Integration of Consumer-Based Activity Monitors into Clinical Practice for Children with Type 1 Diabetes: A Feasibility Study

Current technology commonly utilized in diabetes care includes continuous glucose monitors (CGMs) and insulin pumps. One often overlooked critical component to the human glucose response is daily physical activity habits. Consumer-based activity monitors may be a valid way for clinics to collect physical activity data, but whether or not children with type 1 diabetes (T1D) would wear them or use the associated mobile application is unknown. Therefore, the purpose of this study was to test the feasibility of implementing a consumer-based accelerometer directly into ongoing care for adolescents managing T1D. Methods: Adolescents with T1D were invited to participate in this study and instructed to wear a mobile physical activity monitor while also completing a diet log for a minimum of 3 days. Clinical compliance was defined as the number of participants who were compliant with all measures while also having adequate glucose recordings using either a CGM, insulin pump, or on the diet log. Feasibility was defined as \u3e50% of the total sample reaching clinical compliance. Results: A total of 57 children and teenagers between the ages of 7 and 19 agreed to participate in this study and were included in the final analysis. Chi-square results indicated significant compliance for activity tracking (p \u3c 0.001), diet logs (p = 0.04), and overall clinical compliance (p = 0.04). Conclusion: More than half the children in this study were compliant for both activity monitoring and diet logs. This indicates that it is feasible for children with T1D to wear a consumer-based activity monitor while also recording their diet for a minimum of three days

A home-based exercise intervention to increase physical activity among people living with HIV: study design of a randomized clinical trial

Background While combination antiretroviral therapy has extended the life expectancy of those infected with human immunodeficiency virus (HIV), there is a high prevalence of comorbidities that increase the risk of cardiovascular morbidity and mortality among people living with HIV/AIDS (PLWHA). The side effects associated with antiretroviral therapy (ART) lead to multiple metabolic disorders, making the management of these metabolic issues and risk of cardiovascular disease (CVD) in those treated with ART a critical issue. Clinical research trials, primarily clinical exercise, rarely include this population due to unique challenges in research methods with underserved minority populations living with a life threatening illness like HIV/AIDS. This paper describes the rationale and design of a randomized clinical trial evaluating the feasibility of a home-based exercise program designed to increase physical activity (PA) and reduce the risk of CVD in PLWHA. Methods/design PLWHA being treated with ART will be randomly assigned to one of two groups: a home-based PA intervention or standard care. All participants will receive an educational weight loss workbook and pedometer for self-monitoring of PA. Only those in the intervention group will receive additional elastic Thera-bands® for strength training and behavioral telephone based coaching. Discussion This study will evaluate the feasibility of a home-based program designed to increase PA among PLWHA. Further, it will evaluate the effectiveness of such a program to decrease modifiable risk factors for CVD as a secondary outcome. This study was funded by the NIH/NINR R21 Grant 1R21NRO11281

Association of Markers of Inflammation with Sleep and Physical Activity among People Living with HIV or AIDS

This study examined associations of sleep and minutes spent in moderate-vigorous physical activity (MVPA) with C-reactive protein (CRP) and interleukin (IL)-6 among persons living with HIV (PLWH). Cross-sectional analyses (n=45) focused on associations of inflammatory outcomes (i.e., CRP and IL-6) with actigraph-derived sleep duration, latency, and efficiency; bedtime; wake time; and wake-after-sleep-onset; as well as MVPA. Least square means for CRP and IL-6 by levels of sleep and MVPA were computed from general linear models. Individuals below the median of sleep duration, above the median for bedtime, and below the median of MVPA minutes had higher CRP or IL-6 levels. Generally, individuals with both low MVPA and poor sleep characteristics had higher inflammation levels than those with more MVPA and better sleep. Understanding the combined impact of multiple lifestyle/behavioral factors on inflammation could inform intervention strategies to reduce inflammation and therefore, chronic disease risk

Moderate-Intensity Exercise Improves Body Composition and Improves Physiological Markers of Stress in HIV-Infected Men

HIV/AIDS and its treatment often alter body composition and result in poorer physical functioning. The aim of this study was to determine the effects of a moderate-intensity exercise program on body composition and the hormones and cytokines associated with adverse health outcomes. HIV-infected males (N = 111) were randomized to an exercise group (EX) who completed 6 weeks of moderate-intensity exercise training, or to a nonintervention control group (CON). In pre- and postintervention, body composition was estimated via DXA, peak strength was assessed, and resting blood samples were obtained. There was a decrease in salivary cortisol at wake (P = 0.025) in the EX and a trend (P = 0.07) for a decrease 1 hour after waking. The EX had a significant increase in lean tissue mass (LTM) (P \u3c 0.001) following the intervention. Those in the EX below median body fat (20%) increased LTM (P = 0.014) only, while those above 20% decreased fat mass (P = 0.02), total fat (N = 0.009), and trunk fat (P = 0.001), while also increasing LTM (P = 0.027). Peak strength increased between 14% and 28% on all exercises in the EX group. These data indicate that 6 weeks of moderate-intensity exercise training can decrease salivary cortisol levels, improve physical performance, and improve body composition in HIV-infected men

Metabolic Syndrome and Risk of Cancer Mortality in Men

Background—Metabolic syndrome (MetS) has been linked with an increased risk of developing cancer; however the association between MetS and cancer mortality remains less clear. Little research has focused on pre-cancer risk factors that may affect the outcome of treatment. The purpose of this study was to examine the association between MetS and all-cancer mortality in men. Methods—The participants included 33,230 men aged 20-88 years who were enrolled in the Aerobics Center Longitudinal Study and free of known cancer at baseline. Results—At baseline 28% of all the participants had MetS. During an average of 14 years followup there were a total of 685 deaths due to cancer. MetS at baseline was associated with a 56% greater age-adjusted risk in cancer mortality. Conclusion—These data show that MetS is associated with an increased risk of all-cause cancer mortality in men. Based on these findings it is evident that successful interventions should be identified to attenuate the negative effects of MetS

Association between Physical Activity and Sport Participation on Hemoglobin A1c among Children and Adolescents with Type 1 Diabetes

Purpose: To determine associations between physical activity (PA) and sport participation on HbA1c levels in children with type 1 diabetes (T1D). Method: Pediatric patients with T1D were invited to complete a PA and sport participation survey. Data were linked to their medical records for demographic characteristics, diabetes treatment and monitoring plans, and HbA1c levels. Results: Participants consisted of 71 females and 81 males, were 13 +- 3 years old with an average HbA1c level of 8.75 +- 1.81. Children accumulating 60 min of activity 3 days or more a week had significantly lower HbA1c compared to those who accumulated less than 3 days (p \u3c 0.01) of 60 min of activity. However, there was no significant difference in HbA1c values based on sport participation groups. A multiple linear regression model indicated that PA, race, age, duration of diagnosis, and CGM use all significantly predicted HbA1c (p \u3c 0.05). Conclusion: This study demonstrated the significant relationship between daily PA and HbA1c. Those in this sample presented with lower HbA1c values even if accumulating less than the recommended number of days of activity. Further, it was shown that sport participation alone may not be adequate enough to impact HbA1c in a similar manner

Musculoskeletal Outcomes From Chronic High-Speed, High-Impulse Resistance Exercise

While bones and muscles adapt to mechanical loading, it appears that very specific types of stimuli must be applied to achieve osteogenesis. Our study assessed musculoskeletal outcomes to 30 training sessions on an Inertial Exercise Trainer (Newnan, GA). Subjects (n = 13) performed workouts with their left leg, while their right served as an untreated control. Work-outs entailed three 60-s sets each of knee extension, hip extension and calf press exercises, separated by 90-s rests. Before and after the 30 training sessions, subjects underwent strength tests (knee and ankle extensors of both legs), DEXA scans (hip, knee and ankles of both legs), and blood draws. After 30 training sessions 2 × 2 ANOVAs showed left leg peak torques rose significantly. 2 × 2 ANCOVAs, with bone scan area as a covariate, showed significant left leg calcaneal bone mineral content ( + 29 %) and density ( + 33 %) increases after 30 training sessions. A significant decline in C-terminal telopeptides of type I collagen, a blood marker of bone resorption, also occurred after 30 training sessions. The Inertial Exercise Trainer’s large volume of training session repetitions elicited high peak force, peak acceleration and impulses that likely provided a mechanical loading stimulus that evoked calcaneal accretion

Clinical Exercise, Stress, and Hiv Infection: Identifying the Associations and Testing theEffects

PLWHA are inflicted with a variety of psychological and physiological symptoms associated with the virus itself, related medications, or a combination of both. Due to the nature of these symptoms being experienced concurrently the general well-being and overall quality of life in this population is often reduced. Further, the frequency of reported symptoms is believed to be associated with increased disease progression, decreased functional capacity, reduced adherence to pharmacological treatment, self-medication, and increased psychological disturbances such as anxiety and depression. HIV-related co morbidities associated with risk of chronic diseases have reportedly decreased among PLWHA in recent investigations following prescribed exercise training. The benefits of exercise in reducing chronic stress and disease have long been established among general populations and various clinical groups from longitudinal investigations. Recent studies are suggesting that PLWHA can obtain similar benefits within 6 weeks following a prescribed physical activity routine. The aim of this dissertation was three fold. First a cross-sectional statistical design was utilized for testing the associations of HIV-related symptoms and their distress among psychological and physiological indicators of stress. Significant correlations were further examined to identify mediators of symptom distress. In addition, the effectiveness of a 6 week moderate intensity exercise prescription combining aerobic and resistance training was tested among psychological and physiological variables in PLWHA. These included perceived stress, frequency of symptoms, symptom distress, and circulating resting cortisol measured at wake. The strongest correlates were observed in fatigue and symptom frequency (rs = 0.59, p \u3c 0.001), as well as fatigue and symptom distress (rs = 0.63, p \u3c 0.001). Significant predictors of symptom distress included symptom frequency, depression/dejection, anger/hostility, and fatigue. Only depression/dejection and fatigue remained significant after testing for mediators (p \u3c 0.001). Salivary cortisol (CORT), a physiological indicator of stress, was collected at three time points within two hours following wake and used to identify the total area under the curve (AUC). Resting CORT was collected for comparison pre and post intervention. The data show a significant decrease in the AUC of CORT following 6 weeks of moderate intensity exercise (p \u3c 0.001), whereas no change was observed within the CON group. It was also shown that the 6 week intervention design reduced total mood disturbances measured using the profile of mood states short form (POMS-30) (p \u3c 0.001) as well as the depression/dejection subscale (p \u3c 0.001). Results from the present study show PLWHA are able to reduce the level of psychological and physiological stress experienced daily following a moderate intensity exercise intervention when completed twice a week for six weeks. Further, to our knowledge this is the first investigation to identify partial mediators of HIV-related symptom distress. In conclusion, these results indicate PLWHA are able to obtain psychological and physiological benefits in six weeks when completing a combination aerobic and resistance exercise prescription of moderate intensity twice a week