Prevention Research

Prevention Research

Prevention Research Abstracts 2009-2016

Prevention Research Abstracts 2009-2016

Menkosky, K., Akalan, C., Scales, R. (2016). Medically-directed water therapy programs in Arizona. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation Annual Meeting, Phoenix, Arizona.

Menkosky, K., Akalan, C., Scales, R. (2016). Medically-directed water therapy programs in Arizona. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation Annual Meeting, Phoenix, Arizona.

Individuals with limited mobility are susceptible to cardiorespiratory deconditioning and related medical complications. Water-based exercise may be a low-impact therapeutic option for people with specific types of physical disability. This investigation was conducted to identify and describe the services of medically-directed water therapy (MWT) programs in Arizona. A review of existing state-wide directories (i.e. Arthritis Foundation), an online search and expert opinion were used to identify active programs. Thirty-one MWT clinics were identified within the state. Twenty (65%) completed a standardized telephone survey with questions about the service provided. An updated record through March, 2016 was then compiled. It is recommended that this directory of MWT programs is routinely updated. This will provide a resource for health professionals that treat patients with physical limitations.


Schleifer J. W., Mookadam, F., Scales R., Hurst R T., Cornella K., Alegria J. (2016). Disease prevention, progression and treatment: Short-term effect of physician nutrition counseling during a routine cardiology visit. Advances in Nutrition, Abstract, 7, 1: 18A.

Schleifer J. W., Mookadam, F., Scales R., Hurst R T., Cornella K., Alegria J. (2016). Disease prevention, progression and treatment: Short-term effect of physician nutrition counseling during a routine cardiology visit. Advances in Nutrition, Abstract, 7, 1: 18A.

Nutrition counseling (NC) is recommended as a first line strategy to reduce cardiovascular risk. However, physicians devote little to no time to this type of intervention. This study evaluated the short-term effect of NC delivered by a physician during a routine cardiology visit. Thirty-one patients (35% male; mean age=62 years), receptive to dietary change were counseled in a whole-foods plant-based diet (PBD). The diet was succinctly explained by the physician as (1) eating a wide variety of vegetable foods; (2) avoiding animal products, oils, and processed foods; and (3) supplementing adequate cyanocobalamin (vitamin B-12). A fasting lipid profile was measured prior to dietary change and repeated after a median of 48 days (range 35-119 days). Total cholesterol decreased from 209.2±17.3 mg/dL to 167.8±14.8 mg/dL, p<0.0001; low-density lipoprotein (LDL) cholesterol decreased from 126.1±16.4 mg/dL to 89.4±12.3 mg/dL, p<0.0001; and high-density lipoprotein (HDL) cholesterol decreased from 58.7±6.4 mg/dL to 52.8±5.6 mg/dL, p=0.011. Triglycerides were not significantly changed (increased from 120.7±18.5 mg/dL to 125.7±23.3 mg/dL, p=0.657). Prior to the intervention, 9 patients were previously prescribed statins with unchanged doses, and 2 initiated statins concurrently with NC. The reduction in total and LDL cholesterol were significant whether or not the patients were already taking statins, and remained significant after excluding patients initiating statins concurrently with dietary change. In this self-selected group, significant reductions in total and LDL cholesterol were observed with physician NC. Physicians should at a minimum, include an empathic recommendation for lifestyle change as a part of the clinical visit and/or refer out to an allied healthcare professional for additional support and guidance matched to the individual’s readiness to change.


Scales, R., Cornella, K. A., Mohan, V., Akalan, C., Wu, Q., Halli, S., Hurst, R. T. (2014). Apparently healthy fit asymptomatic adults are not immune to sub-clinical atherosclerosis. Circulation Online, Abstract 442: 444-445.

Scales, R., Cornella, K. A., Mohan, V., Akalan, C., Wu, Q., Halli, S., Hurst, R. T. (2014). Apparently healthy fit asymptomatic adults are not immune to sub-clinical atherosclerosis. Circulation Online, Abstract 442: 444-445.

Evidence suggests that cardiovascular (CV) fitness below the 20th percentile for age and gender is associated with increased cardiac death and all cause mortality. This study assessed the association between CV fitness and sub-clinical atherosclerosis (SCA) in a self-selected group of participants in a cardiology-based prevention program. The study involved a single visit observation of participants. 240 apparently healthy asymptomatic adults <65 years (69% male) received a maximal graded exercise stress test and a carotid intima-media thickness (CIMT) evaluation with B-mode ultrasound. CV fitness was classified based on age-gender norms (very poor=1-19th, poor=20-39th, fair=40-59th, good=60-79th, excellent/superior=80-100th percentile). CIMT was used to define CV health based on age-gender-race norms. SCA was considered present when there was non-occlusive carotid artery plaque (>1.5mm or >50% of the surrounding intima-media) or CIMT >75th percentile. Anyone with a prior history of clinically apparent atherosclerosis or diabetes was excluded from the study. The mean age of participants was 50 yrs (SD= 8.7). 113 participants (47%) had excellent/superior CV fitness. 41 (17%) were classified good, 36 (15%) fair, 20 (8%) poor and 30 (12%) very poor. 69 (61%) participants with excellent/superior CV fitness had advanced atherosclerosis (plaque=43%; n=49 or CIMT >75th percentile=l8%; n=20). In the good classification there were 26 (64%) with plaque (49%; n=20) or CIMT >75th percentile (15%; n=6). There were 23 (63%) in the fair classification with plaque (44%; n=16) or CIMT >75th percentile (19%; n=7), 11 (55%) in the poor classification with plaque (45%; n=9) or CIMT >75th percentile (10%; n=2) and 17 (56%) in the very poor classification with plaque (53%; n=16) or CIMT >75th percentile (3%; n=1). 58 (24%) of the total number of participants were classified with superior CV fitness (95-100th percentile); of which 36 (62%) had SCA (plaque=45%; n=26 or CIMT >75th percentile=17%; n=10). In this self-selected population, CIMT testing detected evidence of SCA across all age-gender fitness classifications, which included very fit individuals. Further investigation is needed to identify other factors that may be associated with increased CV risk in apparently healthy fit asymptomatic adults.


Akalan, C., Scales, R., Cornella, K. A., Halli, S., Hurst, R. T. (2012). Assessing muscular power with a portable device in a clinical setting.  Medicine & Science in Sports & Exercise, Abstract 2455, 44, 5: S446-447.

Akalan, C., Scales, R., Cornella, K. A., Halli, S., Hurst, R. T. (2012). Assessing muscular power with a portable device in a clinical setting.  Medicine & Science in Sports & Exercise, Abstract 2455, 44, 5: S446-447.

An age-related decline in muscular power may have a detrimental effect on sports performance and tasks of daily living. This study assessed lower extremity muscular power in a group of middle-aged adults (40-59 yrs) who elected to participate in a cardiology-based prevention program. The study involved a single visit observation of the participants. Ninety-nine apparently healthy adults (70% male) were assessed for lower extremity muscular power with the Counter Movement Jump (CMJ) Test. Participants performed 5 consecutive vertical counter movement jumps with the hands on the hips. The jumps were performed in a medical exam room on a hard carpeted surface while wearing shoes. None of the participants reported a physical limitation or injury at the time of testing. A Myotest accelerometer was attached to the waist and it instantly calculated the average height jumped, force produced, velocity and power from the best 3 jumps. The mean age of the participants was 50.8 yrs (SD= 5.4). The overall mean height, force, velocity and power scores for men (n=69) and women (n=30) were 24.2 cm (SD= 5.8) Vs 15.0 cm (SD= 4.1),19.3 N/Kg (SD= 2.2) Vs 17.5 cm (SD= 1.9),162.6 cm/s (SD= 31.1) Vs 142.4 cm (SD= 25.3) and 25.6 W/Kg (SD= 7.4) Vs 20.6 cm (SD= 5.0) respectively. The mean scores on the same measures for men 40-49 yrs (n=30) and 50-59 yrs (n=39) were 26.3 cm (SD= 6.4) Vs 22.6 cm (SD= 4.8), 20.1 N/Kg (SD= 2.1) Vs 18.7 N/Kg (SD= 2.2), 169.6 cm/s (SD= 35.4) Vs 157.1 cm/s (SD=26.6) and 27.6 W/Kg (SD= 8.6) Vs 24.0 W/Kg (SD= 6.1) respectively. The mean scores for women 40-49 yrs (n=9) and 50-59 yrs (n=21) were 17.7 cm (SD= 4.1) Vs 13.8 cm (SD= 3.7), 17.4 N/Kg (SD= 1.1) Vs 17.5 N/Kg (SD= 2.1), 153.2 cm/s (SD=18.1) Vs 137.7 cm/s (SD=26.9), 22.2 W/Kg (SD= 3.2) Vs 19.9 W/Kg (SD= 5.5) respectively. The Myotest accelerometer is a small user friendly portable device that can be used to assess muscular power in a clinical setting. This type of technology may assist in the design of exercise programs to improve muscular fitness. A larger, more representative sample is needed to determine age, gender and race norms for CMJ Test scores using the Myotest accelerometer.


Scales, R., Akalan, C., Scales, R., Cornell, K. A., Halli, S., Hurst, R. T. (2012). Screening for perceived stress and subclinical atherosclerosis in a cardiology-based prevention program. Annals of Behavioral Medicine, Abstract D047, 43: S228.

Scales, R., Akalan, C., Scales, R., Cornell, K. A., Halli, S., Hurst, R. T. (2012). Screening for perceived stress and subclinical atherosclerosis in a cardiology-based prevention program. Annals of Behavioral Medicine, Abstract D047, 43: S228.

Clinicians underestimate the influence of emotional distress on the pathogenesis of cardiovascular disease (CVD). This study screened for perceived stress and subclinical atherosclerosis in a group of adults that elected to participate in a cardiology-based prevention program. The study involved a single visit observation of participants. One hundred and sixty-five apparently healthy asymptomatic adults (65% male) with a mean age of 50 years (SD=8.5) completed the 10-item Perceived Stress Scale (PSS-10). A carotid-intima media thickness (CIMT) test with B-mode ultrasound was used as a measure of subclinical atherosclerosis. Plaque was considered to be present when CIMT was >1.5 mm and located in >50% of the surrounding intima-media. Population norms were used to categorize the CIMT scores for cardiovascular risk based on age, gender and race. Inclusion criteria for the study required that participants had no prior history of diabetes or clinically apparent atherosclerosis. The mean PSS-10 score was 15.2 (SD=6.2). Fifty-three percent of the participants were categorized as having an elevated PSS-10 score (>14). Thirty-one percent were in a moderate risk range (scores 15-20), 15% were high (scores 21-24) and 7% were very high (scores 25-40). CIMT testing identified that 61% of the participants had advanced atherosclerosis, which was defined by the presence of carotid artery plaque (44%) or CIMT >75th percentile (17%). There appears to be evidence of increased CVD risk in this self-selected population. Screening for emotional distress may identify individuals who could benefit from stress reduction. Early detection of subclinical atherosclerosis combined with appropriate medical treatment and lifestyle modification may help prevent a future adverse CVD event.


Scales, R., Akalan, C., Herrera, B., Halli, S., Murik, A., Hurst, R. T. (2010). A practical evaluation of functional movement in a cardiology-based prevention program. Medicine & Science in Sports & Exercise, Abstract 2157, 42, 5: S372.

Scales, R., Akalan, C., Herrera, B., Halli, S., Murik, A., Hurst, R. T. (2010). A practical evaluation of functional movement in a cardiology-based prevention program. Medicine & Science in Sports & Exercise, Abstract 2157, 42, 5: S372.

Sports performance and tasks of daily living place demands on the body to function with normal movement patterns. This study assessed functional movement in a group of people (30-64 years) who elected to participate in a cardiology-based prevention program. The study involved a single visit observation of the participants. Ninety asymptomatic adults (76% male) with no clinically apparent atherosclerosis were assessed for functional movement with the Overhead Full Squat (OFS) Test, which required participants to perform a full squat with a dowel held overhead. This test was used to assess bilateral, symmetrical mobility of the ankles, knees, hips, shoulders and thoracic spine. A passing grade was assigned when the squat was performed pain free with the heels on the floor, the feet pointing forward, the knees aligned over the feet, the femur below horizontal, the upper torso parallel with the tibia or toward vertical and the dowel maximally pressed overhead. If this test could not be performed with satisfaction, the participants performed a modified full squat (MFS), which did not require the arms to be held overhead and placed a lower demand on the shoulders and thoracic spine. The mean age of the participants was 51.4 yrs (SD=9.1). Overall, ten participants (11%) were able to perform the OFS Test with satisfaction and thirty-seven participants (41%) were assigned a passing grade for the MFS. In each age category (30-39 yrs; n=12; 40-49 yrs; n=21, 50-59 yrs; n=41; 60-64 yrs; n=16) the number that satisfactorily performed the OFS Test was as follows: three (25%); three (14%) and four (10%) respectively. No one in the 60-64 yr age group was able to perform the OFS Test with satisfaction. For the MFS, the results were as follows: four (33%); ten (48%); twenty (49%) and three (19%) respectively. Mobility appears to be restricted in this self-selected group of adults who participated in a cardiology-based prevention program. The identification of functional movement limitations may assist in the design of exercise programs to improve functional performance.


Halli., S., Scales, R., Akalan, C., Turner-O'Connell, J. A.., Murik, A., Ressler, S. W., Hurst. R. T. (2010). Influence of carotid imaging technology in the treatment of asymptomatic adults with early stage atherosclerosis. Proceedings of a conference (Abstract 339). Preventive Cardiovascular Nursing Association Annual Meeting, Chicago, Illinois.

Halli., S., Scales, R., Akalan, C., Turner-O'Connell, J. A.., Murik, A., Ressler, S. W., Hurst. R. T. (2010). Influence of carotid imaging technology in the treatment of asymptomatic adults with early stage atherosclerosis. Proceedings of a conference (Abstract 339). Preventive Cardiovascular Nursing Association Annual Meeting, Chicago, Illinois.

The early detection of cardiovascular risk in apparently healthy individuals may reduce premature death and morbidity when combined with appropriate treatment. This study investigated the effect of imaging technology on provider recommendations for statin therapy and therapeutic lifestyle change (TLC) in a group of adults who elected to participate in a cardiology-based prevention program. The study involved a single visit observation of participants. Eighty-six (63% male) apparently healthy asymptomatic adults received a carotid intima media thickness (CIMT) test with B-mode ultrasound, blood chemistry/lipid profile and graded exercise stress testing (GXT). Plaque was considered to be present when CIMT was >1.5 mm and >50% of the surrounding intima-media. Everyone received a physical examination from a physician and/or cardiac nurse practitioner plus the option of a nutrition consultation and a physical performance evaluation that was conducted in conjunction with a motivational interview. The mean age of the participants was 50 years (SD=8.5) and there was no prior history of atherosclerosis or diabetes. Twenty-seven (31%) participants were taking a statin on entry to the program. The mean LDL was 130 mg/dL (SD=39.7). Six GXT results required further cardiac evaluation but none were diagnosed with obstructive atherosclerosis. However, 58 participants (67%) had the presence of non-occlusive plaque (n=42; 49%) or a CIMT score in the >75th percentile (n=16; 18%) for age, gender, and race. After completing the program, 41 participants (48%) were prescribed a statin and 10 (12%) were recommended to either change their dose or switch to an alternate statin. In this self-selected population, there appears to be evidence of increased cardiovascular risk that required additional treatment after participation in a cardiology-based prevention program. CIMT may enhance traditional methods to detect cardiac risk and influence treatment in asymptomatic individuals.


Scales, R., Halli, S., Akalan, C., Murik, A., Turner-O'Connell, J. A., Ressler, S. W., Miller, J. H., Hurst, R.T. (2010). Commitment and level of confidence to exercise after a motivational interview in a cardiology-based prevention program. Proceedings of a conference: Rapid Communications (Abstract B-039C, pp. 23). Society of Behavioral Medicine’s 31st Annual Meeting, Seattle, Washington.

Scales, R., Halli, S., Akalan, C., Murik, A., Turner-O'Connell, J. A., Ressler, S. W., Miller, J. H., Hurst, R.T. (2010). Commitment and level of confidence to exercise after a motivational interview in a cardiology-based prevention program. Proceedings of a conference: Rapid Communications (Abstract B-039C, pp. 23). Society of Behavioral Medicine’s 31st Annual Meeting, Seattle, Washington.

Motivational interviewing (MI) encourages talk about behavior change and it can elicit a verbal commitment that makes positive outcomes more likely. This study assessed commitment and confidence to exercise after a motivational interview in people who had elected to participate in a cardiology-based prevention program (CBPP). MI was a component of a comprehensive program that included a cardiac evaluation (blood chemistry, carotid intima-media thickness & exercise stress testing) with feedback from clinicians plus a nutrition consultation. An exercise physiologist (EP) who had previously demonstrated proficiency in MI conducted a motivational interview (45-mins) in conjunction with a physical performance evaluation. Outcome measures included a self-reported 7-day recall of structured exercise and an assessment of the stage of readiness to exercise (>3 hrs/wk) and the level of confidence (1-10 scale) to attain a stated personalized 6-wk goal for exercise. The study evaluated 83 (76% male) asymptomatic adults (30-64 yrs) with a mean age of 50.4 yrs (SD=8.9). No one had prior evidence of atherosclerosis. The mean time invested to exercise on entry to the program was 2.7 hrs/wk (SD=2.9) and after the motivational interview the mean minimum goal for exercise was 5.4 hrs/wk (SD=2.5). Seventy-eight participants (94%) were either ready to start (n=49, Preparation=59%) or continue (n=8, Action=10%; n=21, Maintenance=25%) exercising >3 hrs/wk. The remaining 5 participants (6%) all stated their intention to exercise >2 hrs/wk. Everyone expressed a moderate to very high level of confidence to attain their personal goal (Moderate=11%; High=42%; Very High=47%). It appears that this self-selected group was motivated to exercise after participation in a CBPP. Assessing the level of commitment and confidence to change at the conclusion of a motivational interview may provide a practical self-audit of MI practice with strategic benefits.


Halli., S., Scales, R., Akalan, C., Murik, A., Ressler, S. W., Hurst, R. T. (2009). Family history and associated risk of cardiovascular disease in a cardiology-based prevention program. Proceedings of a conference. American College of Nurse Practitioner's Annual Meeting, Albuquerque, New Mexico.

Halli., S., Scales, R., Akalan, C., Murik, A., Ressler, S. W., Hurst, R. T. (2009). Family history and associated risk of cardiovascular disease in a cardiology-based prevention program. Proceedings of a conference. American College of Nurse Practitioner's Annual Meeting, Albuquerque, New Mexico.

A premature family history of cardiovascular disease (CVD) is an independent risk factor for a heart attack or stroke. This study investigated the relationship between family history and the presence of subclinical atherosclerosis in a self-selected group of participants in a cardiology-based prevention program. Seventy-five asymptomatic adults (72% male) with a mean age of 52 years (SD=10.4) received carotid intima-media thickness (CIMT) testing with B-mode ultrasound. Carotid artery plaque was considered to be present when CIMT was >1.5 mm and was located in >50% of the surrounding intima-media. Anyone with a prior diagnosis of CVD was excluded from the study. However, those with diabetes were included. Participants were initially categorized into one of three categories: premature family history (male <55 years, female <65 years); later life family history (male >55 years, female >65 years) or no family history. Those with a family history were also categorized as having either a first or second degree history based on how they were related to the family member that had CVD. There was a first degree family history if a biological parent and/or sibling had CVD and a second degree history if the relative was a biological grandparent or aunt/uncle. Four percent of the participants had diabetes. Sixty-two out of 75 patients (83%) had a family history of CVD, of which 37 (60%) had a premature family history and 44 (71%) had a first degree family history. Forty-three (70%) were identified as having non-occlusive plaque (59%) or CIMT >75th percentile (11%). There appears to be evidence of increased CVD risk in this group of people who self-selected to participate in a cardiology-based prevention program. Early detection of subclinical atherosclerosis combined with the appropriate treatment and lifestyle modifications may help minimize the risk of future adverse cardiovascular events in this population.


Scales, R., Halli., S., Akalan, C., Turner-O'Connell, J. A., Ressler, S. W., Rollinson, D., Khanderia, B., Buono, R., Hurst. R. T. (2009). Carotid intima-media thickness testing in a cardiology-based prevention program. Journal of Cardiopulmonary Rehabilitation and Prevention, Abstract S124, 29, 4: 273.

Scales, R., Halli., S., Akalan, C., Turner-O'Connell, J. A., Ressler, S. W., Rollinson, D., Khanderia, B., Buono, R., Hurst. R. T. (2009). Carotid intima-media thickness testing in a cardiology-based prevention program. Journal of Cardiopulmonary Rehabilitation and Prevention, Abstract S124, 29, 4: 273.

Carotid intima-media thickness (CIMT) is an independent predictor of myocardial infarction, stroke and/or death from coronary heart disease (CHD). This study used CIMT testing to predict cardiovascular risk in a group of people who elected to participate in a cardiology-based prevention program. The study involved a single visit observation of the participants. Fifty-three apparently healthy adults (72% male) received CIMT testing with B-mode ultrasound and they were assessed for traditional cardiovascular risk factors on entry to the program. Inclusion criteria for the study required that participants had no prior history of diabetes or clinically apparent atherosclerosis. Population norms for cardiovascular risk were used to categorize the CIMT scores based on age, gender and race. Carotid artery plaque was considered to be present when the CIMT was >1.5 mm and it was located in >50% of the surrounding intima-media. The NCEP-ATP III Risk Assessment Tool was used to calculate the Framingham 10-year risk of CHD. The mean age of the participants was 52 years (SD= 9.0) and the age range was 36-75 years. CIMT testing identified that 66% of the participants had advanced atherosclerosis, which was defined by the presence of carotid artery plaque (51%) or CIMT >75th percentile (15%). In those with lower CIMT scores, 15% were in the 50-75th percentile, 13% were in the 25-49th percentile and 6% were in the <25th percentile. Twenty-three percent of the participants were categorized as having an elevated 10-year Framingham risk score (scores >6%). Overall, 77% were categorized as low risk (scores <7%), 23% were intermediate risk (scores 7-20%) and none were high risk (scores >20%) according to the Framingham risk analysis. Sixty-three percent of the participants in the low risk category had advanced atherosclerosis with CIMT testing. In this select population, CIMT testing detected evidence of increased cardiovascular risk in the absence of elevated Framingham risk scores. CIMT testing is a relatively inexpensive, noninvasive measure of subclinical atherosclerosis that may supplement traditional methods of detecting cardiovascular risk in an apparently healthy population. The early detection of risk combined with appropriate treatment may help minimize the risk of future adverse cardiovascular events.