Feasibility of mHealth technology use among a sample of isolated rural men at high risk for cardiovascular disease

Purpose/Hypothesis: Isolated rural men are considered a health disparities group at high risk for cardiovascular disease. The increasing availability of technologies for self-monitoring for healthy eating, activity and weight loss (ie mHealth) may show promise for engaging rural men in lifestyle modification. This study investigated the feasibility of men from rural isolated areas to use a fitness monitor with text messaging support over a 3- week period. The study examined the men’s daily monitor use for tracking activity and eating, and assessed via written survey, their perspectives about mHealth. Number of Subjects: Twelve men, ages 40 to 69, from a US Department of Agriculture defined isolated rural area, participated. These men were a purposive sample originally recruited to participate in a focus group about their perceptions of the utility of mHealth. The men (50.9 6 8.6 yrs) had a baseline BMI of 25 to 44 kg/m2 (34.8 6 6.6 kg/m2). Eligibility included having cell/smartphones capable of sending/ receiving text messages, access to a computer, willing to use a fitness monitor and have research personnel access the men’s logs. Materials/Methods: Men participated in 2 visits at a community center located within 70 miles of their residence, at baseline and 3 weeks. Assessments included baseline health histories and vital sign biomarkers. The men received training using the fitness monitor with supporting technologies (cell/ smartphone and computer) and were asked to wear the monitor daily for 3 weeks. Men received 1–3 text messages/day for 3 weeks for reminders, education and motivation for self-monitoring. At visit 2, men completed post-intervention surveys about their fitness monitoring. Descriptive data were used for analysis. Results: Men were overweight (n 5 3) or obese (n 5 9) and most (9/12) were hypertensive with only four being treated with medications. One man was hypertensive stage 2 under no treatment and another was pre-hypertensive. Nine of 12 men wore the monitor during all 21 days, two wore it 9 and 15 days respectively and one lost the monitor. Survey data of the 12 men revealed seven checking their step count more than 5 times/day, 6 reported using the associated smart phone app and seven used the optional sleep log feature. Eleven of 12 men manually entered food into the log and most (9/12) did this on $15 days. Ten men indicated the log was helpful in learning about eating; though only 3 indicated it was easy to log food. All men reported reading reminder and motivational text messages sent during the study and 11 plan to continue using the fitness monitor. Conclusions: Men were not well managed for blood pressure or overweight/obesity. Both the log records and the survey results indicated that using fitness monitors was feasible and acceptable among this population. Clinical Relevance: Using mHealth appears feasible as an action-oriented tool for therapists to recommend for lifestyle self-monitoring in isolated rural men. The findings reinforce the important role of therapists in routinely assessing vital signs and making referrals as appropriate

Nonlinear dynamics indicates aging affects variability during gait

Objective. To investigate the nature of variability present in time series generated from gait parameters of two different age groups via a nonlinear analysis. Design. Measures of nonlinear dynamics were used to compare kinematic parameters between elderly and young females. Background. Aging may lead to changes in motor variability during walking, which may explain the large incidence of falls in the elderly. Methods. Twenty females, 10 younger (20–37 yr) and 10 older (71–79 yr) walked on a treadmill for 30 consecutive gait cycles. Time series from selected kinematic parameters of the right lower extremity were analyzed using nonlinear dynamics. The largest Lyapunov exponent and the correlation dimension of all time series, and the largest Lyapunov exponent of the original time series surrogated were calculated. Standard deviations and coefficient of variations were also calculated for selected discrete points from each gait cycle. Independent t-tests were used for statistical comparisons. Results. The Lyapunov exponents were found to be significantly different from their surrogate counterparts. This indicates that the fluctuations observed in the time series may reflect deterministic processes by the neuromuscular system. The elderly exhibited significantly larger Lyapunov exponents and correlation dimensions for all parameters evaluated indicating local instability. The linear measures indicated that the elderly demonstrated significantly higher variability. Conclusions. The nonlinear analysis revealed that fluctuations in the time series of certain gait parameters are not random but display a deterministic behavior. This behavior may degrade with physiologic aging resulting in local instability. Relevance Elderly show increased local instability or inability to compensate to the natural stride-to-stride variations present during locomotion. We hypothesized that this may be the one of the reasons for the increases in falling due to aging. Future efforts should attempt to evaluate this hypothesis by making comparisons to pathological subjects (i.e. elderly fallers), and examine the sensitivity and specificity of the nonlinear methods used in this study to aid clinical assessment

Obesity and Physical Function in Rural Women who enroll in a Lifestyle Modification Intervention for Reducing Blood Pressure

Purpose: Rural women have high prevalence of obesity and prehypertension. Obesity, if associated with poor physical function, may have implications for applying activity guidelines for women volunteering for lifestyle modification. This study examined associations of body mass index (BMI) and percent body fat with measures of 1-mile walk time, post-walk perceived exertion, and 10-repetition chair stands in rural women ages 40-69. Methods: Cross-sectional baseline data were collected using standardized methods from 289 rural women with prehypertension who volunteered for a lifestyle clinical trial for reducing blood pressure. ANOVAs and linear regression were used for analysis. Results: With exception of the chair stands measure across categories of BMI, group differences were noted in all measures across categories of BMI and percent body fat, with women in the two highest categories demonstrating the poorest performance. These two body composition measures were significant predictors for 1-mile walk-time and 10-repetition chair stands, after controlling for confounding variables. Conclusions: Poorer scores were observed in performance-based measures in women with higher BMI and percent body fat, though mean scores were above thresholds for functional limitation. Physical performance needs to be assessed and addressed by physical therapists when providing lifestyle interventions for overweight and obese women

Clinical trial of tailored activity and eating newsletters with older rural women.

BACKGROUND: Unhealthy diet and lack of physical activity increase rural midlife and older women\u27s risk of chronic diseases and premature death, and they are behind urban residents in meeting Healthy People 2010 objectives. OBJECTIVES: The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity and healthy eating among rural women. METHODS: In a randomized-by-site, community-based, controlled, clinical trial, Wellness for Women, 225 women aged 50 to 69 years were recruited in two similar rural areas. Over 12 months, women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions (benefits, barriers, self-efficacy, and interpersonal support), activity, and eating. Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed by repeated-measures analysis of variance and chi-square tests (alpha \u3c .05). RESULTS: Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat, whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months. Both groups increased stretching and strengthening exercise, whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months. Both groups had several changes in biomarkers over the study. A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity, fruit and vegetable servings, and percentage of calories from fat at 12 months. DISCUSSION: Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months. Tailored newsletters were more efficacious in facilitating change over 12 months

The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women\u27s healthy eating.

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N = 225) between the ages of 50-69 in rural Nebraska, U.S.A., were recruited. A repeated-measures experimental design was used with randomization of two rural counties to intervention (tailored newsletter) or comparison (standard newsletter) groups. Eating behavior was measured by the Healthy Eating Index. The predictor variables were assessed using standard measures. Data analysis was done using latent growth curve modeling. The tailored newsletter group was successful in improving their healthy eating behavior compared to the standard newsletter group during the one-year intervention, at the end of the intervention, and during the follow-up phase. Family support at the end of the intervention was positively associated with healthy eating at the end of the intervention. Perceived barriers had the strongest impact on healthy eating behavior at all time points. Compared to participants in the standard newsletter group, those in the tailored newsletter group perceived more family support and fewer barriers for healthy eating at the end of the intervention (mediation effects). Based on these findings, both family support and perceived barriers should be central components of interventions focused on healthy eating behavior in rural midlife and older women

The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women\u27s healthy eating

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N ¼ 225) between the ages of 50e69 in rural Nebraska, U.S.A., were recruited. A repeated-measures experimental design was used with randomization of two rural counties to intervention (tailored newsletter) or comparison (standard newsletter) groups. Eating behavior was measured by the Healthy Eating Index. The predictor variables were assessed using standard measures. Data analysis was done using latent growth curve modeling. The tailored newsletter group was successful in improving their healthy eating behavior compared to the standard newsletter group during the one-year intervention, at the end of the intervention, and during the follow-up phase. Family support at the end of the intervention was positively associated with healthy eating at the end of the intervention. Perceived barriers had the strongest impact on healthy eating behavior at all time points. Compared to participants in the standard newsletter group, those in the tailored newsletter group perceived more family support and fewer barriers for healthy eating at the end of the intervention (mediation effects). Based on these findings, both family support and perceived barriers should be central components of interventions focused on healthy eating behavior in rural midlife and older women

Quenched QCD at finite density

Simulations of quenched $QCD$ at relatively small but {\it nonzero} chemical potential $\mu$ on $32 \times 16^3$ lattices indicate that the nucleon screening mass decreases linearly as $\mu$ increases predicting a critical chemical potential of one third the nucleon mass, $m_N/3$, by extrapolation. The meson spectrum does not change as $\mu$ increases over the same range, from zero to $m_\pi/2$. Past studies of quenched lattice QCD have suggested that there is phase transition at $\mu = m_\pi/2$. We provide alternative explanations for these results, and find a number of technical reasons why standard lattice simulation techniques suffer from greatly enhanced fluctuations and finite size effects for $\mu$ ranging from $m_\pi/2$ to $m_N/3$. We find evidence for such problems in our simulations, and suggest that they can be surmounted by improved measurement techniques.Comment: 23 pages, Revte