ SIQ ] , limited duty , or medically released to full duty ) was abstract ed from the subject 's electronic medical record at approximately 4 weeks and then again 12 weeks after study enrollment . Work status in this study population is assigned by a Navy health-care provider at the time of a clinical visit and based on the health-care provider 's determination of medical fitness for duty . This study collapsed work status into two groups , " full duty " ( consisting of " full duty " and " medically released to full duty " ) and " not at full duty " ( consisting of " light duty , " " SIQ , " and " limited duty " ) . METHODS Volunteers completed a baseline question naire consisting of recommended well-vali date d measures , including attitudes and beliefs about LBP and work ( Fear-Avoidance Beliefs Question naire [ FABQ ] and the Tampa Scale of Kinesiophobia ) , distress ( the Pain Catastrophizing Scale ) , clinical depression ( The Center for Epidemiologic Studies Depression scale ) , a numeric pain intensity scale , self-perceived disability ( Oswestry Disability Index ) , and general health status ( 12-Item Short Form Health Survey ) . Navy health-care providers conducted a back pain-specific medical evaluation . Associations are expressed as multivariate-adjusted prevalence ratios ( PRs ) estimated using Poisson regression . RESULTS Two hundred fifty-three participants were enrolled . Work status outcome was collected for 239 participants . Predictors of " not at full duty " at 4 weeks after enrollment included having back pain for 4 weeks or less before study enrollment ( PR , 2.69 ; 95 % CI , 1.21 - 5.97 ) and increased FABQ Work subscale score ( PR , 1.05 ; 95 % CI , 1.01 - 1.08 ) . The sole predictor of work status at 12 weeks after enrollment was increased FABQ Physical Activity ( FABQ Physical ) subscale score ( PR=1.14 ; 95 % CI , 1.00 - 1.30 ) . CONCLUSIONS The findings that fear-avoidance beliefs were predictive of subsequent work status among active duty service personnel in this study population ( after adjusting for clinical , demographic , and psychological covariates ) suggest the clinical utility of addressing these factors during treatment of back pain episodes in the military . These findings reflect the important role that psychological factors may play in the return to work process in an active duty military population INTRODUCTION Military personnel are twice as likely as civilians to use smokeless tobacco ( ST ) . This study evaluated the efficacy of a minimal-contact ST cessation program in military personnel . METHODS Participants were recruited from 24 military dental clinics across the United States during annual dental examinations . Participants were 785 active-duty military personnel who were r and omly assigned to receive a minimal-contact behavioral treatment ( n = 392 ) or usual care ( n = 393 ) . The behavioral treatment included an ST cessation manual , a videotape cessation guide tailored for military personnel , and three 15-min telephone counseling sessions using motivational interviewing methods . Usual care consisted of st and ard procedures that are part of the annual dental examination , including recommendations to quit using ST and referral to extant local tobacco cessation programs . Participants were assessed at 3 and 6 months after enrollment . RESULTS Participants in the ST cessation program were significantly more likely to be abstinent from all tobacco , as assessed by repeated point prevalence at both 3 and 6 months ( 25.0 % ) , and were significantly more likely to be abstinent from ST use for 6 months , as assessed by prolonged abstinence ( 16.8 % ) , compared with participants in usual care ( 7.6 % and 6.4 % , respectively ) . DISCUSSION These results indicate that a minimal-contact behavioral treatment can significantly reduce ST use  in military personnel and has the potential for widespread dissemination . If ST users were identified in dental visits and routinely referred to telephone counseling , this could have a substantial benefit for the health and well-being of military personnel Background Prevention of weight gain has been suggested as an important strategy in the prevention of obesity and people who are overweight are a specifically important group to target . Currently there is a lack of weight gain prevention interventions that can reach large numbers of people . Therefore , we developed an Internet-delivered , computer-tailored weight management intervention for overweight adults . The focus of the intervention was on making small ( 100 kcal per day ) , but sustained changes in dietary intake ( DI ) or physical activity ( PA ) behaviors in order to maintain current weight or achieve modest weight loss . Self-regulation theory was used as the basis of the intervention . Objective This study aims to evaluate the efficacy of the computer-tailored intervention in weight-related anthropometric measures ( Body Mass Index , skin folds and waist circumference ) and energy balance-related behaviors ( physical activity ; intake of fat , snacks and sweetened drinks ) in a r and omized controlled trial . Methods The tailored intervention ( TI ) was compared to a generic information website ( GI ) . Participants were 539 overweight adults ( mean age 47.8 years , mean Body Mass Index ( BMI ) 28.04 , 30.9 % male , 10.7 % low educated ) who where recruited among the general population and among employees from large companies by means of advertisements and flyers .  Anthropometric measurements were measured by trained research assistants at baseline and 6-months post-intervention .  DI and PA behaviors were assessed at baseline , 1-month and 6-month post-intervention , using self-reported question naires . Results Repeated measurement analyses showed that BMI remained stable over time and that there were no statistically significant differences between the study groups ( BMI : TI=28.09 , GI=27.61 , P=.09 ) . Similar results were found for waist circumference and skin fold thickness . Amount of physical activity increased and intake of fat , snacks and sweetened drinks decreased during the course of the study , but there were no differences between the study groups ( eg , fat intake : TI=15.4 , GI=15.9 , P=.74 ) . The first module of the tailored intervention was visited by almost all participants , but only 15 % completed all four modules of the tailored intervention , while 46 % completed the three modules of the general information intervention . The tailored intervention was considered more personally relevant ( TI=3.20 , GI=2.83 , P=.001 ) , containing more new information ( TI=3.11 , GI=2.73 , P=.003 ) and having longer texts ( TI=3.20 , GI=3.07 , P=.01 ) , while there were no group differences on other process measures such as attractiveness and comprehensibility of the information ( eg , attractive design : TI=3.22 , GI=3.16 , P=.58 ) . Conclusions The online , computer-tailored weight management intervention result ed in changes in the desired direction , such as stabilization of weight and improvements in dietary intake , but the intervention was not more effective in preventing weight gain or modifying dietary and physical activity behaviors than generic information . A possible reason for the absence of intervention effects is sub-optimal use of the intervention and the self-regulation components . Further research is therefore needed to gain more insight into how the intervention and exposure to its contents can be improved . Trial Registration NTR1862 ; http://apps.who.int/trial search /trial.aspx?trialid = Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : Objectives : The aim of the Obesity Intervention Program of the German Army was to enhance physical activity levels , to adjust diet behavior , and to reduce risk factors in out patients over a period of 24 months . Methods : The data of the participants in the outpatient intervention from 2003 till 2011 were analyzed . Results : In total , 665 participants took part . All examined parameters were improved by the intervention , already in the second follow-up , significant for all parameters . A total of 12.2 % of all patients reduced their body weight by 5 % , and 8.4 % by 10 % . Conclusions : A significant improvement in all examined parameters was found . With respect to the fact that the participants of this  Obesity Intervention Program were only military servicemen and servicewomen , it should be tested if the program can be transferred on work health promotions outside the military Abstract Objective Acute low back pain ( ALBP ) may limit mobility and impose functional limitations in active duty military personnel . Although some manual therapies have been reported effective for ALBP in military personnel , there have been no published r and omized controlled trials ( RCTs ) of osteopathic manipulative treatment ( OMT ) in the military . Furthermore , current military ALBP guidelines do not specifically include OMT . Methods This RCT examined the efficacy of OMT in relieving ALBP and improving functioning in military personnel at Fort Lewis , Washington . Sixty-three male and female soldiers ages 18 to 35 were r and omly assigned to a group receiving OMT plus usual care or a group receiving usual care only ( UCO ) . Results The primary outcome measures were pain on the quadruple visual analog scale , and functioning on the Rol and Morris Disability Question naire . Outcomes were measured immediately preceding each of four treatment sessions and at four weeks post-trial . Intention to treat analysis found significantly greater post-trial improvement in ‘ Pain Now ’ for OMT compared to UCO ( P = 0·026 ) . Furthermore , the OMT group reported less ‘ Pain Now ’ and ‘ Pain Typical ’ at all visits ( P = 0·025 and P = 0·020 respectively ) . Osteopathic manipulative treatment subjects also tended to achieve a clinical ly meaningful improvement from baseline on ‘ Pain at Best ’ sooner than the UCO subjects . With similar baseline expectations , OMT subjects reported significantly greater satisfaction with treatment and overall self-reported improvement ( P<0·01 ) . Conclusion This study supports the effectiveness of OMT in reducing ALBP pain in active duty military personnel
Results Based on consistent evidence from studies that were rated as moderate or strong , there is good evidence that military weight management interventions are effective in improving body composition for duration s of up to 12 months .
Effective interventions are more likely to be high intensity ( have a greater number of sessions ) , are more often delivered by specialists , and use theoretical base/behavioral change techniques and a st and ardized guideline .
Dietary interventions can potentially reduce total fat and saturated fat intake .
Dietary interventions that target the kitchen staff and /or increase the availability of healthy food are more likely to be effective in the short term .
The results regarding military physical fitness interventions were inconclusive .
Conclusion Despite limitations such as the diversity and heterogeneity of the included interventions , outcome measurements , and follow-up duration , this systematic review found good evidence that weight management interventions are effective , especially in terms of weight loss .
Background Research has been conducted to assess the effectiveness of weight management , dietary and physical activity interventions in military setting s. However , a recent and comprehensive overview is lacking .
The aim of this systematic review is to examine the evidence and describe key components of effective interventions in terms of improving body composition , dietary behaviors , and physical activity among active-duty military personnel .