Optimizing the Exercise Drug to Oppose Glucose Intolerance/T2D

As part of the mini-symposium entitled Divergent Impacts of Physical Activity and Sedentary Behavior on Glucose Intolerance and Vascular Function: From Laboratory to Clinic, this presentation shares data on the role of increased physical activity and sedentary behavior in mediating Type 2 diabetes

Resistance to exercise-induced weight loss: compensatory behavioral adaptations

This is not the published version.In many interventions that are based on an exercise program intended to induce weight loss, the mean weight loss observed is modest and sometimes far less than the individual expected. The individual responses are also widely variable, with some individuals losing a substantial amount of weight, others maintaining weight, and a few actually gaining weight. The media have focused on the sub-population that loses little weight, contributing to a public perception that exercise has limited utility to cause weight loss. The purpose of the symposium was to present recent, novel data that help explain how compensatory behaviors contribute to a wide discrepancy in exercise-induced weight loss. The presentations provide evidence that some individuals adopt compensatory behaviors, i.e. increased energy intake and/or reduced activity, that offset the exercise energy expenditure and limit weight loss. The challenge for both scientists and clinicians is to develop effective tools to identify which individuals are susceptible to such behaviors, and to develop strategies to minimize their impact

Response

This is not the published version.See the article "Resistance to exercise-induced weight loss: compensatory behavioral adaptations" here at http://hdl.handle.net/1808/24571

The impact of a randomized controlled trial of a lifestyle intervention on postpartum physical activity among at-risk hispanic women: Estudio PARTO

AIMS: To assess the impact of a culturally modified, motivationally targeted, individually-tailored intervention on postpartum physical activity (PA) and PA self-efficacy among Hispanic women. METHODS: Estudio PARTO was a randomized controlled trial conducted in Western Massachusetts from 2013-17. Hispanic women who screened positive for gestational diabetes mellitus were randomized to a Lifestyle Intervention (LI, n = 100) or to a comparison Health and Wellness (HW, n = 104) group during late pregnancy. Exercise goals in LI were to meet American College of Obstetrician and Gynecologists guidelines for postpartum PA. The Pregnancy Physical Activity Questionnaire (PPAQ) and the Self-Efficacy for Physical Activity Questionnaire were administered at 6 weeks, 6 months, and 1 year postpartum. RESULTS: Compared to baseline levels, both groups had significant increases in moderate-to-vigorous PA at 6 months and one year postpartum (i.e., LI: mean change = 30.9 MET-hrs/wk, p = 0.05; HW: 27.6 MET-hrs/wk, p = 0.01), with only LI group experiencing significant increases in vigorous PA (mean change = 1.3 MET-hrs/wk, p = 0.03). Based on an intent-to-treat analysis using mixed effects models, we observed no differences in pattern of change in PA intensity and type over time between intervention groups (all p \u3e 0.10). However, there was the suggestion of a greater decrease in sedentary activity in the LI group compared to the HW group (beta = -3.56, p = 0.09). CONCLUSIONS: In this randomized trial among high-risk Hispanic women, both groups benefitted from participation in a postpartum intervention

Metformin modifies the exercise training effects on risk factors for cardiovascular disease in impaired glucose tolerant adults

Impaired glucose tolerant (IGT) adults are at elevated risk for cardiovascular disease (CVD). Exercise or metformin reduce CVD risk, but the efficacy of combining treatments is unclear. To determine the effects of exercise training plus metformin, compared to each treatment alone, on CVD risk factors in IGT adults. Subjects were assigned to: placebo (P), metformin (M), exercise plus placebo (EP), or exercise plus metformin (EM) (8/group). In a double-blind design, P or 2000mg/d of M were administered for 12 weeks and half performed aerobic and resistance training 3 days/week for approximately 60 minutes/day at 70% pre-training heart rate peak. Outcomes included: adiposity, blood pressure (BP), lipids and high sensitivity C-reactive protein (hs-CRP). Z-scores were calculated to determine metabolic syndrome severity. M and EM, but not EP, decreased body weight compared to P (p \u3c0.05). M and EP lowered systolic BP by 6% (p \u3c 0.05), diastolic BP by 6% (p \u3c 0.05), and hs-CRP by 20% (M: trend p = 0.06; EP: p \u3c 0.05) compared to P. Treatments raised HDL-cholesterol (p \u3c 0.05; EM: trend p = 0.06) compared to P and lowered triacyglycerol (p \u3c 0.05) and metabolic syndrome Z-score compared to baseline (EP; trend p = 0.07 and EM or M; p \u3c 0.05). Although exercise and/or metformin improve some CVD risk factors, only training or metformin alone lowered hs-CRP and BP. Thus, metformin may attenuate the effects of training on some CVD risk factors and metabolic syndrome severity in IGT adults

Estudio Parto: postpartum diabetes prevention program for hispanic women with abnormal glucose tolerance in pregnancy: a randomised controlled trial – study protocol

Background: Diabetes and obesity have reached epidemic proportions in the U.S. with rates consistently higher among Hispanics as compared to non-Hispanic whites. Among Hispanic women diagnosed with gestational diabetes mellitus (GDM), 50% will go on to develop type 2 diabetes within 5 years of the index pregnancy. Although randomised controlled trials among adults with impaired glucose tolerance have shown that diet and physical activity reduce the risk of type 2 diabetes, such programs have not been tested in high-risk postpartum women. The overall goal of this randomised controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce risk factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a history of abnormal glucose tolerance during pregnancy. Methods/Design Hispanic pregnant women who screen positive for GDM will be recruited and randomly assigned to a Lifestyle Intervention (n = 150) or a Health & Wellness (control) Intervention (n = 150). Multimodal contacts (i.e., in-person, telephone, and mailed materials) will be used to deliver the intervention from late pregnancy (29 weeks gestation) to 12 months postpartum. Targets of the intervention are to achieve Institute of Medicine Guidelines for postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses the specific cultural and environmental challenges faced by low-income Hispanic women. Assessments will be conducted at enrollment, and at 6-weeks, 6-months, and 12-months postpartum by trained bicultural and bilingual personnel blinded to the intervention arm. Efficacy will be assessed via postpartum weight loss and biomarkers of insulin resistance and cardiovascular risk. Changes in physical activity and diet will be measured via 7-day actigraph data and three unannounced 24-hour dietary recalls at each assessment time period. Discussion Hispanic women are the fastest growing minority group in the U.S. and have the highest rates of sedentary behavior and postpartum diabetes after a diagnosis of GDM. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations. Trial registration NCT0167921

Incommensurable worldviews? Is public use of complementary and alternative medicines incompatible with support for science and conventional medicine?

Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, ?conventional? medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research

The high-velocity clouds and the Magellanic Clouds

From an analysis of the sky and velocity distributions of the high-velocity clouds (HVCs) we show that the majority of the HVCs has a common origin. We conclude that the HVCs surround the Galaxy, forming a metacloud of 300 kpc in size and with a mass of 3 10^9 M_sun, and that they are the product of a powerful ``superwind'' (about 10^58 ergs), which occurred in the Magellanic Clouds about 570 Myr ago as a consequence of the interaction of the Large and Small Magellanic Clouds. The HVCs might be magnetic bubbles of semi-ionized gas, blown from the Magellanic Clouds around 570 Myr ago, that circulate largely through the halo of the Galaxy as a stream or flow of gas.Comment: 28 pages with 23 figure

The individual experience of ageing prisoners: systematic review and meta-synthesis through a Good Lives Model framework

Objective: The existing literature on ageing prisoners tends to focus on such aspects as diagnosis and physical ill-health. In contrast, the experience of imprisonment from the perspective of ageing prisoners has received less attention. Grounded in a Good Lives Model theoretical framework, we reviewed and meta-synthesised literature around their experience of life in prison, its impact on their wellbeing and how prison services are currently addressing their complex needs. We further identify potential areas of improvement. Methods: 1. Systematic search on Assia, PsycInfo, MedLine, Embase, Web of Science, Google and Gov.uk. 2. Extraction and categorisation of data on NVivo. 3. Development of themes through thematic analysis and meta-synthesis. 4. Identification of potential areas of improvement. Results: We selected 25 studies for our review, of which thirteen were from the USA, seven from the UK, two from Australia and one each from Ireland, Switzerland and Israel. We identified three themes: The hardship of imprisonment, addressing health and social care needs, and the route out of prison. Conclusions: Ageing prisoners have unique and complex health and social care needs which, to varying degree across different countries, are mostly unmet. Promising initiatives to address their needs are emerging but, at present time, the overall experience of incarceration for the ageing prisoner is quite poor, given the inconsistent physical, emotional and social care support offered from prison intake to release and beyond