Browsing by Author "Rouleau, Codie R."

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    A randomized controlled trial of a “Small Changes” behavioral weight loss treatment delivered in cardiac rehabilitation for patients with atrial fibrillation and obesity: study protocol for the BE-WEL in CR-AF study
    (2024-10-11) Williamson, Tamara M.; Rouleau, Codie R.; Wilton, Stephen B.; Valdarchi, A. B.; Moran, Chelsea; Patel, Stuti; Lutes, Lesley; Aggarwal, Sandeep G.; Arena, Ross; Campbell, Tavis S.
    Abstract Background Atrial fibrillation (AF) represents a global epidemic. Although international AF practice guidelines indicate weight loss for patients with AF and comorbid obesity (BMI ≥ 30 kg/m2) to alleviate symptom burden and improve prognosis, few cardiac rehabilitation (CR) programs include targeted weight loss treatment. Aims This RCT protocol will evaluate the efficacy of a “Small Changes” behavioral weight loss treatment (BWLT) to produce clinically relevant (≥ 10%) weight loss among patients with AF and obesity undergoing CR, relative to CR alone. Secondary aims are to establish efficacy of CR + BWLT for improving AF symptoms, AF risk factors, and health-related quality of life. Methods Adults (18 +) with AF and obesity will be recruited and randomized to receive CR + BWLT (intervention) or CR-only (control). Controls will receive CR consisting of supervised exercise and risk factor self-management for 12 weeks. The intervention group will receive CR plus BWLT (12 weekly, group-based virtual sessions, followed by 12 weeks of follow-up support). Weight and AF-risk factors will be assessed at pre-randomization, 12 weeks, 24 weeks, and 52 weeks. AF burden will be assessed using 30-s ECGs recorded bidaily and with AF symptoms. The primary endpoint of weight loss will be calculated from baseline to 52 weeks as a percentage of starting weight. Intention-to-treat analyses will compare the proportion in each group achieving ≥ 10% weight loss. Assuming success rates of 5% and 30% among controls and intervention groups, respectively, and a 30% loss to follow-up, 120 patients (60 per group) will provide 80% power to detect a difference using a two-sided independent test of proportions (alpha = 5%). Impact This clinical trial will be the first to demonstrate that adding BWLT to CR promotes clinically meaningful weight loss among patients with AF and comorbid obesity. Findings will inform design and execution of a large efficacy trial of long-term (e.g., 5-year) clinical endpoints (e.g., AF severity, mortality). Implementing weight control interventions designed to target the AF substrate in CR could dramatically reduce morbidity and enhance quality of life among patients living with AF in Canada. Trial registration ClinicalTrials.gov registration number: NCT05600829. Registered October 31, 2022.
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    A Prospective Proof-of-Concept Study Evaluating the Influence of Patient Education on Knowledge, Attitudes, and Cardiac Rehabilitation Attendance among Patients with Coronary Artery Disease
    (2019-08-23) Williamson, Tamara Marie; Campbell, Tavis S.; Rouleau, Codie R.; King-Shier, Kathryn M.; Doyle-Baker, Patricia K.; von Ranson, Kristin M.
    Patient education (PE), delivered during cardiac rehabilitation (CR), aims to promote CR exercise attendance by imparting knowledge about coronary artery disease (CAD; medication, risk factors, etc.) and enhancing CR-related attitudes. This study evaluated the impact of PE on motivational treatment targets (CAD knowledge, CR attitudes), and CR exercise attendance. Adults (18+) with CAD referred to CR were recruited prior to attending PE. CAD knowledge and CR attitudes (perceived necessity/suitability, exercise concerns, barriers) were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review. Seventy-one patients (87% male) participated. CAD knowledge and perceived CR necessity improved pre- to post-PE; gains persisted at 12-weeks. Greater knowledge gains did not predict larger improvements in CR attitudes or increased exercise attendance. Whereas CR-based PE may be useful for improving CAD-related knowledge and perceived need for CR, more formative work is needed to determine whether PE can promote CR exercise attendance.
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    The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients
    (Dove Medical Press Ltd., 2015-6) Garland, Sheila N.; Carlson, Linda E.; Rouleau, Codie R.
    Research on the use of mindfulness-based stress reduction and related mindfulness-based interventions (MBIs) in cancer care has proliferated over the past decade. MBIs have aimed to facilitate physical and emotional adjustment to life with cancer through the cultivation and practice of mindfulness (ie, purposeful, nonjudgmental, moment-to-moment awareness). This descriptive review highlights three categories of outcomes that have been evaluated in MBI research with cancer patients - namely, symptom reduction, positive psychological growth, and biological outcomes. We also examine the clinical relevance of each targeted outcome, while describing recently published original studies to highlight novel applications of MBIs tailored to individuals with cancer. Accumulating evidence suggests that participation in a MBI contributes to reductions in psychological distress, sleep disturbance, and fatigue, and promotes personal growth in areas such as quality of life and spirituality. MBIs may also influence markers of immune function, hypothalamic-pituitary-adrenal axis regulation, and autonomic nervous system activity, though it remains unclear whether these biological changes translate to clinically important health benefits. We conclude by discussing methodological limitations of the extant literature, and implications of matching MBIs to the needs and preferences of cancer patients. Overall, the growing popularity of MBIs in cancer care must be balanced against scientific evidence for their impact on specific clinical outcomes.