Geographic Determinants of Healthy Lifestyle Change in a Community-Based Exercise Prescription Delivered in Family Practice

Background: Evidence is unequivocal that exercise training can improve health outcomes. However, despite this evidence, adoption of healthy lifestyles is poor. The physical environment is one possible determinant of successful adoption of healthy lifestyles that could influence outcomes in community-based intervention strategies. We developed a novel exercise prescription delivered in two different cohorts of older sedentary adults—one delivered by family physicians to patients with identified cardiovascular risk factors (CRF) and the other delivered at a community exercise facility to a larger cohort of healthy sedentary adults (HSA). We then determined whether the place of residence and proximity to facilities promoting physical activity and healthy or unhealthy eating could influence clinical changes related to these community-based exercise prescriptions.Methods: Two different cohorts of older patients were administered similar exercise prescriptions. The CRF cohort was a sedentary group of 41 older adults with either high-normal blood pressure (120–139 mmHg/85–89 mmHg) or impaired glucose tolerance (fasting glucose 6.1–6.9 mmol/l) who were prescribed exercise by their family physicians at baseline and followed over 12 months. The HSA cohort consisted of 159 sedentary older adults who were prescribed a similar exercise prescription and then participated in a chronic training program over 5 years at a community-based training facility. Out- comes of interest were change in fitness (VO2max), resting systolic blood pressure (rSBP) and body mass index (BMI). GIS-determined shortest distance to local facilities promoting physical activity and healthy versus unhealthy were compared at baseline and follow up using simple logistic regression.Those subjects in CRF group were further identified as responders (exhibited an above average change in VO2max) and were then compared to non-responders according to their patterns of proximity to physical activity and eating facilities.Results: In the CRF cohort at baseline, greater GIS-distance to golf courses correlated with higher rSBP (r = 0.38, p = 0.02) while greater distance to bike paths correlated with greater BMI (r = 0.32, p = 0.05). CRF responders who lived closer to a park had higher BMI (r = −0.46, p = 0.05) while no other relationship among responders and proximity to either physical activity or eating facilities was observed. CRF non-responders lived closer to formal physical activity facilities (community centres) and higher fat eating facilities. In the HSA cohort, higher fitness was correlated with greater distance to both formal and informal physical activity facilities (baseball fields or dance studios) while this was also correlated with a higher rSBP (r = 0.17, p = 0.04). In general, physical activity facilities were often located near higher-fat eating facilities regardless of cohort.Conclusion: Those prescribed exercise by their family physician for the presence of health risk tended to closer to any type of physical activity facility compared to those who joined an exercise program on their own. A positive response to the intervention at 12 months was associated with closer access to informal physical activity facilities while non-responders lived closer to both types of physical activity facility as well as high fat eating facilities. In contrast, healthy chronic exercise trainees in the community did not show any meaningful relation between fitness and proximity to healthy lifestyle facilities. Hence, the access to facilities is not as important to those who adopt physical activity on their own whereas those targeted by physicians may be influenced by access. Furthermore, the response or lack thereof to exercise interventions in those at risk may be influenced by proximity to both physical activity and unhealthy eating facilities

The Physical Activity–Related Barriers and Facilitators Perceived by Men Living in Rural Communities

Men, especially those living in rural areas, experience chronic disease at higher rates than the general population. Physical activity is a well-established protective factor against many chronic diseases; however, only a small fraction of men are meeting national guidelines for physical activity. The purpose of this study was to examine the perceived physical activity–related barriers and facilitators experienced by men living in rural areas in Canada. Participants completed a paper-and-pencil or online survey and asked to select personally relevant physical activity-related barriers and facilitators from a list of 9 and 10 choices, respectively. A total of 149 men completed the survey (50.3% between the ages of 18 and 55 years; 43.0% older than 55 years). Participants were predominantly from rural areas and smaller communities. Overall, the response options “I’m too tired,” “I don’t have enough time,” and “I think I get enough exercise as work” were the three most frequently cited barriers to regular physical activity. The response options “Personal motivation to be healthy,” “I enjoy it,” and “Support from family and/or friends” were the three most often cited facilitators to physical activity. Results are similar to those shown in other populations. Results can be used to inform the development of policies and programs that aim to increase the physical activity levels of men living in rural areas and small communities

Engaging men in chronic disease prevention and management programs: A scoping review

Chronic disease has become one of the largest health burdens facing the developed world. Men are at a higher risk of being diagnosed with chronic disease than women. Although lifestyle interventions have been shown to reduce the risk of chronic disease in participants, men are often underrepresented in such programs. The purpose of this study was to explore the individual-level and program-specific factors that affect male participation rates in chronic disease prevention and management (CDPM) programs. A scoping review methodology was selected, and 25 studies met the criteria for inclusion in the review. Results showed that traditional group-based programs that focused on topics such as nutrition and physical activity were often seen by men as inherently feminine, which served as a barrier for participation. Program-specific factors that attracted men to participate in interventions included a group component with like-minded men, the use of humor in the delivery of health information, the inclusion of both nutrition and physical activity components, and the presence of some manner of competition. A past negative health event, personal concern for health status, and motivation to improve physical appearance were cited by men as facilitators to CDPM program participation. Gaps in the research are identified, and results of this study can be used to inform the development of CDPM programs that will improve the engagement and participation of men

Barriers to recruiting men into chronic disease prevention and management programs in rural areas: Perspectives of program delivery staff

Chronic disease is becoming increasingly prevalent in Canada. Many of these diseases could be prevented by adoption of healthy lifestyle habits including physical activity and healthy eating. Men, especially those in rural areas, are disproportionately affected by chronic disease. However, men are often underrepresented in community-based chronic disease prevention and management (CDPM) programs, including those that focus on physical activity and/or healthy eating. The purpose of this study was to explore the experiences and perceptions of program delivery staff regarding the challenges in recruitment and participation of men in physical activity and healthy eating programs in rural communities, and suggestions for improvement. Semistructured interviews were conducted by telephone with 10 CDPM program delivery staff from rural communities in Southwest Ontario, Canada. Time and travel constraints, relying on spouses, and lack of male program leaders were cited as barriers that contributed to low participation levels by men in CDPM programs. Hiring qualified male instructors and engaging spouses were offered as strategies to increase men’s participation. The results of this study highlight many of the current issues faced by rural health organizations when offering CDPM programming to men. Health care organizations and program delivery staff can use the recommendations in this report to improve male participation levels

The Benefits of High-Intensity Interval Training on Cognition and Blood Pressure in Older Adults With Hypertension and Subjective Cognitive Decline: Results From the Heart & Mind Study

Background: The impact of exercise on cognition in older adults with hypertension and subjective cognitive decline (SCD) is unclear. Objectives: We determined the influence of high-intensity interval training (HIIT) combined with mind-motor training on cognition and systolic blood pressure (BP) in older adults with hypertension and SCD. Methods: We randomized 128 community-dwelling older adults [age mean (SD): 71.1 (6.7), 47.7% females] with history of hypertension and SCD to either HIIT or a moderate-intensity continuous training (MCT) group. Both groups received 15 min of mind-motor training followed by 45 min of either HIIT or MCT. Participants exercised in total 60 min/day, 3 days/week for 6 months. We assessed changes in global cognitive functioning (GCF), Trail-Making Test (TMT), systolic and diastolic BP, and cardiorespiratory fitness. Results: Participants in both groups improved diastolic BP [F(1, 87.32) = 4.392, p = 0.039], with greatest effect within the HIIT group [estimated mean change (95% CI): −2.64 mmHg, (−4.79 to −0.48), p = 0.017], but no between-group differences were noted (p = 0.17). Both groups also improved cardiorespiratory fitness [F(1, 69) = 34.795, p \u3c 0.001], and TMT A [F(1, 81.51) = 26.871, p \u3c 0.001] and B [F(1, 79.49) = 23.107, p \u3c 0.001]. There were, however, no within- or between-group differences in GCF and systolic BP at follow-up. Conclusion: Despite improvements in cardiorespiratory fitness, exercise of high- or moderate-intensity, combined with mind-motor training, did not improve GCF or systolic BP in individuals with hypertension and SCD. Clinical Trial Registration: ClinicalTrials.gov (NCT03545958)

The Benefits of High-Intensity Interval Training on Cognition and Blood Pressure in Older Adults With Hypertension and Subjective Cognitive Decline: Results From the Heart & Mind Study

Background: The impact of exercise on cognition in older adults with hypertension and subjective cognitive decline (SCD) is unclear. Objectives: We determined the influence of high-intensity interval training (HIIT) combined with mind-motor training on cognition and systolic blood pressure (BP) in older adults with hypertension and SCD. Methods: We randomized 128 community-dwelling older adults [age mean (SD): 71.1 (6.7), 47.7% females] with history of hypertension and SCD to either HIIT or a moderate-intensity continuous training (MCT) group. Both groups received 15 min of mind-motor training followed by 45 min of either HIIT or MCT. Participants exercised in total 60 min/day, 3 days/week for 6 months. We assessed changes in global cognitive functioning (GCF), Trail-Making Test (TMT), systolic and diastolic BP, and cardiorespiratory fitness. Results: Participants in both groups improved diastolic BP [F(1, 87.32) = 4.392, p = 0.039], with greatest effect within the HIIT group [estimated mean change (95% CI): −2.64 mmHg, (−4.79 to −0.48), p = 0.017], but no between-group differences were noted (p = 0.17). Both groups also improved cardiorespiratory fitness [F(1, 69) = 34.795, p \u3c 0.001], and TMT A [F(1, 81.51) = 26.871, p \u3c 0.001] and B [F(1, 79.49) = 23.107, p \u3c 0.001]. There were, however, no within- or between-group differences in GCF and systolic BP at follow-up. Conclusion: Despite improvements in cardiorespiratory fitness, exercise of high- or moderate-intensity, combined with mind-motor training, did not improve GCF or systolic BP in individuals with hypertension and SCD. Clinical Trial Registration: ClinicalTrials.gov (NCT03545958)

Memory Function and Brain Functional Connectivity Adaptations Following Multiple-Modality Exercise and Mind–Motor Training in Older Adults at Risk of Dementia: An Exploratory Sub-Study

© Copyright © 2020 Boa Sorte Silva, Nagamatsu, Gill, Owen and Petrella. Background: Multiple-modality exercise improves brain function. However, whether task-based brain functional connectivity (FC) following exercise suggests adaptations in preferential brain regions is unclear. The objective of this study was to explore memory function and task-related FC changes following multiple-modality exercise and mind–motor training in older adults with subjective cognitive complaints. Methods: We performed secondary analysis of memory function data in older adults [n = 127, mean age 67.5 (7.3) years, 71% women] randomized to an exercise intervention comprised of 45 min of multiple-modality exercise with additional 15 min of mind-motor training (M4 group, n = 63) or an active control group (M2 group, n = 64). In total, both groups exercised for 60 min/day, 3 days/week, for 24 weeks. We then conducted exploratory analyses of functional magnetic resonance imaging (fMRI) data collected from a sample of participants from the M4 group [n = 9, mean age 67.8 (8.8) years, 8 women] who completed baseline and follow-up task-based fMRI assessment. Four computer-based memory tasks from the Cambridge Brain Sciences cognitive battery (i.e. Monkey Ladder, Spatial Span, Digit Span, Paired Associates) were employed, and participants underwent 5 min of continuous fMRI data collection while completing the tasks. Behavioral data were analyzed using linear mixed models for repeated measures and paired-samples t-test. All fMRI data were analyzed using group-level independent component analysis and dual regression procedures, correcting for voxel-wise comparisons. Results: Our findings indicated that the M4 group showed greater improvements in the Paired Associates tasks compared to the M2 group at 24 weeks [mean difference: 0.47, 95% confidence interval (CI): 0.08 to 0.86, p = 0.019]. For our fMRI analysis, dual regression revealed significant decrease in FC co-activation in the right precentral/postcentral gyri after the exercise program during the Spatial Span task (corrected p = 0.008), although there was no change in the behavioral task performance. Only trends for changes in FC were found for the other tasks (all corrected p \u3c 0.09). In addition, for the Paired Associates task, there was a trend for increased co-activation in the right temporal lobe (Brodmann Area = 38, corrected p = 0.07), and left middle frontal temporal gyrus (corrected p = 0.06). Post hoc analysis exploring voxel FC within each group spatial map confirmed FC activation trends observed from dual regression. Conclusion: Our findings suggest that multiple modality exercise with mind–motor training resulted in greater improvements in memory compared to an active control group. There were divergent FC adaptations including significant decreased co-activation in the precentral/postcentral gyri during the Spatial Span task. Borderline significant changes during the Paired Associates tasks in FC provided insight into the potential of our intervention to promote improvements in visuospatial memory and impart FC adaptations in brain regions relevant to Alzheimer’s disease risk. Clinical Trial Registration: The trial was registered in ClinicalTrials.gov in April 2014, Identifier: NCT02136368

Identifying Personality Characteristics and Indicators of Psychological Well-Being Associated With Attrition in the Motivation Makes the Move! Physical Activity Intervention: : Randomized Technology-Supported Trial

Peer reviewe

Men’s Experiences with the Hockey Fans in Training Weight Loss and Healthy Lifestyle Program

Background: Increasing rates of chronic disease, especially in men, have led to an increased effort to implement lifestyle interventions focusing on healthy eating and physical activity. Men are underrepresented in lifestyle programs and some studies have observed that males prefer men-only programs that occur in the context of sports. This paper reviews men’s feedback regarding motivation for joining and overall experience in a 12-week lifestyle intervention in the context of junior level ice hockey teams. Methods: Men age 35-65 with a BMI ?28 were recruited from local ice hockey team fan bases in London and Sarnia Ontario, Canada and randomized to the 12-week lifestyle intervention or control group. Those who attended at least 6 of the 12 weekly sessions, including at least one session in the final six weeks (n=30) were asked to complete an online questionnaire upon finishing the active phase of the intervention. The questionnaire elicited reasons for joining the program, changes seen following their participation, and the usefulness of specific components of the program. Results: For the 27 men who completed the questionnaire, weight loss and a desire to increase physical activity were the two main reasons cited for joining the program. After the intervention, 100% of the men reported eating a healthier diet and 78% increased their activity level. Program satisfaction was high and 96% of men believed both the classroom and exercise components were useful. Conclusion: Our results support previous research showing increased levels of satisfaction in men when lifestyle interventions are run in...