Physical activity and weight maintenance: the utility of wearable devices and mobile health technology in research and clinical settings

PURPOSE OF REVIEW

The integration of wearable devices and mobile health (mHealth) technology to facilitate behavior change has the potential to transform the efficacy of interventions and implementation programs for weight maintenance. The purpose of this review was to provide a comprehensive analysis of the overall utility of wearable devices for assessing and promoting weight maintenance in research and clinical settings.

RECENT FINDINGS

Recent intervention trials using wearable devices have been successful in increasing physical activity and decreasing or maintaining body weight, but complex study designs involving multiple behavioral strategies make it difficult to assess whether wearable devices can independently influence weight status. The daily feedback that wearable devices and mHealth technology provide may assist in motivating higher levels of physical activity achievement. However, the integration of wearable devices into the healthcare setting and implementation of mHealth programs still need to be tested.

SUMMARY

Recent studies add concrete implications for providers and researchers to better assess and promote physical activity in healthcare settings by identifying how wearable devices can be advantageous for physical activity and health promotion.

Using Google Trends to assess global public interest in osteoarthritis

To evaluate global public interest in osteoarthritis by assessing changes in Internet search popularity of the disease over a 10-year period. Google Trends was used to obtain search popularity scores for the word "osteoarthritis" (OA) between January 2004 and June 2018. We also analyzed changes in search volume relative to changes in search patterns for all health topics. Search interest in OA was high relative to all other health searches over the given timeframe. Overall, searches for OA steadily decreased between May 2004 and December 2012 and then steadily rose from January 2013 to April 2018. We also found consistent annual fluctuations over the pre-specified time range, with biannual peaks typically correlating with national and global awareness days. Biannual dips occurred with changes in seasonal patterns. Google searches for OA have steadily increased in recent years. Awareness initiatives, like World Arthritis Day, may be a reason for the public to search for information on OA. It may be helpful for physicians to search the Internet themselves for websites that provide accurate and high-quality information to recommend to their patients.

Physical activity promotion for patients transitioning to dialysis using the "Exercise is Medicine" framework: a multi-center randomized pragmatic trial (EIM-CKD trial) protocol

BACKGROUND

Patients on dialysis are physically inactive, with most reporting activity levels below the fifth percentile of healthy age-matched groups. Several small studies have reported efficacy of diverse exercise interventions among persons with CKD and those on dialysis. However, no single intervention has been widely adopted in real-world practice, despite a clear need in this vulnerable population with high rates of mortality, frailty, and skilled nursing hospitalizations.

METHODS/DESIGN

We describe a pragmatic clinical trial for an exercise intervention among patients transitioning to dialysis. We will use an existing framework - Exercise is Medicine (EIM) - developed by the American College of Sports Medicine. After undertaking formative qualitative research to tailor the EIM framework to the advanced CKD population (eGFR < 30 ml/min/1.73m2), we will randomize 96 patients from two regions-Atlanta and Bay Area-in two intervention arms with incremental levels of clinical-community integration: physical activity assessment during Nephrology clinical visit, brief counseling at pre-dialysis education, and physical activity wearable (group 1) versus group 1 intervention components plus a referral to a free, EIM practitioner-led group exercise program over 16 weeks (group 2; 8 week core intervention; 8-week follow up). We will assess efficacy by comparing between group differences in minutes/week of objectively measured moderate intensity physical activity. To evaluate implementation, we will use questionnaires for assessing barriers to referral, participation and retention along the path of the intervention. Further we will have a plan for dissemination of the intervention by partnering with relevant stakeholders.

DISCUSSION

The overall goal is to inform the development of a practical, cost-conscious intervention "package" that addresses barriers and challenges to physical activity commonly faced by patients with advanced CKD and can be disseminated amongst interested practices.

TRIAL REGISTRATION

ClinicalTrials.gov identifier (Dated:10/17/2017): NCT03311763 .

Structural developmental psychology and health promotion in the third age

In response to the ever-increasing longevity in Western societies, old age has been divided into two different periods, labelled the third and fourth age. Where the third age, with its onset at retirement, mostly involves positive aspects of growing old, the fourth age involves functional decline and increased morbidity. This article focuses on the entry to the third age and its potential for health promotion initiatives. Well-being is an important factor to emphasize in such health promotion, and this article views the lifestyle of third agers as essential for their well-being. The structural developmental theory of Robert Kegan delineates how a person's way of knowing develops throughout the life course. This theory is an untapped and salient perspective for health promotion initiatives in the third age. This article outlines Kegan's approach as a tool for developing psychologically spacious health promotion, and suggests future directions for research on the topic.

Physical Activity Is an Opportunity for the Health of Nations: What Should We Do Next?

Physical activity provides huge opportunities for the health of nations. Understanding this, the World Health Organization has published a Global Action Plan which aims to provide member states with a framework for action, namely to create active societies, people, environments and systems. The target is set at a 15 % reduction in physical inactivity levels by 2030. We explore in this paper some of the challenges and opportunities that come with it, and give the practitioner some real-world opportunities for relevant action at the local level, as well as for their patients, staying true to the Physician's Pledge (Declaration of Geneva): "I will attend to my own health, well-being, and abilities in order to provide care of the highest standard."

Change in US Adult Consumer Knowledge, Attitudes, and Behaviors Related to Sodium Intake and Reduction: SummerStyles 2012 and 2015

PURPOSE

To describe changes in consumer knowledge, attitudes, and behaviors related to sodium reduction from 2012 to 2015.

DESIGN

A cross-sectional analysis using 2 online, national research panel surveys.

SETTING

United States.

PARTICIPANTS

A total of 7796 adults (18+ years).

MEASURES

Sodium-related knowledge, attitudes, and behaviors.

ANALYSIS

Data were weighted to match the US population survey proportions using 9 factors. Wald χ2 tests were used to examine differences by survey year and hypertensive status.

RESULTS

Despite the lack of temporal changes observed in respondent characteristics (mean age: 46 years, 67% were non-Hispanic white, and 26% reported hypertension), some changes were found in the prevalence of sodium-related knowledge, attitudes, and behaviors. The percentage of respondents who recognized processed foods as the major source of sodium increased from 54% in 2012 to 57% in 2015 ( P = .04), as did the percentage of respondents who buy or choose low/reduced sodium foods, from 33% in 2012 to 37% in 2015 ( P = .016). In contrast, the percentage of self-reported receipt of health professional advice among persons with hypertension decreased from 59% in 2012 to 45% in 2015 ( P < .0001). Other sodium-related knowledge, attitudes, and behaviors did not change significantly during 2012 to 2015.

CONCLUSION

In recent years, some positive changes were observed in sodium-related knowledge and behaviors; however, the decrease in reported health professional advice to reduce sodium among respondents with hypertension is a concern.

Obesity Prevention and Management Strategies in Canada: Shifting Paradigms and Putting People First

PURPOSE OF REVIEW

The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies.

RECENT FINDINGS

Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.

Media and Its Influence on Obesity

PURPOSE OF REVIEW

To review how the media frames obesity and the effect it has upon on public perceptions.

RECENT FINDINGS

The scientific and public health understanding of obesity increasingly points away from individual behaviors and toward medical and community factors, but diffusion of this knowledge is slow. Growing awareness of the importance of body positivity is driving attention to the harms of weight bias and fat shaming. Health science reporting related to obesity, nutrition, and physical activity tends to perpetuate myths and misunderstandings. Moving forward, greater attention to accurate messages about obesity and evidence-based interventions will be essential for progress to reduce suffering and the impact on public health from this chronic disease.

Workshop salutogenesis and the future of health promotion and public health

This presentation is a synthesis of a workshop on Salutogenesis and the Future of Health Promotion and Public Health at the Nordic Health Promotion Research Conference in June 2016. A brief historical review of Public Health and Health Promotion development in a Nordic perspective is included. However, the main thrust of the article is to present how the salutogenic theory and approach could strengthen society's organised efforts to prevent disease, promote health and prolong life. A critical view based on existing evidence is maintained through the presentation that arrives at the conclusion it would be worthwhile to invest in effective theory driven approaches to the development of Public Health and Health Promotion in the future.

We Matter Too! Addressing the Wellness of Program Coordinators in Graduate Medical Education

INTRODUCTION

Burnout and stress in medical settings have been associated with despondent staff and decreased productivity. Although Program Coordinators (PCs) play an integral role in residency training programs, there exist few, if any, interventions aimed at addressing their burnout.

METHODS

A longitudinal study design was used to evaluate data from residency/fellowship training PCs who participated in a wellness retreat held at a single institution in August 2016. Subjects completed anonymous, pre- and post-retreat questionnaires in addition to a 3-month follow-up questionnaire, which included questions used to assess aspects of job demand, resiliency, and well-being. The seven-item Physician Well-Being Index and a logistic regression model were used to assess well-being. Mean values and SDs were reported to examine changes in mental health scores and participants' job satisfaction over the course of the intervention.

RESULTS

Nineteen of the 45 (43%) invited residency/fellowship training PCs completed data collection. Coordinators ranged in age from 25 to 64 years; all were female. Well-being, sleep, resiliency, and employee satisfaction scores improved over the assessment period. Well-being scores initially decreased by 0.37 at the postassessment, but increased at follow-up (mean: 2.0; SD 1.7). Stress scores increased from baseline to post, but decreased from baseline to follow-up: 0.2 and -0.2, respectively.

DISCUSSION

Residency PCs experienced improvements in mental quality of life, resiliency, stress, and sleep scores on attending the wellness program. Attention to such findings may have important implications, as we address the burnout crisis in the medical education community.

Nativity and language preference as drivers of health information seeking: examining differences and trends from a U.S. population-based survey

OBJECTIVE

To examine differences in health information seeking between U.S.-born and foreign-born populations in the U.S.

DESIGN

Data from 2008 to 2014 from the Health Information National Trends Survey were used in this study (n = 15,249). Bivariate analyses, logistic regression, and predicted probabilities were used to examine health information seeking and sources of health information.

RESULTS

Findings demonstrate that 59.3% of the Hispanic foreign-born population reported looking for health information, fewer than other racial/ethnic groups in the sample. Compared with non-Hispanic White, non-Hispanic Black (OR = 0.62) and Hispanic foreign-born individuals (OR = 0.31) were the least likely to use the internet as a first source for health information. Adjustment for language preference explains much of the disparity in health information seeking between the Hispanic foreign-born population and Whites; controlling for nativity, respondents who prefer Spanish have 0.25 the odds of using the internet as a first source of health information compared to those who prefer English.

CONCLUSION

Foreign-born nativity and language preference are significant determinants of health information seeking. Further research is needed to better understand how information seeking patterns can influence health care use, and ultimately health outcomes. To best serve diverse racial and ethnic minority populations, health care systems, health care providers, and public health professionals must provide culturally competent health information resources to strengthen access and use by vulnerable populations, and to ensure that all populations are able to benefit from evolving health information sources in the digital age.

Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990-2011

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.

Development, implementation, and evaluation of a service-learning series for pharmacy students using a public health tool

BACKGROUND AND PURPOSE

The purpose of this article is to describe the utility of the Assessment, Development, Assurance: Pharmacist's Tool (ADAPT) during the design, delivery, and assessment of service-learning events by pharmacy students.

EDUCATIONAL ACTIVITY AND SETTING

The ADAPT instrument was used to develop a series of five service-learning events that featured a health promotion program delivered by 19 pharmacy students and attended by over 200 senior citizens at local senior centers. Student competence was assessed prior to participating in the service-learning activities and each student completed a reflection following the event. Senior center directors evaluated both the quality of the health promotion program as well as the interaction with the sponsoring college of pharmacy.

FINDINGS

Pharmacy students reported achievement of health promotion learning objectives based on self-evaluations. Responses to reflections also indicate that students gained insight to and appreciation for several of the public health essential services, which are the basis of the ADAPT instrument. Feedback from the senior center directors was consistently positive.

DISCUSSION AND SUMMARY

Use of the ADAPT instrument helped to facilitate the delivery of a high-quality, comprehensive service-learning series at local senior centers that had a solid public health foundation. Colleges and schools of pharmacy should strongly consider consulting the tool prior to planning any future health promotion activities for students.

Osteoporosis knowledge translation for young adults: new directions for prevention programs

INTRODUCTION

Osteoporosis prevention is heavily reliant on education programs, which are most effective when tailored to their intended audience. Most osteoporosis prevention education is designed for older adults, making application of these programs to younger adults difficult. Designing programs for young adults requires understanding the information-seeking practices of young adults, so that knowledge about osteoporosis can be effectively translated.

METHODS

Individual interviews were conducted with 60 men and women-multiethnic, Canadian young adults-to explore both the sources and types of information they search for when seeking information on nutrition or bone health.

RESULTS

The results of this study raised themes related to the sources participants use, to their interests and to ways of engaging young adults. Prevention programs should make use of traditional sources, such as peers, family members and medical professionals, as well as emerging technologies, such as social media. Choice of sources was related to the perceived authority of and trust associated with the source. Messaging should relate to young adult interests, such as fitness and food-topics on which young adults are already seeking information-rather than being embedded within specific osteoporosis awareness materials. Engaging young adults means using relatable messages that are short and encourage small changes. Small gender-based differences were found in the information-seeking interests of participants. Differences related to age were not examined.

CONCLUSION

Creating short, action-oriented messages that are designed to encourage small changes in behaviour and are packaged with information that young adults are actively seeking is more likely to result in active engagement in prevention behaviours.

A Second Shot at HPV

HPV vaccination rates remain stubbornly low, and some studies show physician hesitancy about promoting the vaccine is the single biggest problem. TMA's HPV Work Group plans to coordinate with like-minded state and national organizations and agencies to come up with an action plan to improve HPV vaccination rates.