The Dose-Response Association of Physical Activity and the Metabolic Syndrome Among U.S. Adults: NHANES 1999-2004

The purpose of this study was to evaluate the current prevalence of the metabolic syndrome with an emphasis on examining the relationship between leisure time physical activity (LTPA) and the metabolic syndrome in a nationally representative sample of the United States (U.S.) adult population within the 1999-2004 National Health and Nutrition Examination Survey (NHANES). The sample for this study included adults (N=5620), 20 years and older, who attended a mobile examination center (MEC) examination in the NHANES 1999-2004. The American Heart Association and National Heart, Lung, and Blood Institute (AHA/NHLBI) AHA/NHLBI definition was used to define the metabolic syndrome based on the results of a preliminary pilot study found in Appendix A. A metabolic syndrome risk score (MSRS), ranging from 0 to 5 was created to sum cardiovascular (CV) risk factors. Accumulating a MSRS ≥ 3 designated a metabolic syndrome diagnosis, a dependent variable within this study. Physical activity (PA) was measured in two ways; a six-level measure of MET·minutes per week, comprised of PA frequency, intensity, and duration and a three-level variable (no leisure-time physical activity (LTPA), insufficient LTPA, and an LTPA level equivalent to meeting the CDC/ACSM PA recommendation) associated with the current Centers for Disease Control and American College of Sports Medicine public health PA recommendation (CDC/ACSM). SUDAAN statistical software was used to estimate age-adjusted prevalence and logistic and multi-logistic odds risk ratios. The overall age-adjusted prevalence of the metabolic syndrome among the U.S. adult population was 36.3%. A significant difference was found for metabolic syndrome prevalence between those meeting the current public health PA recommendation (29.0%) and those reporting no LTPA (40.0%). Adults who acquired between 736.55 and 1360.15 MET·min·wk-1 of LTPA were found to be 35% (OR 0.65; 95% Cl 0.48-0.88) less likely to meet the AHA/NHLBI metabolic syndrome diagnosis criteria compared to those reporting no LTPA. A similar inverse association was found for an increasing the MSRS (OR 0.69; 95% Cl 0.56-0.85). The strength of this inverse association increased (OR 0.55; 95% Cl 0.42-0.71) when weekly LTPA MET·minutes reached \u3e1360.15 MET·min·wk-1. This inverse association was also found for an MSRS (OR 0.58; 95% Cl 0.48- 0.70) at this level of LTPA. These findings estimate one in three U. S. adults have the metabolic syndrome. This study consistently showed an inverse association between LTPA and metabolic syndrome risk. Furthermore, there appeared to be a stronger inverse association between metabolic syndrome and LTPA when LTPA volume was increased. However, this additional decrease in risk associated with increasing volumes of LTPA may likely revolve around improvements in body composition. Improvements in body composition associated with varying frequencies, intensities, and duration of PA may improve other components defining the metabolic syndrome (i.e. hypertension, obesity.) While this study is cross-sectional and causality cannot be inferred due to the nature of self-reported data, our findings do illustrate a strong inverse association for LTPA and the metabolic syndrome. Researchers can feel confident that if LTPA is measured using all three components (frequency, intensity, and duration) necessary to calculate MET·min·wk-1, that relationships with the metabolic syndrome and its individual defining criteria will be detected. These results support the need for future longitudinal studies and randomized control trials examining PA volume and metabolic syndrome risk

Differences in physical activity domains, guideline adherence, and weight history between metabolically healthy and metabolically abnormal obese adults: a cross-sectional study

BACKGROUND: Despite the accepted health consequences of obesity, emerging research suggests that a significant segment of adults with obesity are metabolically healthy (MHO). To date, MHO individuals have been shown to have higher levels of physical activity (PA), but little is known about the importance of PA domains or the influence of weight history compared to their metabolically abnormal (MAO) counterpart. OBJECTIVE: To evaluate the relationship between PA domains, PA guideline adherence, and weight history on MHO. METHODS: Pooled cycles of the National Health and Nutritional Examination Survey (NHANES) 1999–2006 (≥20 y; BMI ≥ 30 kg/m(2); N = 2,753) and harmonized criteria for metabolic syndrome (MetS) were used. Participants were categorized as “inactive” (no reported PA), “somewhat active” (>0 to < 500 metabolic equivalent (MET) min/week), and “active” (PA guideline adherence, ≥ 500 MET min/week) according to each domain of PA (total, recreational, transportation and household). Logistic and multinomial regressions were modelled for MHO and analyses were adjusted for age, sex, education, ethnicity, income, smoking and alcohol intake. RESULTS: Compared to MAO, MHO participants were younger, had lower BMI, and were more likely to be classified as active according to their total and recreational PA level. Based on total PA levels, individuals who were active had a 70 % greater likelihood of having the MHO phenotype (OR = 1.70, 95 % CI: 1.19–2.43); however, once stratified by age (20–44 y; 45–59 y; and; ≥60 y), the association remained significant only amongst those aged 45–59 y. Although moderate and vigorous PA were inconsistently related to MHO following adjustment for covariates, losing ≥30 kg in the last 10 y and not gaining ≥10 kg since age 25 y were significant predictors of MHO phenotype for all PA domains, even if adherence to the PA guidelines were not met. CONCLUSION: Although PA is associated with MHO, the beneficial effects of PA may be moderated by longer-term changes in weight. Longitudinal analysis of physical activity and weight change trajectories are necessary to isolate the contribution of duration of obesity, PA behaviours, and longer-term outcomes amongst MHO individuals

Physical activity, fear avoidance, and chronic non-specific pain: A narrative review

Background: Chronic non-specific pain (CNSP) and physical inactivity have become increasingly prevalent in the United States; however, the associations between the two remain unclear. The lack of clarity may be due to the presence of a third variable, the individual\u27s pain coping strategy. Objectives: We had three specific aims. 1) To review the associations between fear-avoidance beliefs and behaviors, and levels of physical activity and disability. 2) To review the theoretical mechanisms behind chronic non-specific pain and the potential mediating role of physical activity. 3) Finally, to report the most commonly recommended interventions for fear-avoidant individuals suffering with chronic pain. Conclusions: Further investigation is needed to fully understand the associations between physical activity, chronic non-specific pain, and fear avoidant beliefs and behaviors. Precise relationships notwithstanding, there is strong evidence to suggest that physical activity is an integral piece to the chronic non-specific pain puzzle. For this reason, it is incumbent upon clinicians to strongly recommend participation in regular, yet properly progressed, physical activity to chronic non-specific pain sufferers

Sleep duration and C-reactive protein in US adults

Objective To use gender-stratified logistic regression analysis to examine the associations between elevated C-reactive protein (CRP; \u3e3-10 mg/L) and sleep duration. Methods The study sample included male (n = 5033) and female (n = 4917) adult (20 years old and older) participants in the 2007-2010 National Health and Nutrition Examination Survey. Sleep duration was categorized as short (≤6 hours/day), adequate (7-8 hours/day), or long (≥9 hours/day). Logistic regression models were adjusted for age, race, smoking status, physical activity, and waist circumference. Results Analysis revealed significantly (P = 0.0151) higher odds of elevated CRP in men reporting ≤6 hours/day of sleep (odds ratio 1.26, 95% confidence interval 1.05-1.52) when compared with a referent group of men reporting 7 to 8 hours/day of sleep. Similar associations were not revealed in women. Conclusions Short sleep duration was significantly associated with elevated serum CRP concentration independent of waist circumference and moderate physical activity in men but not in women

Association between lifting weights and metabolic syndrome among u.s. adults: 1999-2004 national health and nutrition examination survey

Association between lifting weights and metabolic syndrome among U.S. adults: 1999- 2004 National Health and Nutrition Examination Survey. J Strength Cond Res 26(11): 3113-3117, 2012-The purpose of this cross-sectional study was to determine the proportion of U.S. adults who participate in the resistance exercise modality of lifting weights (LWs) by demographic characteristics and to investigate the impact of LWs on the prevalence and risk of metabolic syndrome (MetS) in a national representative sample of U.S. adults. The sample (n = 5,618) in this cross-sectional study included adults aged $20 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. Approximately twice as many men (11.2%; 95% confidence interval [CI] 9.5, 13.1) reported LWs as women did (6.3%; 95% CI 5.2, 7.6) with non-Hispanic Whites (9.6%; 95% CI 8.1, 11.4) reporting the highest levels and Mexican Americans reporting the lowest levels (5.6%; 95% CI 4.4, 7.2) of engaging in LWs. Additionally, higher levels of socioeconomic status were associated with greater levels of selfreported LWs. MetS prevalence was found to be significantly lower among U.S. adults reporting LWs (24.6%; 95% CI 19.3, 30.9) compared with adults not reporting LWs (37.3%; 95% CI 35.5, 39.2) with associated risk reductions of 58% (p , 0.001) and 37% (p , 0.01) in the unadjusted model and model adjusted for demographic variables, respectively. These findings suggest that LWs may play a role in reducing the prevalence and risk of MetS among U.S. adults. Therefore, exercise professionals should strongly encourage the activity of LWs among adults of all ages to promote metabolic health and focus programs designed to increase the adoption of LWs among the subgroups who report the lowest levels of LWs. © 2012 National Strength and Conditioning Association

Massage Therapy for Pain and Function in Patients with Arthritis: A Systematic Review of Randomized Controlled Trials

Background Massage therapy is gaining interest as a therapeutic approach to managing osteoarthritis and rheumatoid arthritis symptoms. To date, there have been no systematic reviews investigating the effects of massage therapy on these conditions. Design Systematic review was used. Objectives The primary aim of this review was to critically appraise and synthesize the current evidence regarding the effects of massage therapy as a stand-alone treatment on pain and functional outcomes among those with osteoarthritis or rheumatoid arthritis. Methods Relevant randomized controlled trials were searched using the electronic databases Google Scholar, MEDLINE, and PEDro. The PEDro scale was used to assess risk of bias, and the quality of evidence was assessed with the GRADE approach. Results This review found seven randomized controlled trials representing 352 participants who satisfied the inclusion criteria. Risk of bias ranged from four to seven. Our results found low-to moderate-quality evidence that massage therapy is superior to nonactive therapies in reducing pain and improving certain functional outcomes. It is unclear whether massage therapy is more effective than other forms of treatment. Conclusions There is a need for large, methodologically rigorous randomized controlled trials investigating the effectiveness of massage therapy as an intervention for individuals with arthritis

A narrative review of exercise-associated muscle cramps: Factors that contribute to neuromuscular fatigue and management implications

Although exercise-associated muscle cramps (EAMC) are highly prevalent among athletic populations, the etiology and most effective management strategies are still unclear. The aims of this narrative review are 3-fold: (1) briefly summarize the evidence regarding EAMC etiology; (2) describe the risk factors and possible physiological mechanisms associated with neuromuscular fatigue and EAMC; and (3) report the current evidence regarding prevention of, and treatment for, EAMC. Based on the findings of several large prospective and experimental investigations, the available evidence indicates that EAMC is multifactorial in nature and stems from an imbalance between excitatory drive from muscle spindles and inhibitory drive from Golgi tendon organs to the alpha motor neurons rather than dehydration or electrolyte deficits. This imbalance is believed to stem from neuromuscular overload and fatigue. In concert with these findings, the most successful treatment for an acute bout of EAMC is stretching, whereas auspicious methods of prevention include efforts that delay exercise-induced fatigue. Muscle Nerve 54: 177–185, 2016

Total physical activity volume, physical activity intensity, and metabolic syndrome: 1999-2004 national health and nutrition examination survey

Background: This study examined the association of total physical activity volume (TPAV) and physical activity (PA) from three domains [leisure-time physical activity (LTPA), domestic, transportation] with metabolic syndrome. We also investigated the relationship between LTPA intensity and metabolic syndrome risk. Methods: Sample included adults who participated in the 1999-2004 National Health and Nutrition Examination Survey. Physical activity measures were created for TPAV, LTPA, domestic PA, and transportational PA. For each, a six-level measure based upon no PA (level 1) and quintiles (levels 2-6) of metabolic equivalents (MET)•min•wk -1 was created. A three-level variable associated with the current Department of Health and Human Services (DHHS) PA recommendation was also created. SAS and SUDAAN were used for the statistical analysis. Results: Adults reporting the greatest volume of TPAV and LTPA were found to be 36% [odds ratio (OR) 0.64; 95% confidence interval (CI) 0.49-0.83] and 42% (OR 0.58; 95% CI 0.43-0.77), respectively, less likely to have metabolic syndrome. Domestic and transportational PA provided no specific level of protection from metabolic syndrome. Those reporting a TPAV that met the DHHS PA recommendation were found to be 33% (OR 0.67; 95%; CI 0.55-0.83) less likely to have metabolic syndrome compared to their sedentary counterparts. Adults reporting engaging in only vigorous-intensity LTPA were found to be 37% (OR 0.63; 95 CI 0.42-0.96) to 56% (OR 0.44; 95% CI 0.29-0.67) less likely to have metabolic syndrome. Conclusions: Volume, intensity, and domain of PA may all play important roles in reducing the prevalence and risk of metabolic syndrome. © 2012, Mary Ann Liebert, Inc