Published Cut Points Research Articles

Self-Reported Frailty Concerns in Older Breast Cancer Survivors During the COVID-19 Pandemic

Frailty among older adults is common, especially those who have undergone breast cancer treatment; however, we do not know how frailty among this group presented during the COVID-19 pandemic. The purpose of this descriptive, cross-sectional study was to examine self-reported frailty among older breast cancer survivors (BCS) during the pandemic. This IRB-approved study recruited BCS who were at least 1-year post-treatment and 60 years of age or older, via online advertisements (e.g., Dr. Susan Love Foundation). BCS completed demographic and Tilburg Frailty Indicator (TFI) RedCap questionnaires from 11/2020 to 05/2021. The TFI, is a 15-item measure with 3 sub-scales with published cut points indicating frailty: total (5), physical (3), psychological (2), and social (2). Descriptive statistics were used. Older BCS (n=203) who were on average 65.5 (SD=4.7) years of age, white (93.6%; n=190) and had stage II breast cancer at diagnosis (39.9%; n=81) participated. The average total (M=5.4, SD=2.5) and physical (M=3.2, SD=1.5) frailty scores were above the threshold for frailty. Overall, 58.6% (n=119) and 63.1% (n=128) scored at or above the threshold on the total and physical sub-scales, respectively. In addition,78.8% (n=160) responded that they ‘missed having people around’ on the social frailty sub-scale. Research has shown that higher TFI scores (more frailty) are associated with increased healthcare utilization, poorer quality of life, and even mortality. Thus, frailty among older BCS is an important health concern within the context of the pandemic. Further research is needed to understand the lasting effects of self-reported frailty for BCS including COVID-19 survivors.

Effects Of Exercise Desks On Activity And Reading Skills In Youth With Neurodevelopmental Disorders

Physical activity improves cognitive function and academic achievement, although many youth remain sedentary during school. Exercise desks may be advantageous to improving physical activity as it does not require any teacher education and does not jeopardize time spent on academic instruction. PURPOSE: The purpose of this study was to determine the effect of exercise desks on levels of physical activity and classroom performance in 4th and 7th grade students with neurodevelopmental disorders. METHODS: Thirty-five children (N=13 4th grade; N= 21 7th grade) were monitored with an Actigraph accelerometer (wGT3X-BT) worn on the non-dominant wrist during school hours. Derived variables were time (minutes) in sedentary, light, and moderate intensity using published cut points. Using a repeated measures cross over design, students attended school in two different environments for 8 weeks each: traditional school with chairs and desks and a classroom designed with exercise desks composed of pedaling, a stand and spin, and accordion chairs. Students reading skills were assessed using two curriculum-based measurements: Maze Reading Comprehension and Oral Reading Fluency. RESULTS: Weight significantly correlated with time spent in sedentary (r = .43; p<0.001), light (r = .37; p<0.001) and moderate (r = -.46; p<0.001) activity. There was a significant main effect of the activity desks on decreasing sedentary activities with a proportional increase in moderate activity once controlling for weight. A main effect for grade showed that 4th graders participated in significantly less sedentary activity and greater moderate activity compared with 7th graders. Compared to the traditional classroom, the kinesthetic classroom significantly increased reading skills in both grades although there was a trend for a slightly greater increase in 7th graders. CONCLUSIONS: Exercise desks improved reading skills and decreased time spent in sedentary activities in youth with neurodevelopmental disorders. The greater decline in sedentary activity and concomitant increase in physical activity among fourth graders may suggest that older youth are less inclined to use the exercise desks.

IGF-1 and IL-6 as predictors of sarcopenia in non-metastatic colorectal cancer patients.

e15150 Background: Insulin growth factor-1 (IGF1) and inflammatory biomarkers such as interleukin-6 (IL6) play a role in early carcinogenesis, predict prognosis and response to some therapies in colorectal cancer (CRC), and are altered in patients with sarcopenia. This study examines the association of IGF-1 and IL-6 with sarcopenia in patients with CRC. Methods: Fasting blood samples were collected at diagnosis of non-metastatic CRC (N = 59) and analyzed for serum IGF-1 and IL-6 by ELISA. Skeletal Muscle Index (SMI) was calculated from cross-sectional image at L3 from computed tomography. Sarcopenia was defined based on published cut points for adults with cancer stratified by body mass index (BMI) as: SMI &lt; 43 cm2/m2 for men and &lt; 41 cm2/m2 for women for normal and underweight; and SMI &lt; 53 cm2/m2 for men and &lt; 41 cm2/m2 for women for overweight and obese. Median and interquartile range (IQR) were reported for patients with sarcopenia versus those without sarcopenia. Spearman and logistic regression were used to examine associations between sarcopenia and serum biomarkers. Results: Median (IQR) age was 62 (49-85). Overall prevalence of sarcopenia was 44% (26/59). The prevalence of sarcopenia was 3% for males (2/59) and 5% for females (3/59) with a BMI &lt; 25 and 27% for males (16/59) and 8% for females (5/59) with a BMI≥25. Median and (IQR) for serum biomarkers in patients with CRC and sarcopenia versus those without sarcopenia were: IGF-1 43 (16) vs. 58.7(27.9) ng/mL (p = 0.007). Correlation between IGF-1 and sarcopenia was (r = -0.4, p = 0.004), but was not statistically significant for IL-6 (r = 0.02, p = 0.88). Both IGF-1 (OR = 0.82, 95% CI 0.69-0.98, p = 0.03) and IL-6 (OR = 0.83, 95% CI 0.70-0.98, p = 0.002) were significant predictors of sarcopenia after adjusting for race and BMI. Conclusions: In this sample of patients with CRC, IGF-1 and IL-6 levels were both lower in patients with sarcopenia compared to those without sarcopenia and levels of both markers predicted the presence sarcopenia.

Impact of Software Selection and ImageJ Tutorial Corrigendum on Skeletal Muscle Measures at the Third Lumbar Vertebra on Computed Tomography Scans in Clinical Populations

There is growing interest in computed tomography (CT) measures of skeletal muscle cross-sectional area (CSA) for nutrition assessment. Multiple software programs are available, but little work has been done comparing programs. We aimed to determine if CT-derived measures of skeletal muscle CSA at the level of the L3 are influenced by the software program used. We also demonstrate the importance of the ImageJ corrigendum published in this journal. Two software programs, National Institutes of Health ImageJ and Tomovision sliceOmatic, were compared. ImageJ measures were obtained using both the original tutorial and corrigendum instructions. Skeletal muscle CSA at the level of the L3 was measured in advanced heart failure and head and neck cancer populations by 3 different investigators. Intraclass correlation coefficients were used to calculate intrarater and interrater reliability. Bland-Altman analysis was used to assess agreement. Both software programs yielded excellent intrarater and interrater reliability scores (intraclass correlation coefficients, 0.985-1.000). The overall mean difference (ImageJ tutorial with corrigendum - sliceOmatic) for the entire sample (N = 51) was found to be 1.53 cm2 (95% CI, 0.59-2.47 cm2 ). The overall mean difference (ImageJ corrected - original) for the entire sample (N = 51) was found to be -11.35 cm2 (95% CI, -12.75 to -9.95 cm2 ). Measures of skeletal muscle CSA at the L3 were found to be ∼1.53 cm2 higher with ImageJ than sliceOmatic. This difference was not found to affect interpretation against a published cut point. The importance of accounting for the ImageJ tutorial corrigendum was shown to be clinically significant when applied to published cut points.

Prevalence of sarcopenia and predictors of body composition among women with early-stage breast cancer.

160 Background: Body mass index (BMI) does not accurately reflect body composition, particularly among cancer survivors. Sarcopenia (low skeletal muscle mass) and low muscle radio-density (MD; suggesting fat infiltration into muscle, compromising function) increase risk of surgical complications and chemotherapy toxicity and are associated with worse survival in advanced cancer. Little is known about the prevalence or predictors of sarcopenia and low MD in early-stage breast cancer. Methods: We studied 2,914 Kaiser Permanente members diagnosed with Stage I-III breast cancer from 2005-2013. Using computed tomography (CT) scans of the third lumbar vertebra from clinical care, we determined sarcopenia (skeletal muscle index &lt; 41 muscle [cm2]/height [m2]) and low MD ( &lt; 25-Hounsfield Units for non-obese; &lt; 33 for obese) using published cut points. We assessed associations with characteristics including age, race, BMI, age, stage, lifestyle and co-morbidities with logistic regression. We also examined moderate/vigorous physical activity among a subset of 672 women with activity questionnaires. Results: At diagnosis, mean age was 56 years and time to CT was 1 month. Both sarcopenia and low MD were common among early-stage breast cancer survivors (40% and 38% respectively). In multivariate analyses, the odds of sarcopenia and low MD increased with age (per 5 years, Odds Ratio [OR] 95% Confidence Interval [CI] of OR = 1.33; 95%CI: 1.27, 1.39 and OR = 1.41; 95%CI: 1.35, 1.47 respectively). The odds of sarcopenia decreased with greater BMI (OR = 0.80; 95%CI: 0.78, 0.82 per kg/m2), while the odds of low MD increased (OR = 1.03; 95%CI: 1.01, 1.04 per kg/m2). Black race was associated with lower odds of sarcopenia and low MD, while physical activity levels were associated with lower odds of sarcopenia and more favorable MD. Conclusions: Sarcopenia and low MD are highly prevalent among breast cancer survivors. While older age is strongly associated with these conditions, they occur across ages and stages. Differences in body composition by race and age may underlie differences in the association of BMI with cancer outcomes; understanding these may help guide clinical interventions.

Validating a Pragmatic Approach to Cognitive Screening in Stroke Prevention Clinics Using the Montreal Cognitive Assessment.

The Montreal Cognitive Assessment (MoCA) is used commonly to identify cognitive impairment (CI), but there are multiple published cut points for normal and abnormal. We seek to validate a pragmatic approach to screening for moderate-severe CI, by classifying patients into high-, intermediate-, and low-risk categories. A total of 390 participants attending an academic Stroke Prevention Clinic completed the MoCA and more detailed neuropsychological testing. Between April 23, 2012 and April 30, 2014, all consecutive new referrals to the regional Stroke Prevention Clinic who were English-speaking, not severely aphasic, and could see and write well enough to complete neuropsychological testing were assessed for inclusion, and consenting patients were enrolled. CI was defined as ≥2 SDs below normal for age and education on at least 2 cognitive subtests. A single cut point for CI was compared with 2 cut points (high sensitivity and high specificity) generated using receiver operator characteristic and area under the curve analyses. The intermediate-risk group contained those scoring between the 2 cut points. Thirty-four percent of participants had a symptomatic or silent stroke, 34% were seen for possible or probable transient ischemic attack, and 32% were diagnosed with other vascular or nonvascular conditions. Using a single cut point, sensitivity and specificity were optimal with MoCA ≤22, (sensitivity=60.4%, specificity=89.9%, area under the curve=0.801, positive predictive value=48.5%, negative predictive value=93.5%, positive likelihood ratio=6, and negative likelihood ratio=0.4). Using 2 cut points, sensitivity was optimal with MoCA ≥28 (sensitivity=96.2%, negative predictive value =97.6%, and negative likelihood ratio=1.27), and specificity was optimal with MoCA ≤22 (specificity=89.9%, positive predictive value=48.5%, and positive likelihood ratio=6). Stratifying participants into 3 categories facilitates the identification of a homogenous group at low risk for CI, as well as 2 other groups with intermediate and higher risk. This approach could facilitate clinical care pathways and patient selection for research.

Abstract 11405: The Association of Co-Morbid Symptoms of Depression and Anxiety With All-Cause Mortality in Patients With Heart Failure

Introduction: Depression or anxiety are associated with survival in heart failure (HF); however, whether co-morbid symptoms of anxiety and depression are associated with survival in patients with HF is unknown. Hypothesis: Co-morbid symptoms of depression and anxiety are more strongly associated with all-cause mortality in patients with HF compared to those with anxiety or depression alone. Methods: A total of 1,260 HF patients participated and were followed for mortality outcomes for 12 months. The Patient Health Questionnaire (PHQ-9) and Brief Symptom Inventory-anxiety subscale (BSI) were used to measure symptoms of depression and anxiety. Cox regression analysis was used to determine whether co-morbid symptoms of depression and anxiety independently predicted all-cause mortality controlling for age,gender, ethnicity, and NYHA class. Depression and anxiety were treated first as continuous level variables, then as categorical variables using standard published cut points. Patients were divided into four groups based on the presence of anxiety and depression symptoms: 1) neither anxiety nor depression, 2) depression alone, 3) anxiety alone, and 4) co-morbid depression and anxiety Results: When entered as continuous variables, the interaction between anxiety and depression (HR 1.02; 95% CI: 1.01-1.03; p = 0.002) was a significant predictor of all-cause mortality. When entered as a categorical variable, co-morbid symptoms of depression and anxiety (versus the other three groups) independently predicted all-cause mortality (HR 2.59; 95% CI: 1.49-4.49; p = 0.001). Conclusions: To improve mortality outcomes in patient with HF, attention must be paid by healthcare providers to the assessment and management of co-morbid symptoms of depression and anxiety.

Ability of RT3 accelerometer cut points to detect physical activity intensity in ambulatory children with cerebral palsy.

This study investigated the ability of published cut points for the RT3 accelerometer to differentiate between levels of physical activity intensity in children with cerebral palsy (CP). Oxygen consumption (metabolic equivalents; METs) and RT3 data (counts/min) were measured during rest and 5 walking trials. METs and corresponding counts/min were classified as sedentary, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) according to MET thresholds. Counts were also classified according to published cut points. A published cut point exhibited an excellent ability to classify sedentary activity (sensitivity=89.5%, specificity=100.0%). Classification accuracy decreased when published cut points were used to classify LPA (sensitivity=88.9%, specificity=79.6%) and MVPA (sensitivity=70%, specificity=95-97%). Derivation of a new cut point improved classification of both LPA and MVPA. Applying published cut points to RT3 accelerometer data collected in children with CP may result in misclassification of LPA and MVPA.

The Association of Co-morbid Symptoms of Depression and Anxiety With All-Cause Mortality and Cardiac Rehospitalization in Patients With Heart Failure

Patients with heart failure (HF) experience multiple psychologic symptoms. Depression and anxiety are independently associated with survival. Whether co-morbid symptoms of anxiety and depression are associated with outcomes in patients with HF is unknown. To determine whether co-morbid symptoms of depression and anxiety are associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF. A total of 1260 patients with HF participated in this study. Cox regression analysis was used to determine whether co-morbid symptoms of depression and anxiety independently predicted all-cause mortality and cardiac rehospitalization. Anxiety and depression were treated first as continuous-level variables, then as categorical variables using standard published cut points. Patients were then divided into 4 groups based on the presence of anxiety and depression symptoms. When entered as a continuous variable, the interaction between anxiety and depression (hazard ratio = 1.02; 95% CI: 1.01-1.03; p = 0.002) was a significant predictor of all-cause mortality in patients with HF. When entered as a categorical variable, co-morbid symptoms of depression and anxiety (vs no symptoms or symptoms of anxiety or depression alone) independently predicted all-cause mortality (hazard ratio = 2.59; 95% CI: 1.49-4.49; p = 0.001). None of the psychologic variables was a predictor of cardiac rehospitalization in patients with HF whether using the continuous or categorical level of measurement. To improve mortality outcomes in patients with HF, attention must be paid by health care providers to the assessment and management of co-morbid symptoms of depression and anxiety.

Multilaboratory assessment of threshold versus fold-change algorithms for minimizing analytical variability in multiplexed pneumococcal IgG measurements.

Pneumococcal vaccination is frequently used to assess a patient's humoral immune function. The comparison of pre- and postvaccination levels of antipneumococcal antibodies is widely held to be the gold standard for documenting a response. However, many of the published criteria for defining an adequate response are based on assays that are no longer widely available. We compared the clinical classification of patient response by multiplex pneumococcal assays currently performed at three large reference laboratories using a variety of published criteria for defining responses in adults. The classification of responders agreed for 79% of the patients when using a threshold-based algorithm compared to 57 to 96% of the patients when using various fold-change-based algorithms. The highest rate of discordance was seen when the most stringent criteria for response were used (4-fold increase postvaccination in 70% of serotypes). The discordant samples tended to show similar patterns of response across all three assays, with small variations in the final number of serotypes converting postvaccination. We conclude that the use of published cut points for documenting response to pneumococcal vaccination can be affected by interlaboratory differences in pneumococcal assays, particularly for algorithms that require large fold changes for a response to be documented. However, the overall patterns of response were similar in virtually all samples, regardless of the assay used.

Relationship among salivary androstenedione, body composition and physical activity in young girls

High androgenic activity in young girls may be associated with adiposity and the development of metabolic disturbances. This study examined the relationship between salivary androstenedione, body composition and physical activity (PA) levels in young girls. Twenty-three prepubescent girls (8.4±0.9 years), 9 normal and 14 overweight, according to Centres for Disease Control and Prevention body mass index (BMI) percentile ranking, wore an ActiGraph accelerometer for 5 days. Skinfolds were measured for per cent body fat and fat free mass calculation. Saliva samples were collected three times at home over 1 day (waking, 30-min postwaking and evening). Previously published cut points estimated the minutes of moderate, moderate-to-vigorous (MVPA), vigorous and very vigorous PA. Meeting PA recommendations was defined as accumulating 60 min/day of MVPA. t Tests, correlation and regression analysis examined relationships between the variables. Only 35% of the girls met current PA recommendations. Evening androstenedione levels were significantly higher among girls who did not meet the PA recommendations. Evening androstenedione levels were negatively related to time spent performing very vigorous PA and positively related to the per cent change in androstenedione from waking to evening. There were no correlations between androstenedione and BMI or per cent body fat. Salivary androstenedione is related to PA, but not either BMI or per cent body fat in young girls. This suggests an important role for PA in determining androgenic activity independently from the proposed mechanism linking adiposity with elevated androgenic activity.

Left ventricular mass, abdominal circumference and age: the Fels longitudinal study.

To determine the relationship of abdominal circumference with increased left ventricular mass (LVM) from young adulthood into old age. Cross-sectional echocardiographic images were taken from 182 men and 220 women in the Fels Longitudinal Study 20 to 75 years of age to determine left ventricular mass. Left ventricular mass was divided by stature raised to the power of 2.7 (LVM/ht2.7) in order to minimize the impact of heart size variation from body size without overcompensating for the adverse effect of obesity. Abdominal circumference was measured and BMI calculated from stature and weight and categories of overweight, obesity and abdominal obesity were determined using published cut points. Regression models were used to describe the relationships of age, abdominal circumference, BMI and self-reported physical activity to LVM/ht2.7. Age, abdominal circumference and BMI were each positively and significantly related to an increased LVM/ht2.7 in men and women (p < 0.05). In the men, multivariate models indicated that abdominal circumference and BMI were both significantly related to an increased LVM/ht2.7, but the inclusion of BMI in these models for the women reduced the association of abdominal circumference and physical activity below significant levels. In the men, there was also a quadratic association of abdominal circumference with LVM/ht2.7 that was significant along with BMI and physical activity. Sex-specific logistic regressions with BMI and abdominal circumference obesity categories did not change or improve the initial findings in men or women. In women, increases in abdominal fatness as reflected in abdominal circumference at any age are linearly related to an increase in LVM/ht2.7, but the relationship of overall fatness as reflected in BMI with LVM/ht2.7 is stronger. In men, both abdominal fatness and overall fatness at any age are linearly related to an increase LVM/ht2.7. However, the significant curvilinear association of abdominal circumference and a linear association of BMI and physical activity with LVM/ht2.7 indicate the possible positive covariate relationship of overall muscle mass with LVM/ht2.7. This reflects the physiological changes with age and demonstrate, in part, the complexity of the interpretations of the inter associations of body composition, the cardiovascular system and the aging process, but the impact among the elderly and the known inadequacy of BMI at these ages remains an area for continued clinical study.

Left ventricular mass, abdominal circumference and age: The Fels longitudinal study

To determine the relationship of abdominal circumference with increased left ventricular mass (LVM) from young adulthood into old age. Cross-sectional echocardiographic images were taken from 182 men and 220 women in the Fels Longitudinal Study 20 to 75 years of age to determine left ventricular mass. Left ventricular mass was divided by stature raised to the power of 2.7 (LVM/ht2.7) in order to minimize the impact of heart size variation from body size without overcompensating for the adverse effect of obesity. Abdominal circumference was measured and BMI calculated from stature and weight and categories of overweight, obesity and abdominal obesity were determined using published cut points. Regression models were used to describe the relationships of age, abdominal circumference, BMI and self-reported physical activity to LVM/ht2.7. Age, abdominal circumference and BMI were each positively and significantly related to an increased LVM/ht2.7 in men and women (p < 0.05). In the men, multivariate models indicated that abdominal circumference and BMI were both significantly related to an increased LVM/ht2.7, but the inclusion of BMI in these models for the women reduced the association of abdominal circumference and physical activity below significant levels. In the men, there was also a quadratic association of abdominal circumference with LVM/ht2.7 that was significant along with BMI and physical activity. Sex-specific logistic regressions with BMI and abdominal circumference obesity categories did not change or improve the initial findings in men or women. In women, increases in abdominal fatness as reflected in abdominal circumference at any age are linearly related to an increase in LVM/ht2.7, but the relationship of overall fatness as reflected in BMI with LVM/ht2.7 is stronger. In men, both abdominal fatness and overall fatness at any age are linearly related to an increase LVM/ht2.7. However, the significant curvilinear association of abdominal circumference and a linear association of BMI and physical activity with LVM/ht2.7 indicate the possible positive covariate relationship of overall muscle mass with LVM/ht2.7. This reflects the physiological changes with age and demonstrate, in part, the complexity of the interpretations of the inter associations of body composition, the cardiovascular system and the aging process, but the impact among the elderly and the known inadequacy of BMI at these ages remains an area for continued clinical study.

Actigraph Accelerometer Interinstrument Reliability during Free-Living in Adults

The Actigraph (AG; model 7164 v. 2.2) accelerometer is widely accepted as a valid means of physical activity (PA) assessment. However, no studies have investigated interinstrument reliability for data collection in a free-living condition. To determine agreement (on raw outputs and derived variables) between AG accelerometers worn concurrently on the right hip (RH) and left hip (LH) during 24 h of free-living. Ten distinct pairings of AG were evaluated on 10 participants (four males, six females; age=30.1+/-3.8 yr). AG were worn during waking hours (other than water activities). Raw outputs were activity counts and steps. Derived variables were time (minutes) in sedentary, light, moderate, vigorous, and MVPA (moderate+vigorous) intensity using published cut points. Intraclass correlations (ICC), absolute percent error (APE), coefficient of variation (CV), and paired t-tests were evaluated between accelerometers. Raw variables of total activity counts and steps, and derived variables of time in sedentary, light, vigorous, and MVPA intensity displayed high interinstrument reliability. The ICC, APE, and CV values for moderate intensity were 0.98, 18.8%, and 13.5% and, for MVPA, 0.99, 3.7%, and 4.9%, respectively. Only MVPA displayed a statistically significant mean difference (2 min) between RH versus LH AG, but the effect size was small (ES=0.07). Results display evidence of decreased interinstrument reliability of moderate-intensity time assessed during free-living. If separate moderate and vigorous categories are not necessary for specific research questions, MVPA may be the optimal intensity range to report, at least in terms of interinstrument reliability.

Validation of the Kaiser Physical Activity Survey in Pregnant Women

Participation in physical activity during pregnancy may reduce the risk of maternal and fetal disorders. However, few studies have validated physical activity questionnaires for use during pregnancy, a time characterized by different patterns of activity than nonpregnancy. Therefore, the aim of this study was to assess the validity and reliability of the Kaiser Physical Activity Survey (KPAS) for use during pregnancy. The KPAS, adapted from the Baecke physical activity survey, was designed specifically to assess physical activity in women. Unique features of the KPAS include the assessment of multiple domains of physical activity (household/caregiving, occupational, active living, and sports/exercise) as well as total activity. Summary KPAS indices were compared with objective (ActiGraph accelerometer by ActiGraph LLC) and subjective (Pregnancy Physical Activity Questionnaire (PPAQ)) measures of physical activity. Participants completed the self-administered PPAQ followed by the interviewer-administered KPAS and then wore the accelerometer for the following 7 d. At the end of the 7-d period, the questionnaires were repeated. Intraclass correlation coefficients used to measure reproducibility of the KPAS were r = 0.84 for total activity and ranged from r = 0.76 for active living activities to r = 0.86 for occupational activity. Spearman correlations between the KPAS and three published cut points used to classify accelerometer data ranged from r = 0.49-0.59 for total activity, r = 0.12-0.26 for household/caregiving, r = 0.26-0.33 for occupational activity, r = 0.31-0.36 for active living, and r = 0.34-0.51 for sports/exercise. Spearman correlations between the KPAS and the PPAQ ranged from r = 0.71 for household/caregiving to r = 0.84 for sports/exercise. The KPAS is a reliable and reasonably accurate instrument for estimating physical activity among pregnant women.

Development and Validation of a Pregnancy Physical Activity Questionnaire

The effect of physical activity during pregnancy on maternal and fetal health remains controversial and studies have yet to identify the optimal dose of physical activity associated with favorable pregnancy outcomes. The aim of this study was to develop and validate a pregnancy physical activity questionnaire (PPAQ). To ascertain the type, duration, and frequency of physical activities performed by pregnant women, three 24-h physical activity recalls were administered to 235 ethnically diverse prenatal care patients at a large tertiary care facility in western Massachusetts. The relative contribution of each activity to between-person variance in energy expenditure was used to establish the list of activities for the PPAQ. The PPAQ is self-administered and asks respondents to report the time spent participating in 32 activities including household/caregiving, occupational, sports/exercise, transportation, and inactivity. To validate the PPAQ, 54 pregnant women completed the PPAQ and then wore a Manufacturing Technology, Inc. actigraph for the following 7 d. At the end of the 7-d period, the PPAQ was repeated. Intraclass correlation coefficients used to measure reproducibility of the PPAQ were 0.78 for total activity, 0.82 for moderate activity, 0.81 for vigorous activity, and ranged from 0.83 for sports/exercise to 0.93 for occupational activity. Spearman correlations between the PPAQ and three published cut points used to classify actigraph data ranged from 0.08 to 0.43 for total activity, 0.25 to 0.34 for vigorous activity, 0.20 to 0.49 for moderate activity, and -0.08 to 0.22 for light-intensity activity. Correlations were higher for sports/exercise and occupational activities as compared to household/caregiving activities. household/caregiving activities. The PPAQ is a reliable instrument of physical activities during pregnancy.

Assessing heart rate variability from real-world Holter reports.

Real world clinical Holter reports are often difficult to interpret from a heart rate variability (HRV) perspective. In many cases HRV software is absent. Step-by-step HRV assessment from clinical Holter reports includes: making sure that there is enough usable data, assessing maximum and minimum heart rates, assessing circadian HRV from hourly average heart rates, and assessing HRV from the histogram of R-R intervals and from the plot of R-R intervals or heart rate vs. time. If HRV data are available, time domain HRV is easiest to understand and less sensitive to scanning errors. SDNN (the standard deviation of all N-N intervals in ms) and SDANN (the standard deviation of the 5-min average of N-N intervals in ms) are easily interpreted. SDNN < 70 ms post-MI is a cut point for increased mortality risk. Two times ln SDANN is a good surrogate for ln ultra low frequency power and can be compared with published cut points. SDNNIDX (the average of the standard deviations of N-N intervals for each 5-min in ms) < 30 ms is associated with increased risk in patients with congestive heart failure. RMSSD (the root mean square of successive N-N interval difference in ms) < 17.5 ms has also been associated with increased risk post-myocardial infarction. Frequency domain HRV values are often not comparable to published data. However, graphical power spectral plots can provide additional information about whether the HRV pattern is normal and can also identify some patients with obstructive sleep apnea.

Overweight, fat patterning, and cardiovascular disease risk factors in black and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study

Objective: To determine the association of overweight and central adiposity with cardiovascular disease risk factors in black and white 9- and 10-year-old girls. Design: Cross-sectional analysis of baseline data collected from participants in the National Heart, Lung, and Blood Institute Growth and Health Study. Girls were classified as overweight or not with the use of the age- and sex-specific 85th percentiles of the body mass index (kilograms per square meter) distributions from the combined NHANES (I and II) data set. Mean indexes of central adiposity, blood pressure levels, and lipid concentrations and the clustering of risk factors based on published cut points were compared between weight groups by race and by central adiposity group within weight and race groups. Results: Overweight was associated with increased risk factor levels and with increased clustering in both black and white girls. Among overweight girls greater central adiposity was associated with higher risk factor levels and increased clustering. Conclusions: Given the associations between cardiovascular disease risk factors and both overweight and central adiposity, the secular trends toward increased obesity in American youth portend a worsening of cardiovascular disease risk profiles. (J Pediatr 1999;135:458-64)