Feasibility of an emotion regulation intervention for patients in cardiac rehabilitation

Cardiac rehabilitation is important to improve physical activity and reduce cardiovascular disease risk factors among people who have experienced a major cardiac event. However, poor emotion regulation can make it difficult to change cardiovascular risk factors. The purpose of this paper was to assess the feasibility of the Regulating Emotions to improve Nutrition Exercise and reduce Stress (RENEwS) intervention, an education program aimed at improving emotion regulation strategies among patients in cardiac rehabilitation. Fourteen cardiac rehabilitation patients (mean age 61 years) enrolled in 5 weekly RENEwS sessions. Qualitative analysis of participants’ comments was used to assess eight elements of feasibility. Fifty-seven percent of participants completed the intervention. Participants thought the intervention was feasible, with strengths in the areas of acceptability, demand, adaptation, integration, and implementation. Other comments regarding practicality, expansion, and perceived efficacy provide guidance for intervention refinement.Kelly L. Wierenga was supported in this work as The Nurses Charitable Trust of Greater Miami Scholar of the American Nurses Foundation and by NINR grants T32NR015433 and P30NR015326. David M. Fresco was supported by NHLBI Grant R01HL119977, NINR Grant P30NR015326, NCCIH Grant R61AT009867, and NICHD Grant R21HD095099. Megan Alder was supported by NINR grant P30NR015326 and T32NR015433. This secondary analysis was from a P30 pilot study in the SMART Center: Brain-Behavior Connections in Self-Management Science directed by Dr. Shirley Moore at CWRU (P30NR015326). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Preliminary Efficacy of an Emotion Regulation Intervention on Physical Activity and Depressive and Anxious Symptoms in Individuals in Cardiac Rehabilitation

Background: For the 720 000 Americans expected to experience a new acute cardiac event this year, cardiac rehabilitation is an important part of recovery. Symptoms of depression and anxiety undermine recovery efforts, leaving recovering patients at risk for diminished functional capacity and heightened risk of mortality. Poor emotion regulation can worsen symptoms of depression and anxiety and hinder recovery efforts. Objective: The purpose of this randomized controlled trial was to evaluate the early efficacy testing of a theoretically based emotion regulation treatment (Regulating Emotions to Improve Self-management of Nutrition, Exercise, and Stress [RENEwS]) designed to assist survivors of an acute cardiac event in cardiac rehabilitation to optimize recovery. Methods: Survivors of an acute cardiac event in cardiac rehabilitation (n = 30, 83% men) were randomized to five 1-hour in-person group sessions of RENEwS or a phone-based attention-control group. Participants completed measures of depression and anxiety symptoms at 3 time points. Moderate to vigorous physical activity (MVPA) was objectively measured for 7 days at each time point using waist-worn actigraphy monitors. Between-group differences were calculated using analysis of variance with Cohen f effect sizes calculated to evaluate initial efficacy. Results: There was no statistically significant difference in depression, anxiety, or MVPA over time based on group assignment (all P > .05). Compared with attention control participants, in RENEwS participants, preliminary effects showed greater reductions in depression (Cohen f = 0.34) and anxiety (Cohen f = 0.40) symptoms but only modest improvements in MVPA from baseline to 5 months (Cohen f = 0.08). Conclusions: Findings show that RENEwS is a promising emotion regulation intervention to enhance cardiac rehabilitation and potentially decrease symptoms of depression and anxiety.Kelly L. Wierenga was supported in this work as The Nurses Charitable Trust of Greater Miami Scholar of the American Nurses Foundation and by NINR grants T32NR015433 and P30NR015326. David M. Fresco was supported by NHLBI Grant R01HL119977, NINR Grant P30NR015326, NCCIH Grant R61AT009867, NIMH Grant R01MH118218, NICHD Grant R21HD095099, and NCI Grant R01CA244185. Megan Alder was supported by NINR grant P30NR015326 and T32NR015433. This secondary analysis was from a P30 pilot study in the SMART Center: Brain-Behavior Connections in Self-Management Science directed by Dr. Shirley Moore at CWRU (P30NR015326). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Differences among physical activity actigraphy algorithms in three chronic illness populations

Objectives: In three chronic illness populations and in a combined sample, we assessed differences in two algorithms to determine wear time (WT%) and four algorithms to determine: Kilocalories, light physical activity (PA), moderate-to-vigorous PA (MVPA), and metabolic equivalents (METs). Methods: Data were collected from 29 people living with HIV (PLHIV), 27 participants recovering from a cardiac event, and 15 participants with hypertension (HTN). Participants wore the ActiGraphTM wGT3X-BT for > 3 days on their hip. Analysis of variance (ANOVA) was used to assess differences among the algorithms. Results: No differences were found between the two algorithms to assess WT% or among the four algorithms to assess kilocalories in each of the chronic illness populations or in the combined sample. Significant differences were found among the four algorithms for light PA (p < .001) and METs (p < .001) in each chronic illness population and in the combined sample. MVPA was significantly different among the four algorithms in the PLHIV (p=.007) and in the combined sample (p < .001), but not in the cardiac (p=.064) or HTN samples (p=.200). Discussion: Our findings indicate that the choice of algorithm does make a difference in PA determination. Differences in algorithms should be considered when comparing PA across different chronic illness populations.This work was supported by the National Institute of Nursing Research (grant numbers P30NR015326 and T32NR015433)

Id1 overexpression is independent of repression and epigenetic silencing of tumor suppressor genes in melanoma

The full molecular consequences of oncogene activation during tumorigenesis are not well understood, but several studies have recently linked oncogene activation to epigenetic silencing of specific genes.(1,2) Transcriptional repressor Id1 is overexpressed in many malignancies including melanoma, and Id1 targets include tumor suppressor genes TSP1, CDKN2A (p16) and CDKN1A (p21), which are frequently epigenetically silenced in cancer. We confirmed that both TSP1 and CDKN2A have abnormal promoter region DNA methylation in primary melanoma, but the mechanism by which this silencing occurs remains unknown. Here we explore the effects of stable lentiviral Id1 overexpression on the expression of these Id1 target genes in human melanoma cell lines. Overexpressed Id1 was functional and bound transcriptional activator E2A, but did not sequester E2A from gene promoters and repress gene expression. Therefore, these Id1 target genes were resistant to Id1-mediated gene silencing. Our results suggest that Id1 activation may need to occur at discrete stages in cooperation with additional gene dysregulation to repress and induce epigenetic silencing of tumor suppressor genes during melanoma progression