Examination of Resistance Settings Based on Body Weight for the 3-Minute All-Out Critical Power Test

International Journal of Exercise Science 11(4): 585-597, 2018. There are conflicting suggestions regarding the most valid resistance (3-5% of body weight) to use for the critical power (CP) 3-min all-out (CP3min) test to estimate CP and anaerobic work capacity (AWC). The purpose of this study was to determine if the CP and AWC estimates from the CP3min test were affected by the percentage of body weight used to set the resistance on a Monark cycle ergometer. Ten recreationally trained participants (mean ± SD: Age: 22.2 ± 2.2 yrs.) completed the CP3min test at resistances of 4.5% (CP4.5%) and 3% (CP3%) of body weight to determine the CP and AWC. There were no significant differences between the CP4.5% (167 ± 34 W) and CP3% (156 ± 36 W) estimates. The AWC3% (5.6 ± 2.5 kJ) estimates were significantly lower than the AWC4.5% (9.0 ± 4.0 kJ).The CP and AWC estimates from the CP4.5% were consistent with values reported in the literature, however, the AWC estimate from the CP3% was lower than typically reported. These findings suggested that a resistance set at 3% of body weight for the CP3min test may be too low to accurately estimate AWC, but 3% and 4.5% resulted in the same estimation of CP. Thus, the principal finding of this study was that a resistance of 4.5% of body weight for CP3-min in recreationally trained participants resulted in more accurate estimates of AWC, compared to a resistance of 3%, and supports the use of 4.5% body weight resistance to measure both CP and AWC

Predictors of Arterial Stiffness in Law Enforcement Officers

Background: Compare arterial stiffness among law enforcement officers (LEOs) versus general population normative values and identify predictors of arterial stiffness in LEOs. Methods: Seventy male LEOs (age: 24–54 years) completed body composition, blood pressures, physical activity level, and carotid-femoral pulse wave velocity (cfPWV) measurements. T-tests and regression analyses were utilized to compare LEO data to normative data and predict cfPWV, respectively. Results: Compared to similar age strata within the general population, cfPWV was lower among LEO’s under 30-years (mean difference = −0.6 m·s−1), but higher among LEOs 50–55-years (mean difference = 1.1 m·s−1). Utilizing regression, age, relative body fat, and diastolic blood pressure explained the greatest variance in LEO’s cfPWV (adj. R2 = 0.56, p \u3c 0.001). Conclusion: This investigation demonstrated that arterial stiffness may progress more rapidly in LEOs and LEOs’ relative body fat and blood pressure may primarily affect arterial stiffness and risk of CVD

Adapting the AHA’s Blood Pressure and Nutrition Management Program into Digestible Teaching Plans for Low-Income Communities

Executive Summary: Adapting the AHA’s blood pressure and nutrition management program into digestible teaching plans for low-income communities According to the American Heart Association (AHA), 46% of American adults have high blood pressure (Whelton et al., 2017). High blood pressure, especially for those above the age of 50, is associated with a higher prevalence of heart disease and a shorter life expectancy. The AHA’s Check Change Control program (CCC), is an evidence based, self-directed blood pressure management guide (American Heart Association, 2021). The CCC program incorporates four lesson topics related to lifestyle changes to manage hypertension. The four topics are: self-monitoring of blood pressure, healthy eating and reducing sodium, exercise, and stress management. Our group’s mission focused on creating educational plans on the first two topics, self-monitoring of blood pressure and healthy eating. Our goal was to provide future educators at an independent senior living facility with a condensed framework of the CCC program that would be more easily understood for an older adult population. Background For our project, we worked alongside a nonprofit organization that provided sustainable housing and services for seniors and families. Our group consisted of eight quarter-five Seattle Pacific University (SPU) nursing students working with a representative from the AHA, our clinical instructor, and a representative from the site to create an educational plan based on a needs assessment of the community. Our primary community was an independent living facility for low-income older adults located south of Seattle, Washington. Based on prior assessments by the community management and AHA, they found a knowledge deficit in blood pressure management and understanding of nutrition. In our site assessments we validated these needs. Residents had limited knowledge of the importance of blood pressure management, had no way to self-monitor, and had limited access to healthy food options. Representatives of the food pantry reported that they had no consistent supplies, relying on internal donations. The pantry consisted primarily of high-sodium prepackaged foods like instant noodles and canned beans. A new addition to the community was a garden; but, for the autumn and winter, fresh vegetables were scarce. In our review of the AHA’s CCC program, we found barriers to its implementation. The document itself was wholly online and utilized many hyperlinks, PowerPoints, and videos. For low-income adults with limited knowledge or access to technology, this program was found to be hard to access by themselves. The complex modules the AHA had prepared were difficult for the residents of the community to use and understand due to the sheer size and depth of the content. For future SPU students who would be implementing the education, the length and depth of the program were also much larger than what was possible to cover within a regular ten-week school quarter. Our group worked to reduce these barriers by condensing the material into weekly teaching activities. Activities We generated a lesson outline to target two main areas of concern within the community as determined by site assessments: blood pressure management, and nutrition, for use by future SPU students. From the CCC program, we curated a five-week outline for nursing students or similar educators to implement over the course of a ten-week school quarter. The first two weeks we focused on blood pressure management, and the second two weeks on nutrition, with a flexible fifth week for review, open activity, or a separate teaching topic. The first week’s topic was blood pressure literacy, measurements, and tracking. This included a review of what blood pressure is, the importance of monitoring, an open discussion of barriers to monitoring, how to accurately check and analyze the readings, and physically getting their blood pressure taken by the educators. The second week’s topic was medications and adherence. The education plan included for students to have a brief check in and review of the content from the previous week, and hold information sessions on specific medications. These information sessions would be private and personalized by being held in a one-on-one manner. The education plan also focuses on identifying potential struggles, assessing a lack of education on their medications such as indications, symptoms, and management, as well as reinforcing adherence. The third week’s topic was nutritional literacy. The education plan includes having students assess the residents’ understanding of what a healthy diet consists of, and then they would provide education on sodium intake with a demonstration of serving sizes. The focus of the fourth week was healthy nutrition options. The education plan included having residents create meals with provided food pages and discuss their choices. The fifth week’s topic would be a flex week, where students and/or residents would pick a topic based on their own community needs assessments. The activities in the education plan include different styles of engagement, including lecture, presentations, PowerPoints, videos, hands-on activities, games, surveys, one-on-one sessions and open discussions, and distribution of educational materials and resources to monitor health effectively. We also have incorporated a weekly survey to assess the effectiveness of our project goals. Outcomes Our project was based on goals and topics organized by facility leadership in collaboration with the AHA. We were tasked with creating teaching materials and educational plans for future SPU Nursing Students to teach the residents during their clinicals. Our lesson outline was provided to agency staff in order to ensure the success of the project goals. Evaluation surveys was provided to the students in the implementation document to allow the students to have sources to use to assess the effectiveness of the teaching plan, activities, and resources. Based on survey responses, adjustments, a weekly focus could be made. Further evaluation of the effectiveness of our plan would be overseen by the AHA representative. For this project we have created a lesson outline at the request of the community manager, using AHA resources along with the assessments by the site management and by our group. This was done in order to aid future SPU Nursing Students in the implementation of our lesson plans for the community. Future nursing students will continue to gather and add information based on their own observations and experiences to ensure the continuity of this project and the health outcomes of the focused community. References American Heart Association (2021) Check. Change. Control. check-change-control-implementation-guide.pdf (heart.org) Whelton, P. K., Carey, R.M., Aronow, W.S., Casey, D.E., Jr., Collins, K.J., Himmelfarb Dennison, C., DePalma, S.M., Gidding, S., Jamerson, K.A., Jones, D.W., MacLaughlin, E.J., Muntner, P., Ovbiagele, B., Smith, S.C., Jr., Spencer, C.C., Stafford, R.S., Taler, S.J., Thomas, R.J., Williams, K.A., Sr., … Wright, J.T., Jr. (2017). ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.000000000000006

Are Ethnic and Gender Specific Equations Needed to Derive Fat Free Mass from Bioelectrical Impedance in Children of South Asian, Black African-Caribbean and White European Origin? Results of the Assessment of Body Composition in Children Study

Background Bioelectrical impedance analysis (BIA) is a potentially valuable method for assessing lean mass and body fat levels in children from different ethnic groups. We examined the need for ethnic- and gender-specific equations for estimating fat free mass (FFM) from BIA in children from different ethnic groups and examined their effects on the assessment of ethnic differences in body fat. Methods Cross-sectional study of children aged 8–10 years in London Primary schools including 325 South Asians, 250 black African-Caribbeans and 289 white Europeans with measurements of height, weight and arm-leg impedance (Z; Bodystat 1500). Total body water was estimated from deuterium dilution and converted to FFM. Multilevel models were used to derive three types of equation {A: FFM = linear combination(height+weight+Z); B: FFM = linear combination(height2/Z); C: FFM = linear combination(height2/Z+weight)}. Results Ethnicity and gender were important predictors of FFM and improved model fit in all equations. The models of best fit were ethnicity and gender specific versions of equation A, followed by equation C; these provided accurate assessments of ethnic differences in FFM and FM. In contrast, the use of generic equations led to underestimation of both the negative South Asian-white European FFM difference and the positive black African-Caribbean-white European FFM difference (by 0.53 kg and by 0.73 kg respectively for equation A). The use of generic equations underestimated the positive South Asian-white European difference in fat mass (FM) and overestimated the positive black African-Caribbean-white European difference in FM (by 4.7% and 10.1% respectively for equation A). Consistent results were observed when the equations were applied to a large external data set. Conclusions Ethnic- and gender-specific equations for predicting FFM from BIA provide better estimates of ethnic differences in FFM and FM in children, while generic equations can misrepresent these ethnic differences

GH peak response to GHRH-arginine: relationship to insulin resistance and other cardiovascular risk factors in a population of adults aged 50–90

OBJECTIVE: To assess the GH response to GHRH-arginine in apparently healthy adults in relation to cardiovascular risk factors. DESIGN: Cross-sectional. PATIENTS: Eighty-six male and female volunteers aged 50–90. MEASUREMENTS: GH peak response to GHRH-arginine and cardiovascular risk factors, including obesity, insulin resistance, low levels of high density lipoprotein (HDL) cholesterol, elevated triglycerides, and hypertension. The primary outcome measurement was GH response to GHRH-arginine. The relationship between GH peak responses and cardiovascular risk factors was determined after data collection. RESULTS: GH peaks were highly variable, ranging from 2·3 to 185 µg/l (14% with GH peaks < 9 µg/l). An increasing number of cardiovascular risk factors were associated with a lower mean GH peak (P < 0·0001). By univariate analysis, fasting glucose, insulin, body mass index (BMI), HDL cholesterol and triglycerides were significantly associated with GH peak (all P < 0·0001). Multiple regression analysis revealed that fasting glucose, fasting insulin, BMI, triglycerides and sex accounted for 54% of GH peak variability. The role of abdominal fat as it relates to GH peak was explored in a subset of 45 subjects. Trunk fat and abdominal subregion fat measured by dual energy X-ray absorptiometry (DXA) were inversely related to GH peak (P < 0·008 and 0·001, respectively). Analysis of this subgroup by multiple regression revealed that subregion abdominal fat became the significant obesity-related determinant of GH peak, but still lagged behind fasting insulin and glucose. CONCLUSIONS: GH response to secretagogues was highly variable in apparently healthy adults aged 50–90 years. Peak GH was significantly related to fasting glucose, insulin, BMI, HDL cholesterol, triglycerides, trunk fat and abdominal subregion fat, with fasting glucose ranking first by multiple regression analysis. There was a strong relationship between cardiovascular risk factors and low GH, with individual risk factors being additive. Although these data do not differentiate between low GH being a cause or an effect of these cardiovascular risk factors, they indicate that the relationship between low GH and increased cardiovascular risk may be physiologically important in the absence of pituitary disease

Effects of Growth Hormone and Pioglitazone in Viscerally Obese Adults with Impaired Glucose Tolerance: A Factorial Clinical Trial

OBJECTIVE: Recombinant human growth hormone (GH) and pioglitazone (PIO) in abdominally obese adults with impaired glucose tolerance were evaluated under the hypothesis that the combination attenuates GH-induced increases in glucose concentrations, reduces visceral adipose tissue (VAT), and improves insulin sensitivity over time. DESIGN: Randomized, double-blind, placebo-controlled, 2 × 2 factorial design. SETTING: Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States. PARTICIPANTS: 62 abdominally obese adults aged 40–75 with impaired glucose tolerance. INTERVENTIONS: GH (8 μg/kg/d, or placebo) and pioglitazone (30 mg/d, or placebo) for 40 wk. OUTCOME MEASURES: Baseline and after 40 wk of treatment, VAT content was quantified by CT scan, glucose tolerance was assessed using a 75-g oral glucose tolerance test, and insulin sensitivity was measured using steady-state plasma glucose levels obtained during insulin suppression test. RESULTS: Baseline: body mass index (BMI), plasma glucose, and visceral fat content were similar. 40 wk: visceral fat area declined 23.9 ± 7.4 cm(2) in GH group, mean difference from placebo: −28.1 cm(2) (95% CI −49.9 to −6.3 cm(2); p = 0.02). Insulin resistance declined 52 ± 11.8 mg/dl with PIO, mean difference from placebo of −58.8 mg/dl (95% CI −99.7 to −18.0 mg/dl; p = 0.01). VAT and SSPG declined with GH and PIO combined, mean differences from placebo of −31.4 cm(2) (95% CI −56.5 cm(2) to −6.3 cm(2); p = 0.02) and −55.3 mg/dl (95% CI −103.9 to −6.7 mg/dl; p = 0.02), respectively. Fasting plasma glucose increased transiently in GH group. No significant changes in BMI were observed. CONCLUSIONS: Addition of PIO to GH attenuated the short-term diabetogenic effect of GH; the drug combination reduced VAT and insulin resistance over time. GH plus PIO may have added benefit on body composition and insulin sensitivity in the metabolic syndrome

Non-fasting High-Density Lipoprotein Is Associated With White Matter Microstructure in Healthy Older Adults

A growing body of evidence indicates that biomarkers of cardiovascular risk may be related to cerebral health. However, little is known about the role that non-fasting lipoproteins play in assessing age-related declines in a cerebral biomarker sensitive to vascular compromise, white matter (WM) microstructure. High-density lipoprotein cholesterol (HDL-C) is atheroprotective and low-density lipoprotein cholesterol (LDL-C) is a major atherogenic lipoprotein. This study explored the relationships between non-fasting levels of cholesterol and WM microstructure in healthy older adults. A voxelwise and region of interest approach was used to determine the relationship between cholesterol and fractional anisotropy (FA). Participants included 87 older adults between the ages of 59 and 77 (mean age = 65.5 years, SD = 3.9). Results indicated that higher HDL-C was associated with higher FA in diffuse regions of the brain when controlling for age, sex, and body mass index (BMI). HDL-C was also positively associated with FA in the corpus callosum and fornix. No relationship was observed between LDL-C and FA. Findings suggest that a modifiable lifestyle variable associated with cardiovascular health may help to preserve cerebral WM