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

The Influence of Exercise Dose, Exercise Intensity, and Weight Loss and Change in C-Reactive Protein in Sedentary Overweight Women

Objective: To examine the effect physical activity included in a weight loss program has on high sensitivity C-reactive protein (hs-CRP) levels in sedentary overweight women. Design, Setting, and Participants: This study examined the change in hs-CRP in overweight and obese women in response to a 6 month behavioral weight loss program. The parent study was a randomized trial involving 201 sedentary overweight women who participated in a weight control program, with data from 182 subjects available for this secondary analysis. Methods: Participants were randomly assigned to 1 of 4 exercise groups based on energy expenditure (1000kcal/week or 2000 kcal/week) and intensity (vigorous vs. moderate). Groups included: vigorous intensity/high dose; vigorous intensity/moderate dose; moderate intensity/moderate dose; and moderate intensity/high dose. Participants were prescribed an energy restricted diet consisting of 1200 kcal/day or 1500 kcal/day and daily dietary fat intake between 20%-30% of total energy intake. Results: There were no statistically significant differences between dose of exercise, moderate vs. high, (F=0.330, p=0.58) or level of intensity, moderate vs. vigorous (F=0.118, p=0.731) for change in hs-CRP. However, there was a significant decrease in hs-CRP from baseline to 6 months (F=25.553, p<0.0004); there was a significant 3 way interaction between energy expenditure, intensity, and Pre/Post differences (F=4.035, p=0.035), post hoc analysis revealed a significant decrease in hs-CRP in the moderate/high (p<0.0004) and vigorous/moderate groups (p=004). The results were unchanged after controlling for the change in body weight, body fatness, or body distribution. The change in hs-CRP was not significantly correlated with the change in body weight, percent body fat, waist circumference, or self-reported physical activity. hs-CRP at 6 months was correlated with 6 month measures of weight, BMI, percent body fat, and fat distribution (p<0.0004). Conclusions: hs-CRP was reduced in overweight and obese women in response to a 6 month weight loss intervention that included a prescribed reduction in energy intake and a prescribed increase in exercise with a significant reduction in the moderate intensity/high dose and vigorous intensity/moderate dose groups. Further research is needed to determine what effect exercise and or weight loss may have on markers of inflammation

Comparing Energy Expenditure During Land and Shallow Water Walking in Overweight and Obese Females

Introduction: The prevalence of overweight and obesity in the United States has reached epidemic levels. Reduction in body weight is of great importance for overweight and obese individuals through the increase in physical activity. One particular mode of physical activity that is currently growing in popularity is shallow water walking, although little research has been done examining the energy cost of this activity in an overweight and obese population. Purpose: To compare the energy expenditure (kcal/min) and rating of perceived exertion (RPE) of a bout shallow water walking at a self-selected pace to a bout of land walking at a matched heart rate response and to a bout of land walking at a self-selected pace in overweight and obese women. Methods: Nineteen participants completed three 10-minute experimental trials including a self-selected pace shallow water walking trial, a matched heart rate response land walking trial, and a self-selected pace land walking trial. Results: Significantly lower energy expenditure (p= 0.046) was observed for shallow water walking (6.46 ± 1.38 kcal/min) compared to the matched heart rate response land walking bout (7.26 ± 1.29 kcal/min), although no significant differences were detected for energy expenditure for shallow water walking and self-selected pace land walking (6.92 ± 1.61 kcal/min). No significant differences were detected for RPE across conditions (p=0.439). Exploratory analyses revealed correlations between measures of body composition (BMI and percent body fat) and the difference in energy expenditure between shallow water walking and matched heart rate response land walking. Conclusions: Findings from the current study suggest that although producing energy expenditure compared to heart rate matched land walking, shallow water walking is a viable alternative that can elicit and increase in energy expenditure performed at a moderate intensity, meeting ACSM criteria. Results of the exploratory analyses revealed an association between measures of body composition and differences in energy expenditure. Although only a limited number of participants of the present study had BMI’s above 35.0 kg/m2 (n=2), findings suggest that water exercise may be an alternative form of exercise and produce higher caloric expenditure at higher ranges of BMI and percent body fat

Energy Cost of Land and Shallow Water Walking in Females who are Overweight and Obese

Nineteen overweight or obese females completed three 10-minute experimental trials including a self-selected pace shallow water walking trial, a matched heart rate response land walking trial, and a self-selected pace land walking trial. Energy expenditure (kcal·min-1)was computed from expired gases assessed via indirect calorimetry. Results showed energy expenditure was lower (p= 0.046) during shallow water walking (6.46 ± 1.38 kcal·min-1) compared to matched heart rate response land walking trial (7.26 ± 1.29 kcal·min-1), with no significant difference in between shallow water and self-selected pace land walking (6.92 ± 1.61 kcal·min-1). The present study did not demonstrate superior energy cost of shallow water walking. However, results demonstrate that shallow water walking elicits an increase in energy expenditure, which may indicate that this form of activity is a reasonable alternative to land-based walking. Moreover, this form of activity may be particularly effective for individuals with mobility limitations during land-based exercise

Energy Cost of Land and Shallow Water Walking in Females who are Overweight and Obese

Nineteen overweight or obese females completed three 10-minute experimental trials including a self-selected pace shallow water walking trial, a matched heart rate response land walking trial, and a self-selected pace land walking trial. Energy expenditure (kcal·min-1) was computed from expired gases assessed via indirect calorimetry. Results showed energy expenditure was lower (p= 0.046) during shallow water walking (6.46 ± 1.38 kcal·min-1) compared to matched heart rate response land walking trial (7.26 ± 1.29 kcal·min-1), with no significant difference in between shallow water and self-selected pace land walking (6.92 ± 1.61 kcal·min-1 ). The present study did not demonstrate superior energy cost of shallow water walking. However, results demonstrate that shallow water walking elicits an increase in energy expenditure, which may indicate that this form of activity is a reasonable alternative to land-based walking. Moreover, this form of activity may be particularly effective for individuals with mobility limitations during land-based exercise

The influence of exercise and BMI on injuries and illnesses in overweight and obese adults: a randomized control trial

BACKGROUND: Medically treated injuries have been shown to increase with increasing body mass index (BMI). Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs. METHODS: Sedentary adults with BMIs between 25 and 40 kg/m(2 )(n = 397) enrolled in one of two randomized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program. Interventions differed by duration of the exercise goal (150, 200, or 300 minutes/week or control group). Walking was prescribed as the primary mode of exercise. At six month intervals, participants were asked, "During the past six months, did you have any injury or illness that affected your ability to exercise?" Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise. RESULTS: During the 18-month study, 46% reported at least one injury/illness, and 32% reported at least one injury that was attributed to exercise. Lower-body musculoskeletal injuries (21%) were the most commonly reported injury followed by cold/flu/respiratory infections (18%) and back pain/injury (10%). Knee injuries comprised one-third of the lower-body musculoskeletal injuries. Only 7% of the injuries were attributed to exercise alone, and 59% of the injuries did not involve exercise. BMI (p ≤ 0.01) but not exercise (p ≥ 0.41) was significantly associated with time to first injury and injuries over time. Participants with higher BMIs were injured earlier or had increased odds of injury over time than participants with lower BMIs. Due to the linear dose-response relationship between BMI and injury/illness, any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness. CONCLUSIONS: Overweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults randomized not to participate in prescribed exercise. Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI, weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults. TRIAL REGISTRATION: Clinicaltrials.gov NCT00177502 and NCT0017747

Energy Expenditure and Enjoyment of Active Television Viewing

International Journal of Exercise Science 9(1): 64-76, 2016. This study examined energy expenditure and enjoyment during sedentary television viewing (SED-TV), stepping in place during television commercials (COMM-TV), and physical activity prompted by common character phrases/mannerisms within a television program (PA-TV). Adults (N=38, age: 27.0±8.0 years, BMI: 25.4±4.2 kg/m2) completed three 30-minute sessions in random order: SED-TV, COMM-TV, and PA-TV. Energy expenditure and heart rate were assessed during each session. Enjoyment was assessed after the initial experimental session and at completion of the study. Energy expenditure was greater in the active versus sedentary sessions (COMM-TV vs SED-TV: difference = 32.7±1.9 kcal, p3.0 METS was lower in SED-TV (median = 0 minutes) compared to COMM-TV [median = 4.0 minutes (Inter-Quartile Range: 0.8, 7.3)] (p50% of age-predicted maximal heart rate. Both COMM-TV and PA-TV were reported to be significantly more enjoyable than SED-TV. COMM-TV and PA-TV resulted in higher energy expenditure, more minutes of moderate intensity physical activity, and higher reported enjoyment compared to SED-TV. These findings have implications for reducing sedentary time during television viewing, which may impact health-related outcomes. Intervention trials are warranted to determine the effectiveness of these strategies

Pilot Feasibility Study of a Campaign Intervention for Weight Loss among Overweight and Obese Adults

Background: Behavioral interventions produce significant short-term weight loss. However, these interventions typically require regular in-person sessions, which may not be feasible for all individuals. Purpose: The purpose of this pilot study was to evaluate the feasibility of a 12-week campaign intervention (CI) compared to a standard on-site, group-based behavioral weight loss intervention (SBWL) among overweight/obese adults. Methods: SBWL participants (n=13; age: 42.5 ± 9.1 years; BMI: 33.4 ± 3.8 kg/m²) attended weekly group meetings, were prescribed a daily reduced caloric goal and 200 minutes of moderate-intensity physical activity per week. CI participants (n=13; age: 43.8 ± 9.0 years; BMI: 33.2 ± 3.8 kg/m²) received the same recommendations as the SBWL, attended in-person group meetings at weeks 0 and 12, and received e-mail messages weeks 2-11. Additional CI features included a thematic framework and an incentive-based point system targeting behavioral goals. Results: Significant weight loss was demonstrated for intention-to-treat (SBWL: -5.6 ± 2.9 kg; CI: -3.1 ± 3.4 kg) (

Effects of a Combined Aquatic Exercise and Walking in Sedentary Obese Females Undergoing a Behavioral Weight-Loss Intervention

Background: The effects of the non-weight bearing method of aquatic exercise as a modality for weight loss have not been established. The purpose of this study was to examine the effects of a combined aquatic exercise and walking program compared to walking alone on body weight and selected variables in obese females undergoing a 16-week Standard Behavioral Treatment (SBT) program. Methods: Forty-four obese (BMI 34.9 ± 3.8 kg·m2) sedentary women (age=40.3 years ± 6.8 yrs) were randomly assigned to either an aquatic exercise (AE) group or a traditional walking (W) exercise only group. Both groups were also required to complete 3 sessions of home based walking per week, and reduce energy intake to facilitate weight loss. Results: In the AE group, total body weight, cardiorespiratory fitness, flexibility, strength, and health-related quality of life outcomes significantly improved over time similar to the W group. Significantly greater enjoyment scores also occurred in the AE group. Conclusion: Aquatic exercise in combination with walking can serve as an alternative to walking exercise alone for overweight women during periods of weight loss, and this can improve functional health status

Change in Circulating Klotho in Response to Weight Loss, with and without Exercise, in Adults with Overweight or Obesity

The increased risk in aging-related comorbidities associated with obesity is a significant public health concern. Weight loss via lifestyle intervention has been shown to improve negative health outcomes; however, the mechanistic pathway by which this occurs is unknown. One biomarker of importance is Klotho, with higher levels being associated with slower aging processes. Evidence has shown Klotho to be lower in obese adults compared to normal-weight adults. Exercise may independently increase levels of Klotho; however, whether the effects on Klotho are enhanced when exercise is included within the context of a weight loss intervention is not understood. Purpose: The primary aim was to examine changes in Klotho concentration in response to a behavioral weight loss intervention, by intervention condition, and weight loss response. Methods: Three hundred and eighty-three overweight and obese adults (age: 45.0+7.9 years; BMI: 32.4+3.8 kg/m2) were randomized to DIET, DIET+PA150, and DIET+PA250. One hundred fifty-two of 383 participants provided blood samples at all time points, and were classified as “responder” or “non-responder” for this study. The intervention contained a prescribed calorie restricted diet (1200-1800 kcal/day) and increased physical activity (0-, 150-, 250 min/week). Intervention groups attended weekly in-person group sessions for months 1-6, with combined in-person and telephonic sessions for months 7-12. Results: Participants had significant reductions in weight, BMI, and body composition, and increased cardiorespiratory fitness across the 12-month intervention. Klotho concentration also significantly, increased across the 12-month behavioral weight loss intervention (p=0.010); however, there was no difference by intervention group or weight loss response. Although non-significant, participants who performed physical activity had greater changes in Klotho concentration across the 12-month intervention. Further, Klotho concentration was found to be inversely associated with lean body mass (p=0.021). Conclusion: This study provides evidence within the context of a weight loss intervention, that Klotho concentration significantly, but modestly, increases with weight loss. However, despite sustained weight loss, this increase in Klotho was not sustained throughout the intervention. Results do not support weight loss drive Klotho response. However, non-significant results support physical activity to influence Klotho, within the context of obesity and weight loss. Further investigation to examine how weight loss and physical activity may alter biomarkers of aging in adults with obesity is warranted