Mean Metabolic Equivalents Research Articles

Effect of structured diet with exercise education on anthropometry and lifestyle modification in patients with type 2 diabetes: A 12-month randomized clinical trial

AimsLifestyle modification involving active engagement of specialised dietitian with diet and exercise education, can be effective as first-line treatment for diabetes. Methods192 patients were enrolled with diabetes in a randomised controlled trial and followed up for one year. Ninety-four patients in the intervention group participated in a comprehensive structured diet and exercise education conducted by a specialised dietitian at ambulatory centre in the United Arab Emirates. ResultsThe mean difference in the change in body mass index between study groups at study exit and baseline was statistically significant (BMI difference = -1.86, 95 % CI −2.68 – −1.04, P < 0.01). The intervention group reported significant decrease in total carbohydrate and daily energy intake compared to baseline (173.7 g vs 221.1 g and 1828.5 kcal vs 2177.9 kcal, respectively). Moreover, the mean metabolic equivalents (METs) in the intervention group increased significantly at study exit from baseline compared to control group METs, with mean difference between all between-group differences after baseline of 0.63 (95 % 0.29 – 0.97, P < 0.01). ConclusionsStructured diet and exercise counselling by specialised dietitian in ambulatory settings significantly reduced carbohydrate and daily energy intake, with improved anthropometric measurements and physical activity.

Quality of life and physical functioning in black and white adults with hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is a common and clinically heterogeneous inherited cardiac disease. Quality of life (QOL) and physical functioning are important clinically but are underexplored in diverse populations with HCM. ObjectivesTo examine predictors for and compare QOL and physical functioning in Black and White adults with HCM. MethodsWe analyzed a sub-sample from a longitudinal prospective study on HCM. Eligibility criteria included self-identified Black and White adults (≥18 years) with clinical HCM. QOL was measured with the Minnesota Living with Heart Failure Questionnaire (MLWHF);physical functioning included age-adjusted exercise capacity and NYHA class. Covariates included HCM structural characteristics and common comorbidities. We analyzed data from 434 individuals, 57 (13.1%) of whom self-identified as Black/African American. Results: In this sample, the Black cohort had higher MLWHF scores, 31.2 (27.2) v. 23.9 (22.1), p=0.042, signifying worse QOL, but there were no intergroup differences when QOL was dichotomized. Mean metabolic equivalents (METs) on symptom-limited stress testing were similar, though the Black cohort was younger, 54.6 (13.4) v.62.5 (14.8) years, p=0.001. No one from the Black cohort achieved an “excellent-for-age” exercise capacity, and 64.1% had a “below-average-for-age” exercise capacity vs 47% in the White cohort, though this was not statistically significant, p=0.058. There was no difference between groups in advanced NYHA class. Female gender was associated with worse QOL and physical functioning irrespective of covariates. ConclusionsThis study is a starting point that underscores the need for a more comprehensive examination of well-being and physical functioning in Black populations with HCM.

Associations between socioeconomic status and physical activity among older adults: cross-sectional results from the OUTDOOR ACTIVE study.

BackgroundRegular physical activity (PA) is an important strategy for healthy ageing. Socioeconomic status was found to be a key determinant of PA, however, evidence on associations between socioeconomic status and PA among older adults is limited. The aim of this study was to contribute to research on the associations of socioeconomic status and PA among older adults by including self-reported and objectively measured PA data. Furthermore, we examined the self-reported PA data more closely by looking at the activities separately.MethodsCross-sectional data of 1507 participants (52.5% female) of the OUTDOOR ACTIVE study between 65 and 75 years, residing in Bremen, Germany, were included in the analyses. Self-reported PA was assessed via questionnaire and comprised all organised and non-organised activities. For analyses, mean hours per week of total and moderate to vigorous PA, and mean metabolic equivalents per week were used. Objectively measured PA was assessed using accelerometers over seven consecutive days. Socioeconomic status was included as an additive social class index containing education, income, and occupation. To test for associations between PA and socioeconomic status, linear regressions were carried out.ResultsSelf-reported PA showed significant negative associations with socioeconomic status for both men and women. Objectively measured PA was positively associated with socioeconomic status, which was significant in men but not in women. When examining physical activities separately, time spent on housework, gardening, biking, and walking decreased with increasing socioeconomic status. Women in the second SES quintile and men in the third quintile reported the most, and women in the first quintile and men in the fifth quintile the least hours per week spent on exercise.ConclusionsThe results of this study contributed to the existing research gap on the associations of socioeconomic status and PA among older adults. Moreover, we provided information on both self-reported and objectively measured PA, and showed the discrepancies in the two methods’ results. These findings can help to develop PA promotion interventions targeting specific socioeconomic status groups and to develop accurate, valid, and reliable self-reported and objective measurements of PA for older adults.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-022-03075-7.

Abstract P5-18-07: Heart rate changes, cardiac safety, and exercise tolerance from a phase Ia/b study of giredestrant (GDC-9545) ± palbociclib in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer

Abstract Background Targeting the activity of the estrogen receptor and/or estrogen synthesis is a standard primary treatment for eligible patients with estrogen receptor-positive breast cancer. Giredestrant is a highly potent, nonsteroidal oral selective estrogen receptor antagonist and degrader that achieves robust estrogen receptor occupancy. In animal models and early phase studies, giredestrant was associated with a dose-dependent reduction in heart rate. Therefore, we leveraged an ongoing nonrandomized, open-label, dose-escalation and -expansion phase Ia/b study (GO39932) to evaluate its cardiac safety. Methods Eligibility criteria for the main study are available at https://clinicaltrials.gov/ct2/show/NCT03332797. Additional relevant cardiac exclusion criteria included current treatment with medications known to decrease heart rate, e.g., beta blockers.100 mg giredestrant was given daily on Days 1-28 of each 28-day cycle (monotherapy for 14 days; patients then continued monotherapy or received combination treatment with 125 mg daily oral palbociclib for the study duration, per investigator decision). The 100 mg giredestrant dose for this arm (rather than the phase III 30 mg dose) was evaluated to increase the likelihood of observing relevant cardiac effects. Electrocardiograms were required on Day 1 of each cycle; 24-hour Holter data were collected and treadmill-exercise testing was completed at screening (prior to starting giredestrant), steady state (Day 8 [+3 days]), and as clinically indicated. Exercise testing evaluated baseline heart rate, exercise duration, maximal heart rate, and heart rate recovery. A standard Bruce protocol was followed. Results Clinical data cutoff was Apr 16, 2021. Twenty patients were enrolled and included in the current analysis; median age was 59 (range, 45-72); three patients (15%) had a history of hypertension at screening. During follow-up, no dysrhythmias were observed that required treatment or a change in study medication, and no patients were noted to have a resting heart rate of &amp;lt;50 beats per minute based on routine heart rate monitoring. Two Grade 1 bradycardia events (&amp;lt;60 beats per minute) were reported; both in patients receiving palbociclib. No other cardiac adverse events (AEs) were reported overall, nor any other serious AEs. Holter monitoring reports were available for 19 patients at screening and 20 on treatment. There were no episodes of second- or third-degree atrioventricular block. At screening, 2/19 patients (11%) had a paroxysmal supraventricular tachycardia event (SVT; ≤30 seconds). During the study, 4/20 patients (20%) had a paroxysmal SVT event and, of these, 1/4 had four episodes of an SVT event lasting &amp;gt;30 seconds and 1/4 also experienced one episode of non-sustained ventricular tachycardia. No patients required any cardiac treatment or dose modification. Twenty patients underwent exercise testing. Exercise time was similar among patients before and after starting giredestrant (mean exercise time 7 min 10 sec before; 7 min 44 sec after). Exercise intensity was similar before and after starting treatment (mean metabolic equivalents expenditure 7.52 [standard deviation 2.81] and 8.68 [2.78], respectively). One patient had an abnormal heart rate recovery on exercise testing at screening and again while on treatment. Conclusions In a thorough cardiac safety analysis, applying routine electrocardiograms, 24-hour Holter monitoring, and exercise testing, no clinically relevant cardiac effects were observed with 100 mg giredestrant (a higher dose than the phase III 30 mg dose). Citation Format: Tomas G Neilan, Rafael Villanueva-Vázquez, Meritxell Bellet, Elena López-Miranda, Laura García-Estévez, Peter Kabos, John Bond, Mary R Gates, Ching-Wei Chang, Valentina Boni. Heart rate changes, cardiac safety, and exercise tolerance from a phase Ia/b study of giredestrant (GDC-9545) ± palbociclib in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-18-07.

Effects On Exercise Intensity Associated With Catecholamine Dynamics And Changes In Mood During Yoga Session

The exercise intensity of Vinyasa yoga has been established to meet the criteria for moderate-to-vigorous physical activity reported in an ACSM Position Stand. Little is known about the effects of a single bout of Vinyasa yoga on the sympathetic nervous system and mood in beginners. PURPOSE: To determine the effects of a single bout of Vinyasa yoga on exercise intensity, catecholamine dynamics, and mood. METHODS: A 60-minute yoga session for beginners consisted of Vinyasa as the main component (34 minutes), with warm-up and cool-down exercises from Hatha Yoga. Sixteen healthy beginners (8 women, 8 men) performed exercise while wearing breath gas masks and heart rate monitors. Measures were mean metabolic equivalents (METs), oxygen consumption (VO2), heart rate (HR), and ratings of perceived exertion (RPE). Catecholamine dynamics were measured at pre- and post-rest, and at 55 minutes into the session. Pleasure was assessed using the Two-dimensional Mood Scale (TDMS) prior to the session and after the session. T-tests and analysis of variance were performed for analyses. RESULTS: Mean values across the entire yoga session for METs, HR, and RPE were 3.4 (± 0.5) METS; 100.8 (± 11.2) bpm; and 10.6 (± 1.7); respectively. Although maximal oxygen consumption was significantly lower in women subjects compared with men subjects, there were no significant differences in METs during the yoga session. A single bout of yoga caused a significant increase in circulating plasma norepinephrine levels (pre; 270 ± 146 pg/mL, post; 318 ± 140 pg/mL, p < 0.05), but not epinephrine or dopamine levels. Vitality and stability in the TDMS subscales were significantly increased following yoga (p < 0.01), suggesting that a single bout of yoga improved mood status. CONCLUSION: A light to moderate-intensity yoga session for beginners, which meets the ACSM criteria, is sufficient to affect sympathetic nervous system activity. Additionally, increased pleasure scores indicated improved mood.

Prospective Analysis of Demographic and Echocardiographic Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)

Following ST-Elevation Myocardial Infarction (STEMI), impairment in LV systolic function and reduced Mean Metabolic Equivalents (METs) is associated with worse prognosis. We recently reported a retrospective analysis that showed that minimum left atrial indexed volume (LAVImin) ≥ 18mL/m2, average e’ velocity and E/e’ (diastolic parameters) were associated with METs ≤8 following STEMI.

Thoracic continuous spinal anesthesia for high-risk comorbid older patients undergoing major abdominal surgery: one-year experience of an Italian geriatric hospital.

General anesthesia is associated with high morbidity/mortality in comorbid older adults. Thoracic continuous spinal anesthesia/analgesia (TCSA) may be an alternative for major abdominal surgery. We report a one-year experience of the use of TCSA in an Italian geriatric center. Retrospective review of case notes of high-risk older patients (ASA class ≥III) who underwent TCSA for major abdominal surgery between May 2017-May 2018. TCSA was performed with a 21-gauge Tuohy-shaped spinal needle and a 24-gauge catheter (level of insertion between T6-7 and T10-11). Hyperbaric bupivacaine or levobupivacaine (two boluses of 2.5 mg) plus fentanyl (10-25 µg) were injected before incision, followed by additional doses if needed. Intrathecal levobupivacaine plus fentanyl were infused for 72 hours after surgery. We described the anesthesiologic management and evaluated the incidence of postoperative complications. Ninety patients (age 84.4±6.9 years, 53.3% male) were enrolled. High comorbidity, according to the Geriatric Index of Comorbidity, was found in 64.4% of the patients. Mean Metabolic Equivalents were 2.58±0.99. Switching to general anesthesia was required in one case. Intraoperative noradrenaline (0.17±0.12 mcg/kg/min) was required in 70.6%. Additional intravenous paracetamol or weak opioids were required in 23% and 2.2% of patients, respectively. No direct complications of TCSA were reported. Cardiac, respiratory and surgical complications occurred in 15.6%, 13.3% and 13.3% of patients, respectively. Delirium occurred in 14.4%. Hospital mortality was 5.6%. TCSA may be a valid alternative to general anesthesia in high-risk older patients undergoing major abdominal surgery. Further studies are needed to confirm its safety and benefits.

Retinal microvascular dysfunction in patients with coronary artery disease with and without heart failure: a continuum?

Dynamic retinal vessel analysis is a novel, non-invasive method to assess microvascular function. The primary aim of this study was to investigate whether retinal microcirculation is impaired in patients with stable coronary artery disease (CAD) compared to patients with heart failure due to CAD (ischaemic heart failure, IHF). A total of 150 adults were enrolled to prospectively assess micro- and macrovasculature. The pre-defined primary outcome was flicker-induced arterial dilatation (FIDa) in patients with CAD [n= 40; median age 63 years, interquartile range (IQR) 53-70] and IHF (n= 40; median age 63 years, IQR 59-71) compared to healthy controls (HC, n= 70; median age 57 years, IQR 41-69). Secondary outcomes included arterial stiffness, flow-mediated dilatation, biomarkers, and ergospirometry parameters. Patients with CAD demonstrated impairment in FIDa that was even more pronounced in patients with IHF (CAD: 1.93 ± 0.28% vs. IHF: 0.41 ± 0.28%, P<0.001; FIDa in HC: 3.69 ± 0.21%, both P<0.001) adjusting for age, sex, concomitant medication, and co-morbidities. While pulse wave velocity was increased and flow-mediated dilatation reduced in CAD and IHF patients (both P<0.001 compared to HC), neither differed between CAD and IHF patients. N-terminal pro-B-type natriuretic peptide (r=-0.49, P<0.001,) and high-sensitivity troponin T (r=-0.28, P=0.003) correlated with FIDa. Intriguingly, mean metabolic equivalents (5.3 ± 2.3 kcal/kg/h, n= 39) showed a positive correlation with FIDa (r=0.58, P<0.001). This study demonstrates a decline of retinal arterial function in CAD patients that is significantly more pronounced in the presence of reduced left ventricular ejection fraction, suggesting a continuum of microvascular damage.

Metabolic Demands of Yoga at Varying Tempos and Compared With Walking.

Yoga is a popular alternative to walking, but the tempo at which asanas must be performed to elicit comparable metabolic and cardiorespiratory demands is unknown. Therefore, the authors aim to compare the metabolic demands of moderate-intensity walking to Surya Namaskar yoga performed at varying tempos. Inactive obese adults with limited prior yoga experience (n = 10) completed 10 minutes of treadmill walking at a self-selected pace (rating of perceived exertion = 12-13) and three, 10-minute bouts of yoga at a low (6s/pose; LSUN), medium (4s/pose; MSUN), and high (3s/pose; HSUN) tempo with 10-minutes rest between exercise bouts. Mean metabolic equivalents observed in MSUN (3.64 [0.607]), HSUN (4.22 [0.459]), and treadmill (5.29 [1.147]) were greater than 3.0 (P ≤ .01), but not LSUN (3.28 [0.529], P = .13). Treadmill elicited greater caloric and kilocaloric expenditure (1.36 [0.23]L·min-1; 64 [11] kcal) than LSUN (0.87 [0.24]L·min-1; 39 [11]kcal) and MSUN (1.00 [0.29]L·min-1; 45 [13]kcal) (P ≤ .01). Absolute V˙O2 between yoga tempos were not different, but relative V˙O2 was higher in HSUN (14.89 [1.74]mL·min-1·kg) versus LSUN (11.39 [1.83]mL·min-1·kg) (P = .02). Yoga can meet (LSUN) or exceed (MSUN and HSUN) moderate-intensity exercise recommendations. For unfit or obese populations, varying tempos of yoga practice may serve as a lower-impact option for beginning an exercise program.

Exercise capacity in asymptomatic patients with significant primary mitral regurgitation: independent effect of global longitudinal left ventricular strain.

Despite preserved left ventricular ejection fraction (LVEF), patients with significant primary mitral regurgitation (MR) often have reduced exercise capacity. In asymptomatic patients with ≥3+ primary MR undergoing rest-stress echocardiography (RSE), we sought to evaluate the incremental impact of left ventricular global longitudinal strain (LV-GLS) on exercise capacity. A total of 660 asymptomatic patients with ≥3+ primary MR, non-dilated LV and LVEF ≥60% (mean age, 57±14 years, 66% men, body mass index or BMI 25±4 kg/m2) who underwent RSE at our center between 2001 and 2013 were included. Standard RSE data were obtained. Average resting LV-GLS was measured using Velocity Vector Imaging. Mean mitral effective regurgitant orifice, resting right ventricular systolic pressure (RVSP) and LV-GLS were 0.45±0.2 cm2, 31±12 mmHg and -21.7%±2%, respectively; 28% had flail mitral leaflet. Mean metabolic equivalents (METs) and post-stress RVSP were 9.9±3, and 46±15 mmHg; 28% achieved <100% age-gender predicted METs. No patient had ischemia or significant arrhythmias. On logistic regression, resting LV-GLS [odds ratio (OR), 1.40, 95% confidence interval (CI): 1.21-1.55, BMI (OR, 1.11, 95% CI: 1.06-1.17)] and resting RVSP 1.22 (1.02-1.49) were independent predictors of exercise capacity. Area under the curve for association between 100% age-gender predicted METs and various factors were as follows: (I) BMI (0.60, 95% CI: 0.55-0.65, P<0.001); (II) resting RVSP (0.57, 95% CI: 0.52-0.62, P=0.006) and LV-GLS (0.66, 95% CI: 0.61-0.70, P<0.001). In asymptomatic patients with ≥3+ primary MR, non-dilated LV and preserved LVEF, LV-GLS is independently associated with exercise capacity, beyond known predictors.

Uninterrupted Sedentary Behavior Downregulates BRCA1 Gene Expression

BRCA1 mutation carriers face a high lifetime risk of developing breast cancer. Physical activity induces broad transcriptional changes, and multiple studies have documented its beneficial effects across cancers. Because haploinsufficiency predisposes to breast cancer in these women, factors that increase BRCA1 levels may mitigate the effect of the mutation. Whether physical activity modulates BRCA1 expression and whether lifestyle factors could benefit women with a mutation remain unclear. The objective of this study was to systematically evaluate whether physical activity or sedentary behavior affects BRCA1 mRNA expression. Activity levels were assessed in 50 female participants (14 BRCA1 mutation carriers and 36 noncarriers) using the GT3X Actigraph accelerometer, and BRCA1 mRNA expression was quantified from peripheral blood lymphocytes using the Nanostring nCounter Analysis System. There was a significant negative correlation between the longest sedentary bout and BRCA1 mRNA expression (ρ = -0.32; P = 0.02). Women below the median for the longest sedentary bout had significantly higher BRCA1 mRNA levels compared with women above the median (161 vs. 132 counts; P = 0.04; one-sided Mann-Whitney U test). There was no significant relationship between mean metabolic equivalents of task rate or mean sedentary time and BRCA1 mRNA expression (Spearman correlation P ≥ 0.75; P ≥ 0.14; Mann-Whitney U test). These findings suggest that prolonged periods of sedentary behavior are associated with significantly lower BRCA1 mRNA expression. Whether this translates into a potentially more harmful effect in BRCA1 mutation carriers warrants further investigation.

Cardiorespiratory Fitness and Incident Diabetes: The FIT (Henry Ford ExercIse Testing) Project

Prior evidence has linked higher cardiorespiratory fitness with a lower risk of diabetes in ambulatory populations. Using a demographically diverse study sample, we examined the association of fitness with incident diabetes in 46,979 patients from The Henry Ford ExercIse Testing (FIT) Project without diabetes at baseline. Fitness was measured during a clinician-referred treadmill stress test performed between 1991 and 2009. Incident diabetes was defined as a new diagnosis of diabetes on three separate consecutive encounters derived from electronic medical records or administrative claims files. Analyses were performed with Cox proportional hazards models and were adjusted for diabetes risk factors. The mean age was 53 years with 48% women and 27% black patients. Mean metabolic equivalents (METs) achieved was 9.5 (SD 3.0). During a median follow-up period of 5.2 years (interquartile range 2.6-8.3 years), there were 6,851 new diabetes cases (14.6%). After adjustment, patients achieving ≥12 METs had a 54% lower risk of incident diabetes compared with patients achieving <6 METs (hazard ratio 0.46 [95% CI 0.41, 0.51]; P-trend < 0.001). This relationship was preserved across strata of age, sex, race, obesity, hypertension, and hyperlipidemia. These data demonstrate that higher fitness is associated with a lower risk of incident diabetes regardless of demographic characteristics and baseline risk factors. Future studies should examine the association between change in fitness over time and incident diabetes.

Relation of Resting Heart Rate to Risk for All-Cause Mortality by Gender After considering Exercise Capacity (the Henry Ford Exercise Testing Project)

Whether resting heart rate (RHR) predicts mortality independent of fitness is not well established, particularly among women. We analyzed data from 56,634 subjects (49% women) without known coronary artery disease or atrial fibrillation who underwent a clinically indicated exercise stress test. Baseline RHR was divided into 5 groups with <60 beats/min as reference. The Social Security Death Index was used to ascertain vital status. Cox hazard models were performed to determine the association of RHR with all-cause mortality, major adverse cardiovascular events, myocardial infarction, or revascularization after sequential adjustment for demographics, cardiovascular disease risk factors, medications, and fitness (metabolic equivalents). The mean age was 53 ± 12 years and mean RHR was 73 ± 12 beats/min. More than half of the participants were referred for chest pain; 81% completed an adequate stress test and mean metabolic equivalents achieved was 9.2 ± 3. There were 6,255 deaths over 11.0-year mean follow-up. There was an increased risk of all-cause mortality with increasing RHR (p trend <0.001). Compared with the lowest RHR group, participants with an RHR ≥90 beats/min had a significantly increased risk of mortality even after adjustment for fitness (hazard ratio 1.22, 95% confidence interval 1.10 to 1.35). This relationship remained significant for men, but not significant for women after adjustment for fitness (p interaction <0.001). No significant associations were seen for men or women with major adverse cardiovascular events, myocardial infarction, or revascularization after accounting for fitness. In conclusion, after adjustment for fitness, elevated RHR was an independent risk factor for all-cause mortality in men but not women, suggesting gender differences in the utility of RHR for risk stratification.

Standardizing the Analysis of Physical Activity in Patients With COPD Following a Pulmonary Rehabilitation Program

BACKGROUND:There is a wide variability in measurement methodology of physical activity. This study investigated the effect of different analysis techniques on the statistical power of physical activity outcomes after pulmonary rehabilitation.METHODS:Physical activity was measured with an activity monitor armband in 57 patients with COPD (mean ± SD age, 66 ± 7 years; FEV1, 46 ± 17% predicted) before and after 3 months of pulmonary rehabilitation. The choice of the outcome (daily number of steps [STEPS], time spent in at least moderate physical activity [TMA], mean metabolic equivalents of task level [METS], and activity time [ACT]), impact of weekends, number of days of assessment, postprocessing techniques, and influence of duration of daylight time (DT) on the sample size to achieve a power of 0.8 were investigated.RESULTS:The STEPS and ACT (1.6-2.3 metabolic equivalents of task) were the most sensitive outcomes. Excluding weekends decreased the sample size for STEPS (83 vs 56), TMA (160 vs 148), and METS (251 vs 207). Using 4 weekdays (STEPS and TMA) or 5 weekdays (METS) rendered the lowest sample size. Excluding days with < 8 h wearing time reduced the sample size for STEPS (56 vs 51). Differences in DT were an important confounder.CONCLUSIONS:Changes in physical activity following pulmonary rehabilitation are best measured for 4 weekdays, including only days with at least 8 h of wearing time (during waking hours) and considering the difference in DT as a covariate in the analysis.TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT00948623; URL: www.clinicaltrials.gov

235 The CF couch potato! Habitual physical activity in an adult CF population

Background: Physical activity has been shown as beneficial to CF. Patients health and quality of life are positively affected by physical training (Wilkes 2009). Increased habitual physical activity (HPA) has been shown to reduce the speed of lung function decline. Physical inactivity significantly contributes to exercise intolerance and skeletal muscle weakness in CF (Troosters 2009). Objectives: To compare the HPA of stable adult outpatient CF patients with recognised ranges in other chronic diseases. Method: 10 patients wore the Sensewear® electronic activity monitors. Demographic and anthropometric data were collected. Results: 10 patients (8 male) participated with mean (SD) age, FEV1%, BMI and FFMI of 28.3 years (8.1), 54.2% (19.8), 22.1 kg/m2 (2.0) and 17.9 kg/m2 (1.8) respectively. Patients wore the Sensewear® for a mean (SD) 6.5 days (4.4) and the mean (SD) percentage time on body was 91.6% (8.9). Their mean (SD) shuttle-walk test was 491.4m (202.4). Their mean (SD) Metabolic Equivalents (METS) activity during the monitored period was 1.7 (0.18) with patients spending a mean (SD) time of 200 minutes (71) engaged in activity greater than 3 METS. The mean (SD) number of steps taken per day was 4552 (2475). Conclusion: The mean METS per day equates to very low activity levels such as knitting with patients only spending around 3 hours doing activities equating to light activity such as playing pool which is considered inadequate for cardiovascular conditioning (Jette 1990). The average steps per day are below those considered normal for people living with chronic disability/disease (range 7000–9000) (TudorLocke 2011).

Energy Expenditure in Brass and Woodwind Instrumentalists: The Effect of Body Posture

Body posture appears to influence fatigue and musculoskeletal complaints in musicians. Our aim was to determine energy expenditure and to investigate whether energy expenditure is affected by body posture in brass and woodwind instrumentalists. Eighteen musicians (10 women, 8 men; 6 brass, 12 woodwinds), with a mean age of 39 ± 14 years and mean body mass index of 23.8 ± 4.9 kg/m², played their instruments for 30 minutes twice: once in nonoptimized body posture (posture A), and once in a posture according to the postural exercise therapy method Mensendieck (posture B). Patients were randomized to the order of postures in a crossover design AB/BA. Playing sessions were preceded and followed by 60 minutes of rest. Energy expenditure was measured in a respiration chamber with indirect calorimetry. Basal metabolic rate was measured with a ventilated hood. Mean metabolic equivalents (MET) for playing a wind instrument in the sitting position in a nonoptimized posture and posture according postural exercise therapy were 1.69 (SD 0.18) and 1.80 (SD 0.22), respectively. Percent change between resting metabolic rate and total energy expenditure while playing was 32% (95% CI 25-39%) in posture B and 23% (95% CI 17-30%) in posture A (p = 0.021). Average physical activity while playing a wind instrument approximates 1.8 MET. Our data show an association between energy expenditure and body posture while playing a brass or woodwind instrument: playing a musical instrument in a posture according to postural exercise therapy leads to higher energy expenditure as compared to a nonoptimized body posture. These results suggest that fatigue and the general feeling of lack of energy after playing a musical instrument are not related to actual higher energy expenditure.

The Physiological Cost and Enjoyment of Wii Fit in Adolescents, Young Adults, and Older Adults

Active video games (exergames) increase energy expenditure (EE) and physical activity (PA) compared with sedentary video gaming. The physiological cost and enjoyment of exergaming in adolescents, and young and older adults has not been documented, nor compared with aerobic exercise. This study compared the physiological cost and enjoyment of exergaming on Wii Fit with aerobic exercise in 3 populations. Cardiorespiratory and enjoyment measurements were compared in 14 adolescents, 15 young adults, and 13 older adults during handheld inactive video gaming, Wii Fit activities (yoga, muscle conditioning, balance, aerobics), and brisk treadmill walking and jogging. For all groups EE and heart rate (HR) of Wii Fit activities were greater than handheld gaming (P < .001) but lower than treadmill exercise (P <or= .001). Wii aerobics elicited moderate intensity activity in adolescents, young adults, and older adults with respective mean (SD) metabolic equivalents of 3.2 (0.7), 3.6 (0.8), and 3.2 (0.8). HR during Wii aerobics fell below the recommended intensity for maintaining cardiorespiratory fitness. Group enjoyment rating was greater for Wii balance and aerobics compared with treadmill walking and jogging (P <or= .05). Wii Fit appears an enjoyable exergame for adolescents and adults, stimulating light-to-moderate intensity activity through the modification of typically sedentary leisure behavior.

Folate and Vitamin B6 Intake and Risk of Colon Cancer in Relation to p53 Expression

Considerable evidence suggests that a low-folate diet increases the risk of colorectal cancer, although the results of a recent randomized trial indicate that folate supplementation may not reduce the risk of adenoma recurrence. In laboratory models, folate deficiency appears to induce p53 mutation. We immunohistochemically assayed p53 expression in paraffin-fixed colon cancer specimens in a large prospective cohort of women with 22 years of follow-up to examine the relationship of folate intake and intake of other one-carbon nutrients to risks by tumor p53 expression. A total of 399 incident colon cancers accessible for p53 expression were available. The effect of folate differed significantly according to p53 expression (P(heterogeneity) = .01). Compared with women reporting folate intake <200 microg/day, the multivariate relative risks (RRs) for p53-overexpressing (mutated) cancers were 0.54 (95% confidence interval [CI], 0.36-0.81) for women who consumed 200-299 microg/day, 0.42 (95% CI, 0.24-0.76) for women who consumed 300-399 microg/day, and 0.54 (95% CI, 0.35-0.83) for women who consumed >or=400 microg/day. In contrast, total folate intake had no influence on wild-type tumors (RR, 1.05; 95% CI, 0.73-1.51; comparing >or=400 with <200 microg/day). Similarly, high vitamin B(6) intake conferred a protective effect on p53-overexpressing cancers (top versus bottom quintile: RR, 0.57; 95% CI, 0.35-0.94; P(heterogeneity) = .01) but had no effect on p53 wild-type tumors. We found that low folate and vitamin B(6) intake was associated with an increased risk of p53-overexpressing colon cancers but not wild-type tumors.

Preoperative Exercise Echocardiography and Perioperative Cardiovascular Outcomes in Elderly Patients Undergoing Cancer Surgery

Limited information is available on the value of exercise echocardiography (EE) for identifying operative risk in elderly patients undergoing noncardiac surgery. The authors investigated the outcome in 221 consecutive patients 75 years and older who had EE before intermediate- or high-risk cancer surgery. Baseline clinical data, postoperative adverse cardiovascular events (PACE), and 30-day mortality were collected from the medical records and the Social Security Death Index. The mean age +/- SD of the group was 78.9+/-3.5 years; 57% were men. Significant cardiovascular abnormalities (by echocardiography) were present in 71.5%. Mean metabolic equivalents +/- SD achieved during exercise was 4.9+/-1.9. EE identified 50 (22.6%) patients with ischemia and/or infarction. Perioperative beta-blockers were used in 80% of patients with coronary artery disease vs 48.5% without coronary artery disease (P<.0001). There were 31 PACE in 26 (11.8%) patients. Atrial fibrillation was the most common PACE, seen in 18 (8.1%) patients, followed by congestive heart failure in 8 (3.6%), acute coronary syndrome in 2 (0.9%), and cardiac arrest in 1 (0.5%). Thirty-day mortality was only 0.9%. Hospital lengths of stay for patients with and without PACE were 16.8+/-14.9 and 8.5+/-4.8 days (P< or =.0001), respectively. An abnormal EE predicted PACE (22% vs 8.8%; P< .025). Perioperative beta-blockers reduced the incidence of postoperative atrial fibrillation (4.9% vs 12.2%; P=.052). In conclusion, EE is feasible in very elderly patients. There is a high prevalence of cardiac abnormalities in the elderly. An abnormal EE predicts PACE, which, in turn, is associated with increased length of stay.