Montreal Behavioral Medicine Center

Montréal, Canada

Montreal Behavioral Medicine Center

Montréal, Canada
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Healy L.C.,Newman University | Ntoumanis N.,Curtin University Australia | van Zanten J.J.C.S.V.,University of Birmingham | Paine N.,Concordia University at Montréal | Paine N.,Montreal Behavioral Medicine Center
Journal of Sport and Exercise Psychology | Year: 2014

This investigation sought to clarify mixed results in the literature exploring coach behaviors, basic psychological needs, goal motivation, and well- and ill-being. Regional-level team sport athletes (N = 241) completed questionnaires on the aforementioned variables at the beginning of the season. A subsample (n = 70) provided saliva samples to assess physical ill-being. At the end of the season, athletes (n = 98) reported their goal motivation and attainment. Structural equation modeling demonstrated that coach behaviors were related to needs satisfaction and thwarting, which were related to autonomous and controlled goal motives respectively. Autonomous motives were related to well- and ill-being; controlled motives were only related to ill-being. Over time, only end-of-season autonomous goal motives were related to goal attainment. The findings provide an insight into how coaches can facilitate optimum goal striving and well-being in their athletes. © 2014 Human Kinetics, Inc.


Rash J.A.,University of Calgary | Lavoie K.L.,University of Quebec at Montréal | Lavoie K.L.,Montreal Behavioral Medicine Center | Feldman R.D.,University of Western Ontario | Campbell T.S.,University of Calgary
Current Cardiovascular Risk Reports | Year: 2014

Elevated blood pressure (BP) accounts for the largest global proportion of disease burden and is largely treatable through the use of antihypertensive medications. Adherence to antihypertensive medication may be defined as the extent to which patient behavior coincides with recommendations agreed upon by the health-care provider and the patient and encompasses initiation, implementation, and discontinuation. Despite the proven clinical efficacy of antihypertensive medications to control BP, approximately half of treated patients are nonadherent. Nonadherence to antihypertensive medications is a multifactorial concern. Barriers to antihypertensive medication adherence are numerous and include patient-related (e.g., beliefs about medication, motivation, mental health), provider-related (e.g., patient-provider communication, failure to appropriately escalate treatment), therapy-related (e.g., an asymptomatic disease, side effects, complexity of regimens), and system-related (e.g., medication cost, health literacy, uncoordinated delivery of services) influences. Several techniques to improve adherence to antihypertensive medications have been identified, with sufficient supporting evidence from randomized trials to inform clinical practice recommendations. This review summarizes the current understanding of the prevalence and impact of the failure to adhere to the medical management of hypertension. Factors linked to improved adherence and studies that assessed strategies to improve adherence are also summarized. © 2014, Springer Science+Business Media New York.


Rossi A.M.,Montreal Behavioral Medicine Center | Rossi A.M.,Montreal Heart Institute | Rossi A.M.,Concordia University at Montréal | Davies E.,Montreal Behavioral Medicine Center | And 17 more authors.
Obesity | Year: 2013

Objective: There is limited information regarding the synergistic or additive effects of metabolic syndrome (MS) and endothelial dysfunction (ED) on cardiovascular disease (CVD). Altered cardiovascular responses to exercise have been shown to predict future cardiovascular events as well as assess autonomic function. The present study evaluated the impact of MS and brachial artery reactivity (a proxy of ED) on peak exercise-induced cardiovascular changes. Design and Methods: Individuals (n = 303) undergoing a standard nuclear medicine exercise stress test were assessed for MS. Participants underwent a Forearm Hyperaemic Reactivity test and were considered to have dysfunctional reactivity if their rate of uptake ratio (RUR) was <3.55. Resting and peak blood pressure (BP) and heart rate (HR) were measured. Reactivity was calculated as the difference between peak and resting measures. Results: Analyses, adjusting for age, sex, resting HR, total metabolic equivalents (METs), and a history of major CVD, revealed a main effect of MS (F = 5.51, n2 = 0.02, P = 0.02) and RUR (F = 6.69, n2 = 0.02, P = 0.01) on HR reactivity, such that patients with MS and/or poor RUR had reduced HR reactivity. There were no interactive effects of RUR and MS. There were no effects of RUR or MS on systolic BP (SBP) or diastolic BP (DBP) reactivity or rate pressure product (RPP) reactivity. Conclusions: The presence of decreased HR reactivity among participants with MS or poor brachial artery reactivity, combined with the lack of difference in other exercise-induced cardiovascular changes, indicates that these patients may have some degree of parasympathetic dysregulation. Further longitudinal studies are needed to understand the long-term implications of MS and endothelial abnormalities in this context.


PubMed | McGill University and Montreal Behavioral Medicine Center
Type: Journal Article | Journal: Therapeutic advances in psychopharmacology | Year: 2016

Recent investigations have shown that serotonergic antidepressant (SAd) use may increase the risk of peri-operative bleeding events. Our objective was to evaluate the possibility of a similar association in patients undergoing radiologic breast biopsies.We used data from 3890 patients undergoing 6300 biopsy procedures between January 2011 and October 2014 in the Breast Clinic of McGill University Health Centre, Montreal, Canada. In this case-control study, cases were patients reported to have abnormal bleeding during their biopsy by board-certified radiologists. A control group of nonbleeders was selected using matching according to age and type of biopsy. The correlation between abnormal bleeding and SAd use was assessed using bivariate and multivariate statistical analyses.There were 97 patients with abnormal bleeding and 137 matched controls; 10 bleeders (cases) were on SAds (7 citalopram, 3 paroxetine) while only 1 nonbleeder (control group) was on a SAd (low-dose sertraline, 25 mg/day). SAds were significantly associated with increased bleeding risk (10.3% versus 0.7%, Fishers Exact p = 0.001). Moreover, after adjusting for confounding factors (age, type of biopsy, size of biopsy, needle caliber, pathology result and nonsteroidal anti-inflammatory drug use, multivariate logistic regression confirmed that SAds were associated with elevated bleeding risk (16.2, 95% confidence interval 1.87-140.1, p = 0.01).This is the first study demonstrating increased bleeding events in breast biopsy patients using SAds. Clinicians should be aware that SAds may be associated with peri-operative bleeding risk, even in relatively minor procedures such as breast biopsies.


Thorin-Trescases N.,Montreal Heart Institute | Hayami D.,Montreal Heart Institute | Yu C.,Montreal Heart Institute | Yu C.,University of Montréal | And 15 more authors.
PLoS ONE | Year: 2016

Pro-inflammatory angiopoietin-like 2 (angptl2) promotes endothelial dysfunction in mice and circulating angptl2 is higher in patients with cardiovascular diseases. We previously reported that a single bout of physical exercise was able to reduce angptl2 levels in coronary patients. We hypothesized that chronic exercise would reduce angptl2 in patients with post-acute coronary syndrome (ACS) and endothelial dysfunction. Post-ACS patients (n = 40, 10 women) were enrolled in a 3-month exercise-based prevention program. Plasma angptl2, hs-CRP, and endothelial function assessed by scintigraphic forearm blood flow, were measured before and at the end of the study. Exercise increased VO2peak by 10% (p<0.05), but did not significantly affect endothelial function, in both men and women. In contrast, exercise reduced angptl2 levels only in men (-26±7%, p<0.05), but unexpectedly not in women (+30±16%), despite similar initial levels in both groups. Exercise reduced hs-CRP levels in men but not in women. In men, levels of angptl2, but not of hs-CRP, reached at the end of the training program were negatively correlated with VO2peak (r = -0.462, p = 0.012) and with endothelial function (r = -0.419, p = 0.033) measured at baseline: better initial cardiopulmonary fitness and endothelial function correlated with lower angptl2 levels after exercise. Pre-exercise angptl2 levels were lower if left ventricular ejection time was long (p<0.05) and the drop in angptl2 induced by exercise was greater if the cardiac output was high (p<0.05). In conclusion, in post-ACS men, angptl2 levels are sensitive to chronic exercise training. Low circulating angptl2 reached after training may reflect good endothelial and cardiopulmonary functions. © 2016 Thorin-Trescases et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Rash J.A.,University of Calgary | Lavoie K.L.,University of Quebec at Montréal | Lavoie K.L.,Montreal Behavioral Medicine Center | Sigal R.J.,University of Calgary | And 4 more authors.
Contemporary Clinical Trials | Year: 2016

Background: Statins are a class of medications that are particularly effective for lowering cholesterol and reducing cardiovascular morbidity and mortality. Despite a range of benefits, non-adherence to statin medication is prevalent with 50% to 75% of patients failing to adhere to treatment within the first 2-years. A previous review on interventions to improve adherence to cholesterol lowering medication concluded that rigorous trials were needed with emphasis on the patient's perspective and shared decision making. Motivational interviewing (MInt) is a promising patient-centered approach for improving adherence in patients with chronic diseases. This manuscript describes the rational and design of a randomized controlled trial (RCT) testing the efficacy of MInt in improving adherence to statin medication. Methods: Patients filling their first statin prescription will be recruited to complete a 6-month observation run-in period (phase-1) after which medication possession ratio (MPR) will be assessed. Patients meeting criteria for non-adherence (MPR ≤ 60%) will be invited to participate in the trial. 336 non-adherent new statin users will undergo a fasting lipid panel, complete baseline questionnaires, and be randomly allocated to receive four sessions of adherence education delivered using MInt (EdMInt) or to an education control (EC) delivered at 3-month intervals. Final assessments will occur 12-months after the first EdMInt or EC session. The primary outcome is change in MPR adherence to statin medication from baseline to 12-months. Secondary outcomes include within-patient change in self-reported medication adherence, stage of change and self-efficacy for medication adherence, motivation to adhere to statin medication, and lipid profile. © 2016 Elsevier Inc.


PubMed | Montreal Behavioral Medicine Center
Type: Journal Article | Journal: Obesity (Silver Spring, Md.) | Year: 2013

There is limited information regarding the synergistic or additive effects of metabolic syndrome (MS) and endothelial dysfunction (ED) on cardiovascular disease (CVD). Altered cardiovascular responses to exercise have been shown to predict future cardiovascular events as well as assess autonomic function. The present study evaluated the impact of MS and brachial artery reactivity (a proxy of ED) on peak exercise-induced cardiovascular changes.Individuals (n = 303) undergoing a standard nuclear medicine exercise stress test were assessed for MS. Participants underwent a Forearm Hyperaemic Reactivity test and were considered to have dysfunctional reactivity if their rate of uptake ratio (RUR) was <3.55. Resting and peak blood pressure (BP) and heart rate (HR) were measured. Reactivity was calculated as the difference between peak and resting measures.Analyses, adjusting for age, sex, resting HR, total metabolic equivalents (METs), and a history of major CVD, revealed a main effect of MS (F = 5.51, (2) = 0.02, P = 0.02) and RUR (F = 6.69, (2) = 0.02, P = 0.01) on HR reactivity, such that patients with MS and/or poor RUR had reduced HR reactivity. There were no interactive effects of RUR and MS. There were no effects of RUR or MS on systolic BP (SBP) or diastolic BP (DBP) reactivity or rate pressure product (RPP) reactivity.The presence of decreased HR reactivity among participants with MS or poor brachial artery reactivity, combined with the lack of difference in other exercise-induced cardiovascular changes, indicates that these patients may have some degree of parasympathetic dysregulation. Further longitudinal studies are needed to understand the long-term implications of MS and endothelial abnormalities in this context.

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