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42ALTERNATIVETHERAPIESjulaug2011VOL.17NO.4DiseaseRisImprovesWithIntegrativeImmersionModelPerceivedStressScalePSS.Participantsx19nonspeciBcself-appraisedstresswasmeasuredusingthefour-itemPSS.ThePSSmeasuresperceivedstressoverthepastmonthithasdemon-stratedreliabilityandconstructvalidity.3839Cronbachx19sawas0.78inthepresentstudy.Behavioralx0Activation.PatientActivationMeasurePAM.The13-itemPAMwasusedtoassesspatientsx19nowledgesillandconBdencetowardself-managementofhealth.Higherscoresonthismeasurehaveconsistentlybeenassociatedwithhealthybehav-iorhealthinformationseeingandreadinesstochangeinbothhealthyandchronicallyillpopulations.40-43ThePAMhasbeenshowntobebothvalidandreliable.41Cronbachx19sawas0.77inthepresentstudy.ReadinesstoChangeRTC.Asix-itemRTCquestionnairewasdesignedforthisstudytoassessreadinesstochange44intheareasofweightreductionexercisesmoingcessationdietstressmanagementandmeditation.Theitemshaveindepen-dentlydemonstratedconstructvalidityinpreviousstudies.45-48ExerciseBehavior.Exercisebehaviorwasmeasuredwithabriefquestionnairethatassessedfrequencyofaerobicexercisee20minutesdurationstretchinge15minutesdurationandmuscularstrengtheningexercisee20minutesduration.AvailableresponsesincludedfewerthanoncepermonthonetotwotimesperweethreetofourtimesperweeandBveormoretimesperwee.Interventionx0Integrityx0Check.WheelofHealthQuestionnaireWHQ.The20-itemWHQdesignedforthisstudywasusedtoassesswhetherparticipantsintegratedaspectsoftheinterventionintomultipledomainsofliving.Measureddimensionsincludedmovementandexercisenutritionphysicalenvironmentrelation-shipspersonalgrowthandspiritualitymind-bodyconnectionpreventivemedicineconventionalandCAMtreatmentspharma-ceuticalssupplementsandmindfulness.Performanceandsatis-factionineachofthe10dimensionsoftheWheelofHealthweremeasuredona1-to-10scaleanchoredbythedescriptorsx1clowx1dandx1chigh.x1dAlldimensionsweresummedtocreatesubscoresforWHQperformanceandWHQsatisfaction.ANALYSISAnintention-to-treatanalysiswasconductedbaseduponthe63participantswhowereenrolledinthestudyattendedthe3-dayimmersionandcompletedanyassessmentatbaseline.Thelastobservationwascarriedforwardtoreplaceendpointvaluesforthoseparticipantswithmissingdata.Baselineandendpointdatawereexcludedpairwiseinthecaseswhereaparticipantx19sbaselineques-tionnairewasincomplete.AnalyseswereperformedusingSPSSver-sion17SPSSChicagoIllinois.AlldataexceptfortotalcholesterolandHDLcholesterolwerenon-normallydistributedasmeasuredbythekolmogorov-SmirnovtestwithLillieforsSigniBcanceCorrectionandShapiro-WiltestPx0.054950thereforeallP-valuesweredeter-minedusingthenonparametricWilcoxonSignedRantest.51StatisticalsigniBcancewassetatthePx0.05level.RESULTSParticipantsParticipantsrangedinagefrom33to73yearswithameanageof59.6SD8.2.Thesamplewasnearequallydividedbetweenmenandwomenandconsistedpredominantlyofwhiteindividualswhoreportedrelativelyhighlevelsofeducationandincome.Thirty-threepercentofparticipantshadmetabolicsyn-dromeatbaselineasdefinedbytheInternationalDiabetesFederation.52Descriptivestatisticsonthedemographiccharacter-isticsofthissamplearelistedinTable4.Retentionx0andx0AdherenceDuringthesupportphaseparticipantscompletedamedianoftwooftheBveavailablehealthcoachingcallsandusedanaver-ageof101.0minutesoftotalcoachingperperson50.5ofavail-ablesessiontime.Sixoftheinitial63participantswerelosttocontactorunavailablefortheendpointdatacollection.Diseasex0Riskx0andx0Diseasex0Riskx0Biomarkers.RelativeRisk.Whenmatchedforgenderandagewithanationalsamplethemedian5-yearrelativerispercentileatbaselinewaswellbelowaverageat7SD20.1forcoronaryheartdisease16SD24.1fordiabetesand25SD28.8forstroe.ModiableRisk.Five-yearmedianmodiBablerisofdiabe-tesshiftedP.02from0.37SD2.55atbaselineto0.16SD2.98atendpointFigure2medianstroerisdecreasedP.01from0.37SD2.09to0.23SD2.32.MedianCHDrisdeclinedfrom0.95SD1.30to0.72SD1.97.AlthoughthereductioninmedianCHDrisisnearlyequalinmagnitudetothatofdiabetesandstroeristhechangeincoronaryriswasnotstatisticallysigniBcantP.17dueinparttoanupwardshiftinCHDrisvariabilityinterquartilerangeof0.23-1.73atbaselineto0.20-1.87atendpoint.AbsoluteRisk.Thechangein5-yearabsoluterisofdiabeteswasnonsigniBcantwithadecreaseinmedianrisfrom1.28SD2.87atbaselineto1.06SD3.31atendpoint.MedianabsoluterisofCHDalsodeclinedslightlynonsigniB-cantfrom1.91SD2.42to1.82SD2.96.IncontrasttheabsoluterisofstroedecreasedsigniBcantlyP.02fromamedianof1.28SD2.87atbaselineto1.06SD3.30atendpoint.BiomarersfordiseaserisincludingBMIP.008waistcircumferenceP.003andpulseP.001improvedsigniBcant-lyacrossthestudyperiodTable5.Totalcholesterolincreasedsig-niBcantlyduringthestudyP.007.SystolicbloodpressureP.237diastolicbloodpressureP.095HDLcholesterolP.109glucoseP.300andCRPP.068didnotchange.Thesedatarepresentintention-to-treatanalysesn63howeveranalysesincludingonlycompletersn57yieldedsim-ilarresultsdatanotshownforalloutcomesmeasured.BehavioralandPsychosocial.ParticipantsexperiencedahighlysigniBcantincreaseP.001inactivationPAMduringthestudyperiodTable6andmeasuresofpsychosocialfunc-tionincludingangeranxietydepressionandrelationshipsatis-factionimprovedsigniBcantlyP.05.Importantlybaseline