Physical activity and cardiovascular risk factors among rural and urban groups and rural-to-urban migrants in Peru: a cross-sectional study.

OBJECTIVE: To compare physical activity and sedentary behavior patterns of rural-to-urban migrants in Peru versus lifetime rural and urban residents and to determine any associations between low physical activity and four cardiovascular risk factors: obesity (body mass index > 30 kg/m²), systolic and diastolic blood pressure, hypertension, and metabolic syndrome. METHODS: The PERU MIGRANT (PEru's Rural to Urban MIGRANTs) cross-sectional study was designed to measure physical activity among rural, urban, and rural-to-urban migrants with the International Physical Activity Questionnaire (IPAQ). RESULTS: The World Health Organization (WHO) age-standardized prevalence of low physical activity was 2.2% in lifetime rural residents, 32.2% in rural-to-urban migrants, and 39.2% in lifetime urban residents. The adjusted odds ratios for low physical activity were 21.43 and 32.98 for migrant and urban groups respectively compared to the rural group. The adjusted odds ratio for being obese was 1.94 for those with low physical activity. There was no evidence of an association between low physical activity and blood pressure levels, hypertension, or metabolic syndrome. CONCLUSIONS: People living in a rural area had much higher levels of physical activity and lower risk of being overweight and obese compared to those living in an urban area of Lima. Study participants from the same rural area who had migrated to Lima had levels of physical inactivity and obesity similar to those who had always lived in Lima. Interventions aimed at maintaining higher levels of physical activity among rural-to-urban migrants may help reduce the epidemic of obesity in urban cities

Physical activity and cardiovascular risk factors among rural and urban groups and rural-to-urban migrants in Peru: a cross-sectional study Actividad física y factores de riesgo de enfermedades cardiovasculares en grupos rurales y urbanos y en migrantes de zonas rurales a urbanas en Perú: estudio transversal

OBJECTIVE: To compare physical activity and sedentary behavior patterns of rural-to-urban migrants in Peru versus lifetime rural and urban residents and to determine any associations between low physical activity and four cardiovascular risk factors: obesity (body mass index > 30 kg/m²), systolic and diastolic blood pressure, hypertension, and metabolic syndrome. METHODS: The PERU MIGRANT (PEru's Rural to Urban MIGRANTs) cross-sectional study was designed to measure physical activity among rural, urban, and rural-to-urban migrants with the International Physical Activity Questionnaire (IPAQ). RESULTS: The World Health Organization (WHO) age-standardized prevalence of low physical activity was 2.2% in lifetime rural residents, 32.2% in rural-to-urban migrants, and 39.2% in lifetime urban residents. The adjusted odds ratios for low physical activity were 21.43 and 32.98 for migrant and urban groups respectively compared to the rural group. The adjusted odds ratio for being obese was 1.94 for those with low physical activity. There was no evidence of an association between low physical activity and blood pressure levels, hypertension, or metabolic syndrome. CONCLUSIONS: People living in a rural area had much higher levels of physical activity and lower risk of being overweight and obese compared to those living in an urban area of Lima. Study participants from the same rural area who had migrated to Lima had levels of physical inactivity and obesity similar to those who had always lived in Lima. Interventions aimed at maintaining higher levels of physical activity among rural-to-urban migrants may help reduce the epidemic of obesity in urban cities.OBJETIVO: Comparar los patrones de actividad física y de comportamiento sedentario de migrantes de zonas rurales a urbanas del Perú con los patrones de habitantes permanentes de zonas rurales y urbanas, e identificar cualquier asociación entre el bajo nivel de actividad física y cuatro factores de riesgo de enfermedad cardiovascular: obesidad (índice de masa corporal > de 30 kg/m²), presión arterial sistólica y diastólica, hipertensión y síndrome metabólico. MÉTODOS: El estudio transversal PERU MIGRANT (personas del Perú que emigran de zonas rurales a urbanas) se llevó a cabo para medir la actividad física en personas de zonas rurales y urbanas y en migrantes de zonas rurales a urbanas, por medio del uso del Cuestionario Internacional de Actividad Física (IPAQ). RESULTADOS: La prevalencia de actividad física baja estandarizada según la edad, de conformidad con las normas de la Organización Mundial de la Salud (OMS), fue de 2,2% en las personas que habían residido toda su vida en el campo, de 32,2% en migrantes del campo a la ciudad, y de 39,2% en habitantes de zonas urbanas durante toda la vida. Las razones de posibilidades (odds ratios) ajustadas para un nivel de actividad física bajo fueron 21,43 y 32,98 para individuos de grupos migratorios y urbanos, respectivamente, en comparación con el grupo de personas que vivían en el campo. El odds ratio ajustado para ser obeso fue de 1,94 para las personas con un bajo nivel de actividad física. No se encontraron pruebas de una asociación entre la poca actividad física y los niveles de presión arterial, hipertensión, o el síndrome metabólico. CONCLUSIONES: Los habitantes de zonas rurales tenían niveles de actividad física mucho más altos y un riesgo menor de tener exceso de peso o de ser obesos, en comparación con los residentes de una zona urbana de Lima. Las personas de la misma zona rural que habían emigrado a Lima presentaron niveles de inactividad física y de obesidad similares a los de las personas que habían vivido en Lima toda la vida. Las intervenciones dirigidas a mantener niveles más altos de actividad física entre las personas que emigran de las zonas rurales a las zonas urbanas pueden ayudar a reducir la epidemia de obesidad en las ciudades

Determinants of Behavioral Alertness in Adults with Heart Failure

STUDY OBJECTIVES: The primary objective of this study was to describe characteristics of sleep across the three domains of sleep quality, daytime sleepiness, and behavioral alertness in community-dwelling adults with heart failure. The secondary objective was to identify modifiable factors associated with behavioral alertness. METHODS: A sample of 280 adults with chronic heart failure was enrolled. Widely used, validated, and sensitive measures of sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale, Stanford Sleepiness Scale), and behavioral alertness (Psychomotor Vigilance Test [PVT]) were collected at baseline, 3 and 6 months. Sociodemographic and clinical characteristics, including exercise, were measured at baseline. RESULTS: Participants were primarily male and functionally compromised with a mean left ventricular ejection fraction of 35 percent. The majority of the sample (73%) reported poor sleep quality. The mean (± SD) Epworth Sleepiness Scale score was low (7.0 ± 4.6), indicating they did not perceive daytime sleepiness. In contrast, behavioral alertness was relatively poor as evidenced by a slow PVT mean response time (3.09 ± 0.76). Participants who reported exercising at least one hour in the past week were more alert and had faster response times than those reporting no exercise. CONCLUSIONS: Although sleep quality was poor and behavioral alertness was compromised, these heart failure patients did not feel sleepy. Exercise may help to promote behavioral alertness and reduce daytime sleepiness in adults with heart failure. CITATION: Masterson Creber R, Pak VM, Varrasse M, Dinges DF, Wald J, Riegel B. Determinants of behavioral alertness in adults with heart failure. J Clin Sleep Med 2016;12(4):589–596

Determinants of behavioral alertness in adults with heart failure

Study Objectives: The primary objective of this study was to describe characteristics of sleep across the three domains of sleep quality, daytime sleepiness, and behavioral alertness in community-dwelling adults with heart failure. The secondary objective was to identify modifiable factors associated with behavioral alertness. Methods: A sample of 280 adults with chronic heart failure was enrolled. Widely used, validated, and sensitive measures of sleep quality ( Pittsburgh Sleep Quality Index ), daytime sleepiness ( Epworth Sleepiness Scale, Stanford Sleepiness Scale ), and behavioral alertness ( Psychomotor Vigilance Test [PVT] ) were collected at baseline, 3 and 6 months. Sociodemographic and clinical characteristics, including exercise, were measured at baseline. Results: Participants were primarily male and functionally compromised with a mean left ventricular ejection fraction of 35 percent. The majority of the sample ( 73% ) reported poor sleep quality. The mean ( ± SD ) Epworth Sleepiness Scale score was low ( 7.0 ± 4.6 ), indicating they did not perceive daytime sleepiness. In contrast, behavioral alertness was relatively poor as evidenced by a slow PVT mean response time ( 3.09 ± 0.76 ). Participants who reported exercising at least one hour in the past week were more alert and had faster response times than those reporting no exercise. Conclusions: Although sleep quality was poor and behavioral alertness was compromised, these heart failure patients did not feel sleepy. Exercise may help to promote behavioral alertness and reduce daytime sleepiness in adults with heart failure

Older adults can successfully monitor symptoms using an inclusively designed mobile application

OBJECTIVES Patient-Reported Outcomes Measurement Information System (PROMIS) measures can monitor patients with chronic illnesses outside of healthcare settings. Unfortunately, few applications that collect electronic PROMIS measures are designed using inclusive design principles that ensure wide accessibility and usability, thus limiting use by older adults with chronic illnesses. Our aim was to establish the feasibility of using an inclusively designed mobile application tailored to older adults to report PROMIS measures by examining (1) PROMIS scores collected with the application, (2) patient-reported usability of the application, and (3) differences in usability by age. DESIGN Cross-sectional feasibility study. SETTING Inpatient and outpatient cardiac units at an urban academic medical center. PARTICIPANTS A total of 168 English- and Spanish-speaking older adults with heart failure. INTERVENTION Participants used an inclusively designed mobile application to self-report PROMIS measures. MEASUREMENTS Eleven PROMIS Short-Form questionnaires (Anxiety, Ability to Participate in Social Roles and Activities, Applied Cognition-Abilities, Depression, Emotional Distress-Anger, Fatigue, Global Mental Health, Global Physical Health; Pain Interference, Physical Function, Sleep Disturbance), and a validated health technology usability survey measuring Perceived Ease-of-Use and Usefulness of the application. RESULTS Overall, 27% of participants were between 65 and 74 years of age, 10% were 75 years or older, 63% were male, 32% were white, and 96% had two or more medical conditions. There was no missing PROMIS data, and mean PROMIS scores showed the greatest burden of pain, fatigue, and physical function in the sample. Usability scores were high and not associated with age (Perceived Ease-of-Use P = .77; Perceived Usefulness P = .91). CONCLUSION It is feasible for older adults to use an inclusively designed application to report complete PROMIS data with high perceived usability. To ensure data completeness and the opportunity to study multiple domains of physical, mental, and social health, future work should use inclusive design principles for applications collecting PROMIS measures among older adults