Targeted full energy and protein delivery in critically ill patients : A pilot randomized controlled trial (FEED Trial)

Journal article

Fetterplace, Kate, Deane, Adam, Tierney, Audrey, Beach, Lisa J., Knight, Laura D., Presneill, Jeffrey, Rechnitzer, Thomas, Forsyth, Adrienne, Gill, Benjamin, Mourtzakis, Marina and MacIsaac, Christopher. (2018). Targeted full energy and protein delivery in critically ill patients : A pilot randomized controlled trial (FEED Trial). Journal of Parenteral and Enteral Nutrition. 42(8), pp. 1252-1262. https://doi.org/10.1002/jpen.1166
AuthorsFetterplace, Kate, Deane, Adam, Tierney, Audrey, Beach, Lisa J., Knight, Laura D., Presneill, Jeffrey, Rechnitzer, Thomas, Forsyth, Adrienne, Gill, Benjamin, Mourtzakis, Marina and MacIsaac, Christopher
Abstract

Background
International guidelines recommend greater protein delivery to critically ill patients than they currently receive. This pilot randomized clinical trial aimed to determine whether a volume-target enteral protocol with supplemental protein delivered greater amounts of protein and energy to critically ill patients compared with standard care.

Methods
Sixty participants received either the intervention (volume-based protocol, with protein supplementation) or standard nutrition care (hourly-rate-based protocol, without protein supplementation) in the intensive care unit (ICU). Coprimary outcomes were average daily protein and energy delivery. Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) and malnutrition (subjective global assessment) at ICU discharge.

Results
Mean (SD) protein and energy delivery per day from nutrition therapy for the intervention were 1.2 (0.30) g/kg and 21 (5.2) kcal/kg compared with 0.75 (0.11) g/kg and 18 (2.7) kcal/kg for standard care. The mean difference between groups in protein and energy delivery per day was 0.45 g/kg (95% CI, 0.33–0.56; P < .001) and 2.8 kcal/kg (95% CI, 0.67–4.9, P = .01). Muscle loss (QMLT) at discharge was attenuated by 0.22 cm (95% CI, 0.06–0.38, P = .01) in patients receiving the intervention compared with standard care. The number of malnourished patients was fewer in the intervention [2 (7%) vs 8 (28%); P = .04]. Mortality and duration of admission were similar between groups.

Conclusions
A high-protein volume-based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge.

Keywordscritical illness; dietary proteins; enteral nutrition; enteral formulas; functional outcomes; muscle mass; nutrition support; ultrasound
Year2018
JournalJournal of Parenteral and Enteral Nutrition
Journal citation42 (8), pp. 1252-1262
PublisherJohn Wiley & Sons, Inc.
ISSN0148-6071
Digital Object Identifier (DOI)https://doi.org/10.1002/jpen.1166
Scopus EID2-s2.0-85055518634
Open accessPublished as green open access
Research or scholarlyResearch
Page range1252-1262
FunderMelbourne Health Foundation
Author's accepted manuscript
License
All rights reserved
File Access Level
Open
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online27 Apr 2018
Publication process dates
Accepted27 Feb 2018
Deposited22 Aug 2022
Permalink -

https://acuresearchbank.acu.edu.au/item/8y249/targeted-full-energy-and-protein-delivery-in-critically-ill-patients-a-pilot-randomized-controlled-trial-feed-trial

Log in to edit

Download files

Author's accepted manuscript
AM_Fetterplace_2018_Targeted_full_energy_and_protein_delivery.pdf
License: All rights reserved
File access level: Open

Restricted files

Publisher's version

  • 90
    total views
  • 82
    total downloads
  • 2
    views this month
  • 3
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

The relationship of hedonic hunger, macronutrient balance, nutrition knowledge, and body image and weight control with dietary intake in student athletes and exercisers
Janiczak, Amy, Forsyth, Adrienne, Li, Xia and Trakman, Gina. (2024). The relationship of hedonic hunger, macronutrient balance, nutrition knowledge, and body image and weight control with dietary intake in student athletes and exercisers. Nutrients. 16(6), pp. 1-14. https://doi.org/10.3390/nu16060772
Undergraduate Student Perspectives on Employability : A Mixed Methods Exploration of Nutrition Student Career Awareness, Confidence, and Preparedness
Ng, Ashley H., Reddy, Anj, Horvath, Deanna, Larsen, Amy E., Biesiekierski, Jessica R., Croxford, Sharon, Bramley, Andrea, McLeod, Susan, Stirling, Emma, Murray, Emily and Forsyth, Adrienne. (2023). Undergraduate Student Perspectives on Employability : A Mixed Methods Exploration of Nutrition Student Career Awareness, Confidence, and Preparedness. Journal of Teaching and Learning for Graduate Employability. 14(1), pp. 282-297. https://doi.org/10.21153/jtlge2023vol14no1art1638
A systematic review of interventions targeting modifiable factors that impact dietary intake in athletes
Janiczak, Amy, Alcock, Rebekah, Forsyth, Adrienne and Trakman, Gina Louise. (2023). A systematic review of interventions targeting modifiable factors that impact dietary intake in athletes. British Journal of Nutrition. pp. 1-19. https://doi.org/10.1017/S0007114523001769
An online exploratory survey of Australian athletes' and exercisers' use of and attitudes toward ultra-processed sports foods
Forsyth, Adrienne and Mantzioris, Evangeline. (2023). An online exploratory survey of Australian athletes' and exercisers' use of and attitudes toward ultra-processed sports foods. British Journal of Nutrition. 130(9), pp. 1625-1636. https://doi.org/10.1017/S0007114523000648
Malnutrition defined by GLIM criteria identifies a higher incidence of malnutrition and is associated with pulmonary complications after oesophagogastric cancer surgery, compared to ICD-10-defined malnutrition
Murnane, Lisa C., Forsyth, Adrienne K., Koukounaras, Jim, Shaw, Kalai, King, Susannah, Brown, Wendy A., Mourtzakis, Marina, Tierney, Audrey C. and Burton, Paul R.. (2023). Malnutrition defined by GLIM criteria identifies a higher incidence of malnutrition and is associated with pulmonary complications after oesophagogastric cancer surgery, compared to ICD-10-defined malnutrition. Journal of Surgical Oncology. pp. 1-12. https://doi.org/10.1002/jso.27366
Validity and educational impact of clinical entrustable professional activities linked to the nutrition care process for work-based assessment of entry-level dietetics students : Evaluation of a 3-year implementation study in Australia
Bramley, Andrea, Forsyth, Adrienne and McKenna, Lisa. (2023). Validity and educational impact of clinical entrustable professional activities linked to the nutrition care process for work-based assessment of entry-level dietetics students : Evaluation of a 3-year implementation study in Australia. Journal of the Academy of Nutrition and Dietetics. 123(4), pp. 614-625. https://doi.org/10.1016/j.jand.2022.09.009
Effectiveness of dietary interventions in mental health treatment : A rapid review of reviews
Burrows, Tracy, Teasdale, Scott, Rocks, Tetyana, Whatnall, Megan, Schindlmayr, Julia, Plain, Janice, Latimer, Georgina, Roberton, Michelle, Harris, Deanne and Forsyth, Adrienne. (2022). Effectiveness of dietary interventions in mental health treatment : A rapid review of reviews. Nutrition and Dietetics. 79(3), pp. 279-290. https://doi.org/10.1111/1747-0080.12754
An exploratory study of industry perspectives to inform undergraduate nutrition employability initiatives
Croxford, Sharon, Stirling, Emma, McLeod, Susan, Biesiekierski, Jessica, Murray, Emily, Ng, Ashley H., Bramley, Andrea and Forsyth, Adrienne. (2022). An exploratory study of industry perspectives to inform undergraduate nutrition employability initiatives. Nutrition and Dietetics. 79(4), pp. 447-455. https://doi.org/10.1111/1747-0080.12731
A Mediterranean and low-fat dietary intervention in non-alcoholic fatty liver disease patients : Exploring participant experience and perceptions about dietary change
George, Elena S., Forsyth, Adrienne K., Reddy, Anjana, Itsiopoulos, Catherine, Roberts, Stuart K., Nicoll, Amanda J., Ryan, Marno C. and Tierney, Audrey C.. (2022). A Mediterranean and low-fat dietary intervention in non-alcoholic fatty liver disease patients : Exploring participant experience and perceptions about dietary change. Journal of Human Nutrition and Dietetics. pp. 1-11. https://doi.org/10.1111/jhn.13069
Attitudes and Opinions of Parents towards Water-Only Drink Policy at Junior Triathlon Events
Devlin, Brooke Lea, Staley, Kiera J., Trakman, Gina, Forsyth, Adrienne, Nicholson, Matthew, Cosgriff, Grant, Chisholm, Melanie and Belski, Regina. (2022). Attitudes and Opinions of Parents towards Water-Only Drink Policy at Junior Triathlon Events. International Journal of Environmental Research and Public Health. 19(14), pp. 8529-8529. https://doi.org/10.3390/ijerph19148529
Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics
Bramley, Andrea, Forsyth, Adrienne and McKenna, Lisa. (2022). Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics. Health and Social Care in the Community. 30(6), pp. e5445-e5456. https://doi.org/10.1111/hsc.13967
A systematic review update of athletes' nutrition knowledge and association with dietary intake
Janiczak, Amy, Devlin, Brooke L., Forsyth, Adrienne and Trakman, Gina Louise. (2022). A systematic review update of athletes' nutrition knowledge and association with dietary intake. British Journal of Nutrition. 128(6), pp. 1156-1169. https://doi.org/10.1017/S0007114521004311
Barriers and enablers to health service access amongst people with diabetes : An exploration of the perceptions of health care staff in regional Australia
Kennedy, Elizabeth L., Gordon, Brett A., Ng, Ashley H., Smith, Gillian and Forsyth, Adrienne K.. (2022). Barriers and enablers to health service access amongst people with diabetes : An exploration of the perceptions of health care staff in regional Australia. Health and Social Care in the Community. 30(1), pp. e234-e244. https://doi.org/10.1111/hsc.13433
Use of a sensitive multisugar test for measuring segmental intestinal permeability in critically ill, mechanically ventilated adults : A pilot study
Tatucu-Babet, Oana A., Forsyth, Adrienne, Udy, Andrew, Radcliffe, Jessica, Benheim, Devin, Calkin, Caroline, Ridley, Emma J., Gantner, Dashiell, Jois, Markandeya, Itsiopoulos, Catherine and Tierney, Audrey C.. (2022). Use of a sensitive multisugar test for measuring segmental intestinal permeability in critically ill, mechanically ventilated adults : A pilot study. Journal of Parenteral and Enteral Nutrition. 46(2), pp. 454-461. https://doi.org/10.1002/jpen.2110
Cost effectiveness of dietary interventions for individuals with mental disorders : A scoping review of experimental studies
Burrows, Tracy, Teasdale, Scott, Rocks, Tetyana, Whatnall, Megan, Schindlmayr, Julia, Plain, Janice, Roberton, Michelle, Latimer, Georgina, Harris, Deanne and Forsyth, Adrienne. (2022). Cost effectiveness of dietary interventions for individuals with mental disorders : A scoping review of experimental studies. Nutrition and Dietetics. 79(3), pp. 291-302. https://doi.org/10.1111/1747-0080.12703
A qualitative investigation of factors influencing the dietary intakes of professional Australian football players
Jenner, Sarah, Belski, Regina, Devlin, Brooke, Coutts, Aaron, Kempton, Thomas and Forsyth, Adrienne. (2021). A qualitative investigation of factors influencing the dietary intakes of professional Australian football players. International Journal of Environmental Research and Public Health. 18(8), p. Article 4205. https://doi.org/10.3390/ijerph18084205
Marked losses of computed tomography-derived skeletal muscle area and density over the first month of a critical illness are not associated with energy and protein delivery
Lambell, Kate J., Goh, Gerard S., Tierney, Audrey C., Forsyth, Adrienne, Nanjayya, Vinodh, Nyulasi, Ibolya and King, Susannah J.. (2021). Marked losses of computed tomography-derived skeletal muscle area and density over the first month of a critical illness are not associated with energy and protein delivery. Nutrition. 82, p. Article 111061. https://doi.org/10.1016/j.nut.2020.111061
Interventions to reduce sugar-sweetened beverage consumption using a nudge approach in Victorian community sports settings
Forsyth, Adrienne, Nicholson, Matthew, Skiadopoulos, Anne, Trakman, Gina, Devlin, Brooke, Belski, Regina, Randle, Erica, O'Halloran, Paul, Cameron, Matthew and Staley, Kiera. (2021). Interventions to reduce sugar-sweetened beverage consumption using a nudge approach in Victorian community sports settings. Australian and New Zealand Journal of Public Health. 45(6), pp. 592-598. https://doi.org/10.1111/1753-6405.13182
Design, implementation and evaluation of novel work-based clinical assessment tool : An e-portfolio with embedded Entrustable Professional Activities
Bramley, Andrea, Forsyth, Adrienne and McKenna, Lisa. (2021). Design, implementation and evaluation of novel work-based clinical assessment tool : An e-portfolio with embedded Entrustable Professional Activities. Nurse Education Today. 107, p. Article 105101. https://doi.org/10.1016/j.nedt.2021.105101
Low muscularity increases the risk for post-operative pneumonia and delays recovery from complications after oesophago-gastric cancer resection
Murnane, Lisa C., Forsyth, Adrienne K., Koukounaras, Jim, Pilgrim, Charles H. C., Shaw, Kalai, Brown, Wendy A., Mourtzakis, Marina, Tierney, Audrey C. and Burton, Paul R.. (2021). Low muscularity increases the risk for post-operative pneumonia and delays recovery from complications after oesophago-gastric cancer resection. ANZ Journal of Surgery. 91(12), pp. 2683-2689. https://doi.org/10.1111/ans.17203
Comparison of ultrasound-derived muscle thickness with computed tomography muscle cross-sectional area on admission to the intensive care unit : A pilot cross-sectional study
Lambell, Kate J., Tierney, Audrey C., Wang, Jessica C., Nanjayya, Vinodh, Forsyth, Adrienne, Goh, Gerard S., Vicendese, Don, Ridley, Emma J., Parry, Selina M., Mourtzakis, Marina and King, Susannah J.. (2021). Comparison of ultrasound-derived muscle thickness with computed tomography muscle cross-sectional area on admission to the intensive care unit : A pilot cross-sectional study. Journal of Parenteral and Enteral Nutrition. 45(1), pp. 136-145. https://doi.org/10.1002/jpen.1822
Healthy-canteen displays : A tactic to encourage community sport canteens to provide healthier food and beverage options
Trakman, Gina, Staley, Kiera, Forsyth, Adrienne, Devlin, Brooke, Skiadopoulos, Anne, Pearce, Karen, Nicholson, Matthew and Belski, Regina. (2021). Healthy-canteen displays : A tactic to encourage community sport canteens to provide healthier food and beverage options. International Journal of Environmental Research and Public Health. 18(19), p. Article 10194. https://doi.org/10.3390/ijerph181910194
Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery
Murnane, Lisa C., Forsyth, Adrienne K., Koukounaras, Jim, Pilgrim, Charles H. C., Shaw, Kalai, Brown, Wendy A., Mourtzakis, Marina, Tierney, Audrey C. and Burton, Paul R.. (2021). Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery. European Journal of Surgical Oncology. 47(9), pp. 2295-2303. https://doi.org/10.1016/j.ejso.2021.02.008
How does muscularity assessed by bedside methods compare to computed tomography muscle area at intensive care unit admission? A pilot prospective cross-sectional study
Lambell, K J., Earthman, C. P., Tierney, A. C., Goh, G. S., Forsyth, A. and King, S. J.. (2021). How does muscularity assessed by bedside methods compare to computed tomography muscle area at intensive care unit admission? A pilot prospective cross-sectional study. Journal of Human Nutrition and Dietetics. 34(2), pp. 345-355. https://doi.org/10.1111/jhn.12804
Serum zonulin measured by enzyme-linked immunosorbent assay may not be a reliable marker of small intestinal permeability in healthy adults
Tatucu-Babet, Oana A., Forsyth, Adrienne, Owen, Emma, Navarro-Perez, Diana, Radcliffe, Jessica, Benheim, Devin, Mendis, Himasha, Jois, Markandeya, Itsiopoulos, Catherine and Tierney, Audrey C.. (2020). Serum zonulin measured by enzyme-linked immunosorbent assay may not be a reliable marker of small intestinal permeability in healthy adults. Nutrition Research. 78, pp. 82-92. https://doi.org/10.1016/j.nutres.2020.05.003
Employability initiatives in undergraduate education and application to human nutrition : A scoping review
Murray, Emily, McLeod, Susan, Biesiekierski, Jessica, Ng, Ashley, Croxford, Sharon, Stirling, Emma, Bramley, Andrea and Forsyth, Adrienne. (2020). Employability initiatives in undergraduate education and application to human nutrition : A scoping review. Journal of Teaching and Learning for Graduate Employability. 11(1), pp. 63-80. https://doi.org/10.21153/jtlge2020vol11no1art921
Modifications to the nutrition for sport knowledge questionnaire (NSQK) and abridged nutrition for sport knowledge questionnaire (ANSKQ)
Trakman, Gina, Brown, Freddy, Forsyth, Adrienne and Belski, Regina. (2019). Modifications to the nutrition for sport knowledge questionnaire (NSQK) and abridged nutrition for sport knowledge questionnaire (ANSKQ). Journal of the International Society of Sports Nutrition. 16(1), pp. 1-3. https://doi.org/10.1186/s12970-019-0293-8
Peeling back the layers : An exploration of dietary perspectives and practices of journey-based outdoor leaders in an Australian context
Munge, Jaclyn, Munge, Brendon, Morse, Marcus and Forsyth, Adrienne. (2019). Peeling back the layers : An exploration of dietary perspectives and practices of journey-based outdoor leaders in an Australian context. Journal of Outdoor and Environmental Education. 22(3), pp. 253-268. https://doi.org/10.1007/s42322-019-00042-6
Validity of multi-frequency bioelectric impedance methods to measure body composition in obese patients : A systematic review
Becroft, Louise, Ooi, Geraldine, Forsyth, Adrienne, King, Susannah and Tierney, Audrey. (2019). Validity of multi-frequency bioelectric impedance methods to measure body composition in obese patients : A systematic review. International Journal of Obesity. 43(8), pp. 1497-1507. https://doi.org/10.1038/s41366-018-0285-9
Australian team sports athletes prefer dietitians, the internet and nutritionists for sports nutrition information
Trakman, Gina L., Forsyth, Adrienne, Hoye, Russell and Belski, Regina. (2019). Australian team sports athletes prefer dietitians, the internet and nutritionists for sports nutrition information. Nutrition and Dietetics. 76(4), pp. 428-437. https://doi.org/10.1111/1747-0080.12569
The effect of high-polyphenol extra virgin olive oil on cardiovascular risk factors: A systematic review and meta-analysis
George, Elena S., Marshall, Skye, Mayr, Hannah L., Trakman, Gina L., Tatucu-Babet, Oana A., Lassemillante, Annie-Claude M./, Bramley, Andrea, Reddy, Anjana J., Forsyth, Adrienne, Tierney, Audrey C., Thomas, Colleen J., Itsiopoulos, Catherine and Marx, Wolfgang. (2019). The effect of high-polyphenol extra virgin olive oil on cardiovascular risk factors: A systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 59(17), pp. 2772-2795. https://doi.org/10.1080/10408398.2018.1470491
Targeted full energy and protein delivery in critically ill patients : A study protocol for a pilot randomised control trial (FEED Trial)
Fetterplace, Kate, Deane, Adam M., Tierney, Audrey, Beach, Lisa J., Knight, Laura D., Rechnitzer, Thomas, Forsyth, Adrienne, Mourtzakis, Marina, Presneill, Jeffrey and MacIsaac, Christopher. (2018). Targeted full energy and protein delivery in critically ill patients : A study protocol for a pilot randomised control trial (FEED Trial). Pilot and Feasibility Studies. 4(1), p. Article 52. https://doi.org/10.1186/s40814-018-0249-9
Practical dietary recommendations for the prevention andmanagement of nonalcoholic fatty liver disease in adults
George, Elena S., Forsyth, Adrienne, Itsiopoulos, Catherine, Nicoll, Amanda J., Ryan, Marno, Sood, Siddharth, Roberts, Stuart K. and Tierney, Audrey. (2018). Practical dietary recommendations for the prevention andmanagement of nonalcoholic fatty liver disease in adults. Advances in Nutrition. 9(1), pp. 30-40. https://doi.org/10.1093/advances/nmx007
Association of Energy and Protein Delivery on Skeletal Muscle Mass Changes in Critically Ill Adults: A Systematic Review
Lambell, Kate J., King, Susannah J., Forsyth, Adrienne K. and Tierney, Audrey C.. (2018). Association of Energy and Protein Delivery on Skeletal Muscle Mass Changes in Critically Ill Adults: A Systematic Review. Journal of Parenteral and Enteral Nutrition. 42(7), pp. 1112-1122. https://doi.org/10.1002/jpen.1151
Australian football athletes lack awareness of current sport nutrition guidelines
Trakman, Gina L., Forsyth, Adrienne, Middleton, Kane, Hoye, Russell, Jenner, Sarah Louise, Keenan, Stephen and Belski, Regina. (2018). Australian football athletes lack awareness of current sport nutrition guidelines. International Journal of Sport Nutrition and Exercise Metabolism. 28(6), pp. 644-650. https://doi.org/10.1123/ijsnem.2018-0002
Dietary intake of professional Australian football athletes surrounding body composition assessment
Jenner, Sarah Louise, Trakman, Gina, Coutts, Aaron, Kempton, Thomas, Ryan, Samuel, Forsyth, Adrienne and Belski, Regina. (2018). Dietary intake of professional Australian football athletes surrounding body composition assessment. Journal of the International Society of Sports Nutrition. 15(1), p. Article 43. https://doi.org/10.1186/s12970-018-0248-5
The nutrition for sport knowledge questionnaire (NSKQ) : Development and validation using classical test theory and Rasch analysis
Trakman, Gina Louise, Forsyth, Adrienne, Hoye, Russell and Belski, Regina. (2017). The nutrition for sport knowledge questionnaire (NSKQ) : Development and validation using classical test theory and Rasch analysis. Journal of the International Society of Sports Nutrition. 14(1), p. Article 26. https://doi.org/10.1186/s12970-017-0182-y
Developing and validating a nutrition knowledge questionnaire : Key methods and considerations
Trakman, Gina Louise, Forsyth, Adrienne, Hoye, Russell and Belski, Regina. (2017). Developing and validating a nutrition knowledge questionnaire : Key methods and considerations. Public Health Nutrition. 20(15), pp. 2670-2679. https://doi.org/10.1017/S1368980017001471
Physical activity and fitness outcomes of a lifestyle intervention for primary care patients with depression and anxiety : A randomised controlled trial
Forsyth, Adrienne, Deane, Frank and Williams, Peter. (2017). Physical activity and fitness outcomes of a lifestyle intervention for primary care patients with depression and anxiety : A randomised controlled trial. International Journal of Mental Health and Addiction. 15(3), pp. 545-554. https://doi.org/10.1007/s11469-016-9695-x
A lifestyle intervention for primary care patients with depression and anxiety : A randomised controlled trial
Forsyth, Adrienne, Deane, Frank and Williams, Peter. (2015). A lifestyle intervention for primary care patients with depression and anxiety : A randomised controlled trial. Psychiatry Research. 230(2), pp. 537-544. https://doi.org/10.1016/j.psychres.2015.10.001
Nutrition status of primary care patients with depression and anxiety
Forsyth, Adrienne, Williams, Peter and Deane, Frank. (2012). Nutrition status of primary care patients with depression and anxiety. Australian Journal of Primary Health. 18(2), pp. 172-176. https://doi.org/10.1071/py11023
Dietitians and Exercise Physiologists in Primary Care : Lifestyle Interventions for Patients with Depression and/or Anxiety
Forsyth, Adrienne, Deane, Frank and Williams, Peter. (2009). Dietitians and Exercise Physiologists in Primary Care : Lifestyle Interventions for Patients with Depression and/or Anxiety. Journal of Allied Health. 38(2), pp. 1-6.