Associations of recreational and non-recreational physical activity with coronary artery calcium density vs. volume and cardiovascular disease events: the Multi-Ethnic Study of Atherosclerosis.

AimsThe benefits of physical activity (PA) on cardiovascular disease (CVD) are well known. However, studies suggest PA is associated with coronary artery calcium (CAC), a subclinical marker of CVD. In this study, we evaluated the associations of self-reported recreational and non-recreational PA with CAC composition and incident CVD events. Prior studies suggest high CAC density may be protective for CVD events.Methods and resultsWe evaluated 3393 participants of the Multi-Ethnic Study of Atherosclerosis with prevalent CAC. After adjusting for demographics, the highest quintile of recreational PA was associated with 0.07 (95% confidence interval 0.01-0.13) units greater CAC density but was not associated with CAC volume. In contrast, the highest quintile of non-recreational PA was associated with 0.08 (0.02-0.14) units lower CAC density and a trend toward 0.13 (-0.01 to 0.27) log-units higher CAC volume. There were 520 CVD events over a 13.7-year median follow-up. Recreational PA was associated with lower CVD risk (hazard ratio 0.88, 0.79-0.98, per standard deviation), with an effect size that was not changed with adjustment for CAC composition or across levels of prevalent CAC.ConclusionRecreational PA may be associated with a higher density but not a higher volume of CAC. Non-recreational PA may be associated with lower CAC density, suggesting these forms of PA may not have equivalent associations with this subclinical marker of CVD. While PA may affect the composition of CAC, the associations of PA with CVD risk appear to be independent of CAC

Acceptability of a sitting reduction intervention for older adults with obesity

Abstract Background Older adults spend more time sitting than any other age group, contributing to poor health outcomes. Effective behavioral interventions are needed to encourage less sitting among older adults, specifically those with obesity, but these programs must be acceptable to the target population. We explored participant acceptance of a theory-based and technology-enhanced sitting reduction intervention designed for older adults (I-STAND). Methods The 12-week I-STAND intervention consisted of 6 health coaching contacts, a study workbook, a Jawbone UP band to remind participants to take breaks from sitting, and feedback on sitting behaviors (generated from wearing an activPAL device for 7 days at the beginning and mid-point of the study). Semi-structured interviews were conducted with 22 participants after they completed the intervention. Interview transcripts were iteratively coded by a team, and thematic analysis was used to identify and refine emerging themes. Results Overall, participants were satisfied with the I-STAND intervention, thought the sedentary behavior goals of the intervention were easy to incorporate, and found the technologies to be helpful additions to (but not substitutes for) health coaching. Barriers to standing more included poor health, ingrained sedentary habits, lack of motivation to change sedentary behavior, and social norms that dictate when it is appropriate to sit/stand. Facilitators to standing more included increased awareness of sitting, a sense of accountability, daily activities that involved standing, social support, and changing ways of interacting in the home environment. Participants reported that the intervention improved physical health, increased energy, increased readiness to engage in physical activity, improved mood, and reduced stress. Conclusions The technology-enhanced sedentary behavior reduction intervention was acceptable, easy to incorporate, and had a positive perceived health impact on older adults with obesity. Trial registration The I-STAND study was registered at clinicaltrials.gov (ID: NCT02692560) February 2016

Collaboration between physical activity researchers and transport planners: a qualitative study of attitudes to data driven approaches

Collaboration between physical activity (PA) researchers and transport planners is a recommended strategy to combat the physical inactivity epidemic. Data collected by PA researchers could be used to identify, implement and evaluate active transport (AT) projects. However, despite aligned interests, researchers and transport planners rarely collaborate. This study utilized qualitative methods to 1) gain an in-depth understanding of the data utilized in AT planning, 2) explore the utility of Global Positioning Systems (GPS) and accelerometer data in supporting the planning process, 3) identify the benefits and barriers of researcher and transport agency collaboration, and 4) identify the facilitators to collaboration for these groups. Semistructured interviews were conducted with 17 transport modeling, planning or engineering professionals, transport agency directors, and academics with relevant expertise in health or transport planning. A thematic analysis was conducted following structural coding by two researchers. The analysis revealed that geographic and physical activity data that are current, local, objective and specific to individual AT trips would improve upon currently available data sources. Informants believed that research collaboration could increase capacity by providing unbiased data and access to students to assist with targeted research. Collaboration could also increase the relevance of academic research in applied settings. Identified barriers included: setting up contracts, lack of policy and planning mandates that include health, a disconnect between research interests and agency needs, and competing priorities. Researchers may need to initiate discussions with AT practitioners until health is formally included in the planning process as the first step in understanding data needs and identifying mutual research interests. However, regulations that link health and physical activity metrics to funding, as well as training programs that incorporate public health and transport planning, are needed to encourage cross collaboration

Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program

Abstract Background Community engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale-up, and sustainment of evidence-based interventions. Faith in Action (Fe en Acción) is an evidence-based promotora-led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women. Methods We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of Faith in Action and identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach. Results Pastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: (1) health behavior change training for pastors and staff, (2) tailored messaging, (3) developing community collaborations, and (4) gaining denominational support. Conclusions While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination

Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program

BACKGROUND: Community engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale-up, and sustainment of evidence-based interventions. METHODS: We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of RESULTS: Pastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers\u27 behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: (1) health behavior change training for pastors and staff, (2) tailored messaging, (3) developing community collaborations, and (4) gaining denominational support. CONCLUSIONS: While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination

Acute glucoregulatory and vascular outcomes of three strategies for interrupting prolonged sitting time in postmenopausal women: A pilot, laboratory-based, randomized, controlled, 4-condition, 4-period crossover trial.

Background: Prolonged sitting is associated with cardiometabolic and vascular disease. Despite emerging evidence regarding the acute health benefits of interrupting prolonged sitting time, the effectiveness of different modalities in older adults (who sit the most) is unclear.Methods: In preparation for a future randomized controlled trial, we enrolled 10 sedentary, overweight or obese, postmenopausal women (mean age 66 years ±9; mean body mass index 30.6 kg/m2 ±4.2) in a 4-condition, 4-period crossover feasibility pilot study in San Diego to test 3 different sitting interruption modalities designed to improve glucoregulatory and vascular outcomes compared to a prolonged sitting control condition. The interruption modalities included: a) 2 minutes standing every 20 minutes; b) 2 minutes walking every hour; and c) 10 minutes standing every hour. During each 5-hr condition, participants consumed two identical, standardized meals. Blood samples, blood pressure, and heart rate were collected every 30 minutes. Endothelial function of the superficial femoral artery was measured at baseline and end of each 5-hr condition using flow-mediated dilation (FMD). Participants completed each condition on separate days, in randomized order. This feasibility pilot study was not powered to detect statistically significant differences in the various outcomes, however, analytic methods (mixed models) were used to test statistical significance within the small sample size.Results: Nine participants completed all 4 study visits, one participant completed 3 study visits and then was lost to follow up. Net incremental area under the curve (iAUC) values for postprandial plasma glucose and insulin during the 5-hr sitting interruption conditions were not significantly different compared to the control condition. Exploratory analyses revealed that the 2-minute standing every 20 minutes and the 2-minute walking every hour conditions were associated with a significantly lower glycemic response to the second meal compared to the first meal (i.e., condition-matched 2-hour post-lunch glucose iAUC was lower than 2-hour post-breakfast glucose iAUC) that withstood Bonferroni correction (p = 0.0024 and p = 0.0084, respectively). Using allometrically scaled data, the 10-minute standing every hour condition resulted in an improved FMD response, which was significantly greater than the control condition after Bonferroni correction (p = 0.0033).Conclusion: This study suggests that brief interruptions in prolonged sitting time have modality-specific glucoregulatory and vascular benefits and are feasible in an older adult population. Larger laboratory and real-world intervention studies of pragmatic and effective methods to change sitting habits are needed.ClinicalTrials.gov NCT02743286

Clinical characteristics (n = 10).

<p>Clinical characteristics (n = 10).</p

Change in FMD during sitting conditions.

<p>Condition-associated change in FMD is represented by the ratio of FMD 2 (end of sitting period) to FMD 1 (baseline) and are shown by group (Panels A and B) and by individual (Panels C and D) using raw data (Panels A and C) and allometrically scaled data (Panels B and D) (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188544#sec007" target="_blank">Materials and Methods</a> section). An FMD 2–to–FMD 1 ratio greater than 1 (dotted, horizontal line) indicates that the FMD response was greater at the completion of the sitting period relative to baseline. Box and whisker plots (Panels A and B): x = mean, line = median, dots above boxes are outliers. n = 10 for the control, 2-minute walking every hour, and 10-minute standing every hour conditions; n = 9 for the 2-minute standing every 20 minutes condition. <i>p</i>-value vs. the control condition. * Statistically significant after Bonferroni correction. Bonferroni-corrected cut-off for significance in 3-arm comparison with control was <i>p</i>< 0.0167.</p

BP and heart rate during sitting conditions.

<p>SBP (Panel A), DBP (Panel B), and heart rate (Panel C) measurements at each time point. Panel D. Average iAUC for DBP values across the entire 5-hr sitting period. <i>p</i>-value vs. control condition. Bonferroni-corrected cut-off for significance in 3-arm comparison with control was p< 0.0167. All data are means +/- SEM; n = 10 for the control, 2-minute walking every hour, and 10-minute standing every hour conditions; n = 9 for the 2-minute standing every 20 minutes condition.</p