Objectives-To compare the impact of negotiated vs. mainstreamed follow-up with telephone reinforcement (TR) on maintenance of physical activity (PA) after Fit and Strong! ended. Methods-A multisite comparative effectiveness trial with repeated measures.Results-Single group random effects analyses showed significant improvements at 2, 6, 12, and 18 months on PA maintenance, lower-extremity (LE) pain and stiffness, LE function, sit-stand, 6-minute distance walk, and anxiety/depression. Analyses by follow-up condition showed persons in the negotiated with TR group maintained a 21% increase in caloric expenditures over baseline at 18 months, with lesser benefits seen in the negotiated-only, mainstreamed-with-TR, and mainstreamed-only groups. Significant benefits of telephone dose were also seen on LE joint stiffness, pain, and function as well as anxiety and anxiety/depression. Conclusions-The negotiated follow-up contract that Fit and Strong! uses, bolstered by TR, is associated with enhanced long-term PA maintenance and health outcomes.Address correspondence to Dr Hughes, Center for Research on Health and Aging, 1747 W Roosevelt Road, Rm 558, Chicago, IL 60608. shughes@uic.edu. NIH Public Access Author ManuscriptAm J Health Behav. Author manuscript; available in PMC 2014 May 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript Keywords maintenance; trial; physical activity; arthritis; fit and strong Osteoarthritis (OA) is the most common chronic condition among older adults and also constitutes a major barrier to their participation in physical activity. [1][2][3] Lower-extremity joint impairment, in particular, that is caused by OA is a known risk factor for disability and institutionalization. 4,5 To date, 15 randomized trials of exercise interventions have been conducted among persons with OA. Most trials report positive short-term outcomes at 3 months or less. Only 5 have reported mixed findings on longer-term adherence and related outcomes. [5][6][7][8][9] Three of the 5 used telephone reinforcement (TR) for the maintenance phase of their studies; however, these trials did not explicitly examine the effect of this technique on maintenance itself. This paucity of data on maintenance and facilitators of maintenance of exercise behavior among persons with OA indicates an urgent need for additional studies of this issue.Fit and Strong! is an evidence-based physical activity/behavior-change program that effectively targets this highrisk group. 10,11 Fit and Strong! addresses documented strength and aerobic deficits in this population 12,13 and is inexpensive and simple to replicate as demonstrated by the fact that it has been adopted by 42 community providers to date. It is a group and facility-based program that meets for 90 minutes 3 times per week for 8 weeks (24 sessions total). The first 60 minutes consist of a multiple-component exercise program that incorporates flexibility/balance, aerobic walking and/or low impact aerobics, and lowerextremity strength training using elast...

Objectives: Addiction and overdose related to prescription drugs continues to be a leading cause of morbidity and mortality in the United States. We aimed to characterize the prescribing of opioids and benzodiazepines to patients who had previously presented with an opioid or benzodiazepine overdose. Methods: This was a retrospective chart review of patients who were prescribed an opioid or benzodiazepine in a 1-month time-period in 2015 (May) and had a previous presentation for opioid or benzodiazepine overdose at a large healthcare system. Results: We identified 60,129 prescribing encounters for opioids and/or benzodiazepines, 543 of which involved a patient with a previous opioid or benzodiazepine overdose. There were 404 unique patients in this cohort, with 97 having more than 1 visit including a prescription opioid and/or benzodiazepine. A majority of prescriptions (54.1%) were to patients with an overdose within the 2 years of the documented prescribing encounter. Prescribing in the outpatient clinical setting represented half (49.9%) of encounters, whereas emergency department prescribing was responsible for nearly a third (31.5%). Conclusions:In conclusion, prescribing of opioids and benzodiazepines occurs across multiple locations in a large health care system to patients with a previous overdose. Risk factors, such as previous overdose should be highlighted through clinical decision support tools in the medical record to help prescribers identify patients at higher risk and to mobilize resources for this patient population. Prescribers need further education on factors that place their patients at risk for opioid use disorder and on alternative therapies to opioids and benzodiazepines.