Problem: A positive affective response is associated with increased participation in voluntary exercise, but the mechanisms by which this occurs are not well known. Consistent with a Theory of Planned Behaviour perspective, we tested whether affective response to exercise leads to greater motivation in terms of attitudes, subjective norms, self-efficacy and intentions to exercise. We were also specifically interested in whether a positive affective response leads to more temporally stable intentions. Method: Participants (N = 127) self-reported Theory of Planned Behaviour constructs and exercise behavior at baseline and three months later, and provided reports of exercise-related affect during a 30-minute bout of moderate intensity treadmill exercise at baseline. Results: We show that participants who experience greater improvements in positive affect, negative affect and fatigue during exercise tended to report more positive attitudes, exercise self-efficacy and intentions to exercise three months later. Affective response was not predictive of subjective norms. As hypothesized, positive affective response was associated with more stable intentions over time. Conclusions: We conclude that a positive affective response to acute bouts of exercise can aid in building and sustaining exercise motivation over time.

Within subject slopes for increases in positive affect and decreases in fatigue during exercise, and increased tranquillity and decreased fatigue post-exercise were associated with more frequent participation in exercise at follow-up. Changes in negative affect did not predict exercise at follow-up; however, this was likely due to floor effects leading to lack of baseline variability in negative affect. Importantly, a positive affective response to exercise moderated the intention-behaviour relationship, such that those who responded to exercise more favourably exhibited stronger relationships between intentions and future exercise behaviour Conclusions: We conclude that exercise-related increases in positive affect and tranquillity and decreases in feelings of fatigue can aid in the successful translation of exercise intentions into behaviour.

Pharmacotherapy and psychotherapy are generally effective treatments for major depressive disorder (MDD); however, research suggests that patient preferences may influence outcomes. We examined the effects of treatment preference on attrition, therapeutic alliance, and change in depressive severity in a longitudinal randomized clinical trial comparing pharmacotherapy and psychotherapy. Prior to randomization, 106 individuals with MDD reported whether they preferred psychotherapy, antidepressant medication, or had no preference. A mismatch between preferred and actual treatment was associated with greater likelihood of attrition, fewer expected visits attended, and a less positive working alliance at session 2. There was a significant indirect effect of preference match on depression outcomes, primarily via effects of attendance. These findings highlight the importance of addressing patient preferences, particularly in regard to patient engagement, in the treatment of MDD.Keywords patient preferences; depression treatment; working alliance; attrition; indirect effects; multiple mediation Major depressive disorder (MDD) remains a significant public health problem worldwide. Clinical research suggests that the use of pharmacotherapy and psychotherapy, both singly and in combination, are efficacious treatments for depression (see Hollon, Thase, & Markowitz, 2002). However, it is widely recognized that the efficacy of treatments for depression in clinical practice is limited by multiple factors, including premature dropout and non-adherence (e.g., Keller, Hirschfeld, Demyttenaere, & Baldwin, 2002;Melfi, Chawla, Croghan, Hanna, Kennedy, & Sredl, 1998). The preferences of patients for a given © 2010 Elsevier Ltd. All rights reserved.Corresponding author: Bethany M. Kwan, MA, MSPH University of Colorado at Boulder UCB 345 Boulder, CO 80309-0345 bethany.kwan@colorado.edu phone: 1-720-273-2715 fax: 1-303-492-2967. Correspondence concerning this article should be addressed to Sona Dimidjian, who is at the Department of Psychology, University of Colorado, Boulder, CO 80309-0345. sona.dimidjian@colorado.edu. 2 Data on early working alliance was only available for a portion of the sample (57 out of 73; 78.1% patients and therapists). Due to administrative error, fewer patients and providers completed the WAI in the pharmacotherapy condition (29 out of 42; 69.0%) than in the psychotherapy (28 out of 31, or 90.3%).Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Given the limited and at times equivocal findings, greater clarity of the relationship between preference and key clinic...

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Background: The RE-AIM framework has been widely used in health research but it is unclear the extent to which this framework is also used for planning and evaluating health-related programs in clinical and community settings. Our objective was to evaluate how RE-AIM is used in the “real-world” and identify opportunities for improving use outside of research contexts.Methods: We used purposive and snowball sampling to identify clinical and community health programs that used RE-AIM for planning and/or evaluation. Recruitment methods included surveys with email follow-up to funders, implementers, and RE-AIM working group members. We identified 17 programs and conducted structured in-depth interviews with key informants (n = 18). Across RE-AIM dimensions, respondents described motivations, uses, and measures; rated understandability and usefulness; discussed benefits and challenges, strategies to overcome challenges, and resources used. We used descriptive statistics for quantitative ratings, and content analysis for qualitative data.Results: Program content areas included chronic disease management and prevention, healthy aging, mental health, or multiple, often behavioral health-related topics. During planning, most programs considered reach (n = 9), adoption (n = 11), and implementation (n = 12) while effectiveness (n = 7) and maintenance (n = 6) were considered less frequently. In contrast, most programs evaluated all RE-AIM dimensions, ranging from 13 programs assessing maintenance to 15 programs assessing implementation and effectiveness. On five-point scales, all RE-AIM dimensions were rated as easy to understand (Overall M = 4.7 ± 0.5), but obtaining data was rated as somewhat challenging (Overall M = 3.4 ± 0.9). Implementation was the most frequently used dimension to inform program design (M = 4.7 ± 0.6) relative to the other dimensions (3.0–3.9). All dimensions were considered similarly important for decision-making (average M = 4.1 ± 1.4), with the exception of maintenance (M = 3.4 ± 1.7). Qualitative corresponded to the quantitative findings in that RE-AIM was reported to be a practical, easy to understand, and well-established implementation science framework. Challenges included understanding differences among RE-AIM dimensions and data acquisition. Valuable resources included the RE-AIM website and collaborating with an expert.Discussion: RE-AIM is an efficient framework for planning and evaluation of clinical and community-based projects. It provides structure to systematically evaluate health program impact. Programs found planning for and assessing maintenance difficult, providing opportunities for further refinement.

Designing for dissemination and sustainability (D4DS) refers to principles and methods for enhancing the fit between a health program, policy, or practice and the context in which it is intended to be adopted. In this article we first summarize the historical context of D4DS and justify the need to shift traditional health research and dissemination practices. We present a diverse literature according to a D4DS organizing schema and describe a variety of dissemination products, design processes and outcomes, and approaches to messaging, packaging, and distribution. D4DS design processes include stakeholder engagement, participatory codesign, and context and situation analysis, and leverage methods and frameworks from dissemination and implementation science, marketing and business, communications and visual arts, and systems science. Finally, we present eight recommendations to adopt a D4DS paradigm, reflecting shifts in ways of thinking, skills and approaches, and infrastructure and systems for training and evaluation. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Objective Affective responses during exercise are often important determinants of exercise initiation and maintenance. Current physical activity may be one individual difference that is associated with the degree to which individuals have positive (or negative) affective experiences during exercise. The objective of this investigation was to explore physical and cognitive explanations of the relationship between current activity status (more versus less active) and affective response during a 30-minute bout of moderate-intensity exercise. Method Participants reported their current level of physical activity, exercise self-efficacy, and affect during a 30-minute bout of moderate-intensity exercise. Results More active individuals experienced higher levels of positive affect and tranquility and lower levels of negative affect and fatigue during exercise. Multivariate models for each affective state indicated separate processes through which physical activity may be associated with changes in affect during exercise. Conclusions These models indicate that affect experienced during physical activity is related to current activity level and these relationships can be partially explained by the physical and cognitive factors explored in this study. Recommendations for future research to elucidate whether positive affective response to physical activity improves as a function of becoming more active over time are discussed.

Background It is not known whether sotrovimab, a neutralizing monoclonal antibody (mAb) treatment authorized for early symptomatic COVID-19 patients, is also effective in preventing the progression of severe disease and mortality following SARS-CoV-2 Delta variant infection. Methods Observational cohort study of non-hospitalized adult patients with SARS-CoV-2 infection from October 1st 2021 - December 11th 2021, using electronic health records from a statewide health system plus state-level vaccine and mortality data. We used propensity matching to select 3 patients not receiving mAbs for each patient who received outpatient sotrovimab treatment. The primary outcome was 28-day hospitalization; secondary outcomes included mortality and severity of hospitalization. Results Of 10,036 patients with SARS-CoV-2 infection, 522 receiving sotrovimab were matched to 1,563 not receiving mAbs. Compared to mAb-untreated patients, sotrovimab treatment was associated with a 63% decrease in the odds of all-cause hospitalization (raw rate 2.1% versus 5.7%; adjusted OR 0.37, 95% CI 0.19-0.66) and an 89% decrease in the odds of all-cause 28-day mortality (raw rate 0% versus 1.0%; adjusted OR 0.11, 95% CI 0.0-0.79), and may reduce respiratory disease severity among those hospitalized. Conclusion Real-world evidence demonstrated sotrovimab effectiveness in reducing hospitalization and all-cause 28-day mortality among COVID-19 outpatients during the Delta variant phase.