2011 COMBINED SECTIONS MEETING PLATFORM PRESENTATION SCHEDULE

2011 COMBINED SECTIONS MEETING PLATFORM PRESENTATION SCHEDULE Friday, February 11, 2011 Session I: 8:00-10:00 am 8:00-8:20 am Outcomes of Patients with Left Ventricular Assist Devices Admitted to Acute Rehabilitation: A Pilot Study Session II: 1:00-3:00 pm 1:00-1:20 pm COPD Program: A New Continuum Swanson, Paulette L.; Taber, Brian; Finn, Beth. Dekerlegand, Jennifer; Newland, Elena; Yuen, Lena; O’Donnell, Kerry. 8:20-8:40 am Physical Therapist’s Practices in the Education of Stroke Survivors on Exercise and Physical Activity Guidelines Hansen, Ruth L.; Raza, Bolivar A.; Lichtman, Steven W. 8:40-9:00 am A Home-Based Exercise Program Using Self-Management Strategies for Individuals with Type 2 Diabetes Bartlett, Andrew; Litwin, Bini; Friedman, Maureen; Rosenthal, Rebecca. 9:00-9:20 am Changes in Cardiovascular Endurance and Efficiency after Eight-Week Multi-modal Exercise Training in Individuals with Amputation Lin, Suh-Jen; Adams, Nicole; Bernhardt, Rebecca; Castillo, JoAnna. 9:20-9:40 am Cardiovascular Disease and Vietnam Veterans with Warrelated Amputation: Forty Years Post Injury 1:20-1:40 pm Breath: A Game To Motivate The Compliance Of Breathing Exercises Lange, Belinda; Flynn, Sheryl; Chang, Kevin; Rizzo, Albert; Bolas, Mark. 1:40-2:00 pm Smoking Cessation Counseling Skills and Confidence are Increased in DPT Students Following Communication Skills Education Ohtake, Patricia J.; Homish, Gregory G. 2:00-2:20 pm Assessment of the Built Environment and the Effects on the Perceptions of a Healthy Campus Murphy, Deirdra A.; Ferrara, Cynthia; Bowen, Laura; Laakso, Christine; Picco, Jenna. 2:20-2:40 pm Investigating the Need for Health and Wellness Programming For Employees of the University of South Alabama Gubler, Coral; Irion, Jean; Watson, Jarred; Weaver, Sarah. Mac Kinnon, Joyce L.; Robbins, Christopher; Wolf, Jim. 9:40-10:00 am Maximal Oxygen Consumption in Competitive Runners and Cyclists: A Comparison of Three Sub-maximal Tests with the 1.5 mile Run Peck, Kirk; Grady, Katy; Long, Sarah; Nielsen, John; Cox, Melissa; Hawks, Lauren; Meyer, Kyle; Robinson, Wyatt; Shultz, Matthew. 22 2:40-3:00 pm A Comparison of Energy Expenditure Estimates from the Actiheart and Actical Physical Activity Monitors during Low Intensity Activities, Walking, and Jogging Hagins, Marshall; Spierer, David; Pappas, Evangelos; Rundle, Andrew. Cardiopulmonary Physical Therapy Journal Vol 21 ❖ No 4 ❖ December 2010 ABSTRACTS OF PLATFORM PRESENTATIONS OUTCOMES OF PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICES ADMITTED TO ACUTE REHABILITATION: A PILOT STUDY. tion. Further studies are needed in a larger sample of patients to further document the efficacy of inpatient rehabilitation services in this population. Clinical Relevance: This pilot study demonstrates that with appropriate staff training, patients with VADs can successfully transition to a freestanding inpatient rehabilitation facility safely and complete an acute rehabilitation program with positive outcomes. Dekerlegand, Jennifer; 1Newland, Elena; 1Yuen, Lena; O’Donnell, Kerry. 1Good Shepherd Penn Partners, Philadelphia, PA, USA. PHYSICAL THERAPIST’S PRACTICES IN THE EDUCATION OF STROKE SURVIVORS ON EXERCISE AND PHYSICAL ACTIVITY GUIDELINES. Purpose/Hypothesis: The government approved some ventricular assist devices (VADS) for destination therapy. This change created a new population of adults in need of inpatient rehabilitation as well as the need for qualified therapists to provide this service. The purpose of this study is to describe the development of an inpatient rehabilitation program at a freestanding facility for individuals with VADS and report the initial outcomes. Number of Subjects: Eight patients (6 males, 2 females) with a mean age of 61.6 ± 7.4 years transitioned to acute rehab over a six month period. Six of the patients were implanted with a Heartmate II LVAD® and two with a Heartware VAD™. These patients were admitted with rehabilitation diagnoses that included stroke, cardiac impairment and deconditioning. Patients received occupational and physical therapy for three hours per day provided by VAD trained therapists. Materials/ Methods: Prior to admitting a patient with a VAD, a physical and occupational therapist at the rehabilitation facility were trained as VAD “superusers.” This process required the therapists complete a competency process comprised of inservice training from a manufacturer representative, one-on-one training with the primary acute care VAD therapist and multiple co-treatments. These superusers were responsible for providing therapy for the initial patients with VADs admitted to the facility as well as training the remaining therapy staff. Eight therapists and one aide completed the VAD training competency at the initiation of the program. Results: Mean length of stay for this sample was 18.9 ± 9.0 days. Subjects demonstrated a significant improvement in the FIM total scores increasing from 69.1 ± 8.2 at admission to 92.1 ± 1.2 at discharge (p < .001). The motor skills subtotal demonstrated a greater improvement from 43.3 ± 5.7 to 62.4 ± 9.2 (p < .001), while the cognitive skills subtotal improved from 24.9 ± 5.0 to 28.8 ± 3.6 (p < .05). A six-minute walk test was completed at discharge with a mean walk distance of 133.9 ± 65.3 meters. A patient progress form was developed and completed on a weekly basis as a communication tool. None of the eight patients required readmission to the hospital during their rehabilitation stay. All device issues were managed with the rehabilitation staff contacting the VAD coordinators by phone. Conclusions: The results of this pilot study demonstrate that patients with VADs are able to safely participate in an inpatient acute rehabilitation program and demonstrate significant improvements in FIM scores. These improvements are comparable to those seen in other patient populations who complete acute rehabilita- 1 Hansen, Ruth L.; 1Raza, Bolivar A.; 1Lichtman, Steven W. 1School of Health & Natural Science, Mercy College, Dobbs Ferry, NY, USA. 1 1 Vol 21 ❖ No 4 ❖ December 2010 Purpose/Hypothesis: Stroke survivors are at risk for development of cardiovascular disease (CVD). Physical therapists (PTs) have the responsibility to educate these patients on risk factor modification for CVD. However, there have been no studies examining practice patterns for cardiac education in patients post stroke. The purpose of this study was to survey PTs to determine practice patterns in this area. It was hypothesized that PT degree and years in practice would affect practice patterns for cardiac education in this population. Number of Subjects: The participants of the present study were incidentally selected from email listings and ground mailed addresses obtained from New York Physical Therapy Association (NYPTA) website. A total of 1600 surveys were sent (1435 by email and 165 by ground mail). A total of 166 validated/completed surveys were utilized for a response rate of 10.3%. Materials/Methods: The study utilized a non-experimental, retrospective cross-sectional design. The survey consisted of 17 items addressing demographics, questions relating to education patterns on general CV risk, exercise to prevent CV disease and exercise implementation. Frequencies were utilized to describe the data. Kruskal-Wallis One Way Analysis of Variance by Ranks was utilized to determine practice pattern differences for type of PT degree and ANVOA for years of practice. Alpha was set at p<0.05. Results: The mean 6% of the PTs had certificates, 49% had bachelor, 34% had Masters and 11% had DPT degrees. 17% of the PTs never counsel their patient on CVD risk, 20% counsel between 1 and 25%, 13% counsel between 20 and 50%, 11% counsel between 51 and 75% and 28% counsel between 76 and 100% of their patients. 4% of the PTs never educate their patients on proper exercise, 19% spend 1-5% of treatment time, 22% between 6 and 11%, 13% between 11 and 20%, 14% between 21 and 30% and 13% >30% of their time education patients post stroke on exercise. Neither type of degree nor years of practice were associated with differences in educational practice patterns. Conclusions: The majority of the PTs responding reported counseling less than 50% of their patients on risk of CVD. Only a small amount of time was spent on education of CVD risk reduction. Neither physical therapy degree nor the PT’s years of experience treating stroke survivors affected how many clients were Cardiopulmonary Physical Therapy Journal 23 counseled regarding stroke and increased risk of CV disease, the role of endurance exercise in CVD and health risk reduction, and with client/family education pertaining to safe performance of endurance exercise for fitness, wellness, and prevention. Clinical Relevance: Based on the results of this study, time educating stroke survivors on CVD risk and the role of exercise in CVD risk reduction is not a priority among practicing physical therapists. However, this population is at increased risk for CV events and PT’s should take a more active role in educating this population on primary and secondary prevention. Additionally, given these findings, this concept should be emphasized in PT educational programs. A HOME-BASED EXERCISE PROGRAM USING SELFMANAGEMENT STRATEGIES FOR INDIVIDUALS WITH TYPE 2 DIABETES. Bartlett, Andrew; 1Litwin, Bini; 2Friedman, Maureen; Rosenthal, Rebecca. 1NOVA Southeastern University, Fort Lauderdale, FL; 2Nazareth College, Rochester, NY, USA. tion plan, exercise journal and physical therapist) provided a sense of accountability and promoted self confidence. Participants also perceived the feedback provided by the program facilitated self-management and adherence. Barriers and challenges to the program included: arthritis, use of the weights, blood pressure device and scale. Conclusions: An eight week home-based exercise program using self-management strategies was beneficial for individuals with type 2 diabetes with significant improvements in physical therapy and self reported measures along with a significant decrease in waist circumference. There was also a trend towards a significant decrease in hemoglobin A1C. Clinical Relevance: These findings are relevant to the physical therapy profession as they provide an evidence based treatment model for a short term (8wk) self-managed exercise program that can achieve statistically significant and clinically significant outcomes in individuals with type 2 diabetes within a home-based setting. 2 1 Purpose/Hypothesis: To determine the effect of an eight week home-based combined aerobic and resistive exercise program using self-management strategies on physical therapy and self reported measures and on the value of modifiable cardiovascular risk factors in individuals with type 2 diabetes. Additionally, this study explored perceived barriers and/or contributory factors to program compliance. Number of Subjects: 15 individuals with type 2 diabetes Materials/Methods: Design: A one group pretest-posttest mixed design was used. All participants participated in a home-based eight week combined aerobic and resistive exercise program using self-management strategies (telehealth monitor, action plan, exercise journal, feedback). Dependent variables included: 30-second sit to stand, 30-second arm curl test, 2 minute step test, timed up and go (physical therapy outcome measures), body mass index, waist circumference, heart rate, systolic and diastolic blood pressure, total cholesterol, triglycerides, high density lipoproteins, low density lipoproteins, cholesterol/HDL ratio, and hemoglobin A1c (cardiovascular measures), diabetes self-efficacy, self-management of exercise and health status (self reported measures). One on one in depth interviews were conducted post eight week intervention with themes identified. Results: Data was analyzed using the Wilcoxon Signed Ranks Tests (P=.05) and Spearman’s Rank Correlation Coefficients Tests. Statistically significant improvement was observed in all physical therapy and self reported measures. A statistically significant decrease in waist circumference was noted post eight weeks. Although other risk factor changes were not statistically significant, this study demonstrated a trend toward improved glycemic control (7.2% to 6.6%); decrease in cholesterol, cholesterol/HDL ratio, and an increase in HDL. Self reported measures were not correlated with any other dependent measures with the exception of self-efficacy and health status. Participants reported the components of the entire program (health buddy, ac- 24 CHANGES IN CARDIOVASCULAR ENDURANCE AND EFFICIENCY AFTER 8-WEEK MULTI-MODAL EXERCISE TRAINING IN INDIVIDUALS WITH AMPUTATION. 1 Lin, Suh-Jen; 1Adams, Nicole; 1Bernhardt, Rebecca; 1Castillo, JoAnna. 1School of Physical Therapy, Texas Woman’s University, Dallas, TX, USA. Purpose/Hypothesis: Although health promotion programs for individuals with disabilities are developing as a new frontier for physical therapists, few community-based exercise training programs exist for people with amputation. This study attempted to examine the effects of 8-week multimodal exercise training on cardiovascular endurance and energy efficiency in persons with lower-limb amputation in a community setting. Number of Subjects: Eleven subjects were initially enrolled, but only seven people (3 women, 4 men) completed the study: six with below-knee amputation and one with above-knee amputation (age: 53±13 yr, BH: 175± 10 cm, BW: 98±26 kg). They had stable medical conditions, lived a sedentary life, and walked independently with prosthesis. Materials/Methods: Outcome measures of the six-minute walk test (6MWT) and the 4-stage metabolic exercise test were evaluated pre- and post-training. The 6MWT was conducted on a 150-foot segment of hallway with blood pressure, perceived exertion, and telemetry electrocardiography monitoring. The exercise test utilized a 3-minute staged elliptical cycle ergometer protocol with 4 workloads (25, 50, 75, 100 w), and breath-by-breath gas analysis was performed synchronously via a metabolic cart. The 8-week training involved resistive exercise, balance exercises, and aerobic exercises and subjects were trained either onsite or at home. The onsite aerobic exercise consisted of 20 to 30 minutes of elliptical bike exercise at “moderate intensity” based on the Rating of Perceived Exertion scale. The home-based group followed a custom-design exercise booklet and a walking program with a pedometer. Descriptive statistics were analyzed for demographic data. Paired t test (one-tailed) was used to analyze the changes in distance Cardiopulmonary Physical Therapy Journal Vol 21 ❖ No 4 ❖ December 2010 of the 6MWT. Two-way (time x workload) repeated measures ANOVA was used to compare the oxygen consumption between pre- and post-training for the 4 workloads. Statistical significance was set at p < 0.05. Results: After training, the distance of the 6MWT significantly increased (p = 0.03). For the metabolic exercise test, the oxygen consumption was significantly lower after training at 50w, 75w, and 100w (p < 0.05 respectively); but there was no significant difference at 25 watts (p > 0.05). Conclusions: This community-based short term multimodal exercise training is effective for individuals with lower-limb amputation, as evidenced by the improved endurance on the walk test and a lower oxygen demand after training at three given submaximal workloads. Clinical Relevance: Communitybased multimodal exercise training is feasible and beneficial for apparently healthy individuals with lower-limb amputation. Regular cardiovascular endurance exercise could lower risk factors of heart diseases and diabetes in the long run. Whether the onsite program is more effective than the home-based exercise program, it would require future studies with a larger sample size. Acknowledgement: We appreciate the funding support from the Texas Physical Therapy Foundation for this project. CARDIOVASCULAR DISEASE AND VIETNAM VETERANS WITH WAR-RELATED AMPUTATION: FORTY YEARS POST INJURY. 1 Mac Kinnon, Joyce L.; 1Robbins, Christopher; 1Wolf, Jim. Indiana University, Indianapolis, IN, USA. 1 Purpose/Hypothesis: This presentation uses data collected from research performed through the Indiana-Ohio Center for Traumatic Amputation Rehabilitation Research. The Center was formed in 2006 with funding from the US Department of Defense, and its purpose is to assess long term health outcomes of Vietnam veterans with war-related amputation. The research hypothesis guiding the Center formation was that United States military personnel who experience a traumatic war related amputation would have unique rehabilitation needs in terms of their health and health care over their life span. One of the areas studied was cardiovascular disease and associated risk factors. Number of Subjects: The Center registry currently has 454 Vietnam veterans with war related amputations enrolled; 224 participated in this study. Materials/Methods: A comprehensive survey was created to assess health outcomes among Vietnam veterans with war-related amputations. Areas addressed were chosen based on literature review of relevant articles as well as feedback from veterans, clinicians, and the Center’s Advisory Board. The survey was initially conducted by telephone and available on line. One hundred and one participants completed the survey through the telephone interview and 123 additional participants completed the survey on line. There were no statistically significant differences in results reported in the two groups and therefore the data were collapsed into a single database of 224 completed surveys. Results: Exam- Vol 21 ❖ No 4 ❖ December 2010 ining participants’ responses to health related questions, in particular cardiovascular disease and related risk factors, there was a high rate of hypertension (66%) among these veterans. Other levels of cardiovascular disease were reported such as angina (20.5%), prior heart attack (17.6%), and congestive heart failure (2.7%). Level of amputation was not significantly associated with cardiovascular disease in our sample. Respondents also reported associated cardiovascular risk factors such as diabetes (23.4%), obesity (15.2%), and depression (33.3%). Conclusions: In contrast to other published studies, this study failed to find an association between amputation level and cardiovascular disease. Despite this lack of association it is evident that there is a high level of hypertension among this population of persons with amputations that is consistent with the literature. Study participants exhibited relatively low levels of other cardiovascular disease and risk factors. However, there did appear to be correlations among risk factors and the presence of cardiovascular disease. Clinical Relevance: This study is one of the few studies that examine the long term outcomes of people with amputations, albeit in a specific cohort-Vietnam veterans with war-related amputations. Physical therapists who evaluate and treat patients with amputations of long standing should be aware of the elevated risk for cardiovascular complications even in those patients for who amputation was not due to cardiovascular disease. This awareness will enhance patient care. MAXIMAL OXYGEN CONSUMPTION IN COMPETITIVE RUNNERS AND CYCLISTS: A COMPARISON OF THREE SUB-MAXIMAL TESTS WITH THE 1.5 MILE RUN. 1 Peck, Kirk; 1Grady, Katy; 1Long, Sarah; 1Nielsen, John; Cox, Melissa; 1Hawks, Lauren; 1Meyer, Kyle; 1Robinson, Wyatt; 1Shultz, Matthew. 1PT Dept, Creighton University, Omaha, NE, USA. 1 Purpose/Hypothesis: Physical therapists are integrating more skilled preventative health care services in the fitness industry. As a result, a new paradigm of patient/client management will be required to address evidence-based exercise prescription in the healthy population. Knowledge of the most valid mechanisms to measure maximal oxygen consumption will be needed to assess cardiovascular fitness. The purpose of this study was to compare estimated maximal oxygen consumption values (VO2max) between three sub-maximal clinical tests and the 1.5 mile field run in competitive runners and cyclists. Number of Subjects: Data were collected from eighteen recreational runners (females: n=11, males: n = 7, mean age = 24.0 years) and eleven competitive cyclists (females: n=1, males: n=10, mean age = 42.8) for a total of 29 subjects. Materials/Methods: Subjects volunteered to run a 1.5 mile maximal field test, and complete three sub-maximal VO2 clinical tests, including: 1) Astrand-Rhyming Cycle Ergometer; 2) SingleStage Treadmill Walking Test; 3) Single-Stage Treadmill Jogging Test. The 1.5 mile field test was completed on an indoor track. VO2 max values for all tests were calculated Cardiopulmonary Physical Therapy Journal 25 using standardized equations from the American College of Sports Medicine. Results: Pearson correlation coefficient values and standard estimates of error were calculated for all sub-maximal oxygen consumption tests in comparison to the 1.5 mile run. Data for runners: Astrand-Rhyming (r = 0.509, SEE = 3.34); Single-Stage Treadmill Walking Test (r = 0.828, SEE = 2.17); Single-Stage Treadmill Jogging Test (r = 0.849, SEE = 2.04). Data for cyclists: Astrand-Rhyming (r = 0.724, SEE = 2.79); Single-Stage Treadmill Walking Test (r = 0.556, SEE = 4.46); Single-Stage Treadmill Jogging Test (r = 0.918, SEE = 2.12). Combined data: Astrand-Rhyming (r = 0.520, SEE = 3.34); Single-Stage Treadmill Walking Test (r = 0.516, SEE = 3.71); Single-Stage Treadmill Jogging Test (r = 0.847, SEE = 2.30). Conclusions: The Single-Stage Sub-maximal Treadmill Jogging Test had a high correlation and small standard estimate of error in both runners and cyclists. When data from runners and cyclists were combined, the treadmill jog test maintained a high correlation value of 84.7%. These data indicate that use of a simple treadmill jog test is a good clinical predictor of maximal oxygen consumption in both runners and cyclists. In contrast, the Astrand-Rhyming Cycle Ergometer test poorly correlated to maximal oxygen consumption values in runners, and only marginally correlated in cyclists. Clinical Relevance: Results from this study may be used as a reference to select appropriate sub-maximal VO2 tests to prescribe cardiovascular intensity levels. Future Studies: Different versions of sub-maximal VO2 testing should be selected for comparison to maximal tests such as the 1.5 mile run. In addition, utilizing a maximal oxygen consumption test based on cycling versus running might yield a higher correlation to the sub-maximal Astrand-Rhyming cycle test, especially in competitive cyclists. COPD PROGRAM: A NEW CONTINUUM. 1 Swanson, Paulette L.; 1Taber, Brian; 1Finn, Beth. 1Rehabilitation Services, Middlesex Hospital, Middletown, CT, USA. Purpose: Our COPD program is one of the only programs in Connecticut that manages the care of patients with COPD across the continuum. In 2008 a community health assessment for Middlesex County found 18% of adults reported being current smokers and 33% of adults reported being former smokers. The emergency room admission rate for people with COPD exacerbations was 478/100,000 visits, higher than the state average of 347/100,000 visits. Ninety-five percent of hospitalized patients were discharged without any COPD disease specific care. Description: Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Standard the goal of COPD management at Middlesex Hospital is to relieve symptoms, prevent disease progression, improve exercise tolerance, improve health status, prevent and treat complications, prevent and treat exacerbations, reduce mortality, prevent or minimize side effects from treatments. Goals are achieved through assessment and monitoring of diseases, reducing risk factors, managing stable COPD, and managing exacerbations. 26 Upon admission to the hospital, patients with a diagnosis of COPD are assigned to the COPD pathway and evaluated by a therapist. All patients with a new diagnosis of COPD and/ or newly prescribed oxygen receive therapy in the home. Homecare therapists identify signs of COPD exacerbation, risk factors, medication management, and performing standardized assessments such as the 6MWT, Barthel Index and Tinetti Test. Patients then participate in a 12 week outpatient physical therapy, occupational therapy and group therapy program. Evidenced based measures are used for evaluation including the Chronic Disease Questionnaire (CRQ), Pulmonary Functional Status and Dyspnea Questionnaire, BORG Scale, Geriatric Depression scale, 6MWT, Functional Reach test, and TUG. Vital signs are monitored to determine the need for supplemental oxygen with physician approval. Weight and glucose levels are monitored as needed. Patients participate in lectures by a multidisciplinary team. Individual referrals are made for Speech Therapy, Respiratory Therapy, Nutrition, Psychosocial intervention, Nursing and Smoking Cessation. After discharge from the outpatient program, patients participate in a Better Breathers’ support group. Summary of Use: Since implementation of our COPD program in January 2009, there has been a 3% decrease in admissions of the patients with COPD to the emergency department, a 76% decrease in deaths amongst COPD patients and a 29% increase in the number of patients who were discharged home with services. In the outpatient setting the average improvement in the 6MWT is 59 meters. The CRQ scores also significantly improved: Dyspnea (19%), Fatigue (22%), Emotion (12%), and Mastery (22%). Importance to Members: Since the implementation of our program there has been a decrease in hospital/emergency department admissions and a significant increase in quality of life indicators with patients with COPD. If this program continues to be a success, we hope to use this program model for other populations, including geriatrics and obesity. BREATH: A GAME TO MOTIVATE THE COMPLIANCE OF BREATHING EXERCISES. 1 Lange, Belinda; 2Flynn, Sheryl; 1Chang, Kevin; 1Rizzo, Albert; 1Bolas, Mark. 1Institute for Creative Technologies, University of Southern California, Marina Del Rey, CA; 2Blue Marble Rehabilitation, Altadina, CA, USA. Purpose/Hypothesis: There is a need for breathing exercise programs to improve the lack of motivation often associated with exercise. This project involved the development and initial user testing of a game-based incentive spirometry system to motivate patients to perform breathing exercises. Number of Subjects: Six therapists and six persons with spinal cord injury and prior experience using an incentive spirometer evaluated two prototype systems. Materials/Methods: The spirometry input device uses airflow measured from an incentive spirometer and LabPro system (Vernier Software and Technology) to interact with the computer based video game environment. When attached to Cardiopulmonary Physical Therapy Journal Vol 21 ❖ No 4 ❖ December 2010 the Spirometer, the LabPro System measures the airflow from the spirometer and presents the data in graphical format on a computer screen. The prototype interaction device developed for this project was programmed to use the airflow measured from the spirometer as an input device to interact with two games developed using Microsoft’s XNA Game Studio in C# programming language. The system provides individualized challenge levels and quantitative measurement of progress and compliance. A method was developed to provide the user with control over the settings of the game and to input their own breathing pattern in order to individualize treatment goals and level of challenge. The First game prototype was deep breathing game in which the user must control a person on a magic carpet flying over buildings and under bridges with their breath. The second game was a breath stacking game in which the user must control a camel trying to cross a river by jumping onto two or three logs (consecutive breathes in) and onto the shore (breath out). Participants were asked to play the two game prototypes and provide feedback on the system, hardware, gameplay, and the use of the system for breathing exercises. Results: Therapists were excited about the ability to calibrate the game-based tasks for specific patients. Five patients commented that the ability to calibrate the system to their own breathing ability was an important feature to them. Both therapists and patients agreed that the user interface was simple and easy to use. Suggestions were provided by both groups to add music to the game, providing auditory cues of the breathing pattern required in addition to the visual cues and feedback. Each patient stated that the use of this game based system would motivate them to perform breathing exercises more regularly than the existing system they use. All patients and therapists found the two games visually stimulating and fun to play. Conclusions: The feedback provided by participants has been incorporated into revised prototypes that will be assessed over Summer 2010, leading to a clinical trial at the end of 2010. Clinical Relevance: The integration of medical devices with video game technologies offers great potential to improve assessment, and collect objective data regarding patient compliance and lung function. SMOKING CESSATION COUNSELING SKILLS AND CONFIDENCE ARE INCREASED IN DPT STUDENTS FOLLOWING COMMUNICATION SKILLS EDUCATION. Ohtake, Patricia J.; 2Homish, Gregory G. 1Dept Rehabilitation Science, University at Buffalo, Buffalo, NY; 2Health Behavior, University at Buffalo, Buffalo, NY, USA. of care, allowing for support, monitoring, and follow-up during a smoking cessation attempt. One approach to increase smoking cessation counseling by physical therapists may be to identify and subsequently reduce barriers to providing counseling during the physical therapists’ academic preparation. We recently reported that the most common barrier identified by physical therapy students (n = 42) was a lack of sufficient communication skills to confidently engage in smoking cessation counseling (56%), particularly when providing motivation for increasing a patient’s desire to stop smoking and when addressing issues related to an enabling spouse. The objective of this investigation was to examine the effect of a smoking cessation communication skills seminar (SCCSS) on the proficiency of counseling skills and willingness to engage in smoking cessation counseling in a cohort of physical therapy students. Number of Subjects: Physical therapy students (n = 44) participated in smoking cessation education that consisted of a lecture, two online continuing education courses, and a smoking cessation intervention knowledge assessment [mean (SD) = 88% (6%)]. Materials/ Methods: Students then participated in a SCCSS provided by a seasoned counselor with academic and clinical expertise in addiction counseling techniques. Following the SCCSS, students rated their perceived counseling skill ability and willingness to engage in smoking cessation counseling on a 5 point Likert scale (1= poor; 5 = very good). Smoking cessation counseling skills were objectively evaluated during the practical examination of students who had a smoker for their case (n = 37). Results: Prior to the SCCSS, the majority of students perceived their smoking cessation counseling skills and willingness to engage in smoking cessation counseling to be AVERAGE [skills, median 3 (2 – 5); willingness, median 3 (2-5)]. Following the SCCSS, students’ perceptions of their communication skills and willingness to engage in counseling increased on average by one unit to VERY GOOD. [skills, median 4 (3 – 5); willingness, median 4 (3-5); p < 0.001 for both]. Objective assessment of smoking cessation counseling skills revealed that 29 of 37 students met competency (p < 0.001). Conclusions: These preliminary findings suggest that a SCCSS increased students’ perceived and objective counseling skills and willingness to engage in smoking cessation counseling. Clinical Relevance: Educational opportunities that enhance students’ competence and confidence in counseling skills may facilitate active engagement of smoking cessation counseling in practicing physical therapists. 1 Purpose/Hypothesis: Resolution of many conditions managed by physical therapists is impacted by smoking. While many physical therapists assess smoking status, most rarely engage in active smoking cessation counseling. Physical therapists are ideally positioned to provide smoking cessation counseling because, unlike other healthcare professionals that see patients once or twice per year, physical therapists have frequent patient contact during an episode Vol 21 ❖ No 4 ❖ December 2010 ASSESSMENT OF THE BUILT ENVIRONMENT AND THE EFFECTS ON THE PERCEPTIONS OF A HEALTHY CAMPUS. 1 Murphy, Deirdra A.; 1Ferrara, Cynthia; 1Bowen, Laura; Laakso, Christine; 1 Picco, Jenna. 1Physical Therapy, University of Massachusetts Lowell, Lowell, MA, USA. 1 Purpose/Hypothesis: The purpose of this research study was to assess the built environment and the perceptions of faculty, staff and students on a college campus following an Cardiopulmonary Physical Therapy Journal 27 interdisciplinary initiative. Number of Subjects: 423 faculty, staff, and students from an urban university in the Northeast United States completed a survey. Materials/Methods: 423 respondents participated in a 33 question online survey about the built environment on campus, including self-reported physical activity and nutrition status. The survey was completed each fall for 3 consecutive years beginning in 2007. In addition, an observational assessment of the built environment was conducted using the CDC walkability audit tool during yr 1 and yr 3 of the study. Coalitions were strategically developed to plan interventions, coordinate implementation of interventions and serve as ‘champions for change’ for the proposed environmental changes. Policy and environmental changes included point of decision prompts, media campaigns, stairwell improvements, implementation of a bike share program and campus-wide policy changes. Changes in the built environment and the perceptions of the built environment were measured over a 3-yr period. Results: Of the 423 survey respondents, 37% were men and 68% were women, with a mean age 29.6 yr. The self-reported average BMI was 25.1 + 5.0 in yr 1, 24.7 + 5.1 in yr 2 and 24 + 3.9 in yr 3. A subset of questions was chosen for analysis, which focused on the perception of the built environment and self-reported physical activity. Using the Kruskal-Wallis test on the eight-question subset, a significant change was noted between years on 3 of the 8 questions. Two of these questions were about self-report daily vigorous or strengthening activities, with an overall greater number of participants reporting participation in aerobic or strengthening exercises. A significant change was also noted in the perceptions of the campus environment, with 26% of the respondents in yr 1 reporting that sidewalks were well maintained vs. 36 % in yr 3. Based on the CDC’s walkability audit tool the campus is moderately walkable with the average walkability score for the three campuses of 68/100 on year 1 and 66/100 on year 3 (p>0.05). Conclusions: Although objective measures of campus walkability demonstrate no change, significant positive changes in self reported physical activity and perception of campus sidewalk maintenance are noted during a three year time frame in which specific programs and interventions where conducted on a college campus. Clinical Relevance: Obesity continues to be a public health concern in the United States and throughout the world. The American College Health Association estimates that three out of every 10 college students are overweight or obese. The built environment is one of the contributing causes of the obesity epidemic. The built environment needs to be part of interventions and assessments to increase physical activity and improve nutrition and decrease the risk factors associated with obesity. Purpose/Hypothesis: Recently, employers, including universities, have begun to implement on-site health and wellness programming for their employees. These programs provide benefits to both employees and employers including decreased health care costs, decreased health insurance premiums, a lower turnover rate, decreased sick leave, increased employee job satisfaction and overall better employee fitness. The purpose of this study was to determine if additional health and wellness resources and programs would be both of interest to and beneficial to faculty and staff at the university medical and educational settings at the University of South Alabama (USA). Number of Subjects: 622 Materials/Methods: A survey was designed to investigate the need for and interest in further health promotion programming at the university, which included a Physical Activity Readiness-to-Change Questionnaire. An invitation to participate in the questionnaire, description of the questionnaire and a link to the questionnaire via Zoomerrang were emailed to all university employees. Employees without university computer access were accommodated with a paper format of the questionnaire. Results: Of the 622 respondents, 65.7% were female, 34.3% were male, 59.3% were staff, 23.8% were faculty, 9.2% were medical personnel, and 7.6% were administration. Over 65% of participants were overweight or obese using Body Mass Index (BMI). Approximately 86% of respondents reported a need for additional health and wellness resources. The most frequently reported barrier to participation in physical activity was lack of time (74.9%). The most frequently reported incentive was reduced healthcare insurance premiums (38.8%). Within the Readiness-to-Change Questionnaire, employees’ scores indicate they are between the Contemplation Stage and the Action Stage. Conclusions: Respondents are aware that change is necessary and would like additional assistance and resources to better enable participation in physical activity and health promotion activities. Barriers to and incentives for participation need to be addressed in program development. Additionally, it is evident that there is a strong need for a health and wellness program at this university based on the BMI results of this questionnaire with this result probably being representative of the employees as a whole. Clinical Relevance: Healthcare risks and costs are greatly increased in those that are overweight or obese. Prevention of chronic disease should be a priority, particularly in the Southeast region of the United States where unhealthy lifestyle risk factors are more prevalent. The physical therapist should play an integral role in the development of interventions of health and wellness programming. The literature supports the employer’s responsibility in facilitation of such programs. INVESTIGATING THE NEED FOR HEALTH AND WELLNESS PROGRAMMING FOR EMPLOYEES OF THE UNIVERSITY OF SOUTH ALABAMA. A COMPARISON OF ENERGY EXPENDITURE ESTIMATES FROM THE ACTIHEART AND ACTICAL PHYSICAL ACTIVITY MONITORS DURING LOW INTENSITY ACTIVITIES, WALKING, AND JOGGING. 1 Gubler, Coral; 1Irion, Jean; 1Watson, Jarred; 1Weaver , Sarah; 1Giardina, Michael. 1Department of Physical Therapy, University of South Alabama, Mobile, AL, USA. 28 1 Hagins, Marshall; 2Spierer, David; 1Pappas, Evangelos; Rundle, Andrew. 1Physical Therapy, Long Island Univer- 3 Cardiopulmonary Physical Therapy Journal Vol 21 ❖ No 4 ❖ December 2010 sity, Brooklyn, NY; 2Division of Sports Sciences, Long Island University, Brooklyn, NY; 3Mailman School of Public Health, Columbia University, New York, NY, USA. ABSTRACTS OF POSTER PRESENTATIONS Purpose/Hypothesis: Combining accelerometry with heart rate monitoring has been suggested to improve energy estimates, however, it remains unclear whether the single, currently existing commercially available device combining these data streams (Actiheart) provides improved energy estimates compared to simpler, less expensive, and less burdensome accelerometry-only devices. The purpose of this study was to compare the validity of the Actiheart and Actical devices during low and moderate intensity activities. Number of Subjects: Twenty-seven participants [mean age; 26.3(7.3)] volunteered for the study. Materials/ Methods: Participants wore one Actical on the left hip, an Actiheart on the chest and an indirect calorimeter (K4b2) on the back while card playing, sweeping, lifting weights, walking and jogging. Results: Both devices underestimated energy across all activities although the estimates by both devices were significantly associated with energy expenditure. Results regarding relative accuracy of the devices varied based on a consideration of all activities as a group or by each individual activity. Viewed across all activities, the correlation coefficients for the Actical (0.98) and Actiheart (0.99-1.00) devices to the indirect calorimeter were almost identical, however the slopes (Beta) of the Actical device were substantially better than the Actiheart device, being close to one (1.06) for the Actical and substantially above one (range: 1.46-1.74) for the Actiheart. This suggests that across all activities the Actical device provides superior estimates to the Actiheart device. However, viewed by individual activity, the Actiheart estimates were significantly better than the Actical estimates during card playing, sweeping, and weight lifting. Conclusions: Viewed across all activities, the Actical provides superior estimates of energy expenditure compared to the Actiheart when using the default group calibration formulas within the Actiheart. In contrast, the Actiheart appears to provide better estimates than the Actical for activities in which acceleration is not closely related to energy expenditure (card playing, sweeping, lifting weights). Clinical Relevance: The information provided by this study may be useful to researchers attempting to make practical decisions regarding the selection of accelerometry-only devices versus combined accelerometry plus heart rate devices. Researchers must clearly consider the specific population and specific activities being examined so the aims of the study can be aligned with the appropriate measurement device. This study suggests that, if the group calibration equations with the currently available Actiheart are to be used, there may be a limited number of physical activities for which the increased cost, complexity, and subject burden of the Actiheart are balanced by the degree of improvement in energy estimates. BREATHING EASIER AFTER BARIATRIC SURGERY. Vol 21 ❖ No 4 ❖ December 2010 1 Sobush, Dennis C.; 2Chua, Thomas Y.; 1Luciano, MaryRose; 1Fauth, McKenzie. 1Department of Physical Therapy, Marquette University, Milwaukee, WI; 2Wisconsin Bariatrics, S.C., Milwaukee, WI, USA. Background & Purpose: Bariatric surgery for the morbidly obese (MO) is undertaken for a variety of reasons (cosmesis; controlling DM, HTN, GERD, and/or OSA; and musculoskeletal unloading; to name a few) to improve life quality. The degree to which this restrictive lung condition of MO alters a person’s effort perception and breathing mechanics as contributors to functional performance and life-quality has been given sparse attention. Therefore, the purpose of this Case Study was to document pre- to post-op changes in a person’s life-quality scores, functional performance, dyspnea index, spirometry, ventilatory muscle pump forces, and chest excursion changes as more favorable body mass indexes (BMI) occurred. Case Description: institution review board approval and informed consent were obtained to study a 31 y.o. < > (70 inches tall and 275 pounds excess body weight at 424 pounds) with restrictive MO (BMI of 61.1 and a waist-to-hip ratio of 0.82) and the obstructive lung disease of Asthma( FEV1/FVC% of 0.69 and “triggers” of smoke, pollen, and cold air). A systems review revealed RA, a positive history for bilateral knee OA and right heel spur, HTN, hypercholesterolemia, and a positive family history for DM, CAD, HTN, and MO. Pre- and post-op Gastric band surgery values were obtained for life-quality (SF-36 inventory),functional performance (6-minute walk distance and velocity), spirometry (FEV1/FVC% and peak flow readings), ventilatory muscle pump forces (MIP and MEP), ribcage excursion (<∑> axillary, xiphoid, and lower costal levels), and dyspnea scores (UCSD inventory) spanning four mid-west seasons in an urban setting. On 5 occasions (baseline pre-op, 3-, 6- , 9-, and 12-months post-op), all test results were obtained by the same PT clinician under similar indoor conditions and testing sequence. Outcomes: Clinically significant improvements from pre-op baseline were realized in life-quality (for roles physical, emotional, and general health), functional performance (from 1173 to 1632 feet and 2.2 to 3.1 mph), ventilatory muscle pump forces (1-year MEP was 15 percent greater and MIP equaled pre-op values), rib-cage excursion (from 11.0 cm to 18.0 cm), BMI (50.5% at 1-year), and dyspnea index (from 16 to 10). Less lower extremity joint pain while weight-bearing was also reported. Rescue medication (Proventil) was used only once, in the cold of winter, throughout all 12 months. A loss of 26% (72 pounds) of her weight excess approached a weight goal of 300 pounds to permit future tolerance of a planned pregnancy. Discussion: Following a 6-week period of post-op recovery in which no progressive physical activity was undertaken, daily caloric intake of 650-800 was Cardiopulmonary Physical Therapy Journal 29 the norm, below the 1200 calorie target set by her medical team. As daily activity advanced thereafter (pedometer readings from 3000 to 6000 steps), nutritional intake counseling became a top priority. Future interest is to determine whether breathing easier after bariatric surgery is the same for < > or < > having “Android” versus “Gynoid” MO, with or without obstructive disease superimposed. THE USE OF EXERCISE AND A TELEHEALTH DEVICE TO PROMOTE SELF-EFFICACY IN INDIVIDUALS WITH TYPE II DIABETES. Bartlett, Andrew; 1Brown, Jessica; 1Butler, Aubrie; 1Colin, Amy; 1Couture, Megan. 1Nazareth College, Rochester, NY, USA. cacy scale used. Conclusions: This pilot study suggests that the use of an exercise program and a Telehealth device may help to improve individuals’ adherence to exercise. Clinical Relevance:Clinically, these results may help physical therapists to determine ways to help motivate patients with Type II diabetes to begin an exercise program. Using phone or e-mail reminders, exercise logs, or mentorship programs may act as similar modes of increasing exercise compliance, as suggested by the results of our study. Limitations of this study include a small sample size, faulty pedometers, orthopedic conditions, non-random sample, and accuracy of RPE. 1 Purpose/Hypothesis: The purpose of this study was to examine the use of a structured exercise program and a Telehealth device to improve self-efficacy and exercise adherence in individuals with Type II diabetes. We hypothesized that this combination would significantly improve adherence to physical activity and self-efficacy in subjects with Type II diabetes. We also hypothesized that subjects would make improvements in the strength, aerobic and anthropometric measures used in this study. Number of Subjects: Six subjects with Type II diabetes were recruited from Nazareth College and surrounding community (2 male, 4 female, 63+6.65 y.o.). Three subjects were in an exercise plus Telehealth group (experimental group) and three subjects were in an exercise only group (control group). Materials/Methods: All participants participated in an eight week exercise program two times per week at Nazareth College. The Telehealth group had a monitor in their home which prompted them to do daily self management. Subjects were assessed throughout the study using the following measures: Self-Efficacy Scale for Diabetes, 10RM for eight major muscle groups, one mile walk test, and number of days per week physical activity was performed outside of exercise group. Exercise sessions included cardiovascular and strength training. All participants began with 20 minutes of aerobic exercise and progressed to 35 minutes by the end of study. Resistive exercises targeted eight major muscle groups in upper and lower extremities. Participants began their strength training program at 70% of their 10 RM and were progressed as tolerated. Additionally, subjects were encouraged to participate in at least two 30 minute sessions of aerobic exercise outside of structured exercise group, which they recorded in exercise journals. Results: Data was analyzed using a Repeated Measures test (p=.05) and a Spearman Rank Correlation. Between groups, the experimental group exercised significantly more days per week outside of the group exercise sessions than the control group. A trend toward significant findings included a correlation between time for one mile walk and times they reported they exercised per week (r=.7). Power analysis determined that only 41 subjects would be needed in order to find significant changes between groups for the self-effi- 30 HEART RATE ACHIEVES STEADY STATE DURING UPPER EXTREMITY EXERCISE TUBING EXERCISE. 1 O’Connell, Dennis G.; 1Hinman, Martha R.; 1Leddy, Josh A.; 1Silva, Noe J.; 1Thomas, David A. 1Physical Therapy, Hardin-Simmons University, Abilene, TX, USA. Purpose/Hypothesis: To determine if: (1) steady state heart rate (HR) occurs when performing upper extremity exercise tube exercise (UTE); (2) HR response during UTE is reliable; and (3) steady-state HRs differs using different resistances (colors) during UTE. Number of Subjects: A convenience sample of 12 male and 12 female Doctorate of Physical Therapy students participated. Materials/ Methods: After signing an informed consent, Body Mass Index (BMI), percent fat, arm length, mid-arm circumference, triceps skin fold, and chest circumference were collected. During UTE, subjects sat upright with elbows flexed 90°, arms adducted, with closed fists resting below the clavicles. Subjects held exercise-tube handles with tubing positioned at mid back under the axillary region. Subjects reciprocally extended upper extremities to 90° horizontal flexion at 30 rpm per arm for five minutes. Rate of perceived exertion (RPE) and HR were recorded every exercise minute. Three resistances (red, green, blue) of Thera-band® exercise tubing were randomly ordered in the protocol. The protocol consisted of a five minute bout, a ten minute rest, and a repeated five minute bout. One week of rest was allowed between color trials until all colors were completed. A one-way ANOVA (SPSS 17.0) was computed (Tukey post hoc) to calculate differences in HR between colors. A RMANOVA, split by color, was performed to determine differences between steady-state HRs and colors. Pearson correlations determined relationships between HR by test and by color. Significance was set at p ≤ 0.05. Results: Mean steady-state HR for red, green, and blue were: 87.1, 93.6 and 95.3 b/min, respectively. Based on group averages, subjects were exercising at 44.3%, 47.6% and 48.4% of their age-predicated max HR and at 12.2%, 18.5% and 19.0% of their max workload intensity, respectively. HR was significantly different until minute 3 for red and blue and minute 4 for green. Steady-state HR was significantly different between red and blue work during minutes 1-5 for and between green Cardiopulmonary Physical Therapy Journal Vol 21 ❖ No 4 ❖ December 2010 and red work during minutes 3-5, however, no differences were noted between green and blue. HR for tests 1 and 2 for minutes 4 and 5 were highly correlated (red r=.92, green r=.90, blue r=.92). Conclusions: UTE provided a reproducible steady-state stimulus perceived to be fairly light to somewhat hard on the Borg scale. Steady-state HR was achieved within minute 4 with all three colors. Red provided significantly lower HR than blue, while blue and green provided similar HR responses. Though, red and blue produced significantly different HR throughout exercise, red and green provided similar heart responses after 3 minutes of exercise. Clinical Relevance: Completely functional upper extremities allow for maximal independence. Arm cycle ergometers are expensive, difficult to calibrate, and are often unavailable in typical physical therapy settings. An inexpensive, readily available product (exercise tubing) allows the therapist, as well as the client, optimal flexibility in training the cardiovascular system and increasing muscular endurance. CARDIOVASCULAR DISEASE PREVENTION AND HEALTH PROMOTION THROUGH AN INNOVATIVE SERVICE LEARNING PROJECT. 1 Pollard, Elicia; 1George, Phillip. Langston, OK, USA. 1 APPROPRIATENESS OF AQUATIC EXERCISE FOR WEIGHT LOSS AND FITNESS GAINS IN OVERWEIGHT AND OBESE PARTICIPANTS. Langston University, Purpose: Heart disease is the leading cause of death in America and affects minority populations disproportionately. The Center for Disease Control and Prevention supports addressing modifiable risk factors through education and community awareness programs. Through a service learning project, doctor of physical therapy (DPT) students designed interactive educational activities that integrated current evidence on minority health and minority health disparities as it applies to persons with cardiovascular health concerns. The project met community needs while providing students with the knowledge and skills to create programs that serve the underserved populations. Description: DPT students created an educational series that consisted of 1 meeting per week for 4 weeks for students, faculty and staff at a HBCU (historically black colleges and universities). The students researched scholarly journal articles, formulated behavioral objectives, created innovative teaching strategies, developed assessment tools, analyzed data and reflected on their experience. On week 1, a 3-dimensional model of the heart was created and participants were “blood cells” who traveled through the chambers of the heart, passed through the valves, received oxygen from the lungs and transported oxygen to the body. Week 2, participants walked through a simulated artery with plague build-up. Education on minorities and heart disease was delivered by a power point presentation, heart and artery models, poster boards, and an interactive game. Week 3, students emphasized the benefits of exercise and demonstrated heart healthy activities that can be performed outside a gym. Week 4, participants were “detectives” who Vol 21 ❖ No 4 ❖ December 2010 used items in the evidence room to assist them to solve cases requiring healthy lifestyle changes. Summary of Use: Participants completed an assessment after each session for a total of 419 assessment forms. Data analysis revealed that participants were able to recognize at least 2 modifiable risk factors, demonstrate one exercise/activity to promote heart healthiness, list one function of the heart and recognize 2 risks for heart disease in the minority populations. Participants reported that they felt more knowledgeable about the risks for heart disease and more equipped to be proactive in their own health care. Results were disseminated at the state-wide service learning conference. Importance to Members: Cardiovascular health care providers have a professional responsibility to educate the community regarding the risk factors for heart disease. Creative and interactive methods of instruction can promote change and stimulate internal motivation for people in the community to become more aware and proactive in their health care. Physical therapists can and should be leaders in the movement to increase cardiac awareness in the general public. 1 Donovan, Skye; 1Nicholson, Sarah; 2Walters-Edwards, Michelle. 1Physical Therapy, Marymount University, Arlington, VA; 2Health and Human Performance, Marymount University, Arlington, VA, USA. Purpose/Hypothesis: The purpose of this study was to assess the feasibility and effectiveness of an aquatic exercise program on weight loss on cardiovascular fitness in an overweight and obese population. Number of Subjects: 7. Materials/Methods: Subjects were selected from a convenience sample at our University via a campus wide email solicitation and were students, staff, or faculty. Inclusion criteria consisted of BMI > 24.9 and no contraindications to exercise. Seven participants were eligible and randomly assigned to the aquatic group. Participants completed a body composition and fitness assessment prior to the start of the study, which was repeated at termination of the study. The fitness tests included field tests to assess VO2, flexibility and muscular endurance. The intervention consisted of hour long PT supervised aquatic exercise sessions 2x week for 6 weeks. Each session included 30 minutes of deep water running followed by 20 minutes of strength and flexibility training in the water. Participants wore flotation belts and HR monitors to assist with keeping running pace to match 75% of HR max. Subjects were also enrolled in a nutrition program that included a weekly lesson, on-line discussion boards, weigh-ins, and food journaling. Results: The ages of the participants ranged from 25-60, and consisted of 1 male and 6 females. The BMI of participants ranged from 28.5-43.5 kg/m2. The compliance rates of the program were high, with only one subject dropping out due to time constraints of her job. The remainder of the 6 sub- Cardiopulmonary Physical Therapy Journal 31 jects all showed some improvement in body composition (either body mass or WHR) and in cardiovascular fitness as evidenced by decreased resting HR and BP and improved performance on fitness tests. In a post-intervention survey the participants stated the program was fun, engaging, and effective. They cited camaraderie and ability to exercise in a new way as positive influences to their participation. Conclusions: Despite the small sample size and variance in subjects, this study demonstrates that aquatic exercise is a viable option for weight loss and fitness gains in the overweight and obese population. Clinical Relevance: Most importantly this study illustrates the use of water as an alternative or adjunct exercise modality to land based exercise in those who are overweight and obese in their quest to improve body composition and fitness. CHANGES IN BODY COMPOSITION, FITNESS LEVELS AND CARDIAC RISK FACTORS FOLLOWING A 10 WEEK EXERCISE AND NUTRITION PROGRAM FOR OVERWEIGHT/OBESE CHILDREN. 1 Martino, Sharon A.; 1Sisto, Sue A.; 2Morelli, Peter J. 1Physical Therapy, Stony Brook University, Stony Brook, NY; 2 Pediatrics, Stony Brook University Medical Center, Stony Brook, NY, USA. Purpose/Hypothesis: Childhood obesity studies traditionally use body mass index (BMI) as the primary outcome measure. BMI is a statistical measure of weight classification based on weight and height, however it does not reflect % body fat or distribution of adiposity, and is influenced by linear growth. Fitness levels, body composition, and cardio-metabolic factors may be more accurate indicators of program effectiveness. Purpose: To evaluate the effect of an exercise and nutrition intervention administered to overweight and obese children, ages 8-17, by examining body composition, fitness levels, cardio-metabolic factors, quality of life, and BMI. Hypotheses: Children randomized to the intervention will show improved levels of body composition, fitness, cardio-metabolic factors, and quality of life (QOL), following a ten week exercise and nutrition program and as compared to a matched, wait-list control group. These changes may be maintained over a 10 week home exercise program (HEP). Number of Subjects: n=48 Materials/Methods: The influence of a twice weekly, 10 week exercise and nutrition intervention plus a 10 week HEP was examined in 48 children (treatment group:n=24, WLC group:n=24). Body composition (dual-energy, X-ray absorptiometry), fitness levels (flexibility [sit and reach], agility [“t” test], muscle endurance [push ups and sit ups], strength [hand held dynamometer], cardiovascular endurance [6 min walk test]), and cardio-metabolic risk factors (BP, HR, total cholesterol, and HgA1c) were made at baseline, following a 10 week intervention and following a 10 week home program. QOL was assessed using the Impact of Weight on Quality of Life Scale (IWQOL). Results: Upon completion of the program, there were no differences be- 32 tween groups. Within groups and across time, body composition improved with significant changes in % body fat (-2.1%) and % lean tissue (+1.9%) noted (p<.05). Fitness levels also improved significantly (p<.05) and improvement was noted in cardiovascular endurance (p=.07). Cardiometabolic risk factors remained stable. There was no significant difference in scores for QOL however the domain of body esteem approached significance (p=0.07) following the exercise intervention. Conclusions: A 10 week exercise and nutrition intervention can influence body composition and fitness levels. In this study, % lean tissue increased while growth and BMI remained stable. This increase in % lean tissue was accompanied by an increase in strength and muscle endurance. These changes coincided with a stable BMI. Notably, improvements were maintained or enhanced over a 10 week home program phase, indicating adoption of a healthy lifestyle change. Clinical Relevance: Fitness measures may be better indicators of program effectiveness, and physical therapists are well suited to measure and monitor fitness levels when working with overweight and obese children. Stability of BMI may be a better goal for this population. THE EFFECT OF VENTILATORY STRATEGIES ON SIT-TOSTAND TRANSFERS IN THE GERIATRIC POPULATION: A PILOT STUDY. 1 Ekstrum, Julie A.; 1Brown, Caitlin; 1Economides, Sarah; Simpson, Emily. 1Physical Therapy, Creighton University, Omaha, NE, USA. 1 Purpose/Hypothesis: Many older adults have difficulty rising from chairs, particularly lower or softer surfaces. The use of ventilatory strategies has been described to enhance the ability to complete motor tasks. The purpose of this study was to investigate whether instructing elderly individuals to use ventilatory strategies (inhalation with upward eye gaze) with sit-to-stand transfers would improve the ability to rise from a chair. Number of Subjects: A sample of convenience was recruited from two independent living facilities. Twenty-two subjects (17 female, 5 male) with the mean age of 85.7 years completed pre- and post- testing. Materials/ Methods: After baseline testing, subjects were educated on how to incorporate ventilatory strategies with basic sit-tostand transfers and were instructed to practice daily. Baseline measures included Timed Up and Go (TUG), items 2-4 of the Tinetti Performance-Oriented Mobility Assessment (POMA), and timed five-time sit-to-stand from a standard chair with arms, a standard chair without arms, and a recliner. Qualitative descriptions of arm, leg and head position, overall movement, and attempts required to rise during each sit-to-stand trial were also documented. One week after initial instruction, subjects returned to demonstrate and review the previously learned ventilatory strategies and were re-instructed as needed. Two weeks following initial baseline testing and instruction, subjects were reassessed. Results: The pre- and post-test scores for TUG, Cardiopulmonary Physical Therapy Journal Vol 21 ❖ No 4 ❖ December 2010 items 2-4 POMA, and time to complete the five-time sitto-stand for each chair were analyzed with a paired t-test. No statistically significant differences were found. Conclusions: Although the results of this pilot study did not show statistically significant improvements, ventilatory strategies in clinical practice and in published case studies have been very beneficial in enhancing transitional movements. Based upon these preliminary results, modifications will be made to the current study design. Rather than using a sample of convenience, a larger number of targeted participants with more uniform transfer deficits will be sought and the study will include a control group. The educational method will be modified including increased practice. In addition, the subjects will be allowed to practice the strategy with feedback for a greater length of time. Clinical Relevance: Ventilatory strategies are simple, easily taught techniques that can be used with older adults to enhance functional movements. Improved transitions from sit-to-stand can allow elderly individuals to maintain independence and improve quality of life. CARDIOVASCULAR RISK FACTORS AND PHYSICAL PERFORMANCE PROFILE OF AGING FEMALES WITH DIABETES ENROLLED IN A PUBLIC HEALTH CLASS. 1 Pariser, Gina L.; 1Gillette, Patricia D. 1Physical Therapy, Bellarmine University, Louisville, KY, USA. formance profiles of the AA and W females were not significantly different except for years with diabetes (5.2 ± 3.6 yrs for W and 10.2 ± 8.0 yrs for AA) and waist circumference (38.3 ± 4.7 inches for W and 42.3 ± 4.8 inches for AA); therefore risk factors and physical performance profile are reported in aggregate. Eighty-four percent had a sedentary lifestyle; 92% had hypertension, 94.7 % reported family history of heart disease, 81.5% had hypercholesterolemia, 13.5% were smokers, and 73.7% were obese. Other comorbid conditions included osteoarthritis (92%), peripheral neuropathy (57.8%) and chronic obstructive lung disease (21.1%). Nearly half (42%) used an assistive device for gait. Subjects demonstrated below normal 6MWD (351.8 ± 93.8yds) and an MPPT mean score (27.4) suggesting mild frailty. Conclusions: Aging AA and W females with T2D residing in medically underserved communities had similar CVD risk factors and physical performance profiles. Aging females with T2D in medically underserved areas had well below average physical performance scores in the 6MWD and MPPT. Clinical Relevance: Aging females in medically underserved areas have many CVD risk factors and lower physical performance scores. These data suggest physical therapy intervention would be beneficial in this population. ANALYSIS OF PRE-OPERATIVE PHYSICAL PERFORMANCE IN BARIATRIC SURGICAL PATIENTS: IMPLICATIONS FOR CLINICAL PRACTICE GUIDELINES. 1 Purpose/Hypothesis: Many older adults with physical impairments and/or functional limitations enroll in Diabetes Management Classes typically directed by Diabetes Nurse Educators in medically underserved areas through the local Public Health Department. The purpose of this study was to identify the cardiovascular disease (CVD) risk factors and physical performance profile of older white (W) and African-American (AA) females with type 2 diabetes (T2D) in these classes. These individuals may benefit from specific physical therapy intervention yet are often not referred by their primary care physician. Number of Subjects: Subjects were recruited from Diabetes Management Classes offered in medically underserved areas through the local Public Health Department. Thirty-eight females with T2D age 55 years or older (mean = 66.8 ± 8.5 yrs) volunteered. Twenty-two subjects were AA and 16 subjects were W. Materials/Methods: Subjects completed informed consent and a health risk questionnaire. Vital signs, height, weight, and waist circumference were recorded and body mass index was calculated. Supervised by physical therapists and physical therapist students, subjects completed the Modified Physical Performance Test (MPPT), the Six Minute Walk Test for distance (6MWD), gait speed, and the Timed Up and Go test. Chi-square analyses were used to compare the frequency of CVD risk factors and other health problems between AA and W subjects. T-tests were used to compare physical performance test means for AA and W subjects. Statistical significance was set at p < 0.05. Results: The CVD risk factor/ health status and physical per- Vol 21 ❖ No 4 ❖ December 2010 Galloway, Rebecca; 2Welsh, Rodney; 2Chapman, Karen; Mossberg, Kurt. 1Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX; 2Department of Rehabilitation Services, University of Texas Medical Branch, Galveston, TX, USA. 1 Purpose/Hypothesis: Limited evidence exists to guide physical therapists in the clinical interpretation of physical performance measures for obese clients. Prior to elective bariatric surgery, patients are commonly evaluated for sub-maximal exercise capacity using a six-minute walk test (6MWT). The goals of this study were to: 1) examine the predictive value of a pre-operative 6MWT on bariatric surgical outcomes, and 2) develop clinical guidelines for evidencebased evaluation of exercise capacity for obese patients. Number of Subjects: 180 Materials/Methods: Patient data was retrospectively analyzed from physical therapy preoperative evaluations and a bariatric surgical database from a university hospital. Pearson correlation coefficients were used to determine association between pertinent variables. Linear regression and logistic regression were used to analyze continuous and dichotomous outcome measures, respectively. Clinicians and faculty collaboratively discussed literature and study results to develop guidelines for incorporation of available evidence into the evaluation process. Results: Patients who had bariatric surgery were middleaged (mean = 45.6 years, SD = 10.2) and predominately (80%) female. Distance completed during the 6-minute walk ranged from 30.48 – 731.5 meters (mean = 417.4, SD = 107.9). The immediate post 6MWT heart rate was rela- Cardiopulmonary Physical Therapy Journal 33 tively low. On average, patients’ heart rates were 57.8% (SD = 9.32) of age-predicted maximum post 6MWT. Combined with gait speed, this translated into a low physiological cost index (PCI) of 1.68 beats/meter (SD = 1.50). Performance on the 6MWT was not associated with post-operative surgical outcomes (i.e. number of complications, length of stay, or readmissions). Conclusions: Performance on the 6MWT did not predict surgical outcomes of obese patients receiving gastric bypass or banding. Post hoc discussions with clinicians who performed the assessments suggested to the investigators that patients in this cohort may not have consistently walked “as far as possible” during the 6MWT. In addition, the absence of a subjective measure of exertion and lack of information on types, dosages, and compliance with prescribed medications may have contributed to the inability to predict surgical outcome. Clinical Relevance: For physical assessment of preoperative patients, it is imperative that standardized clinical guidelines be developed and disseminated in order to improve the quality of physical therapy evaluations. Given the lack of literature available for guidance when working with this patient population, we suggest that 1) protocol instruction be consistent with the American Thoracic Society Guidelines 2) the Borg Rating of Perceived Exertion be used, and 3) documentation of cardiac medications be included in the evaluation. and at a frequency of less than 2 times per week. There was no correlation between total time spent in the target zone and any of the measures of interest. Conclusions: The participants’ exercise frequency and duration in the target heart rate zone were insufficient to meet the American College of Sports Medicine (ACSM) guidelines of exercise participation necessary to make fitness gains. Although a cause and effect relationship cannot be inferred from this study, the lack of training load might be responsible in part for the lack of improvements in the participants’ anthropometric and physiological measures. Clinical Relevance: The exercise stimulus in this unsupervised worksite was insufficient to meet ACSM guidelines for training adaptations. Further studies are needed to explore the possibility that a lack of exercise intensity, frequency, and/or guidance may contribute to the modest improvements seen in unsupervised wellness and exercise programs. This information is important to maximize the benefits of such programs. EXERCISE INTENSITY AND TRAINING ADAPTATIONS FOLLOWING PARTICIPATION IN A WORKPLACE WELLNESS PROGRAM: A DESCRIPTIVE STUDY. 1 Pepin, Marie-Eve; 1Drouin, Jacqueline; 1Roobol, Tegan. Physical Therapy, Oakland University, Rochester, MI, USA. 1 Purpose/Hypothesis: Current evidence suggests worksite wellness programs do not commonly increase physical activity, improve aerobic fitness, or decrease cardiovascular risk factors. Limited evidence exists on the exercise training stimulus performed in these programs; therefore, this study measured exercise training intensity during a 12-week worksite wellness program and then assessed the participants’ training adaptations. Number of Subjects: 22 subjects from a university wellness program agreed to participate in this study. Materials/Methods: Informed consent was signed and institutional approval was received prior to starting the study. Participants received exercise training guidelines and wellness education. Exercise load (intensity, frequency, duration) was measured with Polar RS400 heart rate monitors. Pre- and post-intervention tests included: cardiopulmonary fitness (Rockport 1-mile walk test), body composition (body fat percentage, weight, height), serum measures (lipid profile, C-reactive protein, fasting glucose) and resting vitals (heart rate, blood pressure). Analyses: Paired t-test and Pearson product moment were used to assess the data using SPSS 14.0. Results: There were no significant improvements in participants’ anthropometric and physiological measures over the course of the study. Participants trained in the targeted heart rate zone (>50% maximum heart rate [HRmax]) a median of 73 minutes per week 34 Cardiopulmonary Physical Therapy Journal Vol 21 ❖ No 4 ❖ December 2010