Active lifestyles related to excellent self-rated health and quality of life: cross sectional findings from 194,545 participants in The 45 and Up Study

Background: Physical activity and sitting time independently contribute to chronic disease risk, though little work has focused on aspirational health outcomes. The purpose of this study was to examine associations between physical activity, sitting time, and excellent overall health (ExH) and quality of life (ExQoL) in Australian adults. Methods: The 45 and Up Study is a large Australian prospective cohort study (n = 267,153). Present analyses are from 194,545 participants (48% male; mean age = 61.6 ± 10.7 yrs) with complete baseline questionnaire data on exposures, outcomes, and potential confounders (age, income, education, smoking, marital status, weight status, sex, residential remoteness and economic advantage, functional limitation and chronic disease). The Active Australia survey was used to assess walking, moderate, and vigorous physical activity. Sitting time was determined by asking participants to indicate number of hours per day usually spent sitting. Participants reported overall health and quality of life, using a five-point scale (excellent—poor). Binary logistic regression models were used to analyze associations, controlling for potential confounders. Results: Approximately 16.5% of participants reported ExH, and 25.7% reported ExQoL. In fully adjusted models, physical activity was positively associated with ExH (AOR = adjusted odds ratio for most versus least active = 2.22, 95% CI = 2.20, 2.47; P[subscript trend] < 0.001) and ExQoL (AOR for most versus least active = 2.30, 95% CI = 2.12, 2.49; P[subscript trend]  < 0.001). In fully adjusted models, sitting time was inversely associated with ExH (AOR for least versus most sitting group = 1.13, 95% CI = 1.09, 1.18; P[subscript trend]  < 0.001) and ExQoL (AOR for least versus most sitting group = 1.13, 95% CI = 1.10, 1.17; P[subscript trend]  < 0.001). In fully adjusted models, interactions between physical activity and sitting time were not significant for ExH (P = 0.118) or ExQoL (P = 0.296). Conclusions: Physical activity and sitting time are independently associated with excellent health and quality of life in this large diverse sample of Australian middle-aged and older adults. These findings bolster evidence informing health promotion efforts to increase PA and decrease sitting time toward the achievement of better population health and the pursuit of successful aging

Motivating medical students to do research: a mixed methods study using Self-Determination Theory

Citation: Rosenkranz, S. K., Wang, S. Y., & Hu, W. D. (2015). Motivating medical students to do research: a mixed methods study using Self-Determination Theory. Bmc Medical Education, 15, 13. doi:10.1186/s12909-015-0379-1Background: It is widely accepted that all medical graduates should understand the uses and methods of rigorous research, with a need to promote research to graduates who will pursue an academic career. This study aimed to explore, identify and explain what motivates and demotivates medical students to do research. Methods: A convergent parallel mixed methods study was conducted. Cross-sectional quantitative survey data (n = 579) and qualitative semi-structured interview findings (n = 23) data were separately collected and analysed. Informed by Self-Determination Theory (SDT), quantitative and qualitative findings were integrated to develop a model for the factors associated with medical students' expressed motivation to do research, and related to clinical and research learning activities at different stages in an undergraduate medical program. Results: Only 7.5 % of students had research experience prior to entering the program. Survey results revealed that students who had experienced exposure to the uncertainties of clinical practice through clerkships (Pre-Clinical (48 %) vs Clinical Years (64 %), p < 0.001), and a sense of achievement through supported compulsory research activities which were conducted as a team (Pre-Community Research (51 %) vs Post-Community Research (66 %), p < 0.001), were more likely to view future research activities positively. When integrated with qualitative findings using the three SDT domains of autonomy, competence and relatedness, eight major themes were identified: Self & Time, Career, Bureaucracy, Financial, Confidence, Clinical Relevance, Research as a Social Activity, and Personal Relevance. The findings suggest that motivation to do research is associated with increasing internalization of intrinsic motivators; in particular those associated with competence (Confidence) and relatedness (Clinical Relevance, Research as a Social Activity). Conclusions: SDT is useful for understanding the motivation of individuals and how curriculum can be designed to optimise motivation. Study findings suggest that well supported compulsory research activities that incorporate group learning and elements of choice may promote motivation to do research, and potentially, careers in research, even in a research naive student body

Does dietary intake change during an intervention to reduce sedentary behavior and cardiovascular disease risk? A randomized comparative effectiveness trial

Citation: Casey, K., Mailey, E. L., Rosenkranz, R. R., Swank, A., Ablah, E., & Rosenkranz, S. K. (2018). Does dietary intake change during an intervention to reduce sedentary behavior and cardiovascular disease risk? A randomized comparative effectiveness trial. BMC Nutrition, 4(1). https://doi.org/10.1186/s40795-018-0223-1Background: Evidence from physical activity interventions suggests that women, in particular, may overcompensate for exercise energy expenditure by increasing caloric intake. Sedentary behavior and poor dietary quality are independent risk factors for many major chronic diseases, including cardiovascular disease (CVD). The primary purpose of this study was to determine whether insufficiently active women, accumulating less than 60 min per week of moderate-to-vigorous physical activity, alter caloric intake or dietary quality when participating in an 8-week intervention to reduce sedentary behavior and CVD risk. A secondary aim was to determine whether the two treatment groups differed from one another in dietary intake while participating in the intervention. Methods: Insufficiently active women (n = 49) working full-time sedentary jobs were randomized to one of two treatment groups to reduce sedentary behavior during the workweek: short-break (1–2 min breaks from sitting every half hour, SB), or long-break (15 min breaks from sitting twice daily, LB). Three-day food records were collected at baseline, week 4 and week 8. Dietary quality was assessed using the Alternative Healthy Eating Index 2010 (AHEI-2010). Risk factors for CVD were assessed at baseline and week 8. Results: For all participants, average caloric intake decreased significantly from baseline to week 8 by approximately 12% (Δ = − 216.0 kcals, p = 0.003). Average caloric intake decreased significantly over time for the SB group (Δ = − 369.6 kcals, p = 0.004), but not the LB group (Δ = − 179.5 kcals, p = 0.17). There was no significant difference between SB and LB groups with regard to calories from baseline to week 8 (F = 0.51, p = 0.48). Total AHEI-2010 scores did not decrease significantly for all participants (Δ = − 4.0, p = 0.14), SB (Δ = − 5.2, p = 0.16), or LB groups (Δ = − 4.5, p = 0.67). Conclusions: Following an 8-week intervention to reduce sedentary time, insufficiently active women decreased caloric intake over time, however there were no differences between SB and LB groups. In all participants, dietary quality was not altered over time. Future studies should explore sedentary reduction interventions compared to physical activity interventions as a means to create negative energy balance, as frequent sedentary breaks may be effective for improving health outcomes in women. Trial registration: ClinicalTrials.gov registration number NCT02609438, retrospectively registered November 20, 2015

The potential link between sugar-sweetened beverage consumption and post-exercise airway narrowing across puberty: a longitudinal cohort study

Citation: Emerson, S. R., Rosenkranz, S. K., Rosenkranz, R. R., Kurti, S. P., & Harms, C. A. (2016). The potential link between sugar-sweetened beverage consumption and post-exercise airway narrowing across puberty: a longitudinal cohort study. Public Health Nutrition, 19(13), 2435-2440. doi:10.1017/s1368980015003109Objective The prevalence of asthma is rising, presenting serious public health challenges. Recent data suggest that sugar-sweetened beverage (SSB) consumption plays a role in asthma aetiology. The purpose of the present study was to determine whether SSB consumption is linked to post-exercise airway narrowing (predictor of asthma development) across puberty. Design Participants completed pulmonary function tests, physical activity and dietary habit questionnaires, and an exercise test to exhaustion. Setting Community in Manhattan, Kansas, USA. Subjects We recruited ten boys and ten girls from an original cohort of forty participants tested in our laboratory approximately 5 years prior. Participants were aged 97 (sd 09) years at baseline and 147 (sd 09) years at follow-up. Results Pre-puberty, boys consumed 68 (sd 48) servings/week and girls consumed 69 (sd 37) servings/week, while post-puberty boys consumed 115 (sd 53) servings/week and girls consumed 77 (sd 43) servings/week. Using Pearson correlation, SSB consumption was not significantly related to post-exercise airway narrowing at pre-puberty (r=-035, P=0130). In linear regression analyses, SSB consumption was significantly related to post-exercise airway narrowing post-puberty before (standardized =-060, P=0005) but not after (standardized =-033, P=0211) adjustment for confounders. Change in SSB consumption from pre- to post-puberty was significantly associated with post-exercise airway narrowing post-puberty (r=-061, P=0010) and change in post-exercise airway narrowing from pre- to post-puberty (r=-045, P=0048) when assessed via Pearson correlations. Conclusions These findings suggest a possible link between SSB consumption and asthma development during maturation. Reduced SSB intake may be a possible public health avenue for blunting rising asthma prevalence

Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls

Citation: Cull, B. J., Rosenkranz, S. K., Dzewaltowski, D. A., Teeman, C. S., Knutson, C. K., & Rosenkranz, R. R. (2016). Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls. Pilot and Feasibility Studies, 2(1), 26. https://doi.org/10.1186/s40814-016-0066-yChildhood obesity is a major public health problem, with one third of America’s children classified as either overweight or obese. Obesity prevention and health promotion programs using components such as wellness coaching and home-based interventions have shown promise, but there is a lack of published research evaluating the impact of a combined home-based and wellness coaching intervention for obesity prevention and health promotion in young girls. The main objective of this study is to test the feasibility of such an intervention on metrics related to recruitment, intervention delivery, and health-related outcome assessments. The secondary outcome is to evaluate the possibility of change in health-related psychosocial, behavioral, and biomedical outcomes in our sample of participants

Holistic Framework to Contextualize Dietary Quality Assessment: A Critical Review

Numerous dietary quality indices exist to help quantify overall dietary intake and behaviors associated with positive health outcomes. Most indices focus solely on biomedical factors and nutrient or food intake, and exclude the influence of important social and environmental factors associated with dietary intake. Using the Diet Quality Index- International as one sample index to illustrate our proposed holistic conceptual framework, this critical review seeks to elucidate potential adaptations to dietary quality assessment by considering—in parallel—biomedical, environmental, and social factors. Considering these factors would add context to dietary quality assessment, influencing post-assessment recommendations for use across various populations and circumstances. Additionally, individual and population-level evidence-based practices could be informed by contextual social and environmental factors that influence dietary quality to provide more relevant, reasonable, and beneficial nutritional recommendations

Household Air Pollution Exposure and Influence of Lifestyle on Respiratory Health and Lung Function in Belizean Adults and Children: A Field Study

Citation: Kurti, S. P., Kurti, A. N., Emerson, S. R., Rosenkranz, R. R., Smith, J. R., Harms, C. A., & Rosenkranz, S. K. (2016). Household Air Pollution Exposure and Influence of Lifestyle on Respiratory Health and Lung Function in Belizean Adults and Children: A Field Study. International Journal of Environmental Research and Public Health, 13(7), 12. doi:10.3390/ijerph13070643Household air pollution (HAP) contributes to the global burden of disease. Our primary purpose was to determine whether HAP exposure was associated with reduced lung function and respiratory and non-respiratory symptoms in Belizean adults and children. Our secondary purpose was to investigate whether lifestyle (physical activity (PA) and fruit and vegetable consumption (FV)) is associated with reported symptoms. Belizean adults (n = 67, 19 Male) and children (n = 23, 6 Male) from San Ignacio Belize and surrounding areas participated in this cross-sectional study. Data collection took place at free walk-in clinics. Investigators performed initial screenings and administered questionnaires on (1) sources of HAP exposure; (2) reported respiratory and non-respiratory symptoms and (3) validated lifestyle questionnaires. Participants then performed pulmonary function tests (PFTs) and exhaled breath carbon monoxide (CO). There were no significant associations between HAP exposure and pulmonary function in adults. Increased exhaled CO was associated with a significantly lower forced expiratory volume in 1-s divided by forced vital capacity (FEV1/FVC) in children. Exposed adults experienced headaches, burning eyes, wheezing and phlegm production more frequently than unexposed adults. Adults who met PA guidelines were less likely to experience tightness and pressure in the chest compared to those not meeting guidelines. In conclusion, adults exposed to HAP experienced greater respiratory and non-respiratory symptoms, which may be attenuated by lifestyle modifications

Summation of blood glucose and TAG to characterise the 'metabolic load index'

Citation: Emerson, S. R., Haub, M. D., Teeman, C. S., Kurti, S. P., & Rosenkranz, S. K. (2016). Summation of blood glucose and TAG to characterise the 'metabolic load index'. British Journal of Nutrition, 116(9), 1553-1563. doi:10.1017/s0007114516003585Research points to postprandial glucose and TAG measures as preferable assessments of cardiovascular risk as compared with fasting values. Although elevated postprandial glycaemic and lipaemic responses are thought to substantially increase chronic disease risk, postprandial glycaemia and lipaemia have historically only been considered separately. However, carbohydrates and fats can generally 'compete' for clearance from the stomach, small intestine, bloodstream and within the peripheral cell. Further, there are previous data demonstrating that the addition of carbohydrate to a high-fat meal blunts the postprandial lipaemic response, and the addition of fat to a high-carbohydrate meal blunts the postprandial glycaemic response. Thus, postprandial glycaemia and lipaemia are interrelated. The purpose of this brief review is 2-fold: first, to review the current evidence implicating postprandial glycaemia and lipaemia in chronic disease risk, and, second, to examine the possible utility of a single postprandial glycaemic and lipaemic summative value, which will be referred to as the metabolic load index. The potential benefits of the metabolic load index extend to the clinician, patient and researcher

Effects of thirty and sixty minutes of moderate-intensity aerobic exercise on postprandial lipemia and inflammation in overweight men: a randomized cross-over study

Citation: Emerson, S. R., Kurti, S. P., Snyder, B. S., Sitaraman, K., Haub, M. D., & Rosenkranz, S. K. (2016). Effects of thirty and sixty minutes of moderate-intensity aerobic exercise on postprandial lipemia and inflammation in overweight men: a randomized cross-over study. Journal of the International Society of Sports Nutrition, 13, 12. doi:10.1186/s12970-016-0137-8Background: The transient rise in blood lipids following a high-fat meal (HFM), known as postprandial lipemia, is linked to systemic inflammation and cardiovascular disease, but can be blunted by exercise. However, minimal research has investigated the effects of realistic exercise bouts on postprandial lipemia and inflammation in at-risk individuals. The purpose of this study was to assess the effects of moderate-intensity aerobic exercise lasting 30 or 60 min performed the evening before a HFM, on postprandial lipemia and inflammation in overweight, insufficiently active men. Methods: In this randomized-crossover study, twelve participants remained sedentary (CON), or performed a brisk walk on a treadmill at 60 % VO2peak for either 30 min (EX-30) or 60 min (EX-60), after which they consumed a small snack (270 kcal) to partially replace exercise energy expenditure. Following a 12-h overnight fast, participants consumed a standard HFM (1 g fat/kg; 1 g CHO/kg; 1117.8 +/- 117.0 kcal). Blood draws were performed at baseline (pre-HFM) and 1, 2, 4, 6, and 8 h post-HFM to assess glucose, insulin, lipids, and systemic inflammation. Results: There were no significant differences (p > 0.05) in fasting triglycerides between EX-60 (118.7 +/- 68.3 mg/dL), CON (134.8 +/- 66.2 mg/dL) or EX-30 (135.5 +/- 85.4 mg/dL). There were no differences in peak, time-to-peak, total or incremental area-under-the-curve between trials for triglyceride response (p > 0.05). There was no significant main effect of time (p > 0.05) in IL-1ra, IL-4, IL-5, IL-6, IL-10 or TNF-alpha from baseline to 8 h post-HFM in any trial. Conclusions: In summary, we found that in overweight, insufficiently active men, neither 30 nor 60 min of moderate-intensity exercise performed 12 h prior to a HFM attenuated postprandial lipemia or inflammation, which could potentially be explained by the partial caloric replacement of exercise energy expenditure

The effect of moderate intensity exercise in the postprandial period on the inflammatory response to a high-fat meal: an experimental study

Citation: Teeman, C. S., Kurti, S. P., Cull, B. J., Emerson, S. R., Haub, M. D., & Rosenkranz, S. K. (2016). The effect of moderate intensity exercise in the postprandial period on the inflammatory response to a high-fat meal: an experimental study. Nutrition Journal, 15, 13. doi:10.1186/s12937-016-0134-4Background: Consuming a high-fat meal (HFM) may lead to postprandial lipemia (PPL) and inflammation. Postprandial exercise has been shown to effectively attenuate PPL. However, little is known about the impact of postprandial exercise on systemic inflammation and whether PPL and inflammation are associated. The purpose of this study was to determine whether moderate intensity exercise performed 60 min following a true-to-life HFM would attenuate PPL and inflammation. Methods: Thirty-nine young adults (18-40 year) with no known metabolic disease were randomized to either a control group (CON) who remained sedentary during the postprandial period or an exercise (EX) group who walked at 60 % VO2peak to expend approximate to 5 kcal/kgbw one-hour following the HFM. Participants consumed a HFM of 10 kcal/kgbw and blood draws were performed immediately before, 2 h and 4 h post-HFM. Results: At baseline, there were no differences between EX and CON groups for any metabolic or inflammatory markers (p > 0.05). Postprandial triglycerides (TRG) increased from baseline to 4 h in the EX and CON groups (p 0.05). There was an increase in soluble vascular adhesion molecule (sVCAM-1) from baseline to 4 h (p = 0.027) for all participants along with a group x time interaction (p = 0.020). Changes in TRG were associated with changes in interleukin-10 (IL-10) from 0 to 2 h (p = 0.007), but were not associated with changes in any other inflammatory marker in the postprandial period (p > 0.05). Conclusions: Despite significant increases in PPL following a HFM, moderate intensity exercise in the postprandial period did not mitigate the PPL nor the inflammatory response to the HFM. These results indicate that in populations with low metabolic risk, PPL and inflammation following a HFM may not be directly related