Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association

Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study

Objective

To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes.

Design

Metaepidemiological study.

Eligibility criteria

Meta-analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control (placebo or usual care).

Data sources

Medline and Cochrane Database of Systematic Reviews, May 2013.

Main outcome measure

Mortality.

Data synthesis

We combined study level death outcomes from exercise and drug trials using random effects network meta-analysis.

Results

We included 16 (four exercise and 12 drug) meta-analyses. Incorporating an additional three recent exercise trials, our review collectively included 305 randomised controlled trials with 339 274 participants. Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes), 14 716 participants were randomised to physical activity interventions in 57 trials. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. Physical activity interventions were more effective than drug treatment among patients with stroke (odds ratios, exercise vanticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise v antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in heart failure (exercise v diuretics 4.11,1.17to 24.76). Inconsistency between direct and indirect comparisons was not significant.

Conclusions

Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.

Impact of a community-based lifestyle intervention program on health-related quality of life

BACKGROUND

The presence of risk factors for type 2 diabetes and cardiovascular disease, or the conditions themselves, contributes to lower health-related quality of life (HRQoL) among adults. Although community-based lifestyle intervention programs have been shown to be effective for improving risk factors for these diseases, the impact of these interventions on HRQoL has rarely been described.

PURPOSE

To examine changes in HRQoL following participation in the Group Lifestyle Balance program, a community translation of the Diabetes Prevention Program lifestyle intervention for adults with prediabetes and/or the metabolic syndrome.

METHODS

Participants enrolled in the 12-month, 22-session intervention program (N = 223) completed the EuroQol Health Questionnaire (EQ-5D-3L) at baseline, 6, and 12 months. Linear mixed-effects regression models determined change in EQ-5D-visual analog scale (VAS) and Index scores post-intervention.

RESULTS

Mean EQ-5D-VAS was improved by +7.38 (SE = 1.03) at 6 months and by +6.73 (SE = 1.06) at 12 months post-intervention (both; p < 0.0001). Mean changes in EQ-5D index values were +0.00 (SE = 0.01; NS) and +0.01 (SE = 0.01; p < 0.05), respectively. Adjusted for age, baseline score, and achieving intervention goals, mean change in EQ-5D-VAS was +11.83 (SE = 1.61) at 6 months and +11.23 (SE = 1.54) at 12 months (both; p < 0.0001). Adjusted mean change in EQ-5D index value was +0.04 (SE = 0.01) at 6 months and +0.05 (SE = 0.01) at 12 months (both; p < 0.01).

CONCLUSION

Participation in a community lifestyle intervention program resulted in improved HRQoL among adults with prediabetes and/or the metabolic syndrome. These benefits to HRQoL, together with improved clinical and behavioral outcomes, should increase the appeal of such programs for improving health.

Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury

BACKGROUND AND PURPOSE

Effects of high-intensity exercise on endurance, mobility and gait speed of adults with chronic moderate-to-severe acquired brain injury (ABI) were investigated. It was hypothesized that intensive exercise would be associated with improvements in impairment and activity limitation measures.

PARTICIPANTS

Fourteen adults with chronic ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device were studied. Eight presented with low ambulatory status.

METHODS

This was a single group pre- and post-intervention study. Participants received a 6-week exercise intervention for 60-90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Measures (6MWT, HiMAT and 10MWT) were collected at baseline, post-intervention and 6 weeks later. Repeated measures T-test and Wilcoxon Signed Ranks test were used.

RESULTS

Post-intervention improvements were achieved on average on all three measures, greater than minimal detectable change (MDC) for this population. Three participants transitioned from low-to-high ambulatory status and maintained the change 6 weeks later.

DISCUSSION AND CONCLUSION

People with chronic ABI can improve endurance, demonstrate the ability to do advanced gait and improve ambulatory status with 6 weeks of intensive exercise. Challenges to sustainability of exercise programmes for this population remain.

Lifelong Exercise Patterns and Cardiovascular Health

OBJECTIVE

To determine the relationship between lifelong exercise dose and the prevalence of cardiovascular morbidity.

PATIENTS AND METHODS

From June 1, 2011, through December 31, 2014, 21,266 individuals completed an online questionnaire regarding their lifelong exercise patterns and cardiovascular health status. Cardiovascular disease (CVD) was defined as a diagnosis of myocardial infarction, stroke, or heart failure, and cardiovascular risk factors (CVRFs) were defined as hypertension, hypercholesterolemia, or type 2 diabetes. Lifelong exercise patterns were measured over a median of 32 years for 405 patients with CVD, 1379 patients with CVRFs, and 10,656 controls. Participants were categorized into nonexercisers and quintiles (Q1-Q5) of exercise dose (metabolic equivalent task [MET] minutes per week).

RESULTS

The CVD/CVRF prevalence was lower for each exercise quintile compared with nonexercisers (CVD: nonexercisers, 9.6% vs Q1: 4.4%, Q2: 2.8%, Q3: 2.4%, Q4: 3.6%, Q5: 3.9%; P<.001; CVRF: nonexercisers, 24.6% vs Q1: 13.8%, Q2: 10.2%, Q3: 9.0%, Q4: 9.4%, Q5: 12.0%; P<.001). The lowest exercise dose (Q1) significantly reduced CVD and CVRF prevalence, but the largest reductions were found at 764 to 1091 MET-min/wk for CVD (adjusted odds ratio=0.31; 95% CI, 0.20-0.48) and CVRFs (adjusted odds ratio=0.36; 95% CI, 0.28-0.47). The CVD/CVRF prevalence did not further decrease in higher exercise dose groups. Exercise intensity did not influence the relationship between exercise patterns and CVD or CVRFs.

CONCLUSION

These findings demonstrate a curvilinear relationship between lifelong exercise patterns and cardiovascular morbidity. Low exercise doses can effectively reduce CVD/CVRF prevalence, but engagement in exercise for 764 to 1091 MET-min/wk is associated with the lowest CVD/CVRF prevalence. Higher exercise doses do not yield additional benefits.

Cardiovascular diseases in Paralympic athletes

BACKGROUND

Sport participation (SP) of individuals with impairments has recently grown exponentially. Scarce scientific data, however, exist regarding cardiovascular (CV) risk associated with competitive SP.

OBJECTIVE

Assessing the prevalence of CV abnormalities and the risk for SP in Paralympic athletes (PA).

METHODS

PA (n=267; 76% men), aged 35±9 years, engaged in 18 sport disciplines, with a spectrum of lesions including: spinal cord injury (paraplegia and spina bifida) (n=116); amputation, poliomyelitis, cerebral palsy and other neuromuscular and/or skeletal disorders (Les autres) or visual impairment (n=151) entered the study. CV evaluation included history, PE, 12-lead and exercise ECG, echocardiography. Of these, 105 participated in ≥2 consecutive games, and had evaluations available over a 6±4 year follow-up.

RESULTS

Structural CV abnormalities were identified in 33 athletes (12%), including arrhythmogenic cardiomyopathies in 3, aortic root dilation in 3, valvular diseases in 7 (mitral valve prolapse in 4, bicuspid aortic valve in 3) and systemic hypertension in 11 (4%). In addition, ventricular (polymorphic, couplets or non-sustained ventricular tachycardia) or supraventricular tachyarrhythmias (atrial flutter, paroxysmal atrial fibrillation or SVT) were identified in 9 others. Over a 6-year follow-up, 6 of the 105 athletes (6%) developed CV diseases, including dilated cardiomyopathy in 1 and systemic hypertension in 5.

CONCLUSIONS

PA present an unexpected high prevalence of CV abnormalities (12%), including a non-trivial proportion of diseases at risk for sudden death (2%), such as arrhythmogenic cardiomyopathies and dilated aortic root. This observation suggests that tailored recommendations for preparticipation screening and safe SP in this special athletic population are timely and appropriate.

A low-cost system to easily measure spontaneous physical activity in rodents

Spontaneous physical activity (SPA) can be responsible for variations of a lot of physiological parameters at the molecular, cellular, tissue, and systemic levels. It is increasingly recognized that good understanding of a large part of experimental results requires weighting them by SPA in order to reduce variability and thus to decrease the number of animals necessary to conduct a study. However, because of the high cost of this equipment, only a few laboratories are equipped with such equipment to measure the SPA of their animals. Here we present an effective, adaptable, and affordable system to measure SPA in rodents based on video acquisition of the animal in its own environment. We compared results obtained with our system to those collected at the same time with a commercial system of actimetry recording, and we found a high degree of correlation between these two approaches ( r = 0.93; P < 0.001). We also were able to detect small variations of SPA induced by a special environment like chronic hypoxia exposure (25% less spontaneous activity compared with animals in normoxia, P < 0.05) or during the circadian cycle (107% more activity during the nocturnal phase compared with the diurnal phase, P < 0.05).

Mirror, Mirror by the Stairs: The Impact of Mirror Exposure on Stair versus Elevator Use in College Students

Previous research has indicated that self-awareness-inducing mirrors can successfully incite behaviors that align with one's personal values, such as helping others. Other research has found a large discrepancy between the high percentage of young adults who report valuing the healthfulness of physical activity (PA) and the low percentage who actually meet PA participation standards. However, few studies have examined how mirror exposure and both perceived and actual body size influence highly valued PA participation among college students. The present study assessed stair versus elevator use on a western college campus and hypothesized that mirror exposure would increase the more personally healthy transportation method of stair use. In accordance with previous research, it was also hypothesized that males and those with a lower body mass index (BMI) would be more likely to take the stairs, and that body size distorting mirrors would impact the stair-elevator decision. One hundred sixty-seven students (51% male) enrolled in an introductory psychology course were recruited to take a survey about their "transportation choices" at an indoor campus parking garage. Participants were individually exposed to either no mirror, a standard full-length mirror, or a full-length mirror manipulated to make the reflected body size appear either slightly thinner or slightly wider than normal before being asked to go to the fourth floor of the garage for a survey. Participants' choice of floor-climbing method (stairs or elevator) was recorded, and they were administered an Internet-based survey assessing demographic information, BMI, self-awareness, perceived body size, and other variables likely to be associated with stair use. Results from logistic regression analyses revealed that participants who were not exposed to a mirror [odds ratios (OR) = 0.37, 95% CI: 0.14-0.96], males (OR = 0.33, 95% CI: 0.13-0.85), those with lower BMI (OR = 0.84, 95% CI: 0.71-0.99), those with higher exercise participation (OR = 1.09, 95% CI: 1.02-1.18), and those engaging in more unhealthy weight-control behaviors (OR = 1.55, 95% CI: 1.14-2.11) showed increased odds of taking the stairs. Implications and future directions are discussed.

Real-Time Associations Between Engaging in Leisure and Daily Health and Well-Being

BACKGROUND

Engagement in leisure has a wide range of beneficial health effects. Yet, this evidence is derived from between-person methods that do not examine the momentary within-person processes theorized to explain leisure's benefits.

PURPOSE

This study examined momentary relationships between leisure and health and well-being in daily life.

METHODS

A community sample (n = 115) completed ecological momentary assessments six times a day for three consecutive days. At each measurement, participants indicated if they were engaging in leisure and reported on their mood, interest/boredom, and stress levels. Next, participants collected a saliva sample for cortisol analyses. Heart rate was assessed throughout the study.

RESULTS

Multilevel models revealed that participants had more positive and less negative mood, more interest, less stress, and lower heart rate when engaging in leisure than when not.

CONCLUSIONS

Results suggest multiple mechanisms explaining leisure's effectiveness, which can inform leisure-based interventions to improve health and well-being.

Latina and Non-Latina Mothers' Perceived Health Barriers and Benefits and Their Relationship to Children's Health Behaviors

Objectives Disparities exist in rates of overweight/obesity between Latino and non-Latino populations. Attention should be given to risk factors that may be modifiable through interventions involving both the parent and child. The current study sought to identify ethnic differences in parental health beliefs and their relation to children's health behaviors. Methods Latina and non-Latina mothers (N = 203) at rural and urban clinics and health departments completed self-report questionnaires. Key information included beliefs about barriers and benefits to health practices and children's health behaviors. Results Children of Latina mothers consumed significantly more soda and fried foods and exercised less than children of non-Latina mothers. Latina mothers were significantly more likely to perceive barriers to healthy eating and significantly less likely to perceive benefits to healthy eating and physical activity than non-Latina mothers. Ethnicity mediated the relationship between maternal views of health benefits and soda consumption. Conclusions Policy changes are needed to promote health education and increase the accessibility of healthy foods and safe places to exercise for Latino families.

Serum cardiac troponin I analysis to determine the excessiveness of exercise intensity: A novel equation

Physical exertion is often promoted because of its beneficial health effects. This only holds true, however, as long as the optimal exercise intensity is not exceeded. If physical exertion becomes too strenuous or prolonged, cardiac injury or dysfunction may occur. Consequently, a significant elevation of the serum concentration of the sensitive and specific cardiac biomarker troponin I can be observed. In this article, we present the derivation of a novel equation that can be used to evaluate to what extent the intensity of conducted endurance exercise was excessive, based on a post-exercise assessment of serum cardiac troponin I. This is convenient, as exercise intensity is difficult for an athlete to quantify accurately and the currently used heart rate indices can be affected by various physiological and environmental factors. Serum cardiac troponin I, on the other hand, is a post-hoc parameter that directly reflects the actual effects on the myocardium and may therefore be a promising alternative. To our knowledge, this is the first method to determine relative exercise intensity in retrospect. We therefore believe that this equation can serve as a potentially valuable tool to objectively evaluate the benefits or harmful effects of physical exertion.

Comparison of the postural and physiological effects of two dynamic workstations to conventional sitting and standing workstations

Increasing evidence is being found for the association of health risk factors with work-related physical inactivity. An increasing number of people are being exposed to this form of inactivity, and as a result, various interventions aimed at increasing physical activity during working hours are being developed. This study aims to investigate the differences in postural, muscular and physical activities resulting from two dynamic workstations, namely an elliptical trainer and a treadmill workstation, compared with a conventional sitting and standing workstation. Twelve participants completed five standardised office tasks in a laboratory setting at all workstations. No significant effect was found regarding changes in posture and the muscular activity was only significantly higher for the trapezius muscle (50th percentile: 8.1 %MVC) at the dynamic workstations. For the dynamic workstations, physical activity ranged from 4.0 to 14.9 × 10(-2) g, heart rate from 14.3 to 27.5 %HRR and energy expenditure from 1.8 to 3.1 METs. Practitioner Summary: Work-related physical inactivity is associated with health risk factors. In this study, physiological and postural effects of dynamic workstations were assessed in comparison to conventional workstations. No significant effects were found regarding changes in posture and muscular activity. Physical activity, heart rate and energy expenditure increased for the dynamic workstations.

Alternatives to Aerobic Exercise Prescription in Patients with Chronic Heart Failure

Background

Exercise is essential for patients with heart failure as it leads to a reduction in morbidity and mortality as well as improved functional capacity and oxygen uptake (⩒O₂). However, the need for an experienced physiologist and the cost of the exam may render the cardiopulmonary exercise test (CPET) unfeasible. Thus, the six-minute walk test (6MWT) and step test (ST) may be alternatives for exercise prescription.

Objective

The aim was to correlate heart rate (HR) during the 6MWT and ST with HR at the anaerobic threshold (HR_AT) and peak HR (HR_P) obtained on the CPET.

Methods

Eighty-three patients (58 ± 11 years) with heart failure (NYHA class II) were included and all subjects had optimized medication for at least 3 months. Evaluations involved CPET (⩒O₂, HR_AT, HR_P), 6MWT (HR_6MWT) and ST (HR_ST).

Results

The participants exhibited severe ventricular dysfunction (ejection fraction: 31 ± 7%) and low peak ⩒O2 (15.2 ± 3.1 mL.kg_-1.min_-1). HR_P (113 ± 19 bpm) was higher than HR_AT (92 ± 14 bpm; p < 0.05) and HR_6MWT (94 ± 13 bpm; p < 0.05). No significant difference was found between HR_P and HR_ST. Moreover, a strong correlation was found between HR_AT and HR_6MWT (r = 0.81; p < 0.0001), and between HR_P and HR_ST (r = 0.89; p < 0.0001).

Conclusion

These findings suggest that, in the absence of CPET, exercise prescription can be performed by use of 6MWT and ST, based on HR_6MWT and HR_ST

Simple and effective exercise design for assessing in vivo mitochondrial function in clinical applications using (31)P magnetic resonance spectroscopy

The growing recognition of diseases associated with dysfunction of mitochondria poses an urgent need for simple measures of mitochondrial function. Assessment of the kinetics of replenishment of the phosphocreatine pool after exercise using (31)P magnetic resonance spectroscopy can provide an in vivo measure of mitochondrial function; however, the wider application of this technique appears limited by complex or expensive MR-compatible exercise equipment and protocols not easily tolerated by frail participants or those with reduced mental capacity. Here we describe a novel in-scanner exercise method which is patient-focused, inexpensive, remarkably simple and highly portable. The device exploits an MR-compatible high-density material (BaSO4) to form a weight which is attached directly to the ankle, and a one-minute dynamic knee extension protocol produced highly reproducible measurements of post-exercise PCr recovery kinetics in both healthy subjects and patients. As sophisticated exercise equipment is unnecessary for this measurement, our extremely simple design provides an effective and easy-to-implement apparatus that is readily translatable across sites. Its design, being tailored to the needs of the patient, makes it particularly well suited to clinical applications, and we argue the potential of this method for investigating in vivo mitochondrial function in new cohorts of growing clinical interest.

Application of pre-participation cardiovascular screening guidelines to novice older runners and endurance athletes

Objectives:

Despite robust growth in participation in marathons and endurance sports among older individuals, guidance regarding pre-participation cardiovascular evaluation of these athletes is lacking. The objective of this study was to assess the utility of currently available pre-participation cardiovascular evaluation guidelines as applied to a cohort of older novice endurance athletes.

Methods:

We applied data from 1457 novice runners and endurance athletes aged 35 years and older to two pre-participation screening tools, the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and the 2001 Working Group recommendations for pre-participation screening of masters athletes (2001 Masters).

Results:

Application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire identified 42.1% for which pre-participation cardiovascular evaluation was indicated. Of those who met criteria, 51.5% reported completion of a healthcare evaluation. Application of the 2001 Masters guidelines identified 75.2% who qualified for pre-participation electrocardiogram and 34.0% for pre-participation stress testing. Of those who met 2001 Masters criteria for pre-participation testing, 43.7% and 24.6% underwent recommended electrocardiogram and stress testing, respectively. While there was modest concordance with recommendations for pre-participation evaluations based on both American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters, only athlete age was independently associated with completion of a pre-participation healthcare evaluation and only athlete age and athlete’s participation in marathons were independently associated with pre-participation stress testing.

Conclusion:

Among older novice endurance athletes, application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines identifies a significant percentage of athletes for whom pre-participation evaluation and testing are recommended. Concordance with these guidelines was modest and providers were primarily influenced by athlete age and competitive goals when planning pre-participation testing. Given the rarity of cardiovascular events among older participants in endurance events, the cost-effectiveness of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines may be unacceptable for general use.

Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise?

Multiple epidemiological studies document that habitual physical activity reduces the risk of atherosclerotic cardiovascular disease (ASCVD), and most demonstrate progressively lower rates of ASCVD with progressively more physical activity. Few studies have included individuals performing high-intensity, lifelong endurance exercise, however, and recent reports suggest that prodigious amounts of exercise may increase markers for, and even the incidence of, cardiovascular disease. This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including "myocardial" creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.

Feasibility for developing cardiovascular exercise recommendations for persons with motor-complete paraplegia based on manual wheelchair propulsion; A protocol and preliminary data

BACKGROUND

The Center for Disease Control, American Heart Association, and American College of Sports Medicine recommendations for duration and intensity of exercise are based on the amount of energy expenditure required to maintain cardiovascular health in able body individuals; 1000 Kilocalories (Kcals) per week of energy expenditure has been demonstrated to achieve this effect. Manual wheelchair propulsion (MWP) represents a practical and accessible form of exercise for individuals with paraplegia.

OBJECTIVE

To describe a method to determine the duration of MWP required to expend 1000 Kcals, when performed by individuals with paraplegia due to motor-complete spinal cord injury (SCI).

STUDY DESIGN

Cross-sectional study.

SETTING

Rehabilitation Research Laboratory.

PARTICIPANTS

Sixteen adults with motor complete T3-T12 paraplegia (body mass index < 35, duration of paraplegia > 3 months).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Indirect calorimetry during MWP was measured in order to calculate caloric expenditure per minute. These data were used to calculate the number of minutes of MWP required to expend 1000 Kcal in one week.

RESULTS

During MWP, participants expended 3.3 ± 1.0 Kcal/minute. Based on this figure, 1000 Kcal of energy expenditure in one week would require 303 minutes of MWP per week, or 43.3 minutes per day, 7 days per week.

CONCLUSIONS

Our data suggest that it is feasible to create a practical and accessible exercise recommendation based on manual wheelchair propulsion for individuals with paraplegia due to motor-complete SCI. Larger studies are needed in order to develop accurate exercise recommendations for persons with SCI.

Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials

BACKGROUND

Low physical activity has been shown to be one of the most common components of frailty, and interventions have been considered to prevent or reverse this syndrome. The purpose of this systematic review of randomized, controlled trials is to examine the exercise interventions to manage frailty in older people.

METHODS

The PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched using specific keywords and Medical Subject Headings for randomized, controlled trials published during the period of 2003-2015, which enrolled frail older adults in an exercise intervention program. Studies where frailty had been defined were included in the review. A narrative synthesis approach was performed to examine the results. The Physiotherapy Evidence Database (PEDro scale) was used to assess the methodological quality of the selected studies.

RESULTS

Of 507 articles, nine papers met the inclusion criteria. Of these, six included multi-component exercise interventions (aerobic and resistance training not coexisting in the intervention), one included physical comprehensive training, and two included exercises based on strength training. All nine of these trials included a control group receiving no treatment, maintaining their habitual lifestyle or using a home-based low level exercise program. Five investigated the effects of exercise on falls, and among them, three found a positive impact of exercise interventions on this parameter. Six trials reported the effects of exercise training on several aspects of mobility, and among them, four showed enhancements in several measurements of this outcome. Three trials focused on the effects of exercise intervention on balance performance, and one demonstrated enhanced balance. Four trials investigated functional ability, and two showed positive results after the intervention. Seven trials investigated the effects of exercise intervention on muscle strength, and five of them reported increases; three trials investigated the effects of exercise training on body composition, finding improvements in this parameter in two of them; finally, one trial investigated the effects of exercise on frailty using Fried's criteria and found an improvement in this measurement. Exercise interventions have demonstrated improvement in different outcome measurements in frail older adults, however, there were large differences between studies with regard to effect sizes.

CONCLUSIONS

This systematic review suggested that frail older adults seemed to benefit from exercise interventions, although the optimal program remains unclear. More studies of this topic and with frail populations are needed to select the most favorable exercise program.

Advances and challenges in skeletal muscle angiogenesis

The role of capillaries is to serve as the interface for delivery of oxygen and removal of metabolites to/from tissues. During the past decade there has been a proliferation of studies that have advanced our understanding of angiogenesis, demonstrating that tissue capillary supply is under strict control during health but poorly controlled in disease, resulting in either excessive capillary growth (pathological angiogenesis) or losses in capillarity (rarefaction). Given that skeletal muscle comprises nearly 40% of body mass in humans, skeletal muscle capillary density has a significant impact on metabolism, endocrine function, and locomotion and is tightly regulated at many different levels. Skeletal muscle is also high adaptable and thus one of the few organ systems that can be experimentally manipulated (e.g., by exercise) to study physiological regulation of angiogenesis. This review will focus on the methodological concerns that have arisen in determining skeletal muscle capillarity and highlight the concepts that are reshaping our understanding of the angio-adaptation process. We also summarize selected new findings (physical influences, molecular changes, and ultrastructural rearrangement of capillaries) that identify areas of future research with the greatest potential to expand our understanding of how angiogenesis is normally regulated, and that may also help to better understand conditions of uncontrolled (pathological) angiogenesis.

Nonalcoholic fatty liver disease and statins

OBJECTIVE

Nonalcoholic fatty liver disease (NAFLD) is the most frequent cause of elevated transaminase levels and affects approximately one third of the general population. Patients with NAFLD are at increased risk for cardiovascular events, which represent the leading cause of death in this population. We discuss the safety and efficacy of statins in this population.

MATERIALS/METHODS

We reviewed the most recent literature on the safety of statins in patients with NAFLD and on their effects on liver histology and cardiovascular events.

RESULTS

It appears that statins can be safely administered to patients with NAFLD, including those with elevated transaminase levels (<3 times the upper limit of normal). Post-hoc analyses of randomized controlled trials also suggest that statins might reduce cardiovascular morbidity in this population. On the other hand, there are few and controversial data on the effects of statins on liver histology in patients with NAFLD.

CONCLUSIONS

Statins appear to be safe and might also reduce cardiovascular events in patients with NAFLD. Ongoing and future studies will clarify whether statins might also have a role in the treatment of NAFLD.

The prescription or proscription of exercise in endometrial cancer care

OBJECTIVE

To determine the proportion of endometrial cancer patients who can be safely prescribed community/home based unsupervised exercise. A better understanding of the physical dysfunction secondary to comorbidities among endometrial cancer patients would assist clinicians in delineating which patients to send to medically-based supervised rehabilitation versus a community/home based unsupervised exercise program.

METHODS

A literature review identified health issues which could impede patients from successfully completing an unsupervised exercise program after a cancer diagnosis. The charts of 479 endometrial cancer patients treated between 2006 and 2010 were reviewed to determine the health status at the time of diagnosis and the type and percentage of health-issues that could preclude an unsupervised exercise program in this population. Univariable modeling and multivariable modeling were used to evaluate the association of demographic, cancer-related characteristics and clinical variables with ability to participate in unsupervised exercise.

RESULTS

We determined that 14.2% of endometrial cancer patients were able to exercise without supervision based on their health status at the time of diagnosis. After excluding common comorbidities (hypertension, diabetes and morbid obesity) from the identified health-issues, the proportion increased to 20.5%. Older at diagnosis (P=0.007) and higher BMI (P<0.001) are more likely to exclude patients from community/home based unsupervised exercise program.

CONCLUSIONS

Only 14.2% to 20.5% of endometrial cancer patients were deemed able to exercise without supervision based on their health status at diagnosis. Our data suggest that approximately 80% of endometrial cancer patients would benefit from a referral to a medically-based supervised exercise program.

Energy Cost of Lower Body Dressing, Pop-Over Transfers, and Manual Wheelchair Propulsion in People with Paraplegia Due to Motor-Complete Spinal Cord Injury

BACKGROUND

Energy required for able-bodied individuals to perform common activities is well documented, whereas energy associated with daily activities among people with spinal cord injury (SCI) is less understood.

OBJECTIVE

To determine energy expended during several basic physical tasks specific to individuals with paraplegia due to motor-complete SCI.

METHODS

Sixteen adults with motor-complete SCI below T2 level and duration of paraplegia greater than 3 months were included. Oxygen consumption (VO2), caloric expenditure, and heart rate were measured at rest and while participants performed lower body dressing (LBD), pop-over transfers (POTs), and manual wheelchair propulsion (MWP) at a self-selected pace. These data were used to calculate energy expenditure in standard metabolic equivalents (METs), as defined by 1 MET = 3.5 mL O2/kg/min, and in SCI METs using the conversion 1 SCI MET = 2.7 mL O2/kg/min.

RESULTS

VO2 at rest was 3.0 ± 0.9 mL O2/kg/min, which equated to 0.9 ± 0.3 standard METs and 1.1 ± 0.4 SCI METs in energy expenditure. LBD required 3.2 ± 0.7 METs and 4.1 ± 0.9 SCI METs; POTs required 3.4 ± 1.0 METs and 4.5 ± 1.3 SCI METs; and MWP required 2.4 ± 0.6 METs and 3.1 ± 0.7 SCI METs.

CONCLUSIONS

Resting VO2 for adults with motor-complete paraplegia is 3.0 mL O2/kg/min, which is lower than standard resting VO2 in able-bodied individuals. Progressively more energy is required to perform MWP, LBD, and POTs, respectively. Use of the standard METs formula may underestimate the level of intensity an individual with SCI uses to perform physical activities.

Association Between Leisure Time Physical Activity, Cardiopulmonary Fitness, Cardiovascular Risk Factors, and Cardiovascular Workload at Work in Firefighters

BACKGROUND

Overweight, obesity, and cardiovascular disease risk factors are prevalent among firefighters in some developed countries. It is unclear whether physical activity and cardiopulmonary fitness reduce cardiovascular disease risk and the cardiovascular workload at work in firefighters. The present study investigated the relationship between leisure-time physical activity, cardiopulmonary fitness, cardiovascular disease risk factors, and cardiovascular workload at work in firefighters in Hong Kong.

METHODS

Male firefighters (n = 387) were randomly selected from serving firefighters in Hong Kong (n = 5,370) for the assessment of cardiovascular disease risk factors (obesity, hypertension, diabetes mellitus, dyslipidemia, smoking, known cardiovascular diseases). One-third (Target Group) were randomly selected for the assessment of off-duty leisure-time physical activity using the short version of the International Physical Activity Questionnaire. Maximal oxygen uptake was assessed, as well as cardiovascular workload using heart rate monitoring for each firefighter for four "normal" 24-hour working shifts and during real-situation simulated scenarios.

RESULTS

Overall, 33.9% of the firefighters had at least two cardiovascular disease risk factors. In the Target Group, firefighters who had higher leisure-time physical activity had a lower resting heart rate and a lower average working heart rate, and spent a smaller proportion of time working at a moderate-intensity cardiovascular workload. Firefighters who had moderate aerobic fitness and high leisure-time physical activity had a lower peak working heart rate during the mountain rescue scenario compared with firefighters who had low leisure-time physical activities.

CONCLUSION

Leisure-time physical activity conferred significant benefits during job tasks of moderate cardiovascular workload in firefighters in Hong Kong.

Physical Activity and Health: "What is Old is New Again"

Much recent interest has focused on the relationship between physical activity and health and supported with an abundance of scientific evidence. However, the concept of Exercise is Medicine™ copromoted by the American College of Sports Medicine and American Medical Association and similar august bodies worldwide is far from new--the importance of exercise for health has been reported for centuries. Participation in regular physical activity and exercise provides numerous benefits for health with such benefits typically varying according to the volume completed as reflected by intensity, duration, and frequency. Evidence suggests a dose-response relationship such that being active, even to a modest level, is preferable to being inactive or sedentary. Greatest benefits are commonly associated with the previously sedentary individual assuming a more active lifestyle. There is an apparent linear relationship between physical activity and health status and as a general rule, increases in physical activity and fitness result in additional improvements in health status. This narrative review provides a selective appraisal of the evidence for the importance of physical activity for health, commencing with a baseline historical perspective followed by a summary of key health benefits associated with an active lifestyle.

Does Improving Exercise Capacity and Daily Activity Represent the Holistic Perspective of a New COPD Approach?

In COPD patients a reduced daily activity has been well documented, resulting from both respiratory and non-respiratory manifestations of the disease. An evaluation by multisensory armband has confirmed that daily physical activity is mainly associated with dynamic hyperinflation, regardless of COPD severity. This aspect is crucial, since exercise capacity is closely correlated to life expectancy. Notwithstanding the causal key role of lung impairment in the patient's symptoms, some authors have suggested that other factors, such as systemic inflammation and co-morbidities, have an important role, particularly as mortality risk factors. Many studies suggest the efficacy of bronchodilators and rehabilitation in improving exercise capacity, and, speaking in terms of daily life, in increasing the number of days in which patients are able to perform their usual activities. On this evidence, the first aim in the management of COPD should be to improve exercise capacity and daily activity since these outcomes have direct effects on patients' quality of life, co-morbidities (heart and metabolic diseases), and prognosis. Thus, improving physical activity represents a modern approach aimed at dealing with both pulmonary and systemic manifestations of the disease. It is however worth of notice to remember that in patients affected by COPD the relationship between the improvement of "potential" exercise capacity and daily physical activity has been found to be only moderate to weak. Obtaining a significant behavior modification with regard to daily physical activity, together with the optimization of therapy thus represents currently the true challenge.

Exercise Prevention of Cardiovascular Disease in Breast Cancer Survivors

Thanks to increasingly effective treatment, breast cancer mortality rates have significantly declined over the past few decades. Following the increase in life expectancy of women diagnosed with breast cancer, it has been recognized that these women are at an elevated risk for cardiovascular disease due in part to the cardiotoxic side effects of treatment. This paper reviews evidence for the role of exercise in prevention of cardiovascular toxicity associated with chemotherapy used in breast cancer, and in modifying cardiovascular risk factors in breast cancer survivors. There is growing evidence indicating that the primary mechanism for this protective effect appears to be improved antioxidant capacity in the heart and vasculature and subsequent reduction of treatment-related oxidative stress in these structures. Further clinical research is needed to determine whether exercise is a feasible and effective nonpharmacological treatment to reduce cardiovascular morbidity and mortality in breast cancer survivors, to identify the cancer therapies for which it is effective, and to determine the optimal exercise dose. Safe and noninvasive measures that are sensitive to changes in cardiovascular function are required to answer these questions in patient populations. Cardiac strain, endothelial function, and cardiac biomarkers are suggested outcome measures for clinical research in this field.

Associations between multiple health risk behaviors and mental health among Chinese college students

Although there is substantial evidence that health risk behaviors increase risks of premature morbidity and mortality, little is known about the multiple health risk behaviors in Chinese college students. Here, we investigated the prevalence of multiple health risk behaviors and its relation to mental health among Chinese college students. A cross-sectional study was conducted in Wuhan, China from May to June 2012. The students reported their health risk behaviors using self-administered questionnaires. Depression and anxiety were assessed using the self-rating depression scale and self-rating anxiety scale, respectively. A total of 2422 college students (1433 males) aged 19.7 ± 1.2 years were participated in the study. The prevalence of physical inactivity, sleep disturbance, poor dietary behavior, Internet addiction disorder (IAD), frequent alcohol use and current smoking was 62.0, 42.6, 29.8, 22.3, 11.6 and 9.3%, respectively. Significantly increased risks for depression and anxiety were found among students with frequent alcohol use, sleep disturbance, poor dietary behavior and IAD. Two-step cluster analysis identified two different clusters. Participants in the cluster with more unhealthy behaviors showed significantly increased risk for depression (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.83, 2.67) and anxiety (OR: 2.32; 95% CI: 1.85, 2.92). This study indicates that a relatively high prevalence of multiple health risk behaviors was found among Chinese college students. Furthermore, the clustering of health risk behaviors was significantly associated with increased risks for depression and anxiety.

Haemodynamics of aerobic and resistance blood flow restriction exercise in young and older adults

PURPOSE

Light-load blood flow restriction exercise (BFRE) may provide a novel training method to limit the effects of age-related muscle atrophy in older adults. Therefore, the purpose of this study was to compare the haemodynamic response to resistance and aerobic BFRE between young adults (YA; n = 11; 22 ± 1 years) and older adults (OA; n = 13; 69 ± 1 years).

METHOD

On two occasions, participants completed BFRE or control exercise (CON). One occasion was leg press (LP; 20 % 1-RM) and the other was treadmill walking (TM; 4 km h(-1)). Haemodynamic responses (HR, Q, SV and BP) were recorded during baseline and exercise.

RESULT

At baseline, YA and OA were different for some haemodynamic parameters (e.g. BP, SV). The relative responses to BFRE were similar between YA and OA. Blood pressures increased more with BFRE, and also for LP over TM. Q increased similarly for BFRE and CON (in both LP and TM), but with elevated HR and reduced SV (TM only).

CONCLUSION

While BFR conferred slightly greater haemodynamic stress than CON, this was lower for walking than leg-press exercise. Given similar response magnitudes between YA and OA, these data support aerobic exercise being a more appropriate BFRE for prescription in older adults that may contribute to limiting the effects of age-related muscle atrophy.

Physical Activity and Change in Long Distance Corridor Walk Performance in the Health, Aging, and Body Composition Study

OBJECTIVES

To examine the prospective relationship between self-reported physical activity and aerobic fitness in the Health, Aging, and Body Composition Study (Health ABC) using the Long Distance Corridor Walk (LDCW).

DESIGN

Cohort study with 7 years of follow-up.

SETTING

Two U.S. clinical sites.

PARTICIPANTS

Community-dwelling older adults enrolled in Health ABC (N = 3,075, aged 70-79, 52% female, 42% black) with no self-reported difficulty walking one-quarter of a mile or climbing 10 steps.

MEASUREMENTS

Participants were classified based on a physical activity questionnaire as being inactive (≤1,000 kcal/wk exercise activity, ≤2,719 kcal/wk total physical activity), lifestyle active (≤1,000 kcal/wk exercise activity, >2,719 kcal/wk total physical activity), or exercisers (≥1,000 kcal/wk exercise activity). The LDCW, an endurance walking test (400 m), was administered at Years 1 (baseline), 2, 4, 6, and 8 to assess aerobic fitness.

RESULTS

At baseline, LDCW completion times (adjusted for age and sex) were 351.8 seconds (95% confidence interval (CI) = 346.9-356.8 seconds) for the inactive group, 335.9 seconds (95% CI = 332.7-339.1 seconds) for the lifestyle active group, and 307.7 seconds (95% CI = 303.2-312.3 seconds) for the exerciser group (P < .001). From baseline to Year 8, the inactive group slowed 36.1 seconds (95% CI = 28.4-43.8 seconds), the lifestyle active group slowed 38.1 seconds (95% CI = 33.6-42.4 seconds), and the exerciser group slowed 40.8 seconds (95% CI = 35.2-46.5 seconds), and did not differ significantly between groups. In linear mixed-effects models, the rate of change in LDCW time did not differ between the groups, although exercisers consistently had the fastest completion times (P < .001 for all pairwise comparisons).

CONCLUSION

Decline in LDCW time occurred regardless of baseline activity, although exercisers maintained higher aerobic fitness, which may delay reaching a critically low threshold of aerobic fitness at which independence is impaired.

Association between Cardiorespiratory Fitness and Health-Related Quality of Life among Patients at Risk for Cardiovascular Disease in Uruguay

PURPOSE

To examine the association between objectively measured CRF and physical and mental components of HRQoL in a Uruguayan cohort at risk for developing CVD.

METHODS

Patient data records from 2002-2012 at the Calidad de Vida Center were examined. To assess CRF, participants performed a submaximal exercise test. During the evaluation, participants also completed the SF-36, a HRQoL measure comprised of eight dimensions that are summarized by physical and mental component scores (PCS and MCS, respectively). ANCOVA was used to examine the relationship between HRQoL dimensions and CRF. Logistic regression was then used to compare the odds of having a HRQoL component score above the norm across CRF. All analyses were performed separately for males and females with additional stratified analyses across age and BMI conducted among significant trends.

RESULTS

A total of 2,302 subjects were included in the analysis. Among females, a significant relationship was observed between CRF and vitality, physical functioning, physical role, bodily pain, and general health dimensions. However, for males the only dimension found to be significantly associated with CRF was physical health. After adjusting for potential confounders, a significant linear trend (p<0.001) for PCS scores above the norm across CRF levels was observed for females only.

CONCLUSION

Among females with one or more risk factors for developing CVD, higher levels of CRF were positively associated with the vitality and physical dimensions of HRQoL, as well as the overall PCS. However, among males the only dimension associated with CRF was physical functioning. Future studies should examine this relationship among populations at risk for developing CVD in more detail and over time.

Clinical impact of gait training enhanced with visual kinematic biofeedback: Patients with Parkinson's disease and patients stable post stroke

As the world's population ages, falls, physical inactivity, decreased attention and impairments in balance and gait arise as a consequence of decreased sensation, weakness, trauma and degenerative disease. Progressive balance and gait training can facilitate postural righting, safe ambulation and community participation. This small randomized clinical trial evaluated if visual and kinematic feedback provided during supervised gait training would interfere or enhance mobility, endurance, balance, strength and flexibility in older individuals greater than one year post stroke (Gobbi et al., 2009) or Parkinson's disease (PD) (Gobbi et al., 2009). Twenty-four individuals consented to participate. The participants were stratified by diagnosis and randomly assigned to a control (usual gait training (Gobbi et al., 2009)) or an experimental group (usual gait training plus kinematic feedback (Gobbi et al., 2009)). At baseline and 6 weeks post training (18 h), subjects completed standardized tests (mobility, balance, strength, range of motion). Gains were described across all subjects, by treatment group and by diagnosis. Then they were compared for significance using nonparametric statistics. Twenty-three subjects completed the study with no adverse events. Across all subjects, by diagnosis (stroke and PD) and by training group (control and experimental), there were significant gains in mobility (gait speed, step length, endurance, and quality), balance (Berg Balance), range of motion and strength. There were no significant differences in the gain scores between the control and experimental groups. Subjects chronic post stroke made greater strength gains on the affected side than subjects with PD but otherwise there were no significant differences. In summary, during supervised gait training, dynamic visual kinematic feedback from wireless pressure and motion sensors had similar, positive effects as verbal, therapist feedback. A wireless kinematic feedback system could be used at home, to provide feedback and motivation for self correction of gait while simultaneously providing data to the therapist (at a distance).

A Pilot Study: examining the effects and tolerability of structured dance intervention for individuals with multiple sclerosis

PURPOSE

The aims of this pilot were to examine dance as a feasible intervention for persons with multiple sclerosis (MS), specifically to examine issues of tolerability and its longitudinal effects on participants. Dance is an enjoyable physical activity that has been investigated in other neurodegenerative populations but has yet to be studied in MS.

METHOD

A 4-week, two 60-min classes per week, pilot salsa dance intervention was administered to eight individuals with MS. The outcomes measured were effects on gait, balance, self-efficacy, motivation, physical activity and MS symptoms. They were administered at baseline, immediately post-intervention and at 3- and 6-month follow-ups.

RESULTS

Statistically significant pre-post intervention gains were found for the Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Activities-specific Balance Confidence Scale and Godin Leisure Time Questionnaire. Significant improvements were also found for the TUG, DGI and MS Walking Scale between baseline and 3-month follow-up assessments. Participants did not report any problems with fatigue or intolerability with the 60-min suggestions, further supporting the feasibility for the concept of a dance intervention.

CONCLUSIONS

This study suggests that dance for persons with MS may have promise for improving physical activity, gait and balance.

IMPLICATIONS FOR REHABILITATION

Although structured dance has reported benefits in elderly populations and in individuals with cardiovascular and neurological impairments, there is virtually nothing known regarding dance in the MS population. This pilot salsa dance study shows that structured dance demonstrates promise of being well-tolerated, safe and effective at promoting physical activity in people with MS without increased fatigue. A 12-week study has been initiated to test the robustness of initial observations and further examine factors influencing participants' physical activity adherence and behavioral change.

Characteristics of attitude and recommendation of oncologists toward exercise in South Korea: a cross sectional survey study

Background

The purpose of the present study was to examine 1) characteristics and attitudes of oncologists toward exercise and toward recommending exercise to their patients, 2) association among oncologists’ own physical activity levels, exercise recommendations, and their attitudes toward recommending exercise.

Methods

A total of 167 oncologists participated in this survey study (41 surgeons, 78 medical oncologists, 25 radiation oncologists, and 21 others). Most oncologists included in the study treat more than one type of cancer, including colorectal, gastric, breast, lung, and liver cancer. To analyze the data, the one-way ANOVA, and t-test were used. All data were indicated for mean, SD, and proportions.

Results

Most oncologists agreed that exercise is beneficial (72.8%) and important (69.6%), but only 39.2% of them agreed that exercise is safe, and only 7.2% believed that cancer patients manage to exercise during cancer treatment. Forty-six percentage of the surveyed oncologists recommended exercise to their patients during the past month. The average amount of participation in physical activity by oncologists who participated in the study was 139.5 ± 120.3 min per week, and 11.4% of the study participants met the American College of Sports Medicine (ACSM) guidelines. Oncologists’ own physical activity levels were associated with their attitudes toward recommending exercise. Belief in the benefits of exercise in the performance of daily tasks, improvement of mental health, and the attenuation of physical decline from treatment were the three most prevalent reasons why oncologists recommend exercise to their patients. Barriers to recommending exercise to patients included lack of time, unclear exercise recommendations, and the safety of patients.

Conclusions

Oncologists have favorable attitudes toward exercise and toward recommending exercise to their patients during treatment. However, they also experience barriers to recommending exercise, including lack of time, unclear exercise guidelines for cancer patients, and concerns regarding the safety of exercise.

Health-related quality of life in relation to different levels of disease severity in patients with chronic heart failure

The purpose of the present study was to compare differences in physiological outcomes and health-related quality of life (HRQOL) in relation to degree of illness in patients with chronic heart failure (CHF) and to compare HRQOL in CHF patients with that of a normal Japanese population. One hundred and twenty-five patients with stable CHF (93 men, 32 women, mean age 63.3 ± 12.4 years) with left ventricular ejection fraction (LVEF) of less than 40% were enrolled in the present study. We used New York Heart Association (NYHA) functional class as an index of degree of illness. In 64 of the 125 patients, physiological outcome measures included peak oxygen uptake (peak O2) and E/CO2 slope. HRQOL was assessed with the medical outcome study short form-36 (SF-36) Japanese version. In addition, SF-36 scores of CHF patients were compared against Japanese standard values. Age and LVEF did not differ according to NYHA functional class. The eight SF-36 subscale scores and peak O2 decreased with increases in the NYHA functional classes, whereas E/CO2 slope increased with increases in NYHA functional class (p<0.05). Of the 8 SF-36 subscales measured in CHF patients, only the bodily pain score attained that of the normal Japanese population. These findings suggest that HRQOL decreases as NYHA functional class increases and other physiological measures worsen. In addition, HRQOL values of CHF patients were low in comparison with standard values of a normal Japanese population.

Study protocol: effects of school gardens on children's physical activity

BACKGROUND

Childhood obesity is an epidemic. Strategies are needed to promote children's healthy habits related to diet and physical activity. School gardens have the potential to bolster children's physical activity and reduce time spent in sedentary activity; however little research has examined the effect of gardens on children's physical activity. This randomized controlled trial (RCT) examines the effect of school gardens on children's overall physical activity and sedentary behavior; and on children's physical activity during the school day. In addition, physical activity levels and postures are compared using direct observation, outdoors, in the garden and indoors, in the classroom.

METHODS/DESIGN

Twelve New York State schools are randomly assigned to receive the school garden intervention or to serve in the wait-list control group that receives gardens and lessons at the end of the study. The intervention consists of a raised bed garden; access to a curriculum focused on nutrition, horticulture, and plant science and including activities and snack suggestions; resources for the school including information about food safety in the garden and related topics; a garden implementation guide provided guidance regarding planning, planting and maintaining the garden throughout the year; gardening during the summer; engaging volunteers; building community capacity, and sustaining the program. Data are collected at baseline and 3 post-intervention follow-up waves at 6, 12, and 18 months. Physical activity (PA) "usually" and "yesterday" is measured using surveys at each wave. In addition, at-school PA is measured using accelerometry for 3 days at each wave. Direct observation (PARAGON) is used to compare PA during an indoor classroom lesson versus outdoor, garden-based lesson.

DISCUSSION

Results of this study will provide insight regarding the potential for school gardens to increase children's physical activity and decrease sedentary behaviors.

TRIAL REGISTRATION

Clinicaltrial.gov # NCT02148315.

Potential self-regulatory mechanisms of yoga for psychological health

Research suggesting the beneficial effects of yoga on myriad aspects of psychological health has proliferated in recent years, yet there is currently no overarching framework by which to understand yoga’s potential beneficial effects. Here we provide a theoretical framework and systems-based network model of yoga that focuses on integration of top-down and bottom-up forms of self-regulation. We begin by contextualizing yoga in historical and contemporary settings, and then detail how specific components of yoga practice may affect cognitive, emotional, behavioral, and autonomic output under stress through an emphasis on interoception and bottom-up input, resulting in physical and psychological health. The model describes yoga practice as a comprehensive skillset of synergistic process tools that facilitate bidirectional feedback and integration between high- and low-level brain networks, and afferent and re-afferent input from interoceptive processes (somatosensory, viscerosensory, chemosensory). From a predictive coding perspective we propose a shift to perceptual inference for stress modulation and optimal self-regulation. We describe how the processes that sub-serve self-regulation become more automatized and efficient over time and practice, requiring less effort to initiate when necessary and terminate more rapidly when no longer needed. To support our proposed model, we present the available evidence for yoga affecting self-regulatory pathways, integrating existing constructs from behavior theory and cognitive neuroscience with emerging yoga and meditation research. This paper is intended to guide future basic and clinical research, specifically targeting areas of development in the treatment of stress-mediated psychological disorders.

The Use of Text Messaging to Promote Physical Activity in Working Women: A Randomized Controlled Trial

BACKGROUND

The study evaluated the effects of a text message intervention on physical activity in adult working women.

METHODS

Eighty-seven participants were randomized to an intervention (n = 41) or control group (n = 46). Pedometer step counts and measures of self-efficacy were collected at baseline, 12 weeks, and 24 weeks. Intervention participants received approximately 3 text messages per week that were motivational, informational, and specific to performing physical activity.

RESULTS

ANCOVA results showed a significant difference between groups for mean steps per day at 12 weeks (6540.0 vs. 5685.0, P = .01) and no significant difference at 24 weeks (6867.7 vs. 6189.0, P = .06). There was no change in mean step counts during or after the intervention compared with baseline. There was a significant difference between groups for mean self-efficacy scores at 12 weeks (68.5 vs. 60.3, P = .02) and at 24 weeks (67.3 vs. 59.0, P = .03).

CONCLUSIONS

Intervention participants had higher step counts after 12 and 24 weeks compared with a control group; however, the difference was significant only at the midpoint of the intervention and was attributable to a decrease in steps for the control group. Text messaging did not increase step counts but may be a cost-effective tool for maintenance of physical activity behavior.

Associations of physical activity, screen time with depression, anxiety and sleep quality among Chinese college freshmen

Objectives

To investigate the independent and interactive associations of physical activity (PA) and screen time (ST) with depression, anxiety and sleep quality among Chinese college students.

Methods

A cross-sectional study was conducted in Wuhan University, China from November to December 2011. The students reported their PA, ST and socio-economic characteristics using self-administered questionnaires. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Depression and anxiety were assessed using the Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS), respectively. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the independent and interactive relationships of PA and ST with depression, anxiety and sleep quality.

Results

A total of 1106 freshmen (471 females and 635 males) aged 18.9±0.9 years were included in the study. After adjustment for potential confounders, high PA and low ST were independently associated with significantly lower risks for poor sleep quality (OR: 0.48, 95% CI: 0.30–0.78) and depression (OR: 0.67, 95%CI: 0.44–0.89), respectively. An interactive inverse association was observed for combined effects of PA and low ST on depression (OR: 0.62, 95%CI: 0.40–0.92) and sleep quality (OR: 0.51, 95%CI: 0.27–0.91). No statistically significant associations were found between PA, ST and anxiety among the participants.

Conclusions

These findings suggest an independent and interactive relationship of high PA and low ST with significantly reduced prevalence of depressive problems and favorable sleep quality among Chinese college freshmen.

Effect of a physical conditioning versus health promotion intervention in dancers: a randomized controlled trial

Although dancing requires extensive physical exertion, dancers do not often train their physical fitness outside dance classes. Reduced aerobic capacity, lower muscle strength and altered motor control have been suggested as contributing factors for musculoskeletal injuries in dancers. This randomized controlled trial examined whether an intervention program improves aerobic capacity and explosive strength and reduces musculoskeletal injuries in dancers. Forty-four dancers were randomly allocated to a 4-month conditioning (i.e. endurance, strength and motor control training) or health promotion program (educational sessions). Outcome assessment was conducted by blinded assessors. When accounting for differences at baseline, no significant differences were observed between the groups following the intervention, except for the subscale "Pain" of the Short Form 36 Questionnaire (p = 0.03). Injury incidence rate and the proportion of injured dancers were identical in both groups, but dancers following the conditioning program had significant less low back injuries (p = 0.02). Supplementing regular dance training with a 4-month conditioning program does not lead to a significant increase in aerobic capacity or explosive strength in pre-professional dancers compared to a health promotion program without conditioning training, but leads to less reported pain. Further research should explore how additional training may be organized, taking into account the demanding dance schedule of pre-professional dancers. The trial is registered at ClinicalTrials.gov, number NCT01440153.

Standardised pre-competitive screening of athletes in some European and African countries: the SMILE study

Most of the available data on the cardiovascular screening of athletes come from Italy, with fewer records being available outside of Italy and for non-Caucasian populations. The goals of the SMILE project (Sport Medicine Intervention to save Lives through ECG) are to evaluate the usefulness of 12-lead ECGs for the detection of cardiac diseases in athletes from three European countries and one African country and to estimate how many second-level examinations are needed subsequent to the initial screening in order to classify athletes with abnormal characteristics. A digital network consisting of Sport Centres and second and third opinion centres was set up in Greece, Germany, France and Algeria. Standard digital data input was carried out through the application of 12-lead ECGs, Bethesda questionnaires and physical examinations. Two hundred ninety-three of the 6,634 consecutive athletes required further evaluation, mostly (88.4 %) as a consequence of abnormal ECGs. After careful evaluation, 237 were determined to be healthy or apparently healthy, while 56 athletes were found to have cardiac disorders and were thus disqualified from active participation in sports. There was a large difference in the prevalence of diseases detected in Europe as compared with Algeria (0.23 and 4.01 %, respectively). Our data confirmed the noteworthy value of 12-lead resting ECGs as compared with other first-level evaluations, especially in athletes with asymptomatic cardiac diseases. Its value seems to have been even higher in Algeria than in the European countries. The establishment of a digital network of Sport Centres for second/third opinions in conjunction with the use of standard digital data input seems to be a valuable means for increasing the effectiveness of screening.

Multicontextual correlates of adolescent leisure-time physical activity

BACKGROUND

Adolescent moderate to vigorous physical activity (MVPA) is influenced by many factors. MVPA-promotion interventions would fare better if these multiple determinants were better understood.

PURPOSE

To simultaneously assess overall and relative contributions of factors from personal, family, friend, school, and neighborhood contexts to adolescent MVPA. It was hypothesized that (1) key correlates would emerge in each context and (2) factors from more- versus less-proximal contexts would relate more strongly to MVPA.

METHODS

Students in grades 6-12 (n=2,793; mean age=14.4 [SD=2.0] years; 53% girls) were recruited from 20 Minnesota public schools in 2009-2010 to participate in the Eating and Activity in Teens 2010 study. Regression analyses conducted in 2013 examined factors related to weekly MVPA. Data were collected from adolescent participants, their parents and friends, school teachers and administrators, and GIS sources.

RESULTS

Fifty multicontextual factors explained 25% of MVPA variance for boys and 27% for girls. Personal factors (e.g., self-efficacy) were most predictive of MVPA, followed by social factors (e.g., support for PA); environmental factors (e.g., access to PA resources) were least predictive of adolescent PA. Gender differences emerged for several predictors (e.g., in mutually adjusted analyses, MVPA among girls, but not boys, related positively to distance to trails and MVPA among female friends and fathers, and related negatively to perceived barriers).

CONCLUSIONS

Stronger linkages exist between adolescent MVPA and more-proximal (personal, family, and friend) factors compared to more-distal (school and neighborhood) factors, suggesting the importance of working with adolescents, their families, and friends to promote PA.