Physical activity counseling in overweight and obese primary care patients: Outcomes of the VA-STRIDE randomized controlled trial.

The purpose of this 2-arm randomized clinical trial was to evaluate the effectiveness of a 12-month, expert system-based, print-delivered physical activity intervention in a primary care Veteran population in Pittsburgh, Pennsylvania. Participants were not excluded for many health conditions that typically are exclusionary criteria in physical activity trials. The primary outcome measures were physical activity reported using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and an accelerometer-based activity assessment at baseline, 6, and 12 months. Of the 232 Veterans enrolled in the study, 208 (89.7%) were retained at the 6-month follow-up and 203 (87.5%) were retained at 12 months. Compared to the attention control, intervention participants had significantly increased odds of meeting the U.S. recommended guideline of ≥ 150 min/week of at least moderate-intensity physical activity at 12 months for the modified CHAMPS (odds ratio [OR] = 2.86; 95% CI: 1.03-7.96; p = 0.04) but not at 6 months (OR = 1.54; 95% CI: 0.56-4.23; p = 0.40). Based on accelerometer data, intervention participants had significantly increased odds of meeting ≥ 150 min/week of moderate-equivalent physical activity at 6 months (OR = 6.26; 95% CI: 1.26-31.22; p = 0.03) and borderline significantly increased odds at 12 months (OR = 4.73; 95% CI: 0.98-22.76; p = 0.053). An expert system physical activity counseling intervention can increase or sustain the proportion of Veterans in primary care meeting current recommendations for moderate-intensity physical activity. Trial Registration Clinical trials.gov identifier: NCT00731094 URL: http://www.clinicaltrials.gov/ct2/show/NCT00731094

Objectively measured physical activity of USA adults by sex, age, and racial/ethnic groups: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Accelerometers were incorporated in the 2003–2004 National Health and Nutritional Examination Survey (NHANES) study cycle for objective assessment of physical activity. This is the first time that objective physical activity data are available on a nationally representative sample of U.S. residents. The use of accelerometers allows researchers to measure total physical activity, including light intensity and unstructured activities, which may be a better predictor of health outcomes than structured activity alone. The aim of this study was to examine objectively determined physical activity levels by sex, age and racial/ethnic groups in a national sample of U.S. adults.</p> <p>Methods</p> <p>Data were obtained from the 2003–2004 NHANES, a cross-sectional study of a complex, multistage probability sample of the U.S. population. Physical activity was assessed with the Actigraph AM-7164 accelerometer for seven days following an examination. 2,688 U.S. adults with valid accelerometer data (i.e. at least four days with at least 10 hours of wear-time) were included in the analysis. Mean daily total physical activity counts, as well as counts accumulated in minutes of light, and moderate-vigorous intensity physical activity are presented by sex across age and racial/ethnic groups. Generalized linear modeling using the log link function was performed to compare physical activity in sex and racial/ethnic groups adjusting for age.</p> <p>Results</p> <p>Physical activity decreases with age for both men and women across all racial/ethnic groups with men being more active than women, with the exception of Hispanic women. Hispanic women are more active at middle age (40–59 years) compared to younger or older age and not significantly less active than men in middle or older age groups (i.e. age 40–59 or age 60 and older). Hispanic men accumulate more total and light intensity physical activity counts than their white and black counterparts for all age groups.</p> <p>Conclusion</p> <p>Physical activity levels measured objectively by accelerometer demonstrated that Hispanic men are, in general, more active than their white and black counterparts. This appears to be in contrast to self-reported physical activity previously reported in the literature and identifies the need to use objective measures in situations where the contribution of light intensity and/or unstructured physical activity cannot be assumed homogenous across the populations of interest.</p

Effects of Weighted Hula-Hooping Compared to Walking on Abdominal Fat, Trunk Muscularity, and Metabolic Parameters in Overweight Subjects : A Randomized Controlled Study

Background: Weighted hula-hoops have gained popularity, but whether they indeed reshape the trunk or have beneficial metabolic effects in overweight subjects is unknown. Objectives: To determine effects of hula-hooping and walking matched for energy expenditure on android fat %, trunk muscle mass, and metabolic parameters in a randomized cross-over study. Design: We recruited 55 overweight nondiabetic subjects, who were randomized to hula-hooping (HULA) for 6 weeks using a 1.5-kg weighted hula-hoop followed by walking (WALK) for another 6 weeks or vice versa. The increments in energy expenditure were similar by HULA and WALK. Body composition (dual-energy X-ray absorptiometry) and metabolic parameters were measured at baseline and after HULA and WALK. The primary endpoint was the change in fat % in the android region. Results: A total of 53subjects (waist 92 +/- 1 cm, body mass index 28 +/- 1 kg/m(2)) completed the study. Body weight changed similarly (-0.6 +/- 0.2 vs. -0.5 +/- 0.2 kg, nonsignificant; HULA vs. WALK). During the intervention the subjects hula-hooped on average 12.8 +/- 0.5 min/day and walked 9,986 +/- 376 steps/day. The % fat in the android region decreased significantly by HULA but not by WALK (between-group change p <0.001). Trunk muscle mass increased more by HULA than by WALK (p <0.05). Waist circumference decreased more by HULA than by WALK (-3.1 +/- 0.3 cm vs. -0.7 +/- 0.4 cm, p <0.001; HULA vs. WALK). WALK but not HULA significantly lowered systolic blood pressure and increased HDL cholesterol while HULA significantly decreased LDL cholesterol. Conclusions: Hula-hooping with a weighted hula-hoop can be used to decrease abdominal fat % and increase trunk muscle mass in overweight subjects. Its LDL lowering effect resembles that described for resistance training. (c) 2019 The Author(s) Published by S. Karger AG, BaselPeer reviewe

Issues in accelerometer methodology: the role of epoch length on estimates of physical activity and relationships with health outcomes in overweight, post-menopausal women

<p>Abstract</p> <p>Background</p> <p>Current accelerometer technology allows for data collection using brief time sampling intervals (i.e., epochs). The study aims were to examine the role of epoch length on physical activity estimates and subsequent relationships with clinically-meaningful health outcomes in post-menopausal women.</p> <p>Methods</p> <p>Data was obtained from the Woman On the Move through Activity and Nutrition Study (n = 102). Differences in activity estimates presented as 60s and 10s epochs were evaluated using paired t-tests. Relationships with health outcomes were examined using correlational and regression analyses to evaluate differences by epoch length.</p> <p>Results</p> <p>Inactivity, moderate- and vigorous-intensity activity (MVPA) were significantly higher and light-intensity activity was significantly lower (all <it>P </it>< 0.001) when presented as 10s epochs. The correlation between inactivity and self-reported physical activity was stronger with 10s estimates (<it>P </it>< 0.03); however, the regression slopes were not significantly different. Conversely, relationships between MVPA and body weight, BMI, whole body and trunk lean and fat mass, and femoral neck bone mineral density was stronger with 60s estimates (all <it>P </it>< 0.05); however, regression slopes were similar.</p> <p>Conclusion</p> <p>These findings suggest that although the use of a shorter time sampling interval may suggestively reduce misclassification error of physical activity estimates, associations with health outcomes did not yield strikingly different results. Additional studies are needed to further our understanding of the ways in which epoch length contributes to the ascertainment of physical activity in research studies.</p> <p>Trial Registration</p> <p>Clinical Trials Identifier: NCT00023543</p

Recruitment of veterans from primary care into a physical activity randomized controlled trial: the experience of the VA-STRIDE study

Background: Much of the existing literature on physical activity (PA) interventions involves physically inactive individuals recruited from community settings rather than clinical practice settings. Recruitment of patients into interventions in clinical practice settings is difficult due to limited time available in the clinic, identification of appropriate personnel to efficiently conduct the process, and time-consuming methods of recruitment. The purpose of this report is to describe the approach used to identify and recruit veterans from the Veterans Affairs (VA) Pittsburgh Healthcare System Primary Care Clinic into a randomized controlled PA study. Methods: A sampling frame of veterans was developed using the VA electronic medical record. During regularly scheduled clinic appointments, primary care providers (PCPs) screened identified patients for safety to engage in moderate-intensity PA and willingness to discuss the study with research staff members. Research staff determined eligibility with a subsequent telephone screening call and scheduled a research study appointment, at which time signed informed consent and baseline measurements were obtained. Results: Of the 3,482 veterans in the sampling frame who were scheduled for a primary care appointment during the study period, 1,990 (57.2%) were seen in the clinic and screened by the PCP; moderate-intensity PA was deemed safe for 1,293 (37.1%), 871 (25.0%) agreed to be contacted for further screening, 334 (9.6%) were eligible for the study, and 232 (6.7%) enrolled. Conclusions: Using a semiautomated screening approach that combined an electronically-derived sampling frame with paper and pencil prescreening by PCPs and research staff, VA-STRIDE was able to recruit 1 in 15 veterans in the sampling frame. Using this approach, a high proportion of potentially eligible veterans were screened by their PCPs. Trial registration: Clinical trials.gov identifier: NCT00731094

Body size and shape changes and the risk of diabetes in the Diabetes Prevention Program

Prezentowane badanie przeprowadzono w celu sprawdzenia hipotezy, zgodnie z którą ryzyko rozwoju cukrzycy typu 2 zmniejsza się wraz z redukcją masy ciała i otyłości brzusznej. Do badania Diabetes Prevention Program (DPP) włączono osoby, u których rozpoznawano upośledzoną tolerancję glukozy, i zakwalifikowano je do grup otrzymujących placebo lub metforminę albo wprowadzono tylko modyfikację stylu życia. U uczestników badania określono wzrost, masę ciała oraz zmierzono tkankę tłuszczową na poziomie L2-L3 i L4-L5 za pomocą tomografii komputerowej na początku badania oraz po roku. Zastosowano modele proporcjonalnego ryzyka Coxa w celu oceny, zależnie od płci, wpływu zmiany tych parametrów w ciągu roku na rozwój cukrzycy w okresie dalszej obserwacji, którą prowadzono u 758 osób. Modyfikacja stylu życia doprowadziła do redukcji trzewnej tkanki tłuszczowej na poziomie L2-L3 (mężczyźni: -24,3%; kobiety: -18,2%) oraz na poziomie L4-L5 (mężczyźni: -22,4%, kobiety: -17,8%), tkanki tłuszczowej podskórnej na poziomie L2-L3 (mężczyźni: -15,7%, kobiety: -11,4%) i L4-L5 (mężczyźni: -16,7%, kobiety: -11,9%), do zmniejszenia masy ciała (mężczyźni: -8,2%, kobiety: -7,8%), wskaźnika masy ciała (mężczyźni: -8,2%, kobiety: -7,8%) oraz obwodu talii (mężczyźni: -7,5%, kobiety -6,1%). W grupie otrzymującej metforminę zaobserwowano redukcję masy ciała (-2,9%) i obniżenie wskaźnika masy ciała (-2,9%) u mężczyzn oraz zmniejszenie ilości podskórnej tkanki tłuszczowej (-3,6% na poziomie L2-L3 i -4,7% na poziomie L4-L5), masy ciała (-3,3%), wskaźnika masy ciała (-3,3%) oraz obwodu talii (-2,8%) u kobiet. Zmniejszenie ryzyka rozwoju cukrzycy poprzez zmianę stylu życia wiązało się z redukcją masy ciała, wskaźnika masy ciała oraz rozkładu tkanki tłuszczowej po skorygowaniu względem wieku oraz pochodzenia etnicznego (ustalano je na podstawie informacji uzyskanej od uczestników). Zmniejszenie ryzyka rozwoju cukrzycy poprzez zmianę stylu życia może nastąpić zarówno poprzez wpływ na całą tkankę tłuszczową, jak i brzuszną tkankę tłuszczową; wpływ metforminy wydawał się niezależny od zmian tkanki tłuszczowej.The researchers conducted this study to test the hypothesis that risk of type 2 diabetes is less following reductions in body size and central adiposity. The Diabetes Prevention Program (DPP) recruited and randomized individuals with impaired glucose tolerance to treatment with placebo, metformin, or lifestyle modification. Height, weight, waist circumference, and subcutaneous and visceral fat at L2-L3 and L4-L5 by computed tomography were measured at baseline and at 1 year. Cox proportional hazards models assessed by sex the effect of change in these variables over the 1st year of intervention upon development of diabetes over subsequent follow- up in a subset of 758 participants. Lifestyle reduced visceral fat at L2-L3 (men -24.3%, women -18.2%) and at L4-L5 (men -22.4%, women -17.8%), subcutaneous fat at L2-L3 (men -15.7%, women -11.4%) and at L4-L5 (men -16.7%, women -11.9%), weight (men &#8211;8.2%, women &#8211;7.8%), BMI (men -8.2%, women -7.8%), and waist circumference (men -7.5%, women -6.1%). Metformin reduced weight (-2.9%) and BMI (-2.9%) in men and subcutaneous fat (-3.6% at L2-L3 and -4.7% at L4-L5), weight (-3.3%), BMI (-3.3%), and waist circumference (-2.8%) in women. Decreased diabetes risk by lifestyle intervention was associated with reductions of body weight, BMI, and central body fat distribution after adjustment for age and self-reported ethnicity. Reduced diabetes risk with lifestyle intervention may have been through effects upon both overall body fat and central body fat but with metformin appeared to be independent of body fat

Self-Reported Dietary Intake of Youth with Recent Onset of Type 2 Diabetes: Results from the TODAY Study

Despite the widely recognized importance of diet in managing diabetes, few studies have documented usual dietary intake in youth with type 2 diabetes (T2D). The objectives of this study were to assess dietary intake among a large, ethnically diverse cohort of youth with T2D and compare intake to current recommendations. Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) is a multi-center randomized clinical trial of 699 youth aged 10-17. At baseline, following a run-in period that included standard diabetes education, diet was assessed using a food frequency questionnaire between 2004 and 2009. Analysis of variance and non-parametric tests were used to compare mean and median nutrient intakes; logistic regression was used to compare the odds of meeting pre-defined dietary intake recommendation cut points between subgroups of age, sex and race-ethnicity. Percent of energy from saturated fat was consistently 13-14% across all subgroups – substantially exceeding national recommendations. Overall, only 12% of youth met Healthy People (HP) 2010 guidelines of < 10% saturated fat and only 1% of youth met American Diabetes Association recommendations of <7% saturated fat. Dietary intake fell substantially below other HP 2010 targets; only 3% met calcium intake goals, 11% met fruit consumption goals, 5% met vegetable consumption goals, and 67% met grain intake goals. Overall, dietary intake in this large cohort of youth with T2D fell substantially short of recommendations, in ways that were consistent by sex, age, and race-ethnicity. The data suggest a critical need for better approaches to improve dietary intake of these youth

"Food is directed to the area": African Americans' perceptions of the neighborhood nutrition environment in Pittsburgh.

Studies have shown racial disparities in neighborhood access to healthy food in the United States. We used a mixed methods approach employing geographic information systems, focus groups, and a survey to examine African Americans' perceptions of the neighborhood nutrition environment in Pittsburgh. We found that African Americans perceive that supermarkets serving their community offer produce and meats of poorer quality than branches of the same supermarket serving White neighborhoods (p<0.001). Unofficial taxis or jitneys, on which many African Americans are reliant, provide access from only certain stores; people are therefore forced to patronize these stores even though they are perceived to be of poorer quality. Community-generated ideas to tackle the situation include ongoing monitoring of supermarkets serving the Black community. We conclude that stores should make every effort to be responsive to the perceptions and needs of their clients and provide an environment that enables healthy eating

Fit body and soul: a church-based behavioral lifestyle program for diabetes prevention in African Americans.

https://www.ethndis.org/priorarchives/ethn-19-02-135.pd