Sedentary behaviour in rheumatoid arthritis: definition, measurement and implications for health

This is an accepted manuscript of an article published by Oxford Academic in Rheumatology on 07/04/2017, available online: https://doi.org/10.1093/rheumatology/kex053 The accepted version of the publication may differ from the final published version.RA is a chronic autoimmune disease characterized by high grade-inflammation, and associated with elevated cardiovascular risk, rheumatoid-cachexia and functional impairment. Sedentary behaviour (SB) is linked to heightened inflammation, and is highly pervasive in RA, likely as a result of compromised physical function and persistent fatigue. This high sedentarity may exacerbate the inflammatory process in RA, and hold relevance for disease-related outcomes. The aim of this narrative review is to provide an overview of the definition, measurement and health relevance of SB in the context of RA. Contradictions are highlighted with regard to the manner in which SB is operationalized, and the significance of SB for disease outcomes in RA is outlined. The advantages and disadvantages of SB measurement approaches are also discussed. Against this background, we summarize studies that have reported SB and its health correlates in RA, and propose directions for future research

The Effect of Dietary Interventions on Human Vascular Function in the Context of Acute Psychological Stress:A Scoping Review

Episodes of acute psychological stress increase the risk for cardiovascular diseases, partially through stress-induced impairments in vascular function. During psychologically stressful periods, individuals are more likely to consume unhealthy foods and fewer fruits and vegetables. Yet, the impact of dietary choices and their nutritional composition on vascular function in the context of psychological stress is unclear. In this scoping review, comprehensive database searches were carried out to identify articles reporting on studies investigating the effect of diet on vascular function in the context of psychological stress. A total of 523 articles were screened, 20 of which were selected for data extraction based on the inclusion criteria, which required that a dietary component, a psychological stress protocol, and a vascular outcome measure all were included. Some nutrients or bioactives were hypothesized to impair vascular responses to psychological stress (n = 8 articles), whereas others were postulated to be protective during psychological stress (n = 9 articles). In all studies that tested whole-diet interventions (n = 3), the interventions were hypothesized to be protective. Preliminary evidence suggests saturated fat consumption impairs the recovery of vascular function after psychological stress, whereas plant bioactives (eg, cocoa flavanols, nitrates) and vitamin C may be protective during psychological stress. The findings are mixed; nevertheless, this review provides recommendations for research to investigate how dietary choices can modify the impact of psychological stress on vascular health.</p

Examining the associations between physical activity, self‐esteem, perceived stress, and internalizing symptoms among older adolescents

Introduction: In older adolescence, stress has been found to be prevalent. It has been seen that higher physical activity (PA) relates to lower stress levels, which, in turn, relates to fewer anxiety and depressive symptoms (internalizing symptoms). However, how these associations function is not fully understood. PA is strongly associated with greater self‐esteem in adolescents. As greater self‐esteem is thought to aid better coping with stress and has been seen as beneficial for mental health in adolescents, PA may be associated with lower stress and better mental health through self‐esteem and more adaptive stress appraisals. Therefore, the aim of the study was to examine the relationships between PA, self‐esteem, stress, and mental health. Methods: A cross‐sectional design was employed, and path analysis was implemented. PA, self‐esteem, stress appraisals, distress tolerance, perceived stress, anxiety, and depression were assessed using online questionnaires from 244 adolescent participants from the United Kingdom (aged 15–19, M = 16.75 [SD = 0.82], 145 female). Results: Path analysis revealed that PA was associated with lower perceived stress through increased self‐esteem, adaptive appraisals, and higher distress tolerance (total standardized indirect effect; p = .007 (−0.25 to −0.11). Moreover, lower perceived stress was associated with lower anxiety (standardized direct effect; p &lt; .001 [2.65–4.0] and depressive symptoms (standardized direct effect; p &lt; .001 [0.33–0.63]). Conclusions: Findings suggest that higher PA could be effective in improving mental health among older adolescents, due to its association with perceived stress through higher self‐esteem and more adaptive appraisals of stress

Fat intake impairs the recovery of endothelial function following mental stress in young healthy adults

Introduction: Mental stress has been identified as a trigger of cardiovascular events. A single episode of stress can induce acute impairments in endothelial function in healthy adults. Importantly, during stressful periods, individuals often resort to unhealthy behaviors, such as increased consumption of high-fat foods, which is also known to negatively impact endothelial function. Therefore, this study examined whether consumption of a high-fat meal would further exacerbate the negative effect of mental stress on vascular function.Methods: In a randomized, counterbalanced, cross- over, postprandial intervention study, 21 healthy males and females ingested a high-fat (56.5 g fat) or a low-fat (11.4 g fat) meal 1.5 h before an 8-min mental stress task (Paced-Auditory-Serial-Addition-Task, PASAT). Plasma triglyceride (TAG) concentration was assessed pre-and post-meal. Forearm blood flow (FBF), blood pressure (BP), and cardiovascular activity were assessed pre-meal at rest and post-meal at rest and during stress. Endothelial function, measured by brachial flow-mediated dilatation (FMD) was assessed pre-meal and 30 and 90 min following mental stress.Results: Plasma TAG concentration was significantly increased following the high-fat meal compared to the low-fat condition. Mental stress induced similar increases in peripheral vasodilation, BP, and cardiovascular activity, and impaired FMD 30 min post-stress, in both conditions. FMD remained significantly impaired 90 min following stress in the high-fat condition only, suggesting that consumption of fat attenuates the recovery of endothelial function following mental stress.Discussion: Given the prevalence of fat consumption during stressful periods among young adults, these findings have important implications for dietary choices to protect the vasculature during periods of stress

Fat Consumption Attenuates Cortical Oxygenation during Mental Stress in Young Healthy Adults

Mental stress has been associated with cardiovascular events and stroke, and has also been linked with poorer brain function, likely due to its impact on cerebral vasculature. During periods of stress, individuals often increase their consumption of unhealthy foods, especially high-fat foods. Both high-fat intake and mental stress are known to impair endothelial function, yet few studies have investigated the effects of fat consumption on cerebrovascular outcomes during periods of mental stress. Therefore, this study examined whether a high-fat breakfast prior to a mental stress task would alter cortical oxygenation and carotid blood flow in young healthy adults. In a randomised, counterbalanced, cross-over, postprandial intervention study, 21 healthy males and females ingested a high-fat (56.5 g fat) or a low-fat (11.4 g fat) breakfast 1.5 h before an 8-min mental stress task. Common carotid artery (CCA) diameter and blood flow were assessed at pre-meal baseline, 1 h 15 min post-meal at rest, and 10, 30, and 90 min following stress. Pre-frontal cortex (PFC) tissue oxygenation (near-infrared spectroscopy, NIRS) and cardiovascular activity were assessed post-meal at rest and during stress. Mental stress increased heart rate, systolic and diastolic blood pressure, and PFC tissue oxygenation. Importantly, the high-fat breakfast reduced the stress-induced increase in PFC tissue oxygenation, despite no differences in cardiovascular responses between high- and low-fat meals. Fat and stress had no effect on resting CCA blood flow, whilst CCA diameter increased following consumption of both meals. This is the first study to show that fat consumption may impair PFC perfusion during episodes of stress in young healthy adults. Given the prevalence of consuming high-fat foods during stressful periods, these findings have important implications for future research to explore the relationship between food choices and cerebral haemodynamics during mental stress

Cognitive ability in early adulthood is associated with systemic inflammation in middle age: The Vietnam experience study

We examined the prospective association between cognitive ability in early adulthood and erythrocyte sedimentation rate, a marker of inflammation, in middle age. Participants were 4256 male Vietnam era US veterans. Data on cognitive ability, assessed by the Army General Technical Test, ethnicity, and place of service were extracted from enlistment files. Smoking behaviour, alcohol consumption, basic socio-demographics, and whether participants suffered from a physician diagnosed chronic disease were determined by telephone interview in middle-age in 1985. Erythrocyte sedimentation rate, cholesterol, blood pressure, height, and weight were measured at a 3-day medical examination in 1986. In linear regression models that adjusted for age and then additionally for circumstantial, socio-demographic, lifestyle, and health factors, poor cognitive ability in early adulthood was associated with greater erythrocyte sedimentation rate in middle age, β = -.09. Thus, it would appear that not only does systemic inflammation affect cognition, but also that poor cognitive ability earlier in life increases the risk of developing inflammation

A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure

BACKGROUND: There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences. METHODS: A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources. RESULTS: Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were 'the organisation of healthcare system', 'the organisation of cardiac rehabilitation programmes', 'healthcare professional' factors and 'guidelines'. The most frequent themes included 'lack of resources: time, staff, facilities and equipment' and 'professional's knowledge, awareness and attitude'. CONCLUSIONS: Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research

Mastery Imagery Ability Is Associated With Positive Anxiety and Performance During Psychological Stress

Mastery imagery (i.e., images of being in control and coping in difficult situations) is used to regulate anxiety. The ability to image this content is associated with trait confidence and anxiety, but research examining mastery imagery ability's association with confidence and anxiety in response to a stressful event is scant. The present study examined whether trait mastery imagery ability mediated the relationship between confidence and anxiety, and the subsequent associations on performance in response to an acute psychological stress. Participants (N = 130; 55% male; M age = 19.94 years; SD = 1.07 years) completed assessments of mastery imagery ability and engaged in a standardized acute psychological stress task. Immediately prior to the task, confidence, cognitive and somatic anxiety intensity, and interpretation of anxiety symptoms regarding the task were assessed. Path analyses supported a model whereby mastery imagery ability mediated the relationship between confidence and cognitive and somatic anxiety interpretation. Greater mastery imagery ability and confidence were both directly associated with better performance on the stress task. Mastery imagery ability may help individuals experience more facilitative anxiety and perform better during stressful tasks. Improving mastery imagery ability by enhancing self-confidence may help individuals successfully cope with anxiety elicited during stressful situations.</p

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis:where are we, and where do we need to go?

In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go

Comparison of sedentary behaviour questionnaires in people with multiple sclerosis

BACKGROUND: People with multiple sclerosis are at risk of developing co-morbidities associated with sedentary behaviour. Despite an increase in studies examining sedentary behaviour in multiple sclerosis, researchers have not yet examined the appropriateness of the content or format of questionnaires assessing sedentary behaviour in multiple sclerosis.OBJECTIVE: Evaluate perceptions of sedentary behaviour questionnaires for people with multiple sclerosis.METHODS: Fifteen people with multiple sclerosis completed six validated sedentary behaviour questionnaires: Longitudinal Ageing Study Amsterdam, Marshall Sitting Questionnaire, International Physical Activity Questionnaire, Measure of Older Adults Sedentary Time, Sedentary Behaviour Questionnaire and SIT-Q. Participants' perceptions regarding questionnaire content and format were explored by interviews.RESULTS: Self-reported sedentary time ranged between a mean of 470 (standard deviation 260) (Measure of Older Adults Sedentary Time) and 782 (322) min (Longitudinal Ageing Study Amsterdam) per weekday. Analysis of variance revealed a significant effect of questionnaire on mean sitting time: Longitudinal Ageing Study Amsterdam and SIT-Q yielded higher mean estimates of weekday sitting time than other questionnaires. The questionnaires were viewed as being suitable for use in multiple sclerosis but failed to capture some sedentary activities. Variability of symptoms yielded difficulties in describing a "typical day".CONCLUSIONS: The questionnaires were considered suitable for multiple sclerosis but produced variation in estimated sedentary time. Future work might validate questionnaire data with device-based assessments of sedentary time. Implications for rehabilitation Self-reported sitting time ranged from 7.8 to 13.0 h per day in people with multiple sclerosis. Sedentary behaviour questionnaires are suitable for multiple sclerosis but yield variable estimates of sitting time. Watching television was the most prevalent sedentary activity and may have implications for interventions that break up sedentary time.</p