The effects of neighborhood density and street connectivity on walking behavior: the Twin Cities walking study

A growing body of health and policy research suggests residential neighborhood density and street connectivity affect walking and total physical activity, both of which are important risk factors for obesity and related chronic diseases. The authors report results from their methodologically novel Twin Cities Walking Study; a multilevel study which examined the relationship between built environments, walking behavior and total physical activity. In order to maximize neighborhood-level variation while maintaining the exchangeability of resident-subjects, investigators sampled 716 adult persons nested in 36 randomly selected neighborhoods across four strata defined on density and street-connectivity – a matched sampling design. Outcome measures include two types of self-reported walking (from surveys and diaries) and so-called objective 7-day accelerometry measures. While crude differences are evident across all outcomes, adjusted effects show increased odds of travel walking in higher-density areas and increased odds of leisure walking in low-connectivity areas, but neither density nor street connectivity are meaningfully related to overall mean miles walked per day or increased total physical activity. Contrary to prior research, the authors conclude that the effects of density and block size on total walking and physical activity are modest to non-existent, if not contrapositive to hypotheses. Divergent findings are attributed to this study's sampling design, which tends to mitigate residual confounding by socioeconomic status

No effect of exercise on insulin-like growth factor (IGF)-1, insulin and glucose in young women participating in a 16-week randomized controlled trial

Introduction: Insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) have been associated with increased risk of breast cancer. Methods: We report our findings on the effects of 16 weeks of aerobic exercise on IGF axis proteins, insulin, glucose and insulin resistance of 319 young sedentary women. Demographics, health surveys, body composition, dietary intake and blood samples were collected at baseline and 16 weeks. IGF-1 and IGF binding proteins 1, 2, and 3 were measured by ELISA’s. Results: Exercise adherence was 88% and the dropout rates for the exercise and control groups were 21.7% and 14.5%, respectively. There was a small significant change from baseline in IGFBP-3 concentrations. IGFBP-3 levels decreased in controls and increased in exercisers. The between group difference was significant. No other changes were noted. Conclusion: Sixteen weeks of exercise had minimum or no effect on IGF proteins of young women. Impact: Our study supports findings from previous studies conducted in older populations and raises the question of what type of intervention is needed to change circulating levels of IGF proteins in humans

Psychosocial Correlates of Physical Activity and Sedentary Leisure Habits in Young Adolescents: The Teens Eating for Energy and Nutrition at School Study

BACKGROUND: Low levels of physical activity (PA) and highly sedentary leisure habits (SLH) in youth may establish behavioral patterns that will predispose youth to increased chronic disease risk in adulthood. The purpose of this paper was to examine associations of demographic and psychosocial factors with self-reported PA and SLH in young adolescents. METHODS: A general linear mixed model predicted self-reported PA and SLH in the spring from demographic and psychosocial variables measured the previous fall in 3798 seventh grade students. RESULTS: PA and SLH differed by race, with Caucasian students reporting among the highest PA and lowest SLH. Perceptions of higher academic rank or expectations predicted higher PA and lower SLH. Depressive symptomatology predicted higher SLH scores but not PA. Higher self-reported value of health, appearance, and achievement predicted higher PA and lower SLH in girls. Girls who reported that their mothers had an authoritative parenting style also reported higher PA and lower SLH. CONCLUSIONS: Determinants of PA and SLH appear to differ from each other, particularly in boys. Development of effective programs to increase PA and/or decrease SLH in young adolescents should be based on a clear understanding of the determinants of these behaviors

Synergy Between Licensed Rehabilitation Professionals and Clinical Exercise Physiologists: Optimizing Patient Care for Cancer Rehabilitation

Objectives: To differentiate between rehabilitation and exercise training and propose how rehabilitation professionals and exercise physiologists can collaborate to optimize cancer survivor care.Data Source: Professional organizations and peer-reviewed manuscripts.Conclusion: Both professions offer complementary skillsets that, when integrated, optimize the ability of the cancer care team to implement more effective survivorship care plans. Future models of care must incorporate efficient communications between the cancer rehabilitation program and oncology team, include various reimbursement/payment/funding options, and continuously assess program efficacy.Implications for Nursing Practice: Nurses must be cognizant of physical needs (ie, functional and conditioning status) and cancer-related comorbidities when referring cancer survivors for exercise reconditioning

A systematic review of home-based dietary interventions during radiation therapy for cancer.

Purpose: Our objectives are to assess (1) the acceptability and feasibility of dietary interventions for patients undergoing radiation therapy (RT), and (2) the impact of dietary interventions on patient reported outcomes, toxicities, and survival. Methods: A PICOS/PRISMA/MOOSE selection protocol was used to include articles that evaluate adding dietary interventions to patients receiving RT. Acceptability was defined as (# accepting/# approached); feasibility was (# completing/# approached). Patient-reported outcomes were reported based on questionnaires used in each study and survival was measured from the date of diagnosis until death in each study. Level of evidence was assessed with Center for Evidence-Based Medicine (CEBM) criteria. Results: Sixteen articles were included; among these, 2027 patients were approached regarding the intervention, and 1661 accepted (81.9%); of these, 1543 (92.9%) completed the prescribed diet + RT course. The most common cancers included were gynecological, head and neck, and gastrointestinal. For patients with pelvic cancers, a high fiber diet may improve diarrhea (CEBM level 1b). Enteral nutrition formula, including formulas with proteins such as L-arginine, lipids such as eicosapentaenoic acids, glucids, and ribonucleotides, may help prevent of malnutrition in head and neck cancer patients undergoing RT (level 2b). Vitamin C and β-carotene may reduce of xerostomia in head and neck cancer patients; however, the studies evaluating these vitamins included vitamin E, which increases all-cause mortality (level 2b). No dietary intervention for cancer patients receiving RT has been shown to improve survival. Conclusion: There are limited data to support safe and efficacious use of dietary interventions during RT

Physical and Social Contexts of Physical Activities Among Adolescent Girls

Background: With limited opportunities for physical activity during school hours, it is important to understand the contexts of physical activities done outside of school time. Given the importance of physical and social aspects of environments, the purpose of this study was to describe where and with whom girls participate in physical activities outside of school. Methods: Participants were 1925 sixth-grade girls in the Trial of Activity for Adolescent Girls (TAAG). At baseline, they completed a 3-day physical activity recall (3DPAR), reporting the main activity performed during 30-minute intervals and the physical and social contexts of physical activities. Results: The most frequently reported physical activities done outside of school time were house chores, walking (for transportation or exercise), dance, basketball, playing with younger children, and running or jogging. The most common location for these activities was at home or in the neighborhood. With the exception of household chores, these activities were typically done with at least one other person. Conclusions: Interventions that promote physical activities that can be done at or around home or developing supportive social networks for physical activity would be consistent with the current physical activity contexts of adolescent girls

Objectively Measured Physical Activity in Sixth-Grade Girls

Objectives - To describe the objectively-measured physical activity (PA) characteristics of a diverse sample of 6th grade girls to examine influences on PA, and to report compliance with PA guidelines. Design - Cross-sectional study. Setting - Six locations across the United States. Participants - 1578 6th grade girls. Actigraph accelerometers were worn for 7 days, and data for 6 days were included in the analyses. Main exposure - Race/ethnicity, free-or-reduced price lunch (FRPL), and geographic region. Main outcome measure - Six operational definitions of adequate activity (60 min or 30 min of daily MVPA at or above 4.6, 3.8 or 3.0 METS (metabolic equivalents)) were applied to examine whether girls met physical activity guidelines. Results - Average time spent in sedentary, light, moderate, and vigorous activities was 460, 342, 18, and 6 min/day, respectively. White girls were more active than girls in other race/ethnic groups, and girls who did not receive FRPL were more active than girls who did. Girls in western states were most active. Percentages of girls in compliance with the 6 thresholds for adequate activity varied widely, and ranged from 0.6% to 99.8%. Conclusions - When physical activity is measured objectively and a 4.6 MET cupoint for MVPA is applied, most 6th grade girls fall below guidelines for adequate physical activity. One notable finding was the impact of different accelerometer scoring protocols on estimates of compliance. Conceptual and empirical work is needed to define appropriate physical activity for youth using objective physical activity measures

Early detection of brain metastases in a supervised exercise program for patients with advanced breast cancer : A case report

Introduction Around 25% of metastatic breast cancer (mBC) patients develop brain metastases, which vastly affects their overall survival and quality of life. According to the current clinical guidelines, regular magnetic resonance imaging screening is not recommended unless patients have recognized central nervous system–related symptoms. Patient Presentation The patient participated in the EFFECT study, a randomized controlled trial aimed to assess the effects of a 9-month structured, individualized and supervised exercise intervention on quality of life, fatigue and other cancer and treatment-related side effects in patients with mBC. She attended the training sessions regularly and was supervised by the same trainer throughout the exercise program. In month 7 of participation, her exercise trainer detected subtle symptoms (e.g., changes in movement pattern, eye movement or balance), which had not been noticed or reported by the patient herself or her family, and which were unlikely to have been detected by the oncologist or other health care providers at that point since symptoms were exercise related. When suspicion of brain metastases was brought to the attention of the oncologist by the exercise trainer, the response was immediate, and led to early detection and treatment of brain metastases. Conclusion and clinical implications The brain metastases of this patient were detected earlier due to the recognition of subtle symptoms detected by her exercise trainer and the trust and rapid action by the clinician. The implementation of physical exercise programs for cancer patients requires well-trained professionals who know how to recognize possible alterations in patients and also, good communication between trainers and the medical team to enable the necessary actions to be taken

Predicting Energy Expenditure from Accelerometry Counts in Adolescent Girls

Calibration of accelerometer counts against oxygen consumption to predict energy expenditure has not been conducted in middle school girls. We concurrently assessed energy expenditure and accelerometer counts during physical activities on adolescent girls to develop an equation to predict energy expenditure

Defining Accelerometer Thresholds for Activity Intensities in Adolescent Girls

Purpose - To derive a regression equation that estimates metabolic equivalent (MET) from accelerometer counts, and to define thresholds of accelerometer counts that can be used to delineate sedentary, light, moderate, and vigorous activity. Methods - Seventy-four healthy 8th grade girls, age 13-14 yr, were recruited from urban areas of Baltimore, MD, Minneapolis/St. Paul, MN, and Columbia, SC, to participate in the study. Accelerometer and oxygen consumption (VO2) data for 10 activities that varied in intensity from sedentary (e.g., TV watching) to vigorous (e.g., running) were collected. While performing these activities, the girls wore two accelerometers, a heart rate monitor and a Cosmed K4b2 portable metabolic unit for measurement of VO2. A random-coefficients model was used to estimate the relationship between accelerometer counts and VO2. Activity thresholds were defined by minimizing the false positive and false negative classifications. Results - The activities provided a wide range in VO2 (3-36 mL·kg-1·min-1) with a correspondingly wide range in accelerometer counts (1-3928 counts·30 s-1). The regression line for MET score versus counts was MET=2.01+0.00171 (counts·30 s-1) (mixed model R2=0.84, SEE=1.36). A threshold of 1500 counts·30 s-1 defined the lower end of the moderate intensity (~4.6 METs) range of physical activity. That cutpoint distinguished between slow and brisk walking, and gave the lowest number of false positive and false negative classifications. The threshold ranges for sedentary, light, moderate, and vigorous physical activity were found to be 0-50, 51-1499, 1500-2600, and \u3e2600 counts·30 s-1, respectively. Conclusion - The developed equation and these activity thresholds can be used for prediction of MET score from accelerometer counts and participation in various intensities of physical activity in adolescent girls