Physical activity, hormone replacement therapy, and insulin resistant coronary artery disease risk factors in postmenopausal women

Low physical activity levels and high serum C-reactive protein (CRP) levels are risk factors for coronary artery disease (CAD) in both men and women. However, postmenopausal women who take hormone replacement therapy (HRT) may have increased risk of CAD because of HRT-related increases in serum CRP. There are two manuscripts in this dissertation. The purpose of the first manuscript was to determine whether higher physical activity energy expenditure was associated with lower serum CRP, independent of oral HRT status and body fatness, in 133 postmenopausal women. Higher physical activity energy expenditures were significantly associated with lower serum CRP levels (r=-0.21, p=0.0l9), independent of oral HRT use, age, smoking behavior, alcohol consumption, aspirin use, and statin use. However, in the complete multivariate model, which included body fat, the association between higher physical activity and lower serum CRP levels was abolished. The purpose of the second study was to quantify the biological variability of insulin resistant CAD risk factors in a sample of 8 postmenopausal women. Risk factor outcomes, including serum total cholesterol, serum triglycerides (TG), serum high-density lipoprotein cholesterol (HDL-C), serum glucose, plasma insulin, serum CRP, waist and hip circumferences, abdominal sagittal diameter, body fat, systolic (SBP) and diastolic blood pressure, and self-reported physical activity energy expenditure, were measured on two occasions, 7-12 days apart. High absolute biological variability values (by standard error of measurement) were observed for serum TG (32.0 mg/dl), serum CRP (5.6 mg/l), SBP (4.0 mmHg), and physical activity (9.4 kcal/kg/week). High relative biological variability (by within-subjects coefficient of variation ≥27.3%) was also observed for serum TG, serum CRP, and physical activity. Bland-Altman plots identified individual outliers for serum TG, serum CRP, plasma insulin, and SBP. Together, the results suggest that the correlations between lower levels of serum CRP and higher levels of physical activity, though significant, may have been attenuated by the high biological variability of both serum CRP and physical activity. Thus, the importance of higher levels of physical activity, in decreasing serum CRP and the concomitant risk of heart disease, may be underestimated in the absence of serial measurement of serum CRP and physical activity

SenseWear Armband and Stroke: Validity of Energy Expenditure and Step Count Measurement during Walking

The purpose of this study was to test the validity of the SenseWear Pro Armband (SWA) for the measurement of energy expenditure (EE) and step count against a criterion in persons with stroke. Twelve participants with chronic stroke (mean age 64.2 ± 10.4 years; mean gait speed 0.67 ± 0.25 m/sec) completed two trials of a six-minute walk test, while wearing a SenseWear Armband (SWA) on each arm and being continuously monitored using a portable metabolic cart. Agreement between estimates of energy expenditure from the SWA and the metabolic cart was fair for the armband on the hemiplegic arm (intraclass correlation cefficient (ICC) = 0.586) and good for the armband on the unaffected arm (ICC = 0.702). Agreement between the SWA estimate of step count, and step count as measured by the Step Activity Monitor was poor (ICC < 0.352), with significant underestimation by the SWA. Our results show that, for these moderately impaired persons with stroke, the SWA should be used with caution for the measurement of energy expenditure and should not be used to measure step count

Tricks and treats: designing technology to support mobility assistance dogs

Assistance dogs are a key intervention to support the autonomy of people with tetraplegia. Previous research on assistive technologies have investigated ways to, ultimately, replace their labour using technology, for instance through the design of smart home environments. However, both the disability studies literature and our interviews suggest there is an immediate need to support these relationships, both in terms of training and bonding. Through a case study of an accessible dog treats dispenser, we investigate a technological intervention responding to these needs, detailing an appropriate design methodology and contributing insights into user requirements and preferences

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Spinal cord injury and quality of life: what determines quality of life and what is the relationship between physical activity, fitness and quality of life

This thesis is comprised of two investigations. The first investigation, using naturalistic inquiry, determined the domains that represented quality of life for persons with a spinal cord injury. Seven persons with complete quadriplegic injuries (one female, six males) and eight persons with complete paraplegic injuries (five females, three males) participated in this study. Results showed that quality of life for this population, regardless of severity of impairments, was represented by nine domains: 1) physical function and independence; 2) accessibility; 3) emotional well being; 4) stigma; 5) spontaneity; 6) relationships and social function; 7) occupation; 8) finances; and 9) physical well being. The domains of life quality were similar for quadriplegic and paraplegic individuals; however, physical function and independence and physical well being affected the quality of life of persons with a quadriplegic injury to a greater extent. These findings may provide health professionals with information necessary to assist in the development of programs to enhance quality of life. The objective of the second investigation in this thesis was to explore the relationships amongst four variables of interest; subjective and objective quality of life scores, and fitness and physical activity in individuals with a spinal cord injury. Both qualitative and quantitative methodologies were utilized in this second study and qualitative data collection was done in conjunction with Study One. The same 15 persons described in Study One, in addition to discussing quality of life, also provided information about physical activity and fitness and the role it played in their quality of life. Quantitative data collection with 40 individuals with spinal cord injury included measurements of: fitness, physical activity, subjective quality of life and objective quality of life. Results were reported for each of three level of injury groupings (high quadriplegia, low quadriplegia and paraplegia). Results showed that physical activity was significantly correlated with the total score for objective quality of life in the groups of persons with high quadriplegia and paraplegia. Qualitative results supported these findings especially in relation to the importance of fitness and physical activity to the objective domain of functional ability. There were no significant correlations between subjective quality of life and the other three primary variables; objective quality of life, fitness and physical activity, for any of the level of injury groupings. However, qualitative results suggested that activity may play an important role in an individual's perception of quality of life. Thus, although the results from this investigation suggest a relationship between fitness, physical activity and objective quality of life, the relationship with subjective quality of life requires further exploration

Respiratory training for a person with C3-C4 tetraplegia

Persons with high tetraplegic spinal cord injuries commonly have respiratory complications that may negatively impact their health and quality of life. Treatment of these respiratory problems often requires significant health care dollars. This case report describes and evaluates the effect of a year-long respiratory intervention, which included inspiratory muscle training and positive expiratory pressure therapy, for a person with C3-C4 tetraplegia. The intervention improved both inspiratory muscle force and pulmonary function values. Respiratory infections, frequency of suctioning and physiotherapy treatment time decreased progressively throughout the intervention. There were no admissions to the acute care hospital after the interventions began. This intervention improved the participant's health and wellbeing and reduced costs to the health care system

Compositional associations between movement-related behaviours and functional outcomes post-stroke

To examine the associations between the composition of movement-related behaviours (sedentary behaviour, sleep, standing, and stepping) and functional outcomes post-stroke. This study included 34 adults with stroke (mean age: 64.6 ± 12.5 years; time since stroke: 3.5 ± 1.1 months) who underwent an 8-week sedentary behaviour intervention. Functional outcomes were assessed using the timed up and go (TUG) and gait speed tests. Compositional data analysis was used to investigate the relationships between movement-related behaviours and functional outcomes. The baseline composition of movement-related behaviours showed significant associations with changes in TUG (F = 4.28, p = 0.01) and gait speed (F = 4.63, p = 0.01) after the 8-week reducing sedentary behaviour intervention. Reallocating ≥ 30 min/day to stepping, while proportionally decreasing other movement-related behaviours, was associated with a significant change in TUG. Similarly, a relative reallocation of ≥ 40 min/day to stepping was associated with a clinically meaningful change in gait speed. This study highlights the importance of considering movement-related behaviours in relation to functional outcomes post-stroke. Reallocating at least 30 min per day to stepping, relative to a reduction in other movement-related behaviours, is associated with significant and meaningful change in functional outcomes. Reallocating at least 30 minutes/day to stepping, relative to a decrease in other movement-related behaviours, is associated with a positive change in functional mobility after an 8-week post-stroke sedentary behaviour intervention.Relative to a decrease in other movement-behaviours, reallocating ≥ 40 minutes/day to stepping is associated with a meaningful change in gait speed.Reallocating time to standing or sleep at the expense of other movement behaviours is not associated with better functional mobility or gait speed.Finding the optimal balance in movement-related behaviours that favours more stepping may lead to improvements in both functional mobility and gait speed. Reallocating at least 30 minutes/day to stepping, relative to a decrease in other movement-related behaviours, is associated with a positive change in functional mobility after an 8-week post-stroke sedentary behaviour intervention. Relative to a decrease in other movement-behaviours, reallocating ≥ 40 minutes/day to stepping is associated with a meaningful change in gait speed. Reallocating time to standing or sleep at the expense of other movement behaviours is not associated with better functional mobility or gait speed. Finding the optimal balance in movement-related behaviours that favours more stepping may lead to improvements in both functional mobility and gait speed.</p

Stroke survivors partner in research: a case example of collaborative processes

Abstract The Canadian Strategy for Patient-Oriented Research supports the inclusion of patients as partners throughout the research process. Purposeful and meaningful engagement of patient partners after stroke can present unique challenges due to the potential impacts on cognition, communication, or mobility. The purpose of this paper is to provide a case example of working together with three individuals who bring their post-stroke lived experience, including one person with aphasia, from study design through to dissemination. The designed and executed qualitative research was the purpose of this collaboration; this paper describes the collaborative process rather than the outcomes of the original research. The Strategy for Patient-Oriented Research Patient Engagement Framework was followed to engage the patient partners fully as part of the research team. Patient partners were involved at regularly scheduled team meetings and provided guidance on key aspects of project design and decision-making. The patient partners provided robust and important contributions to many aspects of the research, including shaping interview questions, assisting with thematic analysis, and contributing to the dissemination of research findings. Effective team dynamics were fostered by focusing on the value of the lived experience knowledge, using best-practice communication strategies, as well as taking time for relationship-building and story sharing. With appropriate support and guidance, the individuals who have experienced stroke were valuable contributing members of our research team.Plain Language summary Whenever possible, including patients as partners in the research process can improve the quality of the research and the relevance of the results. Sometimes, there can be challenges when engaging people with lived experience in health research. For example, after a stroke, some patients can have trouble moving, thinking, or speaking. The purpose of this paper is to describe the processes used by our research team, comprised of two researchers and three patient partners with lived experience who had knowledge and insights into surviving a moderate to severe stroke. The research was a graduate student project exploring what patients think of physical therapy tests and measures used post-stroke. This article describes the process, rather than the outcomes of that research. We collaborated through virtual meetings, which were held every time decisions about the research had to be made or where feedback was required. The patient partners improved the interview question guide, helped to analyze the data, and helped to communicate the research findings. We found several strategies that helped us to be successful, including focusing on the value of the patient perspective and insights, taking time to build relationships, and allowing time to share stories. We also took special care to follow recommendations about communication to make sure that all the patient partners understood the project aim and activities that we were working on together. We feel this paper shows how patients who have had a stroke can collaborate as valued members of health research teams

Relationships between sedentary behaviour, physical activity levels and red blood cell distribution width in children and adolescents

Background: Red blood cell distribution width (RDW) is a biomarker for cardiovascular disease(CVD). RDW is associated with sedentary behavior (SB) and physical activity (PA) in adults.To date, no study has evaluated this association in children. The purpose of this study was to evaluate the association between RDW and SB and PA levels of children and adolescents.Methods: This observational study included data from participants aged 12-20 years in the 2003–2006 National Health and Nutrition Examination Survey (NHANES). SB and PA were measured using accelerometers. Activity levels were classified into intensity categories. Sex specific multivariable regression analyses (adjusted for covariates) were used to explore the associations between SB, PA and RDW. Results: The study included 2143 children and adolescents (1080 boys and 1063 girls). In the fully adjusted regression model for boys, SB was positively associated with RDW (β =0.116,P=0.004) while moderate PA was negatively associated with RDW (β =-0.082, P=0.048). In girls, there were no significant associations between activity levels and RDW. Conclusion: This study provides preliminary evidence of the association between SB, moderate intensity PA and RDW in boys, but not in girls. Further research to determine the mechanisms associated with this relationship and underlying sex differences is warranted