Sedentary Behavior and Cardiovascular Disease Risk Factors among Latino Adults

Background: Compared to other racial/ethnic subgroups in the U.S., Latinos experience increased rates of cardiovascular disease (CVD) and CVD risk factors such as hypertension, inactivity, and diabetes. Sedentary behavior has also been defined as an additional risk factor for CVD, independent of physical activity participation. However, while sedentary behavior has been associated with increased risk for CVD among primarily White samples, previous studies in Latinos have shown mixed results. Purpose: To explore the relationships between sedentary behavior and CVD risk factors, including BMI, waist circumference, blood pressure, physical activity, dyslipidemia, and diabetes, among a sample of Latino adults. Methods: Cross-sectional secondary analysis of the Latino Health and Well-Being Study. Latino adults were recruited from the Greater Lawrence Family Health Center (N= 602). Surveys of sedentary behavior and physical activity were verbally administered. Anthropometric measurements included weight, height, waist circumference and blood pressure. Medical record data for diabetes and dyslipidemia were obtained. Results: This study showed that individuals in older age strata, females, and individuals with a less than high school education were more sedentary than their younger, male, and more educated counter parts. Sedentary behavior was positively associated with BMI (β = .164, p \u3c .001) and waist circumference (β = .162, p \u3c .001). There were no associations between sedentary behavior and blood pressure, high cholesterol, diabetes, or physical activity. Conclusions: There is growing evidence that sedentary behavior may have its own unique set of metabolic consequences. However, the consequences of sedentary behavior may not be uniform across subgroups. Evaluating the relationship between sedentary behavior and CVD risk is critical in identifying behaviors, like sedentariness, that contribute to the development of CVD

Recruiting Low Income Post-Partum Women into a Weight Loss Trial: In-Person versus Facebook Delivery

Several studies, such as the Diabetes Prevention Program (DPP), have provided foundational evidence for the effect of lifestyle modification interventions on diabetes prevention and weight loss. However, translating these programs to the real-world has proven difficult. There remains a need to increase the feasibility and reach of translational weight loss interventions. PURPOSE: To compare the recruitment rates of overweight low income postpartum women into a DPP-adapted behavioral weight loss program delivered in-person versus delivered via Facebook. METHODS: We compared two 8-week pilot behavioral weight loss trials; one delivered via weekly in-person group sessions and the other delivered entirely via Facebook. Both trials used the same recruitment methods: participants were overweight low income postpartum women within five Women Infants and Children (WIC) clinics in the Worcester, Massachusetts area recruited by nutritionists during routine WIC visits. Inclusion criteria included, childbirth in the previous 6 weeks to 6 months, age 18 or older, a body mass index (BMI) of \u3e 27 kg/m2, and obstetric provider approval for participation in the diet and physical activity components of the intervention. Additional eligibility criteria for the Facebook intervention included: 1) ability to use the Internet daily; 2) having a Facebook account; 3) currently using Facebook at least once per week. RESULTS: 27 and 54 women participated in the in-person and Facebook pilot trials, respectively. Among eligible women in the in-person trial, 62.1% gave permission to be contacted for the in-person trial, and 23.3% enrolled. Among eligible women in the Facebook trial, 59.7% of women agreed to be contacted, and 39.1% enrolled. CONCLUSIONS: Recruitment rates for a Facebook-based weight loss intervention were higher than rates for an in-person intervention. Future efforts are needed to increase reach of weight loss interventions among overweight and obese low income diverse women

Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women

BACKGROUND: Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. OBJECTIVE: The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. METHODS: This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants\u27 questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. RESULTS: Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. CONCLUSIONS: Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention

Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review

Obesity remains a persistent public health and health disparity concern in the United States. Eliminating health disparities, particularly among racial/ethnic minority groups, is a major health priority in the US. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions conducted among adults in the United States. The secondary aims were to assess recruitment and study design approaches to include racial/ethnic groups and the extent of racial/ethnic sub-group analyses conducted in these studies. PubMed, PsycInfo, Medline, and CINAHL were searched for behavioral weight loss intervention trials conducted in 2009-2015 using keywords: weight, loss, overweight, obese, intervention and trial. Most of the 94 studies included a majority of White participants compared to any other racial/ethnic group. Across the included studies, 58.9% of participants were White, 18.2% were African American, 8.7% were Hispanic/Latino, 5.0% were Asian and 1.0% were Native Americans. An additional 8.2% were categorized as Other . Nine of the 94 studies exclusively included minority samples. Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions to groups that might most benefit from weight loss. Given racial/ethnic disparities in obesity rates and the burden of obesity and obesity-related diseases among minority groups in the United States, greater inclusion in weight loss intervention studies is warranted

Methods for Evaluating the Content, Usability, and Efficacy of Commercial Mobile Health Apps

Commercial mobile apps for health behavior change are flourishing in the marketplace, but little evidence exists to support their use. This paper summarizes methods for evaluating the content, usability, and efficacy of commercially available health apps. Content analyses can be used to compare app features with clinical guidelines, evidence-based protocols, and behavior change techniques. Usability testing can establish how well an app functions and serves its intended purpose for a target population. Observational studies can explore the association between use and clinical and behavioral outcomes. Finally, efficacy testing can establish whether a commercial app impacts an outcome of interest via a variety of study designs, including randomized trials, multiphase optimization studies, and N-of-1 studies. Evidence in all these forms would increase adoption of commercial apps in clinical practice, inform the development of the next generation of apps, and ultimately increase the impact of commercial apps. Boudreaux, Rajani S Sadasivam, Sean P Mullen, Jennifer L Carey, Rashelle B Hayes, Eric Y Ding, Gary G Bennett, Sherry L Pagoto. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 18.12.2017

Spirituality and Physical Activity and Sedentary Behavior among Latino Men and Women in Massachusetts

INTRODUCTION: To examine the relationships between spirituality and physical activity and sedentary behavior in a sample of Latino adults in Massachusetts. DESIGN: This is a cross-sectional analysis of the Lawrence Health and Well Being Study; a study that was conducted among patients at the Greater Lawrence Family Health Center (GLFHC) in Lawrence, Massachusetts. PARTICIPANTS: 602 Latino or Hispanic adults aged 21 to 85 years completed the study. RESULTS: There was a significant negative relationship between spirituality and sedentary behavior (beta= -.12, p = .004). Although not statistically significant, higher spirituality was associated with increased odds of engaging in physical activity. There were no significant associations between spirituality and physical activity among men or women. Men with greater spirituality were significantly less sedentary (beta = -.17, P = .005). There was no relationship between sedentary behavior and spirituality among women. CONCLUSIONS: This study found that individuals who are more spiritual are also less sedentary, and this association was stronger in men than women. Findings provide insight for developing future interventions to promote activity in this high-risk population, which has been greatly understudied. Future research endeavors should consider investigating the impact of spirituality-based messages to reduce sedentary behavior among Latinos

Neighborhood environment correlates of physical activity and sedentary behavior among Latino adults in Massachusetts

Abstract Background U.S. Latinos experience high rates of cardio-metabolic diseases and have high rates of physical inactivity and sedentary behavior. Understanding the environmental factors associated with physical activity and sedentary behaviors among Latinos could inform future interventions. The purpose of this study is to explore the neighborhood environment correlates of physical activity and sedentary behavior in a sample of U.S. Latino adults. Methods Cross-sectional study of 602 Latino adults in Lawrence, MA. Survey assessments of physical activity, sedentary behavior, and neighborhood environment were verbally administered. The neighborhood environment scale assessed violence, safety, aesthetic quality, walkability, availability of healthy foods, social cohesion, and activities with neighbors. Results After controlling forage, gender, education, body mass index (BMI), and smoking status, two variables were associated with the outcomes of interest. Living in more walkable neighborhoods was associated with an increased likelihood of engaging in adequate levels of physical activity (>150 min per week, as recommended by the American College of Sports Medicine (ACSM)) (OR = 1.403, p = .018); and greater frequency of activities with neighbors was associated with greater sedentary behavior (β = .072, p = .05). Conclusions There were different neighborhood environment correlates of physical activity and sedentary behavior in this Latino community. Focusing on a greater understanding of the distinct social and physical environmental correlates of physical activity and sedentary behavior may provide important insights for reducing CVD risk and health disparities among Latinos

Does provider advice to increase physical activity differ by activity level among US adults with cardiovascular disease risk factors?

Background: Regular physical activity (PA) lowers the risk of cardiovascular disease (CVD), but few US adults meet PA guidelines. The United States Preventive Services Task Force (USPSTF) recommends primary care providers offer PA counselling for CVD prevention. We examined the association between adherence to PA guidelines and reported provider advice to increase PA among US adults with overweight/obesity and \u3e /=1 additional CVD risk factor. Methods: Cross-sectional data from the National Health and Nutrition Examination Survey (2011-2014) on PA and provider advice to increase PA were analysed for 4158 adults ( \u3e /=20 years old) with overweight/obesity who reported \u3e /=1 of hypertension, high cholesterol or impaired fasting glucose. Adherence to federal PA guidelines was determined using self-reported PA data from the Global Physical Activity Questionnaire. Meeting PA guidelines was defined as \u3e /=150 minutes/week moderate intensity PA, \u3e /=75 minutes/week vigorous intensity, or an equivalent combination. Participants self-reported provider advice to increase PA. Results: In total, 57.7% of US adults with overweight/obesity and \u3e /=1 additional CVD risk factor who did not meet PA guidelines reported provider advice to increase PA compared to 49.7% of adults who met PA guidelines. Adults who did not meet PA guidelines were more likely to report provider PA advice (aOR = 1.21; 95% CI = 1.00-1.47). Conclusions: US adults with CVD risk factors who do not meet PA guidelines are more likely to receive provider advice to increase PA, but only half receive such advice. Strategies to increase provider advice are needed to improve adherence to USPSTF guidelines among US adults with overweight/obesity and additional CVD risk factors

Objective measurement of physical activity outcomes in lifestyle interventions among adults: A systematic review

Valid, reliable, and direct measures of physical activity (PA) are critical to assessing the impact of lifestyle PA interventions. However, little is known about the extent to which objective measures have been used to assess the outcomes of lifestyle PA interventions. This systematic review had two aims: 1) evaluate the extent to which PA is measured objectively in lifestyle PA interventions targeting adults and 2) explore and summarize what objective measures have been used and what PA dimensions and metrics have been reported. Pubmed, Cochrane Central Register, and PsychInfo were searched for lifestyle PA interventions conducted between 2006 and 2016. Of the 342 articles that met the inclusion criteria, 239 studies measured PA via subjective measures and 103 studies measured PA via objective measures. The proportion of studies using objective measures increased from 4.4% to 70.6% from 2006 to 2016. All studies measuring PA objectively utilized wearable devices; half (50.5%) used pedometers only and 40.8% used accelerometers only. A majority of the 103 studies reported steps (73.8%) as their PA metric. Incorporating objective measures of PA should continue to be a priority in PA research. More work is needed to address the challenges of comprehensive and consistent collecting, reporting, and analyzing of PA metrics. Keywords: Accelerometry, Pedometer, Physical activity, Interventions, Systematic review/meta-analysi

Reporting of Physical Activity Device Measurement and Analysis Protocols in Lifestyle Interventions

This systematic review examined the extent to which lifestyle physical activity interventions that used wearable devices (eg, pedometers, accelerometers) reported on the length of device wear time requested in their protocols, criteria for analytic inclusion of data, and participant compliance with device use protocols. Literature were searches were conducted using PubMed, Cochrane Central Register, and PsychInfo. Studies were included if they were the main outcomes paper of a trial that reported on a randomized or quasi-randomized trial focused on increasing lifestyle physical activity and were published between January 1, 2006 and March 30, 2016. Titles and abstracts were screened by 2 independent reviewers; eligible full texts were retrieved and reviewed by 2 independent reviewers. A total of 104 studies used wearable devices (n = 57 pedometers, n = 47 accelerometers). Most studies (n = 65, 67.3%) asked participants to wear devices for 7 days. Almost half of the studies (n = 46, 44.2%) did not report minimum device wear time required for analytic inclusion of data, and variation existed among studies reporting these criteria. Most studies (n = 60, 57.7%) did not report average device wear time, or participant compliance with device wear. Overall, there was heterogeneity in reporting of physical activity device data. Refinement and streamlining of guidelines for device use, analysis, and reporting of data could improve comparability across studies