High-Intensity Functional Training (HIFT): Definition and Research Implications for Improved Fitness

High-intensity functional training (HIFT) is an exercise modality that emphasizes functional,multi-joint movements that can be modified to any fitness level and elicit greater muscle recruitmentthan more traditional exercise. As a relatively new training modality, HIFT is often compared tohigh-intensity interval training (HIIT), yet the two are distinct. HIIT exercise is characterized byrelatively short bursts of repeated vigorous activity, interspersed by periods of rest or low-intensityexercise for recovery, while HIFT utilizes constantly varied functional exercises and various activitydurations that may or may not incorporate rest. Over the last decade, studies evaluating theeffectiveness of HIIT programs have documented improvements in metabolic and cardiorespiratoryadaptations; however, less is known about the effects of HIFT. The purpose of this manuscript is toprovide a working definition of HIFT and review the available literature regarding its use to improvemetabolic and cardiorespiratory adaptations in strength and conditioning programs among variouspopulations. Additionally, we aim to create a definition that is used in future publications to evaluatemore effectively the future impact of this type of training on health and fitness outcomes

The Effect of Habitual Smoking on VO2max

VO2max is associated with many factors, including age, gender, physical activity, and body composition. It is popularly believed that habitual smoking lowers aerobic fitness. PURPOSE: to determine the effect of habitual smoking on VO2max after controlling for age, gender, activity and BMI. METHODS: 2374 men and 375 women employed at the NASA/Johnson Space Center were measured for VO2max by indirect calorimetry (RER>=1.1), activity by the 11 point (0-10) NASA Physical Activity Status Scale (PASS), BMI and smoking pack-yrs (packs day*y of smoking). Age was recorded in years and gender was coded as M=1, W=0. Pack.y was made a categorical variable consisting of four levels as follows: Never Smoked (0), Light (1-10), Regular (11-20), Heavy (>20). Group differences were verified by ANOVA. A General Linear Models (GLM) was used to develop two models to examine the relationship of smoking behavior on VO2max. GLM #1(without smoking) determined the combined effects of age, gender, PASS and BMI on VO2max. GLM #2 (with smoking) determined the added effects of smoking (pack.y groupings) on VO2max after controlling for age, gender, PASS and BMI. Constant errors (CE) were calculated to compare the accuracy of the two models for estimating the VO2max of the smoking subgroups. RESULTS: ANOVA affirmed the mean VO2max of each pack.y grouping decreased significantly (p<0.01) as the level of smoking exposure increased. GLM #1 showed that age, gender, PASS and BMI were independently related with VO2max (R2 = 0.642, SEE = 4.90, p<0.001). The added pack.y variables in GLM #2 were statistically significant (R2 change = 0.7%, p<0.01). Post hoc analysis showed that compared to Never Smoked, the effects on VO2max from Light and Regular smoking habits were -0.83 and -0.85 ml.kg- 1.min-1 respectively (p<0.05). The effect of Heavy smoking on VO2max was -2.56 ml.kg- 1.min-1 (p<0.001). The CE s of each smoking group in GLM #2 was smaller than the CE s of the smoking group counterparts in GLM #1. CONCLUSIONS: After accounting for the effects of gender, age, PASS and BMI the effect of habitual smoking on reducing VO2max is minimal, about 0.85 ml/kg/min, until the habit exceeds 20 pack.y at which point an additional decrease of 1.71 ml/kg/min is noted. Adding pack.y data improves the accuracy of predicting the VO2max of smokers

Testing the performance of the ENRICHD Social Support Instrument in cardiac patients

BACKGROUND: Previous investigations suggest an important role of social support in the outcomes of patients treated for ischemic heart disease. The ENRICHD Social Support Instrument (ESSI) is a 7-item self-report survey that assesses social support. Validity and reliability of the ESSI, however, has not been formally tested in patients undergoing percutaneous coronary intervention (PCI). METHODS: The ESSI, along with the Short Form-36 (SF-36), was sequentially administered to a cohort of 271 patients undergoing PCI. The test-retest reliability was examined with an intra-class correlation coefficient by comparing scores among 174 patients who completed both instruments 5 and 6 months after their procedure. Internal reliability was assessed using Cronbach's alpha at the time of patients' baseline procedure. The concurrent validity of the ESSI was assessed by comparing scores between depressed (MHI-5 score < 44) vs. non-depressed patients. The correlation between the ESSI and the SF-36 Social Functioning sub-scale, an accepted measure of social functioning, was also examined. RESULTS: Test-retest reliability showed no significant differences in mean scores among ESSI questionnaires administered 1 month apart (27.8+/-1.4 vs 27.8+/-1.5, p = 0.98). The intra-class correlation coefficient was 0.94 and Cronbach's alpha was 0.88. Mean ESSI scores were significantly lower among depressed vs. non-depressed patients (24.6+/-1.7 vs 27+/-1.4, p < 0.018) and a positive albeit modest correlation with social functioning was seen (r = 0.19, p = 0.002). CONCLUSION: The ESSI appears to be a valid and reliable measure of social support in patients undergoing treatment for coronary artery disease. It may prove to be a valuable method of controlling for patient variability in outcomes studies where the outcomes are related to patients' social support

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This study evaluated the effectiveness of nondieting versus dieting treatments for overweight, bingeeating women. Participants (N = 219) were randomly assigned to 1 of 3 groups: diet treatment (DT), nondiet treatment (NDT), or wait-list control (WLC). DT received a balanced-deficit diet reinforced with behavioral strategies. NDT received therapy designed to help participants break out of their dieting cycles. Treatment in both conditions was administered in weekly groups for 6 months, followed by 26 biweekly maintenance meetings, for a total of 18 months of contact. At 6 months posttreatment, DT lost 0.6 kg while NDT gained 1.3 kg. Both treatment groups reduced their Binge Eating Scale scores significantly more than WLC. At 18-month follow-up, both treatment groups experienced weight gain but maintained similar reductions in binge eating. Results indicate that neither intervention was successful in producing short-or long-term weight loss. Therapist biases, which may have affected treatment integrity, and other methodological issues are discussed in relation to the small weight losses achieved. Estimates of binge eating among obese patients range from 20% to 50%, depending on the criteria used and the study population (Bruce &amp; Wilfiey, 1996; It is unclear whether or not binge-eating obese patients experience greater difficulty in treatment programs as a result of these liabilities. Obese binge eaters have been found to respond to weight loss programs similarly to nonbingers, and experience similar or lower attrition rates This research was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant DK43109 and by a Minority Scientist Development Award from the American Heart Association and its Puerto Rican Affiliate. Correspondence concerning this article should be addressed to G. Ken Goodrick, Behavioral Medicine Research Center, Baylor College of Medicine, 6535 Fannin, Mailstop F-700, Houston, Texas 77030. outcomes Several nondieting therapeutic approaches have been developed for the treatment of obesity The purpose of this prospective, randomized, controlled study was to evaluate the effectiveness of this nondieting approach in the treatment of obese, binge-eating women, compared with a standardized, behavioral dieting treatment and a control group. Method Participants The mean age of participants was 40 years (SD = 6.3, range = 25 to 50 years). Participants&apos; mean pretreatment weight was 88 kg (SD = 9.6, range = 66 to 110 kg). The mean body mass index (BMI) was 33 kg/m 2 (SD = 3.4), with a range of 26 to 43 kg/m 2. The ethnic-racial composition of the sample was 85% White, 8% Black, and 7% Hispanic. Of the total participants, 62% were married, 21% were single or divorced, and 17% were never married. Twenty-four percent of the participants had a college degree, 65% had some college, and 11% had a high school diploma or less. Sixty-nine percent were employed full time, and 9% part time. Procedure Female participants were recruited from Houston and the surrounding area using print and electronic media to publicize the study. Those 36

Associations between the built environment and physical activity in public housing residents

Background: Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments. Methods: Physical activity data from 452 adult residents residing in 12 low-income housing developments were combined with measured environmental data that examined the neighborhood (800 m radius buffer) around each housing development. Aggregated ecological and multilevel regression models were used for analysis. Results: Participants were predominately female (72.8%), African American (79.6%) and had a high school education or more (59.0%). Overall, physical activity rates were low, with only 21% of participants meeting moderate physical activity guidelines. Ecological models showed that fewer incivilities and greater street connectivity predicted 83% of the variance in days walked per week, p < 0.001, with both gender and connectivity predicting days walked per week in the multi-level analysis, p < 0.05. Greater connectivity and fewer physical activity resources predicted 90% of the variance in meeting moderate physical activity guidelines, p < 0.001, and gender and connectivity were the multi-level predictors, p < 0.05 and 0.01, respectively. Greater resource accessibility predicted 34% of the variance in days per week of vigorous physical activity in the ecological model, p < 0.05, but the multi-level analysis found no significant predictors. Conclusion: These results indicate that the physical activity of low-income residents of public housing is related to modifiable aspects of the built environment. Individuals with greater access to more physical activity resources with few incivilities, as well as, greater street connectivity, are more likely to be physically active

Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort

Objectives To develop a predictive model for pre-eclampsia based on clinical risk factors for nulliparous women and to identify a subgroup at increased risk, in whom specialist referral might be indicated

The duration of sexual relationship and its effects on adverse pregnancy outcomes

This study aims to determine if a short duration of sexual relationship is more common among women who experience adverse pregnancy outcomes including gestational hypertension (GHT), preeclampsia, small for gestational age (SGA) pregnancies and spontaneous preterm birth (sPTB) with or without abnormal uterine artery Doppler compared to women who have uncomplicated pregnancies. 5591 nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. The risk for pregnancy complications for women who had a duration of sexual relationship of ≤3 months, 4–6 months, 7–9 months, 10–12 months was compared with women who had a duration of sexual relationship of >12 months. Uterine artery Doppler was performed at 20 ± 1 weeks’ gestation. A short duration of sexual relationship (≤3 months) was more common among women with SGA in the presence of abnormal uterine artery Doppler [9.8% vs 3.0%, aOR (95% CI) 3.4 (1.6–7.08] compared to women who had uncomplicated pregnancies. A short duration of sexual relationship (≤3 months) was also more common among women who had abnormal uterine artery Doppler compared to those with normal uterine artery Doppler [6.1% vs 3.1%, aOR (95% CI) = 2.1 (1.4–3.2)]. A short duration of sexual relationship was not associated with preeclampsia after adjusting for confounders. A short duration of sexual relationship is more common among women who deliver SGA infants with features of placental insufficiency as indicated by abnormal uterine artery Doppler

Prediction of Small for Gestational Age Infants in Healthy Nulliparous Women Using Clinical and Ultrasound Risk Factors Combined with Early Pregnancy Biomarkers

Objective Most small for gestational age pregnancies are unrecognised before birth, resulting in substantial avoidable perinatal mortality and morbidity. Our objective was to develop multivariable prediction models for small for gestational age combining clinical risk factors and biomarkers at 15±1 weeks’ with ultrasound parameters at 20±1 weeks’ gestation. Methods Data from 5606 participants in the Screening for Pregnancy Endpoints (SCOPE) cohort study were divided into Training (n = 3735) and Validation datasets (n = 1871). The primary outcomes were All-SGA (small for gestational age with birthweight <10th customised centile), Normotensive-SGA (small for gestational age with a normotensive mother) and Hypertensive-SGA (small for gestational age with an hypertensive mother). The comparison group comprised women without the respective small for gestational age phenotype. Multivariable analysis was performed using stepwise logistic regression beginning with clinical variables, and subsequent additions of biomarker and then ultrasound (biometry and Doppler) variables. Model performance was assessed in Training and Validation datasets by calculating area under the curve. Results 633 (11.2%) infants were All-SGA, 465(8.2%) Normotensive-SGA and 168 (3%) Hypertensive-SGA. Area under the curve (95% Confidence Intervals) for All-SGA using 15±1 weeks’ clinical variables, 15±1 weeks’ clinical+ biomarker variables and clinical + biomarkers + biometry /Doppler at 20±1 weeks’ were: 0.63 (0.59–0.67), 0.64 (0.60–0.68) and 0.69 (0.66–0.73) respectively in the Validation dataset; Normotensive-SGA results were similar: 0.61 (0.57–0.66), 0.61 (0.56–0.66) and 0.68 (0.64–0.73) with small increases in performance in the Training datasets. Area under the curve (95% Confidence Intervals) for Hypertensive-SGA were: 0.76 (0.70–0.82), 0.80 (0.75–0.86) and 0.84 (0.78–0.89) with minimal change in the Training datasets. Conclusion Models for prediction of small for gestational age, which combine biomarkers, clinical and ultrasound data from a cohort of low-risk nulliparous women achieved modest performance. Incorporation of biomarkers into the models resulted in no improvement in performance of prediction of All-SGA and Normotensive-SGA but a small improvement in prediction of Hypertensive-SGA. Our models currently have insufficient reliability for application in clinical practice however, they have potential utility in two-staged screening tests which include third trimester biomarkers and or fetal biometry

Clinical, ultrasound and molecular biomarkers for early prediction of large for gestational age infants in nulliparous women: an international prospective cohort study

Objective: To develop a prediction model for term infants born large for gestational age (LGA) by customised birthweight centiles. Methods: International prospective cohort of nulliparous women with singleton pregnancy recruited to the Screening for Pregnancy Endpoints (SCOPE) study. LGA was defined as birthweight above the 90th customised centile, including adjustment for parity, ethnicity, maternal height and weight, fetal gender and gestational age. Clinical risk factors, ultrasound parameters and biomarkers at 14–16 or 19–21 weeks were combined into a prediction model for LGA infants at term using stepwise logistic regression in a training dataset. Prediction performance was assessed in a validation dataset using area under the Receiver Operating Characteristics curve (AUC) and detection rate at fixed false positive rates. Results: The prevalence of LGA at term was 8.8% (n = 491/5628). Clinical and ultrasound factors selected in the prediction model for LGA infants were maternal birthweight, gestational weight gain between 14–16 and 19–21 weeks, and fetal abdominal circumference, head circumference and uterine artery Doppler resistance index at 19–21 weeks (AUC 0.67; 95%CI 0.63–0.71). Sensitivity of this model was 24% and 49% for a fixed false positive rate of 10% and 25%, respectively. The addition of biomarkers resulted in selection of random glucose, LDL-cholesterol, vascular endothelial growth factor receptor-1 (VEGFR1) and neutrophil gelatinase-associated lipocalin (NGAL), but with minimal improvement in model performance (AUC 0.69; 95%CI 0.65–0.73). Sensitivity of the full model was 26% and 50% for a fixed false positive rate of 10% and 25%, respectively. Conclusion: Prediction of LGA infants at term has limited diagnostic performance before 22 weeks but may have a role in contingency screening in later pregnancy

Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study

Letter to the EditorLuke E. Grzeskowiak, Lisa G. Smithers, Jessica A. Grieger, Tina Bianco-Miotto, Shalem Y. Leemaqz, Vicki L. Clifton, Lucilla Poston, Lesley M. McCowan, Louise C. Kenny, Jenny Myers, James J. Walker, Robert J Norman, Gus A. Dekker and Claire T. Robert