Behavior Technology Laboratory
A Pennington Biomedical Research Center Laboratory
A Pennington Biomedical Research Center Laboratory
| The Behavior Technology Laboratory conducts research on behavioral approaches to assess and prevent negative health outcomes by improving health behaviors, physical and mental performance, and resilience. This research includes the development and testing of community-based, clinic-based, and internet/ technologically advanced mobile-based (e.g. Smartphones, iPad apps, e-health games) interventions for health behavior change, targeting nutrition, fitness, sleep, body weight, body image, and positive mental coping.
Army H.E.A.L.T.H. Pennington Diabetes Clinic Physical & Mental Resilience in Female Athletes Female Athlete Body Project (FAB)
Selected Research
Weight Measurements and Standards for Soldiers Army H.E.A.L.T.H. ® U.S. Department of Defense (DoD) Tiffany Stewart , Ph.D., Principal Investigator The mission of the Army H.E.A.L.T.H.® program is to empower soldiers in healthy and safe lifestyle change to sustain healthy weight and performance on a year-round basis. This program was developed in order to promote Soldier readiness, prevent unhealthy dieting practices, enhance compliance with standards specified by AR 600-9, and to improve eating, exercise, and sleep habits of the Soldier and family members. Core features of the Army H.E.A.L.T.H.® program include customized meal plans, food tracking, personalized fitness plans, a comprehensive fitness tool to build your own workouts, and remote activity tracking. The Army H.E.A.L.T.H.® program was tested at Ft. Bragg, NC, throughout the New England Reserves, and with the Louisiana National Guard.
View Weight Measurements and Standards for Soldiers Study Information Here
Healthy Eating, Activity, & Lifestyle Training Headquarters II (H.E.A.L.T.H.- II) Army H.E.A.L.T.H.® Intensive U.S. Department of Defense (DoD) Tiffany Stewart , Ph.D., Principal Investigator The Army H.E.A.L.T.H.® Intensive program aims to combine evidence-based tools and guidance (Army H.E.A.L.T.H.®) previously tested in three PBRC studies and a new, remote clinical intervention model (individualized remote coaching model) that also includes mobile tracking technology/devices for personal activity, weight, nutrition, and sleep. The Army H.E.A.L.T.H.® Intensive program has been tested with Soldiers and their family members. The purpose of this investigation is to test the efficacy of an intensive intervention to assist Soldiers in meeting standards for body fat and fitness and to assist family members in the improvement of nutrition, fitness and sleep. View Army H.E.A.L.T.H.Intensive Study Information Here
Healthy Eating, Activity, & Lifestyle Training Headquarters: The Army H.E.A.L.T.H.® IOS App Tiffany Stewart , Ph.D., Principal Investigator The Army H.E.A.L.T.H.® program combines evidence-based tools and guidance previously tested in four PBRC studies and is now an IOS app for Smartphones. This app includes mobile tracking technology/device linkage for personal activity, weight, nutrition, sleep, and mind and body wellness components. View Army H.E.A.L.T.H. App Information Here
The Assessment of Female Athlete Resilience Wu Tsai Center of Excellence for Female Athlete Health and Performance Alliance at Harvard Medical School*
Tiffany Stewart, Ph.D., Principal Investigator Carolyn Becker, Ph. D., co-PI, Trinity University Kimberly O’Brien, Ph.D., co-PI, Harvard Site Miriam, Rowan, PsyD, co-PI, Boston Ballet
The goal of this project is to identify potential modifiable risk factors of psychological resilience among female athletes, we will conduct a longitudinal assessment survey study with female athletes. Constructs that will be included in the assessment will include: emotion regulation, experiential avoidance, intolerance of uncertainty, sleep, low energy availability, injury history, contextual body image, excessive training/body disregard, and social support. We will test the cross-sectional and longitudinal associations between each construct and psychological resilience, and will examine differences across age, sexual and/or gender minority identification. We also will test the criterion validity of psychological resilience in female athletes by testing the degree to which psychological resilience predicts increased depression, anxiety, eating disorder pathology, substance use and psychosocial stress. In an ancillary study, participants will use a fitness tracker (i.e., WHOOP Strap 3.0) to measure physiologic data and test their associations with psychosocial factors and psychological resilience. For instance, we will use WHOOP sleep data to test the validity of a self-report measure of sleep in female athletes. To date, the vast majority of resilience research (both with female athletes and in other populations) has been conducted cross-sectionally, even though this approach can only identify correlates. The proposed work would be a first step in identifying predictive risk factors that can be modified to increase the future resilience of female athletes. With this crucial information, we aim to gather data that will inform the development of a resilience-focused intervention (e.g., a skills training program for female athletes), and test feasibility and efficacy in subsequent controlled trials. The findings from this study also will result in multiple publications and grant applications. The goal of the present study is to identify potential modifiable risk factors of resilience in female athletes and to also assess the criterion validity of psychological resilience in female athletes.
* We acknowledge support of this work by the Wu Tsai Human Performance Alliance at Harvard University and the Joe and Clara Tsai Foundation.
Physical & Mental Resilience in Female Athletes Wu Tsai Center of Excellence for Female Athlete Health and Performance Alliance at Stanford University*
Tiffany Stewart, Ph.D., Principal Investigator Carolyn Becker, Ph. D., Co-Principal Investigator, Trinity Site Neil Johannsen, Ph.D., Co-Investigator, Department of Kinesiology, Louisiana State University Guillaume, Spielmann, Ph.D., Co-Investigator, Department of Kinesiology, Louisiana State University
Female athletes are exposed to chronic stress (academic and competitive), placing them at increased risk for reduced immune function, higher hormonal stress markers, and a decline in mental health, performance, and resilience. Optimization and resilience-based strategies have been under-investigated in athletes, particularly in female athletes. This project aims to investigate mental, physical, hormonal and immune resilience factors in female athletes in an effort to inform the later development of a clinical intervention, and test feasibility and efficacy in subsequent controlled trials. The main objective of this study is to assess mental, physical, hormonal and immune measures of resilience in female athletes across three visits (V0 - baseline, V1 – moderate allostatic stress load due to training/physical stress, V2 – high allostatic stress load due to combined academic and competitive stressors), separated by 2 training periods (T1 – pre-season and T2 – in-season). To achieve this objective, we will investigate the impact of chronic exposure to academic and competitive stressors on biomarkers of physical resilience and immune reserve. We hypothesize that during periods of heightened physical stress alone (V1) or in combination with competitive and academic stressors (V2), athletes will exhibit altered concentrations in biomarkers of salivary immune competency and stress at rest. We also will characterize changes in heart rate variability (HRV) during 30 minutes of rest. In addition, we will examine HR, ventilatory and blood lactate responses to exercise between V0, V1 and V2 during two training periods (T1 & T2). We will also investigate the association of physical resilience and reduced physiological reserve with mental health and resilience. The study aims to pave the way for future studies that have clear mechanistic conclusions. The understanding of various compounding stress loads included in this trial will provide insight into the development and testing of optimal athletic schedules.
* We acknowledge support of this work by the Wu Tsai Human Performance Alliance at Stanford University and the Joe and Clara Tsai Foundation.
The Female Athlete Body Project (FAB) National Institutes of Health NIH 1 RO1 MH094448-01 Tiffany Stewart , Ph.D., Principal Investigator Carolyn Becker, Ph.D., Co-Principal Investigator
Given the cost of treating eating disorders (EDs) and the substantial morbidity and mortality associated with these disorders, prevention of EDs has considerable public health significance. Research supports the use of a Healthy Weight (HW) program targeting small lifestyle modifications in the prevention of ED onset and in reducing ED risk factors. Research suggests that disordered eating among female athletes is prevalent, and is especially dangerous in female athletes because it increases risk for the Female Athlete Triad (i.e., low energy availability/disordered eating, menstrual disorders, and decreased bone mineral density/osteoporosis) and subsequent injury. This study is a cluster randomized controlled trial to test the effectiveness of the HW intervention among 500 collegiate female athletes in three sites, including Louisiana State University (LSU; Baton Rouge, LA), Trinity University (TU; San Antonio, TX), and American University (AU; Washington, D.C.). The FAB program is now available to schools who would like to deploy it at their university. Contact us for more details. View FAB Program Information Here
Sport Carried Onward for Resilience & Enrichment (S.C.O.R.E.)
Nearly 8 million students currently participate in high school athletics in the United States. Only slightly more than 480,000 go on to compete as NCAA athletes and just a select few become professional athletes. The limited professional opportunities for athletes further limit sport beyond college. Student athletes invest untold hours into their sport through practice and competition, perfecting their skills and attaching themselves to a unique way of life. Sport becomes the defining identity of an athlete. Collegiate athletes are students catapulted into a high performance environment full of both expectations and rewards. This environment creates pressure on athletes to perform and behave by a particular set of rules. In this way, athletes are not immune to mental and behavioral health struggles. At the college level, many are offered mental health services, although those are usually centered on sports- performance. Stigma and program culture can prevent athletes from seeking mental health help beyond sport- specific mental health needs. We have identified this gap in athlete well-being and have created this program as a strategy to enhance performance, called S.C.O.R.E. (Sport Carried Onward for Resilience & Enrichment). The S.C.O.R.E. program aims to influence post-sport health behavior and provide an intervention program to aid in athletes’ adjustment into the world after college/elite athletics.
*Pilot funded by the Pennington Family Foundation
Sisu and You A New Health Perspective: The Body Revolution Kids Need Tiffany Stewart , Ph.D., Principal Investigator
Science tells us that if we don't appreciate our bodies, we don't treat our bodies well. How we view our bodies is a key component of successful health behaviors and significantly affects our quality of life. This workshop series teaches children and adults to keep their bodies healthy through nutrition, fitness, sleep, and body image. The experiences gained through these workshops will reframe the dialogue between kids and adults about healthy bodies, while empowering kids to establish positive behaviors and improve their health for the long-term. This workshop series, soon to be accompanied by a Smartphone application, is currently a partnership with the Knock Knock Children’s Museum and Mayor Broome’s Healthy Baton Rouge Initiative. The workshop is currently being deployed at the museum, schools and summer camps throughout Baton Rouge. View Sisu & You Program Information Here
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The Pennington Biomedical Diabetes Clinic
The Problem
*Source American Diabetes Association
A Proposed Solution for Louisiana To establish a model clinic in weight management for prediabetes and type 2 diabetes prevention and remission in an underserved population of Medicaid recipients in Louisiana. If found efficacious and cost-effective, a secondary aim will be to disseminate the program more widely.
Background/Significance Pennington Biomedical Research Center has entered into a cooperative endeavor agreement with the Louisiana Department of Health (LDH) to develop an innovative model for diabetes prevention, reversal and treatment for patients in the state of Louisiana. The model is informed by diabetes prevention and remission research and can be described as a weight-centric treatment program delivered to members of underserved populations, with Medicaid insurance, who have been diagnosed with type 2 diabetes within the last 5 years and for pre-diabetes. Louisiana Department of Health Secretary Rebekah Gee recommended the creation of such a clinic to the Louisiana Board of Regents and LSU leadership. This Medicaid pilot demonstration clinic effort is a pragmatic example of a research-informed, evidence-based program with potential application in primary care settings. The State of Louisiana has provided support with a $2 million investment.
Pennington Biomedical is a research leader in diabetes prevention and management and has participated in all the landmark clinical trials including the Diabetes Prevention Program (DPP) and the Look AHEAD (Action for Health in Diabetes) Study, both funded by the National Institutes of Health. Pennington Biomedical has also developed pragmatic clinical trials of weight management in primary care settings, including Louisiana Obese Subjects Study (LOSS), Heads Up Project: Observational Study of Surgical and Intensive Medical Interventions for Severe Obesity (Heads Up) and PROPEL (Promoting Successful Weight Loss in Primary Care in Louisiana), a PCORI-funded weight management intervention underway in 18 primary care clinics, including 14 Federally Qualified Health Centers (FQHCs), across the state. Pennington Biomedical has also developed mobile (web and Smartphone-based) interventions for weight management for the Department of Defense (DOD), Army H.E.A.L.T.H.®(Healthy Eating Activity Lifestyle Training Headquarters). It is this science that we aim to translate into practical applications and ultimately help the citizens of Louisiana.
Strategy Obesity and type 2 diabetes are biologically linked, with obesity being a primary driver of insulin resistance and also being implicated in failure of the pancreas’s beta cells to control glucose levels. Furthermore, weight loss of 10% is a proven means for maximizing diabetes prevention in patients with prediabetes. Weight can also dramatically improve the lives of patients with established type 2 diabetes. However, even modest (5-10%) weight loss is difficult to achieve and sustain in the setting of the primary care office visit, thus challenging weight-centric diabetes prevention and management. The objective of the Pennington Biomedical Model Diabetes Clinic is to create a successful business model for delivery of cutting-edge approaches to diabetes prevention and remission in private practice, thus translating Pennington Biomedical Research Center’s research into practical applications that ultimately help the citizens of Louisiana.
We will partner with managed care companies (MCOs) to enroll patients initially from their Medicaid insured population in Baton Rouge. The clinic program is multimodal- including diet, medication, behavioral, and telehealth components. The program includes its own Smartphone application to make treatment accessible anytime, anywhere.
For more information on the Pennington Biomedical Diabetes Clinic smartphone app and telehealth platform, click here.
The Pennington Biomedical Model Diabetes Clinic has also developed a tracking and evaluation system for the program. The Pennington Biomedical analytics team will assess impact on weight loss, measures of health risks associated with weight loss (blood pressure, blood glucose, blood lipids), quality of life, and economic outcomes (i.e., total medical costs). Follow up evaluation would include a cost effectiveness analysis, comparing patient health care costs of those who received the clinical program, versus those who did not receive the program. If this pilot is successful, we plan to disseminate the program across Louisiana to improve access and treatment outcomes in primary care settings for Louisiana Medicaid recipients who are overweight or obese with diabetes or prediabetes.
Pennington Biomedical aims to become a leader in pragmatic, evidence-based care in our community and eventually dissemination on a wider scale. The Model Diabetes Clinic is the first step in a new strategic plan in which we envision creating a multi-modal “center” offering treatment in sub-specialty clinics for weight loss, and other specialty treatments, e.g. binge eating, pediatrics, bariatric surgery.
Pennington Biomedical Model Diabetes Clinic is a demonstration clinic. Our goal is not to compete with local physicians, but to partner with hospitals, physicians, and managed care companies to demonstrate that the program(s) work and are viable for community physician practice, as well as provide quality care to our citizens of Louisiana.
for more information on the Pennington Biomedical Diabetes Clinic, or for enrollment, click here. |
