Lifestyle Exercise Research Articles

A cross-sectional epidemiological study of the relationship between sleep duration, quality, and rhythm and presenteeism in workers

This study aims to examine the relationship of sleep (sleep duration, sleep quality, and sleep rhythm) with presenteeism in workers while controlling for other confounding factors. A total of 2375 workers of six Japanese companies received self-administered questionnaires from June to November 2018. Information on sleep duration was used to evaluate sleep quantity, the Athens Insomnia Scale (AIS) was used to evaluate sleep quality, and workers’ engagement in shift work was used to determine their sleep rhythms. We used the World Health Organization Health and Work Performance Questionnaire to evaluate presenteeism. Information on lifestyle (exercise, smoking, etc.), sex, and age was also collected. We conducted a logistic regression analysis with high absolute/relative presenteeism as an objective variable, sleep duration, AIS, and shift work as dependent variables, and basic attributes and lifestyle factors as adjustment factors. Completed questionnaires were collected from 1992 workers (aged 18–79 years; 25.2% women; response rate: 83.9%). Logistic regression analysis showed that high absolute presenteeism was significantly associated with poor sleep quality (high AIS score; P < 0.001) but not with sleep duration (P = 0.326) and shift work (P = 0.177). High relative absenteeism was significantly associated with poor sleep quality (high AIS score; P = 0.001) but not with sleep duration (P = 0.461) or shift work (P = 0.245). We showed that poor sleep quality is significantly associated with a high level of presenteeism. This suggests focusing on improving sleep quality is important for reducing presenteeism among workers.

56-OR: Fibro-inflammatory Plasma Biomarkers and Relation to Cardiovascular Remodeling in Type 2 Diabetes (T2D)

Objective: People with T2D have increased risk of heart failure, with fibro-inflammatory pathways implicated in the pathogenesis. This secondary analysis assessed the relationship between multiple fibro-inflammatory biomarkers and cardiovascular (CV) structure and function in patients with T2D and asymptomatic nondiabetic controls and the impact of two lifestyle interventions, exercise training or meal replacement plan (MRP). Methods: Data was derived from a randomised controlled trial (RCT), including a nested case-control study. Adults with T2D and no CV disease were randomized (1:1:1) to a 12-week intervention of 1) supervised aerobic exercise training, 2) a low-energy (∼810 kcal/day) MRP or 3) standard care. Fasting bloods for fibro-inflammatory biomarkers and cardiac MRI (CMR) were undertaken pre- and post-intervention. Principal component analysis (PCA) was performed to visualise this multivariate dataset in a 3D space to understand the relationship between CMR outcomes of interest (e.g., cardiac geometry, systolic and diastolic function), key demographic variables (age, sex, ethnicity and smoking status) and the fibro-inflammatory biomarkers (total of 68 variables) between cases and controls and pre-post intervention. Results: At baseline 36 controls and 83 T2D were compared of which 76 participants completed the RCT. People with T2D had an adverse fibro-inflammatory profile compared to controls’. The PCA 3D-visulisation containing demographics, biomarkers and CMR data shows almost complete separation between controls and those with T2D. Following MRP there was a marked shift in the PCA but not for the exercise intervention. Conclusion: Alterations in fibro-inflammatory pathways impact CV structure and function before the onset of symptomatic heart failure in people with T2D. The MRP improved this fibro-inflammatory profile but not exercise. Longer term studies are required to determine whether the MRP can reduce symptomatic heart failure. Disclosure E. M. Brady: Other Relationship; Self; Bristol Myers Squibb Pharmaceutical company. E. Mirkes: None. K. Parke: None. G. S. Gulsin: None. L. Athithan: None. J. Henson: None. T. Yates: None. M. J. Davies: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Limited (UK), Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Self; AstraZeneca, NIHR Leicester Biomedical Research Centre, Novo Nordisk, Speaker's Bureau; Self; Astra Zeneca Pharma India Ltd, Boehringer Ingelheim (China), Boehringer Ingelheim (Philippines), Inc., Boehringer Ingelheim International GmbH, Boehringer Ingelheim Limited (UK), Boehringer Ingelheim Saudi Arabia Trading, Boehringer Ingelheim Singapore Pte. Ltd, Boehringer Ingelheim Sp. Z o. o., Eli Lilly and Company, Napp Pharmaceuticals, Novo Nordisk, Novo Nordisk A/S, S. C. Sanofi Romania SRL, Sanofi K. K. G. P. Mccann: None. P. Kanagala: None. L. Ng: None. Funding National Institute for Health Research (CDF2014-07-045 to G.P.M.)

Lifestyle exercise attenuates immunosenescence; flow cytometry analysis

BackgroundInteraction of physical activity and overall immune profile is very complex and depends on the intensity, duration and frequency of undertaken physical activity, the exposure to cytomegalovirus (CMV) infection and the age-related changes in the immune system. Daily physical activity, which particularly influences immunity, declines dramatically with age. Therefore, the aim of the study was to explain whether physical activity sustained throughout life can attenuate or reverse immunosenescence.MethodsNinety-nine older adults (60–90 years) were recruited for the study. According to the 6-min walk test (6WMT), the Åstrand-Ryhming bike test (VO2max) and Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire, the individuals were classified as physically active (n = 34) and inactive (n = 20) groups. The analysis of T lymphocytes between active vs. inactive participants was performed using eight-parameter flow cytometry.ResultsAnalysis of the baseline peripheral naïve and memory T lymphocytes showed a significant relationship of lifestyle exercise with the CD4/CD8 ratio. Above 50% of physically active participants demonstrated the CD4/CD8 ratio ≥ 1 or ≤ 2.5 contrary to the inactive group who showed the ratio < 1. The older adults with the result of 6WMT > 1.3 m/s and VO2max > 35 mL/kg/min had a significantly higher CD4+CD45RA+ T lymphocyte percentage and also a higher ratio of CD4+CD45RA+/CD4+CD45RO+. Interestingly, in active older adults with IgG CMV+ (n = 30) the count of CD4+CD45RA+ T lymphocytes was higher than in the inactive group with IgG CMV+ (n = 20).ConclusionBased on the flow cytometry analysis, we concluded that lifestyle exercise could lead to rejuvenation of the immune system by increasing the percentage of naïve T lymphocytes or by reducing the tendency of the inverse CD4/CD8 ratio.

Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance

ObjectivesPeople with progressive multiple sclerosis (PwPMS) report that they recognise the benefits of activity on their physical and psychological health but need support to achieve their physical activity goals. We...

Abstract PS8-09: Dietary supplement use in a healthy eating and exercise lifestyle intervention in breast cancer survivors: The lifestyle exercise and nutrition (LEAN) study

Abstract Background: Dietary supplements (DS), defined as herbal preparations, vitamins and minerals (DSHEA Act 1994), are used by 70% of cancer survivors. The World Cancer Research Fund/American Institute for Cancer Research 2018 Cancer Prevention Recommendations specify not to use DS to protect against cancer. There is some evidence that DS are linked to harmful outcomes, including increased mortality and breast cancer recurrence. DS have potential pharmacokinetic interactions via cytochrome P450 enzyme and pharmacodynamic interactions via estrogenic or hepatotoxic activity, which may increase or reduce clinical efficacy or potentiate adverse effects of Tamoxifen and Aromatase Inhibitors (AIs). This analysis examines baseline usage of DS and potential interactions with Tamoxifen and AIs among breast cancer survivors enrolled in the Lifestyle, Exercise, and Nutrition (LEAN) study, a randomized healthy eating and exercise lifestyle intervention. Methods: We examined the use of DS in 151 breast cancer survivors enrolled in the LEAN Study. Women with a body mass index (BMI) ≥ 25 kg/m 2 were randomly assigned to a 6-month healthy eating and exercise lifestyle intervention (n=93) or to usual care (n=58). At baseline and 6 months, we asked participants to self-report regular DS use, defined as at least 3 times a week for at least one month. The intervention group received evaluation and counseling of DS use by a Registered Dietitian (RD) with a Certified Specialty in Oncology Nutrition (CSO). Potential interactions of moderate and major ratings between DS with Tamoxifen and AIs (Letrozole, Exemestane and Anastrozole) were identified through the Natural Medicines Database by both a pharmacist specializing in oncology and a RD, CSO. Results: Out of 151 women, at baseline 120 (80%) reported using DS. Fifty-four different formulations were enumerated. The majority of women (72, 60%) were taking ≥ 3 formulations. One quarter of women (29, 24%) were taking ≥ 5 formulations (range = 1 - 20). Of the 54 formulations, 33% had potential interactions with Tamoxifen and/or AIs according to the Natural Medicines Database. Total interactions by medication were: 18 Tamoxifen, 14 Letrozole, 14 Exemestane, 9 Anastrozole. The majority of these interactions (87%) were associated with herbal preparations. Conclusions: Our findings are indicative of the high prevalence of DS use among breast cancer survivors and the potential risk of interactions with prescribed hormonal therapy. More research is needed to test if counseling from a RD, CSO can reduce DS use and ultimately lead to better outcomes due to fewer interactions with breast cancer treatments. Citation Format: ThaiHien Nguyen, Maura Harrigan, Courtney Mcgowan, Annette Hood, Fangyong Li, Brenda Cartmel, Leah Ferrucci, Melinda L Irwin, Tara Sanft. Dietary supplement use in a healthy eating and exercise lifestyle intervention in breast cancer survivors: The lifestyle exercise and nutrition (LEAN) study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-09.

The efficacy of bone marrow mononuclear stem cell transplantation in patients with non-ischemic dilated cardiomyopathy-a meta analysis.

Cardiomyopathy refers to a wide spectrum of heart pathologies that interfere with normal heart function. Management options of patients with cardiomyopathy depended mainly on the severity of the condition. Lifestyle modifications and regular exercise together with a healthy diet is compatible for mild conditions. Severe conditions, however, rely on medications or surgery. Here, we aim to investigate the efficacy of bone marrow mononuclear stem cell transplantation in patients with dilated cardiomyopathy. We searched PubMed, Scopus, and Cochrane CENTRAL for relevant clinical trials and excluded observational studies. We performed the quality assessment of this study following GRADE guidelines. The assessment of the risk of bias was performed by the Cochrane’s risk of bias tool. We present an analysis of the following outcomes: left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and six minutes walking test. Data were pooled as mean differences (MD) and relative confidence intervals (CI). The analysis of 667 patients from 11 studies receiving autologous bone marrow cell therapy for non-ischemic dilated cardiomyopathy is presented. A total of 338 patients were allocated to the treatment group, and 329 participants entered the control group. The mean age of the patients in the treatment group is 52.4 ± 4.3 years, while that of the control is 53.7 ± 3.7 years. Seven studies (14.18–23) reported transplantation through the intracoronary route. Table 1 shows a summary of the baseline characteristics of the included studies and participants, the number of injected cells, and the type of injected cells in each trial. Table 2 summarizes and illustrates the previous treatment history of included patients in each trial, as well as the baseline values of different scores used as outcome measures in this analysis. We found that bone marrow mononuclear stem cell therapy leads to significantly increased LVEF (MD = 4.54%, 95% CI [3.52, 5.56], P < 0.0001). Patients in the transplant group experienced less left ventricular end-diastolic diameter (millimeter) than the control arm (MD = −1.86 mm, 95% CI [−4.01, 0.29], P = 0.09). Additionally, Patients in the transplant group could walk 28.53 m more than the controls (MD = 28.53 m, 95% CI [2.51, 54.55], P = 0.03). Transplantation of bone marrow stem cells yields acceptable results regarding left ventricular ejection fraction and lowers the left ventricular end-diastolic diameter. Additionally, the six minutes walking test is improved in the transplant group.

Practical and clinical approaches using pacing to improve self-regulation in special populations such as children and people with mental health or learning disabilities

For special populations such as people with a mental health issue or learning disability, a disconnect between the ability to accurately monitor and regulate exercise behaviour can lead to reduced levels of physical activity, which, in turn, is associated with additional physical or mental health problems. Activity pacing is a strategy used in clinical settings to address issues of pain amelioration, while self-pacing research is now well addressed in sport and exercise science literature. It has been proposed recently that these overlapping areas of investigation collectively support the development of self-regulatory, lifestyle exercise skills across broad population groups. Activity pacing appears to have substantial application in numerous development and rehabilitation settings and, therefore, the purpose of this short communication is to articulate how an activity pacing approach could be utilized among population groups in whom self-regulatory skills may require development. This paper provides specific examples of exercise practice across 2 discrete populations: children, and people with mental health and learning difficulties. In these cases, homeostatic regulatory processes may either be altered, or the individual may require extrinsic support to appropriately self-regulate exercise performance. A support-based exercise environment or approach such as programmatic activity (lifestyle) pacing would be beneficial to facilitate supervised and education-based self-regulation until such time as fully self-regulated exercise is feasible.LAY ABSTRACTActivity pacing is a practical means of supporting selfregulation in physical activity. This could be achieved through lifestyle support or in specific practical sport or physical activity situations, depending on the population. Improving the development of self-regulatory, lifestyle exercise skills across broad population groups could be helpful in addressing deficiencies in physical activity levels, which, in turn, can be associated with additional physical or mental health problems. This paper provides specific examples of pacing-based exercise practice across 2 example populations: children, and people with mental health and learning difficulties. In these cases, self-regulation processes may need to be developed, or require external support. Pacing is therefore relevant to different populations in different ways.

Integrated Review of Lifestyle Interventions Targeting Diet and Exercise in Early or First-Episode Psychosis

Aims: Life expectancy is reduced by 10 - 20 years in psychotic disorders compared with the general population, largely due to high incidence of physical health disorders: heart attack, stroke, obesity, cardiovascular disease (CVD), and type 2 diabetes. Early or first-episode psychosis patients can be especially vulnerable to physical health, psychological and social consequences of antipsychotic medication weight gain. The aim of this paper is to review diet and exercise lifestyle interventions employed to address these issues. Method: A review of research evidence on lifestyle interventions (diet and exercise) for individuals with early or first-episode psychosis (2000 to 2020) was undertaken. An internet-based literature search employed Medline, PsycINFO, Embase, PubMed and Web of Science. Results: Nine studies meeting the criteria were identified: comprising of three exercise intervention studies, one diet intervention study, and five combined diet and exercise intervention studies. Only one study used a RCT design with prior power analysis to determine participant numbers, two had a RCT design, two had a comparison group and four had no control group. Overall, these studies show that exercise and diet focused interventions may provide beneficial physical and mental health outcomes, but participant engagement and behaviour change may be difficult to achieve in early or first-episode psychosis due to individual factors associated with the experience of psychosis and medication prescribed, and health service related factors. Conclusion: There is a need for evidence-based lifestyle programmes in early or first-episode psychosis that includes individually targeted evidence based exercise and diet interventions. Further appropriately powered RCTs are required to strengthen the evidence base.

A Technology-Mediated Interventional Approach to the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis.

Background: Technology-mediated interventions help overcome barriers to program delivery and spread metabolic syndrome prevention programs on a large scale. A meta-analysis was performed to evaluate the impact of these technology-mediated interventions on metabolic syndrome prevention. Methods: In this meta-analysis, from 30 January 2018, three databases were searched to evaluate interventions using techniques to propagate diet and exercise lifestyle programs for adult patients with metabolic syndrome or metabolic risk. Results: Search results found 535 citations. Of these, 18 studies met the inclusion criteria analyzed in this article. The median duration of intervention was 4 months and the follow-up period ranged from 1.5 to 30 months. The standardized mean difference (SMD) between the two groups was waist circumference −0.35 (95% CI −0.54, −0.15), triglyceride −0.14 (95% CI −0.26, −0.03), fasting blood glucose −0.31 (95% CI −0.42, −0.19), body weight −1.34 (95% CI −2.04, −0.64), and body mass index −1.36 (95% CI −2.21, −0.51). There was no publication bias in this study. Conclusion: Technology-mediated intervention improved clinically important metabolic syndrome related indicators such as excess body fat around the waist, fasting glucose, and body mass index. These interventions will play an important role in the dissemination of metabolic syndrome prevention programs.

Does Change Predict Change in the CHANGE Intervention Study?

Does change in one lifestyle factor (e.g., exercise/fitness) help explain change in another factor or process (i.e., dietary behavior or cardiovascular risk)? The current modeling was a secondary analysis of a primary care feasibility study of individualized lifestyle (diet and exercise) treatment of metabolic syndrome (n=293; mean age = 59yrs) that achieved 19% reversal over one year. Diet quality was assessed by the Healthy Eating Index (HEI) (2005 Canada); while fitness was assessed by several measures (VO2max, flexibility, curl-ups, push-ups). Three occasions (i.e., baseline, 3-, and 12-month) were examined using latent change score and latent growth curve models (in AMOS) to assess whether changes in one domain predicted changes in the remaining domains: (1) diet (measured by HEI or latent construct); (2) fitness (measured by VO2max percentiles or latent construct); and, (3) 10-year risk of cardiovascular disease (by Procam Risk score). Results showed significant improvement in all three domains separately during the intervention, with greater change between baseline and 3-month assessment and continued change between 3- and 12-months. Initial status variables on observed constructs were moderately positively correlated and change in dietary behavior was significantly related to change in fitness levels, but neither were significantly related to change in the 10-year risk of cardiovascular disease. In addition, the associations between change in diet and changes in fitness were inconsistent baseline to 3 months, and 3-12 months. These results offered new insight on relationships among interventions in a behavioural counselling program which can inform future programming.

Effects of the Intensity of Lifestyle Exercise on Changes in Blood Pressure.

The purpose of this study was to investigate whether the amount of time participants exercised in the target heart rate zone (THRZ) influenced change in blood pressure (BP) one year following a cardiac event. Lifestyle exercise (habitual, small exercise opportunities) and intensity were objectively measured using portable heart rate monitors. Linear mixed models were used to analyze change in BP among 331 participants. Mean BP at baseline was 118/70 mmHg, and both systolic and diastolic BP increased from baseline to one year-4.79 mmHg (p <.001) and 2.09 mmHg (p =.002), respectively. Overall, participants had a decrease in levels of lifestyle exercise. After controlling for time, age, gender, and study group, SBP change was inversely associated with amount of time in THRZ. Given suboptimal engagement in recommended exercise, the underlying mechanisms of lifestyle exercise effects on the time spent in THRZ to reduce BP warrants further study in this population.

A lifestyle intervention during pregnancy to reduce obesity in early childhood: the study protocol of ADEBAR \u2013 a randomized controlled trial

BackgroundThe prevalence of obesity in childhood is increasing worldwide and may be affected by genetic factors and the lifestyle (exercise, nutrition behavior) of expectant parents. Lifestyle factors affect adipokines, namely leptin, resistin, and adiponectin as well as cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), which are involved in the regulation of maternal metabolic homeostasis, glucose metabolism, and the development of insulin resistance, metabolic syndrome, gestational diabetes mellitus, and hypertension. However, studies focusing on the effect of exercise or a combination of parental exercise and nutrition on the above-mentioned markers in newborns (venous cord blood) and especially on the long-term development of infants’ weight gain are lacking. The study will investigate the effects of a multimodal intervention (regular exercise, diet) on parental and childhood adipocytokines (leptin, resistin, adiponectin, TNF-α, IL-6, BDNF). The effect of a lifestyle-related change in “fetal environmental conditions” on the long-term weight development of the child up to the age of two will also be assessed.Methods/designA randomized multi-center controlled trial will be conducted in Germany, comparing supervised aerobic and resistance training 2x/week (13th to 36th weeks of gestation) and nutritional counseling (6th to 36th weeks of gestation) during pregnancy with usual care. Thirty women (pre-pregnancy Body Mass Index ≥25 kg/m2, 6th–10th week of gestation) will be included in each group. Maternal anthropometric and physical measurements as well as blood sampling will occur at the 6th–10th, 13th–14th, 21st-24th, and 36th week of gestation, at delivery as well as 8 weeks and 24 months postpartum. Neonatal measurements and umbilical blood sampling will be performed at birth. Maternal and infants’ weight development will be assessed every 6 months till 24 months postpartum. A difference in childhood BMI of 1 kg/m2 at the age of two years between both groups will be assumed. A power size of 80% using a significance level of 0.05 and an effect size of 1.0 is presumed.DiscussionA better understanding of how lifestyle-related changes in the fetal environment might influence infants’ outcome after two years of life could have a profound impact on the prevention and development of infants’ obesity.Trial registrationThe trial is registered at the German Clinical Trial Register (DRKS00007702); Registered on 10th of August 2016; retrospectively registered https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007702

Collaborative model of care between Orthopaedics and allied healthcare professionals trial (CONNACT) \u2013 a feasibility study in patients with knee osteoarthritis using a mixed method approach

BackgroundOsteoarthritis is a leading cause of global disability resulting in significant morbidity and cost to the healthcare system. Current guidelines recommend lifestyle changes such exercises and weight loss as first line treatment prior to surgical consideration. Our current model of care is inefficient with suboptimal allied health intervention for effective behaviour changes. A 12-week community based, individualized, multidisciplinary new model of care for knee osteoarthritis was developed in light of current deficiencies.MethodsThe primary aim of this study was to determine the feasibility of a full randomized controlled trial evaluating this new model of care using pre-defined progression criteria. The secondary aim was to optimize the intervention and study design through a process evaluation. A pilot exploratory, parallel arm, single blinded randomized trial design using a mixed method approach was utilized. Progression criteria for a full trial including key domains of patient recruitment and retention, outcome measure acceptability and improvement, adverse events were developed. The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 12-weeks. Secondary outcomes included quality of life, functional and psychological assessments. Semi-structured interviews were conducted with the patients at 12-weeks.Results20 patients (3 males, 17 females) were randomized (10 intervention, 10 control). Intervention arm patients reported better improvements in their knee function, quality of life, psychological outcome, dietary improvement and weight loss compared to the control arm at 12-weeks. Semi-structured interviews revealed several themes pertaining to feasibility and intervention optimization. 5 out of the 6 progression criteria’s domains were met (recruitment criteria not met).ConclusionThis pilot has demonstrated the feasibility of a full randomized control trial investigating the potential effectiveness of the new proposed model of care for knee osteoarthritis using pre-defined progression criteria and process evaluation. Results from the qualitative study were used to modify and improve the intervention content, delivery model and study design for a large effectiveness-implementation hybrid randomized control trial that is currently underway.Trial registrationRetrospectively registered on 18 January 2019 at http://clinicaltrial.gov ID: NCT03809975.

Presenting Meaningful Lifestyle Physical Activity Images to People for a More Realistic, Doable, and Enjoyable Way to Meet Our Physical Activity Guidelines

Most Americans and Canadians do not meet their respective country’s physical activity (PA) guidelines of 150 minutes of moderate to vigorous activity and 2 or more strengthening activities per week. More recent studies have indicated a preference for lifestyle PA rather than traditional exercise, suggesting a need for a change of strategy in how we motivate, educate and connect people to their meaningful PA. The purpose of this study was to examine peoples’ beliefs, outlooks, and attitudes towards PA and exercise in Southern Ontario, Canada and South Carolina, United States with the overarching goal of adding a new paradigm to the already established standard of exercise. The study was conducted in two phases: first, a qualitative focus-group based phase in which feedback towards attitudes towards exercise and PA was used to generate a quantitative questionnaire which was used in phase two. Our results indicate that the majority of participants from Southern Ontario and South Carolina, ages 18-64, perceive a difference between lifestyle PA and exercise (Southern Ontario, 84% of males, 80% of females; South Carolina, 82% males, 74% females), and that engaging in lifestyle PA is a more natural, realistic and enjoyable part of their day than exercise (Southern Ontario, 83% of males, 78% of females; South Carolina, 81% males, 74% females). Additionally, participants indicated a preference towards lifestyle PA as opposed to within a gym environment. Overall, Southern Ontarians and South Carolinians were consistent in their message for a more unstructured, unregimented, natural way of being physically active throughout the day. Physical activity needs to be customized, tailored and meaningful for everyone.

Cultural adoption, and validation of the Persian version of the coronary artery disease education questionnaire (CADE-Q): a second-order confirmatory factor analysis

BackgroundEvaluating knowledge in patients with coronary artery disease requires a specific measure. The aim of the present study was to translate and evaluate the CADE-Q in patients with coronary artery disease in Iran.MethodsForward-backward procedure was applied to translate the questionnaire from English into Persian. Then a cross-sectional study was conducted to evaluate psychometric properties of the questionnaire. A sample of patients with coronary artery disease attending to cardiac departments of teaching hospitals affiliated to medical universities in Tehran, Iran completed the 19-item CADE-Q from April to December 2017. Structural validity of CADE-Q was assessed using both exploratory and confirmatory factor analyses. Reliability was examined using Cronbach’s alpha coefficient. Stability was evaluated by estimation intraclass correlation coefficient.ResultsIn all 500 patients participated in the study. The mean age of patients was 53.63. (SD = 14.36) years, and 57% were male. The results obtained from the exploratory factor analysis showed a four factor solution (lifestyle habits and exercise, risk factors, diagnosis and treatment, signals & symptoms and medicine) that jointly explained 48.9% of the total variance observed. However, the second-order confirmatory factor analysis supported the three-factor solution while convergent and divergent validity were not confirmed. Finally, the Cronbach’s alpha coefficient of 0.84 ranging from 0.50 to 0.82 was obtained for the scale and its subscales. In addition, the ICC value of 0.88 showed satisfactory stability for the questionnaire.ConclusionThe Coronary Artery Disease Education Questionnaire was found to be a multidimensional instrument. The results confirmed the factor structure of the questionnaire with a second-order analysis. Since the convergent and divergent validity of the scale were not confirmed, further assessment is essential to establish fitness of the questionnaire in Iran.

A Healthy Lifestyle Intervention During Pregnancy: Key To Preventing Chronic Disease Risk?

Gestational hypertension disorders and diabetes affect 6-15% of all pregnancies worldwide and are associated with adverse maternal and neonatal outcomes that can have a programming effect on future chronic disease risk. Pregnant women who receive lifestyle interventions, including healthy eating and/or physical activity, may have a decreased risk of developing complications. PURPOSE: To analyze the effects of a supervised healthy lifestyle intervention (nutrition and exercise) during pregnancy on diagnosis of gestational diabetes, hypertension, caesarean delivery, stillbirth, macrosomia (babies > 4500g), and low birth weight (babies < 2500g) in a cohort in London, Canada. METHODS: From 2016 to 2019, 111 women were enrolled at 12-18 weeks gestation in the Nutrition and Exercise Lifestyle Intervention Program (NELIP; Clinical Trials #NCT02804061) up to delivery. The nutrition goals for the intervention were: 1) Submit a weekly 24 hour-food intake record; 2) Consume approximately 1800-2200 kcal/d; and 3) Consume 200-250 g carbohydrates/d (40-55% of total energy intake). The exercise goals were: 1) Duration of session: Walk for 25 minutes and add 2 minutes each week until 40 minutes were achieved and then maintain this walking duration until delivery; 2) Frequency: 3-4 times per week; and 3) Submit a weekly step log (pedometers were provided to each participant). RESULTS: As of October 2019, the average duration of the intervention was 20.9 ± 3.9 wks. Out of the 75 participants that completed the intervention, maternal age was 32.2 ± 3.3 yrs, self-reported pre-pregnancy weight was 71.2 ± 15.3 kg, and gestational age at delivery was 278.1 ± 9.0 days. No participants were diagnosed with gestational diabetes or hypertension. Data from 52 babies indicated: birth weight was 3456.0 ± 442.4 g and length was 50.7 ± 3.1 cm. None were born with low birth weight and there were no cases of stillbirth. The rate of macrosomia was 1.9% (n = 1) and caesarean delivery was 27% (n = 14). CONCLUSION: A healthy lifestyle intervention during pregnancy may help to prevent gestational diabetes and hypertension, and help to reduce the prevalence of stillbirth, macrosomia, low birth weight, and caesarean deliveries. Taken together, these findings may have major positive implications for the long-term health of both mothers and babies.

Management of patients with prior lumbar fusion: a cross-sectional survey of Veterans Affairs chiropractors\u2019 attitudes, beliefs, and practices

BackgroundLittle is known about the preferred treatment strategies of chiropractors in managing low back pain patients with prior lumbar fusions. There are several case reports which describe chiropractic care following surgical intervention, but there are no cohort or experimental studies published. Therefore, we sought to examine self-reported management approaches and practice patterns related to the management of patients with prior surgical lumbar fusion, among United States Veterans Affairs (VA) chiropractors.MethodsAn electronic survey was administered nationwide to all chiropractors providing clinical care within VA. Questions were informed by a prior survey and piloted on a sample of chiropractors external to VA. Statistical analysis included respondent background information, and quantitative analysis of chiropractic referral patterns and practices. This survey collect information on 1) provider demographics, 2) VA referral patterns, and 3) attitudes, beliefs, practices and interventions utilized by VA chiropractors to manage patients with a history of surgical lumbar fusion.ResultsThe survey response rate was 46.3% (62/134). The respondents were broadly representative of VA chiropractic providers in age, gender, and years in practice. The majority of respondents (90.3%) reported seeing at least 1 post-fusion patient in the past month. The most common therapeutic approaches utilized by VA chiropractors were healthy lifestyle advice (94.9%), pain education (89.8%), exercise prescription (88.1%), stretching (66.1%) and soft tissue manual therapies (62.7%). A relatively smaller proportion described always or frequently incorporating lumbar (16.9%), thoracic (57.6%) or pelvic (39.0%) spinal manipulation.ConclusionThis survey provides preliminary data on VA chiropractic services in the management of patients with prior lumbar fusion. These patients are often seen by VA chiropractors, and our findings support the need for further study to advance understanding of interventions utilized by chiropractors in this patient population.

Are pre-pregnancy weight fluctuations and adherence to prenatal nutrition and exercise recommendations related to excessive gestational weight gain?

Women who have an overweight or obese pre-pregnancy body mass index (BMI) may be recommended to lose weight before pregnancy, however the association of preconception weight fluctuations and prenatal adherence to nutrition and exercise recommendations with gestational weight gain (GWG) have not been assessed. One hundred women with a pre-pregnancy BMI ≥ 25.0kg/m2 who participated in the Nutrition and Exercise Lifestyle Intervention Program (NELIP) were included and stratified as gained weight excessively (n = 47) or not (n = 53) using the 2009 Institute of Medicine GWG guidelines. Participants completed a Weight Health History Questionnaire providing information about weight loss prior to the index pregnancy. Adherence was scored based on meeting six nutrition and exercise goals for the NELIP (/6). More women who gained excessively reported that they had actively tried to lose weight a year before the current pregnancy (61%) than women who did not gain excessively (39%; p = 0.02). Of the women attempting preconception weight loss, those who gained excessively lost more weight (6.7 ± 10.2kg) than women who did not (2.1 ± 3.8kg; p = 0.003). Adherence to the NELIP was lower among women who gained excessively (3.3 ± 0.8; 55%) than those who did not (4.4 ± 0.9;73%; p < 0.001). Program adherence (p < 0.001) was related to excessive GWG.

Self-Reported Omega-3 Supplement Use Moderates the Association between Age and Exercising Cerebral Blood Flow Velocity in Older Adults.

Cerebral blood flow (CBF) decreases across the lifespan, and chronic conditions such as dementia and stroke accelerate this decline. Impaired CBF results in reduced delivery of oxygen and nutrients, which can damage the brain over time. Thus, there is a need to identify lifestyle interventions, including diet and exercise, to maintain CBF with aging and in the presence of chronic disease. In the present study, we used transcranial Doppler ultrasound to record middle cerebral artery velocity (MCAv), a surrogate measure of CBF, during moderate-intensity exercise in sedentary, cognitively normal older adults (n = 90). A multiple linear regression model (F(4, 85) = 3.21, p = 0.02) showed that self-reported omega-3 supplement use significantly moderated the association between age and mean exercising MCAv in these individuals (p = 0.01). Older age was associated with lower exercising MCAv in the group not taking omega-3 supplements, while exercising MCAv showed no decline with increasing age in the group who reported omega-3 supplement use. These findings suggest omega-3 supplementation may have an important role in the preservation of CBF with aging.

Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study.

BackgroundThere is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer.ObjectiveThe Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters.MethodsThe ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations.ResultsOverall, 49 participants (mean age 55 years; recruitment rate 94%) were enrolled and 96% adhered to the exercise prescription (attrition rate 2%). Statistically significant improvements in the 6-minute walking distance test (+7%, P<.001) and isometric quadriceps strength (+22%, P<.001), as well as decreases in body mass index (-2.5%, P=.03) and hip circumference (-4.0%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16%, P=.07) in fatigue was observed.ConclusionsThe high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted.Trial RegistrationClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886