Olive Oil Nutraceuticals in the Prevention and Management of Diabetes: From Molecules to Lifestyle.

Lifestyle is the primary prevention of diabetes, especially type-2 diabetes (T2D). Nutritional intake of olive oil (OO), the key Mediterranean diet component has been associated with the prevention and management of many chronic diseases including T2D. Several OO bioactive compounds such as monounsaturated fatty acids, and key biophenols including hydroxytyrosol and oleuropein, have been associated with preventing inflammation and cytokine-induced oxidative damage, glucose lowering, reducing carbohydrate absorption, and increasing insulin sensitivity and related gene expression. However, research into the interaction of OO nutraceuticals with lifestyle components, especially physical activity, is lacking. Promising postprandial effects have been reported when OO or other similar monounsaturated fatty acids were the main dietary fat compared with other diets. Animal studies have shown a potential anabolic effect of oleuropein. Such effects could be further potentiated via exercise, especially strength training, which is an essential exercise prescription for individuals with T2D. There is also an evidence from in vitro, animal, and limited human studies for a dual preventative role of OO biophenols in diabetes and cancer, especially that they share similar risk factors. Putative antioxidative and anti-inflammatory mechanisms and associated gene expressions resulting from OO biophenols have produced paradoxical results, making suggested inferences from dual prevention T2D and cancer outcomes difficult. Well-designed human interventions and clinical trials are needed to decipher such a potential dual anticancer and antidiabetic effects of OO nutraceuticals. Exercise combined with OO consumption, individually or as part of a healthy diet is likely to induce reciprocal action for T2D prevention outcomes

Exercise physiologists: essential players in interdisciplinary teams for noncommunicable chronic disease management

Noncommunicable diseases (NCDs), such as obesity and type 2 diabetes mellitus, are a growing public health challenge in Australia, accounting for a significant and increasing cost to the health care system. Management of these chronic conditions is aided by interprofessional practice, but models of care require updating to incorporate the latest evidence-based practice. Increasing research evidence reports the benefits of physical activity and exercise on health status and the risk of inactivity to chronic disease development, yet physical activity advice is often the least comprehensive component of care. An essential but as yet underutilized player in NCD prevention and management is the “accredited exercise physiologist,” a specialist in the delivery of clinical exercise prescriptions for the prevention or management of chronic and complex conditions. In this article, the existing role of accredited exercise physiologists in interprofessional practice is examined, and an extension of their role proposed in primary health care settings

Inclined ergometer to enhance FES-assisted indoor rowing exercise performance

Improving the FES-assisted indoor rowing exercise (FES-rowing) performance enables the spinal cord injury (SCI) people to perform hybrid FES-exercise in a higher level of intensity. High level of exercise volume and intensity can play a big role in prevention of cardiovascular disease, type 2 diabetes and obesity which is a significant threat to the health of people with chronic SCI. FES-rowing can be enhanced to achieved the high level exercise through the arrangement of the rowing ergometer. In this paper, the performance of FES-rowing using an adjustable inclined rowing ergometer is investigated. Two different methods to enhance the FES-rowing performance using inclined ergometer are implemented. A model of the adjustable inclined ergometer and humanoid are developed using the Visual Nastran (vN4D) software environment and validated by the experimental work. Fuzzy logic control is implemented to control the knee and elbow trajectories for smooth rowing manoeuvre. The generated level of electrical stimulations for activation of quadriceps and hamstrings muscles are recorded and analysed. The FES-rowing efficiency for both methods have been defined and illustrated. The results show the inclined ergometer with upper body effort is the best performance in enhancing the FES-rowing

Combating Diabetes in Chittenden County: A Healthcare Provider Referral Campaign to Increase Patient Participation in the Vermont Diabetes Prevention Program

As of 2016, diabetes affects more than 29 million people in the United States and is the 7th leading cause of death nationwide. In Vermont, 1/10 people are diagnosed with either diabetes or prediabetes, with 6% of Vermonters affected by prediabetes and 5% of Chittenden Country affected by prediabetes. The public health burden of this chronic disease is immense: diabetes costs Vermont an estimated $543 million each year and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. Prediabetes occurs when blood sugar is higher than normal but not at the diagnostic threshold of diabetes. Prediabetes does not definitely progress to type 2 diabetes if interventions are made, including healthier eating and physical activity to promote modest weight loss. The CDC has developed evidence-based curricula for lifestyle intervention in prediabetics with intensive individual counseling and motivational support on effective diet, exercise, and behavior modification. One of these curricula is currently run through the CDC-led National YMCA Diabetes Prevention Program (YDPP). Participation in this program reduces the risk of developing type 2 diabetes by 58% across all ethnic groups and sexes overall and by 71% in individuals over age 60. The Vermont YDPP had 325 participants in 2016, with only 21% (n=70) of those referrals to the program coming from healthcare providers. Healthcare providers have a unique role in the community of being the voices of health promotion. With the correct provider awareness of the YDPP and patient identification, awareness, and education, an increase in the percentage of YDPP-referring healthcare providers can increase the overall YDPP participation in Chittenden county. As of 2016, 60,038 people in Chittenden county have prediabetes, but only 8,026 are diagnosed, and an additional 52,012 people could be diagnosed with prediabetes by their healthcare professional and referred to the YDPP. This campaign intends to serve as a pilot project to create provider and patient awareness of the YDPP, identify patients with prediabetes, and ensure providers screen and refer prediabetic patients to the YDPP. Through exam room posters, panel query management, electronic medical record reprogramming, and targeted patient intervention, this study aims to increase YDPP patient participation via healthcare provider referral and refine the model for adaptation and implementation in other healthcare centers throughout Chittenden County.https://scholarworks.uvm.edu/fmclerk/1301/thumbnail.jp

Recruiting hard-to-reach populations to physical activity studies : evidence and experiences

Most researchers who are conducting research with a public health focus face difficulties in recruiting the segments of the population that they really want to reach. This symposium presented evidence and experiences on recruiting participants to physical activity research, including both epidemiological and intervention based studies. Results from a systematic review of recruitment strategies suggested that we know little about how best to recruit and highlighted the need for researchers to report this in more detail, including metrics of reach into the target population such as number, proportion, and representativeness of participants. Specific strategies used to optimise responses to a population-based mail survey were presented such as study promotion, survey design, multiple mailings, and personal engagement. Finally, using place based recruiting via schools or places of worship to target ethnic minority youth were discussed. Overall the symposium presenters suggested that we need to learn more about how best to recruit participants, in particular those typically under-represented, and that researchers need to apportion a similar amount of planning effort to their recruitment strategies as they do the their research design. Finally we made a plea for researchers to report their recruitment processes in detail

The importance of diet and exercise in preventing type 2 diabetes

Diabetes is reaching epidemic proportions globally with estimates of 374 million people worldwide (WHO 2014 ) and impacts on the people with the condition, their families and on health service resources. While type 1 diabetes is an autoimmune disease, the causes of type 2 diabetes are more multi-factorial. In the UK there are about 2.9 million with diabetes of whom approximately 90% will have type 2. It is also estimated that there are about 850,000 people in the UK who have type 2 diabetes but have not as yet been diagnosed ( NHS UK 2014). Coupled with this, there are people who have known risk factors for developing diabetes. This article aims to consider the role of diet in adults in preventing those who are at high risk of developing type 2 diabetes and to present the evidence and practical application for nurses

Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program.

BACKGROUND:One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on low-cost changes in eating, physical activity and weight management can lower diabetes risk and delay onset, these programs have yet to be tailored to postpartum Latina women. This study aims to tailor a IT-enabled health communication program to promote DPP-concordant behavior change among postpartum Latina women with recent gestational diabetes. The COM-B model (incorporating Capability, Opportunity, and Motivational behavioral barriers and enablers) and the Behavior Change Wheel (BCW) framework, convey a theoretically based approach for intervention development. We combined a health literacy-tailored health IT tool for reaching ethnic minority patients with diabetes with a BCW-based approach to develop a health coaching intervention targeted to postpartum Latina women with recent gestational diabetes. Current evidence, four focus groups (n = 22 participants), and input from a Regional Consortium of health care providers, diabetes experts, and health literacy practitioners informed the intervention development. Thematic analysis of focus group data used the COM-B model to determine content. Relevant cultural, theoretical, and technological components that underpin the design and development of the intervention were selected using the BCW framework. RESULTS:STAR MAMA delivers DPP content in Spanish and English using health communication strategies to: (1) validate the emotions and experiences postpartum women struggle with; (2) encourage integration of prevention strategies into family life through mothers becoming intergenerational custodians of health; and (3) increase social and material supports through referral to social networks, health coaches, and community resources. Feasibility, acceptability, and health-related outcomes (weight loss, physical activity, consumption of healthy foods, breastfeeding, and glucose screening) will be evaluated at 9 months postpartum using a randomized controlled trial design. CONCLUSIONS:STAR MAMA provides a DPP-based intervention that integrates theory-based design steps. Through systematic use of behavioral theory to inform intervention development, STAR MAMA may represent a strategy to develop health IT intervention tools to meet the needs of diverse populations. TRIAL REGISTRATION:ClinicalTrials.gov NCT02240420

Examination of Acute Care Nurses Ability to Engage in Patient Education Related to Physical Activity as a Health Behavior

Physical activity is important for management and prevention of chronic disease. The current physical activity guidelines recommend engaging in physical activity for at least 30 minutes per day on at least 5 days a week. Acute care settings may present opportunities for patient education about physical activity. PURPOSE: The purpose of this study was to examine the ability of acute care nurses to engage in patient education regarding physical activity as a health behavior. Additionally, this study examined the influence of level of nurse training, age, personal physical activity and years of experience on these outcomes. METHODS: Nurses from an academic medical center (N=194) were surveyed. Knowledge of current physical activity guidelines, rank of importance of physical activity as a patient care activity and a healthy lifestyle behavior, and confidence to counsel patients about physical activity were queried. RESULTS: Of nurses queried, 32.5% reported days per week and 83% reported minutes per day to engage in physical activity consistent with current guidelines. Physical activity counseling was ranked least important of ten patient care activities and fifth as a healthy lifestyle behavior. The majority of nurses (51%) felt some degree of confidence to counsel patients regarding physical activity. Baccalaureate level nurses were more likely to be consistent with physical activity guidelines than master’s level nurses. Nurses <25 years of age were more current in knowledge of physical activity guidelines than nurses ≥41 years of age. Nurses who exercised were more likely to report knowing current physical activity guidelines. Reported time spent counseling patientsregarding physical activity averaged 6 minutes per patient per day. CONCLUSION: Acute care nurses are counseling patients regarding physical activity although it is ranked least important of ten patient care activities. Future research should include studying: a variety of patient populations; other hospital settings; objective measures of evaluation; and nurses’ training regarding physical activity

Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of South Asians at high risk of diabetes

&lt;b&gt;Objective&lt;/b&gt; To explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Design&lt;/b&gt; Qualitative study using narrative interviews of a purposive sample of trial participants following completion of the intervention. Data were thematically analysed.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Setting&lt;/b&gt; The intervention was conducted in Scotland and resulted in a modest decrease in weight, but did not statistically reduce the incidence of diabetes.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Participants&lt;/b&gt; We conducted 21 narrative interviews with 24 participants (20 trial participants and four family volunteers).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; Many participants were motivated to participate because of: known family history of diabetes and the desire to better understand diabetes-related risks to their own and their family's health; ways to mitigate these risks and to benefit from personalised monitoring. Home-based interventions, communication in the participant's chosen language(s) and continuity in dietitians supported their continuing engagement with the trial. Adaptations in food choices were initially accommodated by participants, although social and faith-based responsibilities were reported as important barriers to persevering with agreed dietary goals. Many participants reported that increasing their level of physical activity was difficult given their long working hours, physically demanding employment and domestic commitments; this being compounded by Scotland's challenging climate and a related reluctance to exercise in the outdoors.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; Although participants had strong personal interests in participation and found the information provided by dietitians useful, they nonetheless struggled to incorporate the dietary and exercise recommendations into their daily lives. In particular, increasing levels of physical exercise was described as an additional and in some cases unachievable burden. Consideration needs to be given to strengthening and supporting lifestyle interventions with community-based approaches in order to help overcome wider social and environmental factors