Rationale and design of Smart Walk: A randomized controlled pilot trial of a smartphone-delivered physical activity and cardiometabolic risk reduction intervention for African American women

Relation Between Self-Reported Physical Activity Level, Fitness, and Cardiometabolic Risk

BackgroundSmart Walk is a culturally relevant, social cognitive theory–based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women.ObjectiveThis study aimed to describe the development and initial usability testing results of Smart Walk.MethodsSmart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results.ResultsThe 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week.ConclusionsThe development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention.

PURPOSE: African- American women have a significantly higher cardiometabolic risk at a younger age and experience an earlier onset along with a greater severity of cardiovascular disease than White- American women in the United States. African- American women, when compared to White- American women, have a lower rate of exercise and leisure physical activity time. Research indicates that an increase in physical activity reduces the risk of cardiometabolic diseases among healthy individuals.To examine whether there is a health disparity in the prevalence of cardiometabolic risk factors between 20-50-year-old African- American and White- American women compared based on their physical activity levels (low, moderate, vigorous). METHODS: The data were harvested from the 2015 to 2018 National Health and Nutrition Examination Survey (NHANES). The sample consisted of 615 women: 355 White- American (57.7%, age 34.92 ± 9.67), and 260 African- American (42.3%, age 35.81 ± 9.47). The prevalence of cardiometabolic risk factors were calculated using descriptive statistics and crosstabs and chi square to assess statistical significance. RESULTS: There was no difference in the prevalence of pre-diabetes and high cholesterol amongst the two groups exercising at low, moderate, or vigorous physical activity levels. There was a statistically significant difference in the prevalence of diabetes between the two groups at the moderate physical activity level. There was a statistically significant difference between the two groups in the prevalence of high blood pressure at low, moderate, and vigorous physical activity levels. CONCLUSIONS: Regardless of their physical activity level, 20-50-year-old African- American women have a higher prevalence of high blood pressure when compared to White- American Women.

Patients with inflammatory bowel disease (IBD) have higher risk of developing cardiometabolic diseases due to chronic gut and systemic inflammation which promotes atherogenesis. Adopting healthy lifestyle habits can prevent development of cardiometabolic diseases, but can be challenging for people with IBD. The IBD exercise and diet (IBDeat) habits study describes the lifestyle habits and cardiometabolic disease risk factors of adults with IBD in Aotearoa, New Zealand (NZ).This is a cross-sectional study including adult NZ IBD patients recruited online via Crohn’s and Colitis NZ and Dunedin hospital from 2021 to 2022. An online questionnaire collected demographics, smoking status, comorbidities, medications, disease severity scores, quality of life, physical activity, and dietary intake. The Dunedin cohort had physical measurements taken including anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers, and faecal calprotectin. Data were compared to established reference values and linear regression analysis investigated associations between lifestyle habits and cardiometabolic risk factors. The study received University of Otago ethical approval (reference: H21/135). A total of 213 adults with IBD (54% Crohn’s disease; 46% ulcerative colitis) completed the online questionnaire and a subset of 102 from Dunedin provided physical measurements. Participants characteristics were: median age 37 (IQR 25, 51) years, 71% female, 82% NZ European, 4% smokers, and 1.4% had active IBD. Thirty-five percent of participants had at least one comorbidity and 34% of participants had poor quality of life. Known dietary risk factors associated with cardiometabolic diseases were common: low intakes of vegetables (77%), fruit (51%), fibre (35%) and high intakes of total fat (84%) and saturated fat (98%). Physical activity recommendations were met by 61% of participants and 63% reported barriers to being more active from fatigue (63%) and joint pain (54%). Other cardiometabolic risk factors were common in the Dunedin cohort: high LDL (79%) and total cholesterol (76%), central adiposity (64%), high body fat percentage (44%), high blood pressure (26%), and low handgrip strength (25%). Regression analysis showed that vegetable (per serve) and carbohydrate (per 5% of total daily energy intake (TE)) were associated with 0.22 mmol/L (95%CI 0.43, 0.013) and 0.20 mmol/L (95%CI 0.34, 0.057) lower LDL cholesterol. Discretionary food items were associated with higher LDL cholesterol, 0.11 mmol/L per daily serve (95%CI 0.028, 0.19). A 5% difference in TE intake from carbohydrate was associated with 1.11% (95%CI 2.22%, 0.0038%) lower body fat percentage while protein was associated with 3.1% (95%CI 0.81%, 5.39%) higher body fat percentage. Physical activity had weak associations with cardiometabolic disease risk factors. Adults with IBD have multiple modifiable risk factors for cardiometabolic diseases. Vegetable and carbohydrate intake were associated with lower LDL cholesterol concentration while discretionary food items showed otherwise. Protein intake was associated with higher body fat percentage.

Effects of the Active Smarter Kids (ASK) physical activity intervention on cardiometabolic risk factors in children: A cluster-randomized controlled trial

Understanding the association between diet quality and cardiometabolic risk by education level is important for preventing increased cardiometabolic risk in the Mexican population, especially considering pre-existing disparities in diet quality. The present study examined the cross-sectional association of overall diet quality with cardiometabolic risk, overall and by education level, among Mexican men and women. Cardiometabolic risk was defined by using biomarkers and diet quality by the Mexican Diet Quality Index. We computed sex-specific multivariable logistic regression models. Mexico. Mexican men (n 634) and women (n 875) participating in the Mexican National Health and Nutrition Survey 2012. We did not find associations of diet quality with cardiometabolic risk factors in the total sample or in men by education level. However, we observed that for each 10-unit increase in the dietary quality score, the odds of diabetes risk in women with no reading/writing skills was 0·47 (95 % CI 0·26, 0·85) relative to the odds in women with ≥10 years of school (referent). Similarly, for each 10-unit increase of the dietary quality score, the odds of having three v. no lipid biomarker level beyond the risk threshold in lower-educated women was 0·27 (95 % CI 0·12, 0·63) relative to the odds in higher-educated women. Diet quality has a stronger protective association with some cardiometabolic disease risk factors for lower- than higher-educated Mexican women, but no association with cardiometabolic disease risk factors among men. Future research will be needed to understand what diet factors could be influencing the cardiometabolic disease risk disparities in this population.

Fitness and Fatness Are Both Associated with Cardiometabolic Risk in Preadolescents

Introduction

Poor sleep increases cardio-metabolic risk, but limited information on the impact of sleep for the improvement of cardio-metabolic health exists. This analysis examined the impact of sleep on a health and lifestyle modification programme to reduce cardio-metabolic disease risk factors. Secondary analysis of the MODERN randomised controlled trial to reduce cardio-metabolic risk was undertaken at baseline and 24-month follow-up. Participants aged 40-70years (n=121) with three or more cardio-metabolic risk factors were randomised to a health and lifestyle modification intervention (n=59) or usual care (n=62), and underwent 7day/night actigraphy to assess total sleep time, sleep efficiency (%), number of awakenings/night and physical activity levels. Blood pressure, blood lipid and glycaemic levels, anthropometric and diet measures were collected. The mean age was 59±7years and 37% were male. Baseline sleep measures were not different between groups. At the 24-month follow-up, both groups showed improvements in cardio-metabolic risk factors, albeit the change in blood pressure was greater in the intervention compared with the usual care group (systolic blood pressure: -11 versus -4mmHg, p=.014). There were no differences between groups for diet, physical activity or sleep parameters. An increase in sleep efficiency was independently associated with lower systolic blood pressure (β=-2.117, p=.002) and higher high-density lipoprotein levels (β=0.040, p=.033); an increase in total sleep time was associated with lower low-density lipoprotein levels (β=-0.003, p=.038) at 24months. Overall, improvement in sleep quality over time was beneficial to reduce blood pressure and lipid levels. These findings highlight sleep as a potential target to reduce cardio-metabolic risk.

The prevalence of severe obesity is increasing markedly, as is prevalence of comorbid conditions such as hypertension and type 2 diabetes mellitus; however, apart from bariatric surgery and pharmacotherapy, few clinical trials have evaluated the treatment of severe obesity. To determine the efficacy of a weight loss and physical activity intervention on the adverse health risks of severe obesity. Single-blind randomized trial conducted from February 2007 through April 2010 at the University of Pittsburgh. Participants were 130 (37% African American) severely obese (class II or III) adult participants without diabetes recruited from the community. One-year intensive lifestyle intervention consisting of diet and physical activity. One group (initial physical activity) was randomized to diet and physical activity for the entire 12 months; the other group (delayed physical activity) had the identical dietary intervention but with physical activity delayed for 6 months. Changes in weight. Secondary outcomes were additional components comprising cardiometabolic risk, including waist circumference, abdominal adipose tissue, and hepatic fat content. Of 130 participants randomized, 101 (78%) completed the 12-month follow-up assessments. Although both intervention groups lost a significant amount of weight at 6 months, the initial-activity group lost significantly more weight in the first 6 months compared with the delayed-activity group (10.9 kg [95% confidence interval {CI}, 9.1-12.7] vs 8.2 kg [95% CI, 6.4-9.9], P = .02 for group × time interaction). Weight loss at 12 months, however, was similar in the 2 groups (12.1 kg [95% CI, 10.0-14.2] vs 9.9 kg [95% CI, 8.0-11.7], P = .25 for group × time interaction). Waist circumference, visceral abdominal fat, hepatic fat content, blood pressure, and insulin resistance were all reduced in both groups. The addition of physical activity promoted greater reductions in waist circumference and hepatic fat content. Among patients with severe obesity, a lifestyle intervention involving diet combined with initial or delayed initiation of physical activity resulted in clinically significant weight loss and favorable changes in cardiometabolic risk factors. clinicaltrials.gov Identifier: NCT00712127.

BackgroundEmerging evidence suggests that remnant cholesterol (RC) is strongly associated with an increased incidence of cardiometabolic diseases (CMD). However, the causality have not been confirmed. We aimed to evaluate the causal associations of RC with CMD and the relative risk factors using two-sample Mendelian randomization (MR) methods.MethodsSummary-level statistics of RC, CMD, and cardiometabolic risk factors were obtained from the published data from individuals with a predominantly European ancestry mainly from the UK Biobank and the FinnGen biobank. Univariable and multivariable MR analyses were used to evaluate the causal relationships between RC and CMD. A bidirectional MR analysis was performed to estimate the causality between RC and cardiometabolic risk factors. The main MR method was conducted using the inverse-variance weighted method.ResultsUnivariable MR analyses showed that genetically predicted RC was causally associated with higher risk of ischemic heart disease, myocardial infarction, atrial fibrillation and flutter, peripheral artery disease, and non-rheumatic valve diseases (all P < 0.05). Multivariable MR analyses provided compelling evidence of the harmful effects of RC on the risk of ischemic heart disease (P < 0.05). Bidirectional MR analysis demonstrated that RC was bidirectionally causally linked to total cholesterol, triglycerides, low-density lipoprotein cholesterol, hypercholesterolemia (all P < 0.05). However, no genetic association was found between RC and metabolic disorders or the other cardiometabolic risk factors.ConclusionsThis MR study demonstrates that genetically driven RC increases the risk of several CMD and cardiometabolic risk factors, suggesting that targeted RC-lowering therapies may be effective for the primary prevention of CMD.

Sedentary time (ST) and physical activity energy expenditure (PAEE) are associated with obesity and related comorbidities, especially among older men and women. Older African Americans (AA) may have lower PAEE, higher ST, and greater cardiometabolic health disparities than other racial/ethnic groups. Thus assessing effects of physical activity interventions that improve PAEE and ST on cardiometabolic risk factors (CMRF) within this group is important. PURPOSE: To evaluate the association between physical activity intervention associated PAEE and ST changes and CMRF responses to the intervention among older AA. METHODS: Fifty-six sedentary older (mean ± SD, 69.2 ± 3.4 years) AA were randomized to a physical activity group (PAG, n = 28) or successful aging group (SAG, n = 28) for 12 weeks. PAG participants attended twice-weekly physical activity group sessions at a local YMCA. In addition, the PAG participants exercised 2-3 days per week at home for a total of 150 minutes of MVPA per week. The SAG participants attended weekly educational sessions on general aging topics not related to physical activity. Accelerometers worn on the waist before and during the last week of intervention were used to calculate PAEE and ST using 60-second epoch. Body mass index, fasted glucose (GLU), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides, and blood pressure were collected before and after the intervention to assess cardiometabolic risk. Linear regression was used to test the association between PAEE and ST changes and CMRF. RESULTS: PAEE and ST change were not different between PAG and SAG participants (PAEE: 45.5 ± 149.1 vs. 10.9 ± 79.5 kcal/d resp., p = 0.298; ST: 41.6 ± 149.6 vs. -10.6 ± 122.9 min/d resp., p = 0.169). Baseline CMRF were not different between PAG and SAG participants (all p > 0.05). Change in PAEE was not associated with change in any CMRF within PAG participants (all p > 0.161). A decrease in ST was associated with an increase in HDL (F[1, 26] = 7.380, p = 0.012, R2 = 0.221) and a marginally significant decrease in GLU (F[1, 26] = 3.162, p = 0.087, R2 = 0.108) within PAG participants. CMRF changes were not related to PAEE change (all p > 0.159) or ST change (all p > 0.123) for SAG. CONCLUSIONS: The PAG may not have received sufficient stimulus to improve PAEE and ST, thus preventing more robust changes in CMRF.

Introduction. Cardiometabolic diseases represent a significant burden on global health. To ensure prevention of chronic heart failure, coronary artery disease and atrial fibrillation, it is crucial to understand changes in echocardiographic parameters with increase in cardiometabolic and residual risk in young adults. Aim. This study aims to identify predictors of cardiac structural and functional changes in young adults with cardiometabolic risk factors and propose an algorithm for differentiated management considering the cardiometabolic disease staging. Materials and Methods. This case-control study included 191 patients with a median age 35 [30.0-39.0] years. Patients were grouped according to the cardiometabolic disease staging. We performed in-depth clinical and laboratory examination, and echocardiography. Statistical analyses were performed in IBM SPSS Statistics 23. Results and Discussion. With progression of cardiometabolic disease stage, there is a rise in the cardiometabolic and residual risk and changes in cardiac structure and function (pK-W = 0.001–0.028). Visceral fat level strongly correlated with end-systolic volume (rs = 0.568; p = 0.000), end-diastolic volume (rs = 0.563; p = 0.000), left atrial volume (rs = 0.471; p = 0.000), stroke volume (rs = 0.464; p = 0.000), and ejection fraction (rs = -0.351; p = 0.000). We observed a weak inverse relationship between the N-terminal pro-brain natriuretic peptide and waist circumference (rs = -0.257; p = 0.001), waist-to-hip ratio (rs = -0.332; p = 0.000), and visceral fat level (rs = -0.205; p = 0.011). Various statistical analyses showed independent role of visceral fat level in increasing the cardiac pre- and afterload. This allowed us to identify a subgroup CMDS 3-overly high, within CMDS 3. We proposed an algorithm suggesting a differentiated approach for the management of young adults with cardiometabolic risk factors that helps in stratifying individuals possessing higher risk of developing chronic heart failure, coronary artery disease, and atrial fibrillation. Conclusions. An increase in the burden of cardiometabolic and residual risk factors is associated with an increase in cardiac pre- and afterload. Excess visceral fat level most significantly contributed to cardiac structural and functional changes. Per our proposed algorithm, individuals with CMDS 3-overly high group are advised to consult a cardiologist and undergo echocardiography to detect early cardiac changes.

BackgroundStudies that have examined the impact of a physical activity intervention on cardiometabolic risk factors have yielded conflicting results. The objective of this study was to assess the impact of a standardized physical activity program on adiposity and cardiometabolic risk factors in schoolchildren.MethodsCluster randomized trial study of 712 schoolchildren, 8–10 years, from 20 public schools in the Province of Cuenca, Spain. The intervention (MOVI-2) consisted of play-based and non-competitive activities. MOVI-2 was conducted during two 90-minute sessions on weekdays and one 150-minute session on Saturday mornings every week between September 2010 and May 2011. We measured changes in adiposity (overweight/obesity prevalence, body mass index [BMI], triceps skinfold thickness [TST], body fat %, fat-free mass, waist circumference) and other cardiometabolic risk factors (LDL-cholesterol, triglycerides/HDL-cholesterol ratio, insulin, C-reactive protein and blood pressure). The analyses used mixed regression models to adjust for baseline covariates under cluster randomization.ResultsAmong girls, we found a reduction of adiposity in intervention versus control schools, with a decrease in TST (−1.1 mm; 95% confidence interval [CI] -2.3 to −0.7), body fat % (−0.9%; 95% CI −1.3 to −0.4), waist circumference (−2.7 cm; 95% CI −4.5 to −0.9), and an increase in fat-free mass (0.3 kg; 95% CI 0.01 to 0.6). The intervention also led to lower serum LDL-cholesterol and insulin levels. Among boys, a reduction in waist circumference (−1.4 cm; 95% CI −2.6 to −0.1; P = 0.03), and an increase in fat-free mass (0.5 kg; 95% CI 0.2 to 0.9; P = 0.003) was associated with the intervention versus control schools. The prevalence of overweight/obesity or underweight, BMI, and other cardiometabolic risk factors was not modified by the intervention. No important adverse events were registered.ConclusionsAn extracurricular intervention of non-competitive physical activity during an academic year, targeting all schoolchildren regardless of body weight, is a safe and effective measure to reduce adiposity in both genders and to improve cardiometabolic risk profile in girls.Trial registrationClinical trials NCT01277224.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0154-4) contains supplementary material, which is available to authorized users.

Associations between self-reported sleep duration and cardiometabolic risk factors in young African-origin adults from the five-country modeling the epidemiologic transition study (METS)