BackgroundMobile phone based programs for kidney transplant recipients are promising tools for improving long-term graft outcomes and better managing comorbidities (eg, hypertension, diabetes). These tools provide an easy to use self-management framework allowing optimal medication adherence that is guided by the patients’ physiological data. This technology is also relatively inexpensive, has an intuitive interface, and provides the capability for real-time personalized feedback to help motivate patient self-efficacy. Automated summary reports of patients’ adherence and blood pressure can easily be uploaded to providers’ networks helping reduce clinical inertia by reducing regimen alteration time.ObjectiveThe aim of this study was to assess the feasibility, acceptability, and preliminary outcomes of a prototype mobile health (mHealth) medication and blood pressure (BP) self-management system for kidney transplant patients with uncontrolled hypertension.MethodsA smartphone enabled medication adherence and BP self-management system was developed using a patient and provider centered design. The development framework utilized self-determination theory with iterative stages that were guided and refined based on patient/provider feedback. A 3-month proof-of-concept randomized controlled trial was conducted in 20 hypertensive kidney transplant patients identified as non-adherent to their current medication regimen based on a month long screening using an electronic medication tray. Participants randomized to the mHealth intervention had the reminder functions of their electronic medication tray enabled and received a bluetooth capable BP monitor and a smartphone that received and transmitted encrypted physiological data and delivered reminders to measure BP using text messaging. Controls received standard of care and their adherence continued to be monitored with the medication tray reminders turned off. Providers received weekly summary reports of patient medication adherence and BP readings.ResultsParticipation and retention rates were 41/55 (75%) and 31/34 (91%), respectively. The prototype system appears to be safe, highly acceptable, and useful to patients and providers. Compared to the standard care control group (SC), the mHealth intervention group exhibited significant improvements in medication adherence and significant reductions in clinic-measured systolic blood pressures across the monthly evaluations. Physicians made more anti-hypertensive medication adjustments in the mHealth group versus the standard care group (7 adjustments in 5 patients versus 3 adjustments in 3 patients) during the 3-month trial based on the information provided in the weekly reports.ConclusionsThese data support the acceptability and feasibility of the prototype mHealth system. Further trials with larger sample sizes and additional biomarkers (eg, whole blood medication levels) are needed to examine efficacy and effectiveness of the system for improving medication adherence and blood pressure control after kidney transplantation ov...

The study tested the effect of aerobic exercise training on executive function in overweight children. Ninety-four sedentary, overweight but otherwise healthy children (mean age = 9.2 years, body mass index 85th percentile) were randomized to a low-dose (20 min/day exercise), high-dose (40 min/day exercise), or control condition. Exercise sessions met 5 days/week for 15 weeks. The Cognitive Assessment System (CAS), a standardized test of cognitive processes, was administered individually before and following intervention. Analysis of covariance on posttest scores revealed effects on executive function. Group differences emerged for the CAS Planning scale (p = .03). Planning scores for the high-dose group were significantly greater than those of the control group. Exercise may prove to be a simple, yet important, method of enhancing aspects of children's mental functioning that are central to cognitive and social development.

The study tested the effect of aerobic exercise training on executive function in overweight children. Ninety-four sedentary, overweight but otherwise healthy children (mean age = 9.2 years, body mass index 85th percentile) were randomized to a low-dose (20 min/day exercise), high-dose (40 min/day exercise), or control condition. Exercise sessions met 5 days/week for 15 weeks. The Cognitive Assessment System (CAS), a standardized test of cognitive processes, was administered individually before and following intervention. Analysis of covariance on posttest scores revealed effects on executive function. Group differences emerged for the CAS Planning scale (p = .03). Planning scores for the high-dose group were significantly greater than those of the control group. Exercise may prove to be a simple, yet important, method of enhancing aspects of children's mental functioning that are central to cognitive and social development.

Objective. Current generation smartphones' video camera technologies enable photoplethysmographic (PPG) acquisition and heart rate (HR) measurement. The study objective was to develop an Android application and compare HRs derived from a Motorola Droid to electrocardiograph (ECG) and Nonin 9560BT pulse oximeter readings during various movement-free tasks. Materials and Methods. HRs were collected simultaneously from 14 subjects, ages 20 to 58, healthy or with clinical conditions, using the 3 devices during 5-minute periods while at rest, reading aloud under observation, and playing a video game. Correlation between the 3 devices was determined, and Bland-Altman plots for all possible pairs of devices across all conditions assessed agreement. Results. Across conditions, all device pairs showed high correlations. Bland-Altman plots further revealed the Droid as a valid measure for HR acquisition. Across all conditions, the Droid compared to ECG, 95% of the data points (differences between devices) fell within the limits of agreement. Conclusion. The Android application provides valid HRs at varying levels of movement free mental/perceptual motor exertion. Lack of electrode patches or wireless sensor telemetric straps make it advantageous for use in mobile-cell-phone-delivered health promotion and wellness programs. Further validation is needed to determine its applicability while engaging in physical movement-related activities.

BackgroundMobile phone–based interventions present a means of providing high quality health care to hard-to-reach underserved populations. Migrant farm workers (MFWs) are among the most underserved populations in the United States due to a high prevalence of chronic diseases yet limited access to health care. However, it is unknown if MFWs have access to mobile phone devices used in mobile health (mHealth) interventions, or if they are willing to use such technologies.ObjectiveDetermine rates of ownership of mobile devices and willingness to use mHealth strategies in MFWs.MethodsA demonstration of mHealth devices and a survey were individually administered to 80 Hispanic MFWs to evaluate use of mobile phones and mHealth devices and willingness to use such technologies.ResultsOf the 80 participants, 81% (65/80) owned cell phones capable of sending and receiving health-related messages. Most participants (65/80, 81%) were receptive to using mHealth technology and felt it would be helpful in enhancing medication adherence, self-monitoring health conditions, and receiving quicker medication changes from their doctors (median scores ≥4 on 5-point Likert scales). Relations between age and attitudes toward using mHealth were not statistically significant.ConclusionsHispanic MFWs have access to mobile phones and are willing to use mHealth devices. Future work is needed to comprehensively evaluate the degree to which these devices could be used.

Purpose Evaluate impact of breathing awareness meditation (BAM), Botvin LifeSkills® Training (LST), and health education control (HEC) on ambulatory blood pressure (BP) and sodium excretion in African American (AA) adolescents. Methods Following three consecutive days of systolic blood pressure (SBP) screenings, 166 eligible participants (i.e., SBP > 50th – 95th percentile) were randomized by school to either BAM (n = 53), LST (n= 69), or HEC (n=44). In-school intervention sessions were administered for three months by health education teachers. Before and after the intervention overnight urine samples and 24-hour ambulatory SBP, diastolic blood pressure (DBP), and heart rate (HR) were obtained. Results Significant group differences were found for changes in overnight SBP and SBP, DBP and HR over the 24-hour period and during school hours. The BAM treatment exhibited the greatest overall decreases on these measures (Bonferroni adjusted, ps <.05). For example, for school-time SBP, BAM showed a change of −3.7 mmHg compared to no change for LST and a change of −0.1 mmHg for HEC. There was a non-significant trend for overnight urinary sodium excretion (p = .07) with the BAM group displaying a reduction of −.92 ± 1.1 mEq/hr compared to increases of .89 ± 1.2 mEq/hr for LST, and .58±0.9 mEq/hr for HEC group. Conclusion BAM appears to improve hemodynamic function and may impact sodium handling among AA adolescents at increased risk for development of cardiovascular disease (CVD).

DAVIS, CATHERINE L., JOSEPH TKACZ, MATHEW GREGOSKI, COLLEEN A. BOYLE, AND GORDANA LOVREKOVIC. Aerobic exercise and snoring in overweight children: a randomized controlled trial. Obesity. 2006;14:1985-1991. Objective: To determine whether regular aerobic exercise improves symptoms of sleep-disordered breathing in overweight children, as has been shown in adults. Research Methods and Procedures: Healthy but overweight (BMI Ն85th percentile) 7-to 11-year-old children were recruited from public schools for a randomized controlled trial of exercise effects on diabetes risk. One hundred children (53% black, 41% male) were randomly assigned to a control group (n ϭ 27), a low-dose exercise group (n ϭ 36), or a high-dose exercise group (n ϭ 37). Exercise groups underwent a 13 Ϯ 1.5 week after-school program that provided 20 or 40 minutes per day of aerobic exercise (average heart rate ϭ 164 beats per minute). Group changes were compared on BMI z-score and four Pediatric Sleep Questionnaire scales: Snoring, Sleepiness, Behavior, and a summary scale, Sleep-Related Breathing Disorders. Analyses were adjusted for age. Results: Both the high-dose and low-dose exercise groups improved more than the control group on the Snoring scale. The high-dose exercise group improved more than the lowdose exercise and control groups on the summary scale. No group differences were found for changes on Sleepiness, Behavior, or BMI z-score. At baseline, 25% screened positive for sleep-disordered breathing; half improved to a negative screen after intervention. Discussion: Regular vigorous exercise can improve snoring, a symptom of sleep-disordered breathing, in overweight children. Aerobic exercise programs may be valuable for prevention and treatment of sleep-disordered breathing in overweight children.

The short-term aftereffects of a bout of moderate aerobic exercise were hypothesized to facilitate children's executive functioning as measured by a visual task-switching test. Sixty-nine children (mean age = 9.2 years) who were overweight and inactive performed a category-decision task before and immediately following a 23-min bout of treadmill walking and, on another session, before and following a nonexercise period. The acute bout of physical activity did not influence the children's global switch cost scores or error rates. Age-related differences in global switch cost scores, but not error scores, were obtained. These results, in concert with several studies conducted with adults, fail to confirm that single bouts of moderately intense physical activity influence mental processes involved in task switching.Keywords exercise psychology; pediatrics; cognition; information processing Exercise-induced physical arousal has been shown to facilitate specific types of mental functioning in adults (see reviews by Brisswalter, Collardeau, & Arcelin, 2002;McMorris & Graydon, 2000;Tomporowski, 2003b); however, very few studies have assessed the shortterm aftereffects of acute bouts of physical activity on children's cognitive function, and most of these studies have focused on children with developmental disabilities (Tomporowski, 2003a). Research conducted with children without development disorders has been designed, for the most part, to determine whether bouts of physical activity performed as part of school curricula would have a detrimental impact on children's classroom behavior and academic performance. The results of three field-based studies indicated that bouts of physical activity improved, rather than debilitated, children's cognitive performance (Caterino & Polak, 1999;Gabbard & Barton, 1979;McNaughten & Gabbard, 1993), and another study (Raviv & Low, 1990) found no evidence to support anecdotal observations that recess and physical education activities overly excite children. Only one laboratory-based experiment has evaluated normal children's cognitive function immediately following a bout of steady-state exercise. Zervas, Apostolos, and Klissouras (1991) recruited 9 pairs of monozygotic twin boys (age range = 11-14 years) and assigned one twin to a 25-week structured aerobic physical fitness training program and the other twin to a traditional physical education class. Following training, the children performed a design-matching task before and 15 min following a strenuous 20-min treadmill run (speed range = 12-14 kph). The pre-and postexercise cognitive performance of trained and untrained twins was compared with the performance of eight age-matched children who did not complete the treadmill run. The acute bout of exercise resulted in improved design-NIH Public Access