Physical activity and musculoskeletal injuries in women: the Women's Injury Study

BACKGROUND

Increased injury rates have been associated with physical activity (PA). The differences in musculoskeletal injury (MSI) characteristics resulting from PA, versus those unrelated to PA, are unknown. We describe the pattern of PA and non-PA MSI incurred by community-dwelling women.

METHODS

Data were extracted from the Women's Injury Study, a web-based observational study that tracked weekly PA behaviors and self-reported MSI of 909 community-dwelling women ages 20-83 years. The primary outcome was self-reported MSI that interrupted daily activities ≥2 days and/or required treatment from a health care provider. Follow-up telephone reporting of MSIs allowed further description of injuries. Mixed effects logistic regression was used to identify injury sites associated with PA, controlling for age, body mass index, previous injury, and use of alcohol.

RESULTS

Incidence of PA and non-PA MSIs were comparable; some differences in injury characteristics were evident across 83,241 person-weeks of reporting. Non-PA MSIs were more likely to come on "suddenly" (54% vs. 8%) and commonly involved head/jaw/neck injuries. Reported PA-related MSIs were less likely to require health care provider treatment (60% vs. 80%) and resulted in less missed days of work/school (11%) versus non-PA MSIs (17%). Compared to non-PA related injuries, PA-related injuries were more likely to involve the lower (odds ratio [OR]=3.10, p=0.002) or upper limbs (OR=2.54, p=0.01) and less likely to involve the head/jaw/neck (OR=0.21, p=0.002).

CONCLUSION

There are some differences in mechanisms of injury, the distribution of injuries by anatomical location, and the treatment of injuries depending on aerobic activity participation, although absolute rates of MSI were comparable.

The relationship between asthma and self-reported anxiety in a predominantly healthy adult population

BACKGROUND

Numerous studies involving patients with severe asthma have cited a relation between asthma and anxiety; this relation is responsible for decreased quality of life, increased morbidity, and higher health care usage. However, whether a link between milder asthma and anxiety exists remains unclear.

OBJECTIVE

To determine whether asthma and anxiety share an association in a group of predominantly healthy adults.

METHODS

Adults seen at the Cooper Clinic in Dallas, Texas from March 2000 through January 2013 for preventive medical examinations that included an extensive medical history, including a questionnaire regarding anxiety history, a physician-based physical examination, and laboratory and spirometric testing were used in the analysis. Multiple logistic regressions were used to determine the relation between asthma and anxiety.

RESULTS

The sample consisted of 15,675 patients, of whom 1,403 (9%) had an asthma diagnosis. A sizeable majority of patients with asthma rated their health good or excellent, did not use an inhaler, and had a ratio of forced expiration volume in the first second to forced vital capacity greater than 70%. When controlling for covariates, milder asthma was significantly associated with anxiety (odds ratio 1.435, 95% confidence interval 1.238-1.663, P < .001). Smoking, a variable associated with asthma severity, was significantly associated with anxiety (odds ratio 1.432, 95% confidence interval 1.261-1.626, P < .001), although other variables, such as the ratio of forced expiration volume in the first second to forced vital capacity or use of an inhaled corticosteroid or combined inhaled corticosteroid and a long-acting β agonist, were not significantly associated with anxiety.

CONCLUSION

In this cohort of patients with predominantly mild asthma, there was a 43.5% increased risk of anxiety. All patients with asthma should be considered at a higher risk of anxiety and a target population for anxiety screening.

Neural mechanisms of brain plasticity with complex cognitive training in healthy seniors

Complex mental activity induces improvements in cognition, brain function, and structure in animals and young adults. It is not clear to what extent the aging brain is capable of such plasticity. This study expands previous evidence of generalized cognitive gains after mental training in healthy seniors. Using 3 MRI-based measurements, that is, arterial spin labeling MRI, functional connectivity, and diffusion tensor imaging, we examined brain changes across 3 time points pre, mid, and post training (12 weeks) in a randomized sample (n = 37) who received cognitive training versus a control group. We found significant training-related brain state changes at rest; specifically, 1) increases in global and regional cerebral blood flow (CBF), particularly in the default mode network and the central executive network, 2) greater connectivity in these same networks, and 3) increased white matter integrity in the left uncinate demonstrated by an increase in fractional anisotropy. Improvements in cognition were identified along with significant CBF correlates of the cognitive gains. We propose that cognitive training enhances resting-state neural activity and connectivity, increasing the blood supply to these regions via neurovascular coupling. These convergent results provide preliminary evidence that neural plasticity can be harnessed to mitigate brain losses with cognitive training in seniors.

Depressed Adolescents Treated with Exercise (DATE): A pilot randomized controlled trial to test feasibility and establish preliminary effect sizes

The Depressed Adolescents Treated with Exercise (DATE) study evaluated a standardized aerobic exercise protocol to treat nonmedicated adolescents that met DSM-IV-TR criteria for major depressive disorder. From an initial screen of 90 individuals, 30 adolescents aged 12-18 years were randomized to either vigorous exercise (EXER) (>12 kg/kcal/week [KKW]) or a control stretching (STRETCH) activity (< 4 KKW) for 12 weeks. The primary outcome measure was the blinded clinician rating of the Children's Depression Rating Scale - Revised (CDRS-R) to assess depression severity and Actical (KKW) accelerometry 24hr/7days a week to assess energy expenditure and adherence. Follow-up evaluations occurred at weeks 26 and 52. The EXER group averaged 77% adherence and the STRETCH group 81% for meeting weekly target goals for the 12 week intervention based on weekly sessions completed and meeting KKW requirements. There was a significant increase in overall weekly KKW expenditures (p < .001) for both groups with the EXER group doubling the STRETCH group in weekly energy expenditure. Depressive symptoms were significantly reduced from baseline for both groups with the EXER group improving more rapidly than STRETCH after six weeks (p < .016) and nine weeks (p < .001). Both groups continued to improve such that there were no group differences after 12 weeks (p = .07). By week 12, the exercise group had a 100% response rate (86% remission), whereas the stretch group response rate was 67% (50% remission) (p = .02). Both groups had improvements in multiple areas of psychosocial functioning related to school and relationships with parents and peers. Anthropometry reflected decreased waist, hip and thigh measurements (p = .02), more so for females than males (p = .05), but there were no weight changes for either gender. The EXER group sustained 100% remission at week 26 and 52. The STRETCH group had 80% response and 70% remission rates at week 26 and by week 52 only one had not fully responded. The study provides support for the use of exercise as a non-medication intervention for adolescents with major depressive disorders when good adherence and energy expenditure (KKW) are achieved.

Relationship between serum homocysteine levels and depressive symptoms: the Cooper Center Longitudinal Study

OBJECTIVE

Elevated serum levels of the amino acid homocysteine (HCY) are associated with a variety of diseases. To resolve conflicting findings in studies that suggest a relationship between elevated serum HCY levels and depression, we examined the relationship between HCY levels and depressive symptoms in the largest sample studied to date.

METHOD

We conducted a cross-sectional study of 11,757 participants (68.9% men) aged 20 to 90 years who completed preventive health examinations at the Cooper Clinic, Dallas, Texas, from 2007 to 2010. Currently experiencing depression was defined as a 10-item Center for Epidemiologic Studies Depression Scale (CES-D) score of ≥ 10. Serum HCY levels were obtained. Data were analyzed in a multiple logistic regression model of CES-D score of ≥ 10.

RESULTS

When controlling for age, sex, body mass index, exercise, education, smoking, antidepressant use, creatinine level, alcohol use, and chronic medical conditions, elevated HCY was associated with 26% greater odds of currently experiencing depressive symptoms (P = .007) as defined by CES-D score.

CONCLUSIONS

In the largest sample examined to date, we found a significant positive relationship between elevated serum HCY levels and currently experiencing depressive symptoms. Given the cross-sectional nature of the study, it is not possible to determine the direction of the relationship or whether lowering HCY levels will ameliorate depressive symptoms. Thus, longitudinal studies are needed.

Abstract 191: Association of Midlife Fitness with Healthcare Charges in Later Life: the Cooper Center Longitudinal Study

Background: The inverse association between cardiorespiratory fitness and mortality is well described. However, the association between midlife fitness in healthy adults and healthcare charges in later life has not been reported. We hypothesized that higher midlife fitness would be associated with lower healthcare charges independent of traditional risk factors.

Methods: Linking individual participant data from the Cooper Center Longitudinal Study with Medicare claims files, we studied 20,489 healthy individuals (mean age 51, 21% women) free of prior myocardial infarction, stroke and cancer who survived to receive Medicare coverage through 1999-2009 for a total of 134,070 years of Medicare exposure. Traditional risk factors and fitness were measured at study entry. Fitness was estimated by Balke protocol treadmill time and categorized into age- and sex-specific quintiles, with quintile 1 as low fitness. Healthcare charges were cumulated using Medicare claims files and adjusted for inflation. Associations between midlife fitness and healthcare charges in later life were estimated using a Tobit censored regression model after adjustment for age, body mass index, blood pressure, cholesterol, diabetes, and smoking.

Results: Compared to quintile 1 (low fitness), quintiles 4-5 (high fitness) measured at a mean age of 51 were associated with lower median annual healthcare charges at age ≥65 in both men ($3277 vs. $5134, p<0.001) and women ($2755 vs. $4565, p<0.001). The inverse associations between fitness and healthcare charges were consistent across levels of traditional risk factor burden (Figure) and persisted after multivariable adjustment in men [β = -0.34 (95% confidence interval -0.21 to -0.46), p<0.001, quintiles 4-5 vs. quintile 1] and women [β = -0.32 (95% CI -0.09 to -0.54), p<0.01]. Similar findings were observed when fitness was analyzed as a continuous variable (METs) in men [β = -0.07 (95% CI -0.049 to -0.091), p<0.001] and women [β = -0.12 (95% CI -0.076 to -0.16), p<0.001].

Conclusions: Higher fitness in healthy, middle-aged adults is strongly associated with lower healthcare charges decades later in older age, independent of other traditional risk factors.

Depressive symptoms and metabolic syndrome in preventive healthcare: the Cooper Center longitudinal study

BACKGROUND

Depression, metabolic syndrome, and reduced cardiorespiratory fitness (CRF) are known to increase the risk of developing diabetes and cardiovascular disease. The association among these factors in a generally healthy, active population with access to health care is not well defined.

METHODS

This was a cross-sectional analysis of data collected on 5,125 women and men during preventive care examinations at the Cooper Clinic from 2000 to 2008. The main outcome measures were depressive symptoms as assessed by the Centers for Epidemiologic Studies Depression Scale short form (CES-D-10) questionnaire, presence or absence of metabolic syndrome, and CRF as measured by a maximal exercise treadmill test.

RESULTS

Women and men who exhibited depressive symptoms had a statistically higher prevalence of metabolic syndrome compared to those who did not (for women, 15.4% versus 7.2%, P < 0.0001; for men, 31.6% versus 22.8%, P < 0.0001). Individuals with depressive symptoms had an increased frequency of higher waist circumference, higher triglycerides, and lower high-density lipoprotein. Women with depressive symptoms also had marginally higher fasting blood glucose levels. After adjusting for age and smoking status, the odds of metabolic syndrome in women with depressive symptoms was 2.81 [95% confidence interval (CI), 2.01-3.93] times the odds of metabolic syndrome in those without depressive symptoms, and in men with depressive symptoms, the odds were 1.69 (95% CI, 1.42-2.00) times the odds of metabolic syndrome in men without. When controlled for CRF level, the presence or absence of depressive symptoms on the presence of metabolic syndrome is attenuated but remains statistically significant in women.

CONCLUSION

Even in a generally healthy population with access to health care, the presence of depressive symptoms was associated with increased metabolic syndrome.

Effects of omega-3 supplementation in combination with diet and exercise on weight loss and body composition

BACKGROUND

In addition to the metabolic and cardiovascular benefits of omega-3 (n-3) fatty acids, several studies have suggested an added weight loss-enhancing benefit to this supplement.

OBJECTIVE

The objective was to assess whether supplemental omega-3 fatty acids in conjunction with diet and exercise augment weight loss over a 6-mo period.

DESIGN

In a single-institution, placebo-controlled, randomized clinical trial, 128 individuals with a body mass index (in kg/m(2)) between 26 and 40 were assigned to receive 5 omega-3 [3.0 g eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) at a 5:1 ratio (EPA:DHA)] or placebo capsules daily in conjunction with lifestyle modification. The primary endpoint was weight loss; secondary endpoints included metabolic and psychometric variables. Analyses were by intention-to-treat.

RESULTS

Overweight and obese individuals were assigned to the omega-3 arm (n = 64) or to the placebo arm (n = 64). Subjects in both arms received dietary and exercise counseling. Eighty-one individuals completed the 24-wk study, and the dropout rate was 27%. Subjects in both arms lost an average of >5% of their body weight. No significant differences in weight loss were observed between the omega-3 (-5.2 kg; 95% CI: -6.0, -4.4 kg) and placebo (-5.8 kg; 95% CI: -6.7, -5.1 kg) arms. The absolute mean (±SEM) change difference was 0.61 ± 0.58 kg (P = 0.29). In addition, no significant differences in the other factors assessed were observed.

CONCLUSION

Omega-3 fatty acids were not effective as an adjunct for weight loss in this otherwise healthy, overweight population.

Psychometric evaluation of the Montreal Cognitive Assessment (MoCA) in three diverse samples

Our objective was to evaluate the utility of the Montreal Cognitive Assessment (MoCA) in both non-clinical and clinical populations. The MoCA, a tool used widely in clinical geriatric practice to detect and quantify cognitive impairment, was administered to three diverse samples to assess the psychometric properties of the instrument. Participants were 482 healthy persons seen in the Cooper Center Longitudinal Study (CCLS), 1923 healthy volunteers evaluated by the Dallas Heart Study (DHS), a population-based sample of Dallas County residents and 69 persons with known or suspected brain pathology, seen for clinical evaluation. The standard deviations in the CCLS and DHS groups were small (2.81, 3.87) and moderate in the clinical group (5.22). The corresponding raw coefficients alpha were. 50,. 63, and. 75. Thus, variability and internal consistency were associated. MoCA scores generally did not correlate with gender and correlated with age only in the clinical group. However, there were moderately strong positive correlations between MoCA scores and education in all three samples. The reliability of the MoCA was extremely low in the two non-clinical groups, but was high in the clinical group. Although useful in large non-clinical studies, the MoCA is best suited to detect and quantify cognitive impairment in clinical patients.