By Marianne Matzo, PhD, GNP-BC, FAAN,
and Jane A. Hill, MS, RN
Evidence for Excellence is a
periodic department show-
casing new evidence-based
practice guidelines and results
of systematic literature reviews
to help the nurse in practice.
Practice Guidelines
Systematic Review
OBESITY-PREVENTION
PROGRAMS IN SCHOOLS
The evidence of their effectiveness is
insufficient at present.
besity among U.S. children
O continues to become more
prevalent each year, one source
indicating that as many as 17%
are obese and nearly 34% are at
risk for being overweight or obese.
A recent nationwide survey indi-
cates that parents expect the edu-
cation system to take the primary
responsibility in efforts toward
a reduction in childhood obesity.
A 2008 systematic review consid-
ers research published since 1990
that addresses curricular and
environmental obesity-prevention
programs in schools.
The review authors consid-
ered the quality of evidence in the
14 studies that met the criteria
to be inadequate, overall, but
they did note some qualitative
trends.
• Sex was found to be a signifi-
cant factor in the response
to obesity interventions in
school—girls tend to be “social
learners” (that is, they learn
better with and from others),
whereas boys are more respon-
sive to increased physical
activity and improved diet.
• Although factors in the home
environment appear to exert
an influence on a child’s weight,
ajn@wolterskluwer.com
the researchers write that “inter-
ventions specifically including
familial components have not
been more effective in the pri-
mary or secondary prevention
setting than those without spe-
cific targeting or inclusion of
parents or families.”
• Children ages seven to 10 re-
spond better to obesity inter-
ventions than younger children
do. (Children older than age
10 also responded well in the
few trials that included them.)
The crux of the matter. Ideally,
obesity-prevention programs in
schools would be a cost-effective
way to facilitate safe and lasting
changes in diet and exercise, but
there’s insufficient evidence to
guide their development and
implementation.—MM
Kropski JA, et al. Obesity 2008;6(5):
1009-18.
CANCER: PHYSICAL ACTIVITY
AND PALLIATIVE CARE
Interventions appear to be promising.
xcellent palliative care pro-
E vided to patients with end-
stage cancer includes improving
quality of life, which entails the
management of fatigue, defined
as a “constant, subjective sensa-
tion of exhaustion associated
with cancer or its treatment
that impedes normal function-
ing and that is out of propor-
tion to recent activity.” About
60% to 90% of such patients
experience cancer-related fatigue.
Physical activity has been docu-
mented as effective in the man-
agement of fatigue in the early
stages of cancer, and a recent
review focuses on the evidence
of its benefit in patients with
end-stage cancer receiving pallia-
tive care. Included were patients
18 years old or older with any
type of cancer, the treatment of
which included physical activity
defined as “any bodily movement
produced by the skeletal muscles
that resulted in a substantial
increase in energy expenditure
over resting levels.” Among the
six studies that met the inclusion
criteria, three involved aerobic
exercise and three involved a
mixture of aerobic and resistance-
training components. All the
studies represented pilot research,
but they did document that the
majority of the 84 end-stage
palliative care participants were
able to tolerate physical activ-
ity; the one randomized, con-
trolled trial documented “a
statistically significant slower
rate of decline in total well-being,
as well as a statistically signifi-
cant slower rate of increase in
total fatigue.”
The crux of the matter. The
results of the studies reviewed
suggest that physical activity
interventions can benefit patients
with cancer throughout the entire
course of the disease. Further
research to substantiate that
finding is necessary.—MM
Lowe SS, et al. J Support Oncol 2009;7(1):
27-34.
MEDICATION FOR DEMENTIA
Medication confers only a modest benefit.
ognitive decline secondary to
C a variety of dementia diag-
noses presents increasingly sig-
nificant health and health care
problems in the United States.
Alzheimer’s disease, in particular,
is expected to afflict one in 45
Americans by the year 2058.
Much research has focused on
the assessment of drug therapy
to treat the symptoms of cogni-
tive decline, and in March 2008
the American College of Physi-
cians and the American Academy
of Family Physicians issued
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