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Hieda M, Sarma S, Hearon CM, MacNamara JP, Dias KA, Samels M, Palmer D, Livingston S, Morris M, Levine BD. One-Year Committed Exercise Training Reverses Abnormal Left Ventricular Myocardial Stiffness in Patients With Stage B Heart Failure With Preserved Ejection Fraction. Circulation 2021; 144:934-946. [PMID: 34543068 DOI: 10.1161/circulationaha.121.054117] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with left ventricular (LV) hypertrophy and elevated cardiac biomarkers in middle age are at increased risk for the development of heart failure with preserved ejection fraction. Prolonged exercise training reverses the LV stiffening associated with healthy but sedentary aging; however, whether it can also normalize LV myocardial stiffness in patients at high risk for heart failure with preserved ejection fraction is unknown. In a prospective, randomized controlled trial, we hypothesized that 1-year prolonged exercise training would reduce LV myocardial stiffness in patients with LV hypertrophy. METHODS Forty-six patients with LV hypertrophy (LV septum >11 mm) and elevated cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [>40 pg/mL] or high-sensitivity troponin T [>0.6 pg/mL]) were randomly assigned to either 1 year of high-intensity exercise training (n=30) or attention control (n=16). Right-heart catheterization and 3-dimensional echocardiography were performed while preload was manipulated using both lower body negative pressure and rapid saline infusion to define the LV end-diastolic pressure-volume relationship. A constant representing LV myocardial stiffness was calculated from the following: P=S×[Exp {a (V-V0)}-1], where "P" is transmural pressure (pulmonary capillary wedge pressure - right atrial pressure), "S" is the pressure asymptote of the curve, "V" is the LV end-diastolic volume index, "V0" is equilibrium volume, and "a" is the constant that characterizes LV myocardial stiffness. RESULTS Thirty-one participants (exercise group [n=20]: 54±6 years, 65% male; and controls (n=11): 51±6 years, 55% male) completed the study. One year of exercise training increased max by 21% (baseline 26.0±5.3 to 1 year later 31.3±5.8 mL·min-1·kg-1, P<0.0001, interaction P=0.0004), whereas there was no significant change in max in controls (baseline 24.6±3.4 to 1 year later 24.2±4.1 mL·min-1·kg-1, P=0.986). LV myocardial stiffness was reduced (right and downward shift in the end-diastolic pressure-volume relationship; LV myocardial stiffness: baseline 0.062±0.020 to 1 year later 0.031±0.009), whereas there was no significant change in controls (baseline 0.061±0.033 to 1 year later 0.066±0.031, interaction P=0.001). CONCLUSIONS In patients with LV hypertrophy and elevated cardiac biomarkers (stage B heart failure with preserved ejection fraction), 1 year of exercise training reduced LV myocardial stiffness. Thus, exercise training may provide protection against the future risk of heart failure with preserved ejection fraction in such patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03476785.
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Affiliation(s)
- Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.).,Kyushu University, School of Medicine, Fukuoka, Japan (M.H.)
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Sheryl Livingston
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Margot Morris
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
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Abstract
One- half of women in the United States do not meet the weekly dose of physical activity recommended by the Centers for Disease Control. Many women could benefit tremendously if they were to adopt a more active lifestyle. Health benefits from exercise include lowering the risk for cardiovascular disease, slowing the rate of bone loss in osteoporosis, and improving mood during pregnancy. In this article, we review the health benefits that women may gain from physical activity and the recommendations for physical activity for adults in the United States. We offer evidence supporting use of the exercise prescription, discuss how to write an exercise prescription, and how to tailor the exercise prescription for women with particular medical problems.
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Affiliation(s)
- Carlin Senter
- />Departments of Medicine and Orthopedics, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
| | - Nicole Appelle
- />Division of General Internal Medicine, University of California, San Francisco, 1545 Divisadero, 2nd Floor, San Francisco, CA 94143 USA
| | - Sarina K. Behera
- />Departments of Cardiology and Pediatrics, California Pacific Medical Center, 3700 California Street, Ste 1560, San Francisco, CA 94118 USA
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3
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Baruth M, Wilcox S, Sallis JF, King AC, Marcus BH, Blair SN. Changes in CVD risk factors in the activity counseling trial. Int J Gen Med 2011; 4:53-62. [PMID: 21403793 PMCID: PMC3048340 DOI: 10.2147/ijgm.s15686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary care facilities may be a natural setting for delivering interventions that focus on behaviors that improve cardiovascular disease (CVD) risk factors. The purpose of this study was to examine the 24-month effects of the Activity Counseling Trial (ACT) on CVD risk factors, to examine whether changes in CVD risk factors differed according to baseline risk factor status, and to examine whether changes in fitness were associated with changes in CVD risk factors. ACT was a 24-month multicenter randomized controlled trial to increase physical activity. Participants were 874 inactive men and women aged 35-74 years. Participants were randomly assigned to one of three arms that varied by level of counseling, intensity, and resource requirements. Because there were no significant differences in change over time between arms on any of the CVD risk factors examined, all arms were combined, and the effects of time, independent of arm, were examined separately for men and women. Time × Baseline risk factor status interactions examined whether changes in CVD risk factors differed according to baseline risk factor status. Significant improvements in total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, the ratio of total cholesterol to HDL-C, and triglycerides were seen in both men and women who had high (or low for HDL-C) baseline levels of risk factors, whereas significant improvements in diastolic blood pressure were seen only in those men with high baseline levels. There were no improvements in any risk factors among participants with normal baseline levels. Changes in fitness were associated with changes in a number of CVD risk factors. However, most relationships disappeared after controlling for changes in body weight. Improvements in lipids from the ACT interventions could reduce the risk of coronary heart disease in people with already high levels of lipids by 16%-26% in men and 11%-16% in women. Interventions that can be implemented in health care settings nationwide and result in meaningful population-wide changes in CVD risk factors are needed. The ACT physical activity interventions produced substantial improvements among men and women with elevated CVD risk factors.
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Affiliation(s)
- Meghan Baruth
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Public Health Research Center, Columbia, SC, USA.
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Baruth M, Wilcox S, Dunn AL, King AC, Marcus BH, Rejeski WJ, Sallis JF, Blair SN. Psychosocial mediators of physical activity and fitness changes in the activity counseling trial. Ann Behav Med 2010; 39:274-89. [PMID: 20431975 DOI: 10.1007/s12160-010-9178-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Improved understanding of the mediators of physical activity (PA) interventions could lead to improvements in theory and programs. PURPOSE To examine the 24-month mediating effects of psychosocial variables on PA and cardiorespiratory fitness (CRF) outcomes in 878 initially sedentary adults aged 35-75 participating in the Activity Counseling Trial. METHODS Participants were assigned to one of three intervention arms: physician advice, assistance, or counseling. MacKinnon's product of coefficients was used to test for longitudinal and contemporaneous mediation. RESULTS Changes in behavioral processes of change from baseline to 24 months significantly mediated the relationship between the active intervention arms and improvements in PA and CRF from baseline to 24 months in both men and women. None of the other psychosocial variables tested met criteria for mediation. CONCLUSIONS Results indicate that behavioral interventions should incorporate methods to encourage participants to use these behavioral strategies as they attempt to become more active.
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Affiliation(s)
- Meghan Baruth
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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5
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Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH, Kumanyika S, Kraus WE, Fleg JL, Redeker NS, Meininger JC, Banks J, Stuart-Shor EM, Fletcher BJ, Miller TD, Hughes S, Braun LT, Kopin LA, Berra K, Hayman LL, Ewing LJ, Ades PA, Durstine JL, Houston-Miller N, Burke LE. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 2010; 122:406-41. [PMID: 20625115 PMCID: PMC6893884 DOI: 10.1161/cir.0b013e3181e8edf1] [Citation(s) in RCA: 668] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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James D, Mills H, Crone D, Johnston LH, Morris C, Gidlow CJ. Factors associated with physical activity referral completion and health outcomes. J Sports Sci 2009; 27:1007-17. [PMID: 19847684 DOI: 10.1080/02640410903214248] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Participant socio-demographic characteristics and referral reason were investigated in relation to completion and health outcomes in a Primary Care Physical Activity Referral Scheme using a prospective population-based longitudinal design. Participants (n = 1735) were recruited over a 2-year period. A three-stage binary logistic regression analysis identified the factors associated with the outcomes of completion (model 1), body mass reduction (model 2) and blood pressure reduction (model 3). Participant's age, gender, ethnicity, occupation and referral reason were the independent variables for model 1, with the variables of completion added in model 2 and completion and body mass reduction added in model 3. Logistic regression analysis revealed that increasing age is associated with the likelihood of completion (Odds Ratio, OR = 1.019; Confidence Interval, CI = 1.008-1.030; P = 0.001). Participants with a pulmonary condition are less likely to complete (OR = 0.546; CI = 0.346-0.860; P < 0.01) compared to those referred for cardiovascular conditions. For ethnicity, in comparison to the white category, patients in the mixed category are significantly more likely to achieve a reduction in body mass (OR = 3.991; CI = 1.191-13.373; P < 0.05). Those who complete are more likely to achieve a reduction in body mass (OR = 3.541; CI = 2.721-4.608; P < 0.001). When compared to the unemployed category, the skilled manual category had an increased likelihood of achieving a reduction in blood pressure (OR = 1.875; CI = 1.044-3.227; P < 0.05). Participants who completed also demonstrated an increased likelihood of a reduction in blood pressure (OR = 1.680; CI = 1.250-2.003; P < 0.001). Furthermore, those participants who achieved a reduction in body mass had an increased likelihood of achieving a reduction in blood pressure (OR = 1.292; CI = 1.008-1.641; P < 0.05). Completion is associated with health outcomes of reduced body mass and blood pressure.
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Affiliation(s)
- David James
- Faculty of Sport, Health & Social Care, University of Gloucestershire, Gloucester, United Kingdom.
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Grandes G, Sánchez A, Torcal J, Sánchez-Pinilla RO, Lizarraga K, Serra J. Targeting physical activity promotion in general practice: characteristics of inactive patients and willingness to change. BMC Public Health 2008; 8:172. [PMID: 18498623 PMCID: PMC2412873 DOI: 10.1186/1471-2458-8-172] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 05/22/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Counselling in routine general practice to promote physical activity (PA) is advocated, but inadequate evidence is available to support this intervention, and its sustainable implementation over time is difficult. OBJECTIVES To describe the characteristics of physically inactive adults visiting GPs and the factors associated with their willingness to change PA. METHODS A cross-sectional analysis of 4317 Spanish people aged 20-80 years, selected by systematic sampling among those attending 56 public primary health care practices identified as inactive by their GPs in 2003. PA (7-day PAR), PA stage of change, health-related quality of life (SF-36), cardiovascular risk factors, and social and demographic characteristics were measured. Multivariate mixed effects ordinal logistic models were adjusted to identify factors associated with motivational readiness to change. RESULTS At least 70% (95% CI: 67.6% to 72.8%) of patients assessed by GPs did not achieve minimal PA recommendations. In addition, 85% (95% CI: 83% to 86.3%) had at least an additional cardiovascular risk factor. Only 30% (95% CI: 25.8% to 33.5%) were prepared for or attempting a change. A younger age; retirement or work at home; higher education and social class levels; obesity; and hypertension were associated with a higher motivational readiness to change (p < 0.05). CONCLUSION The overburden that would result from counselling such a high proportion of inactive primary care patients justifies a targeted strategy for PA promotion in family practice. Selection of a target population based on readiness to change, the combination of risk factors and socio-demographic characteristics of patients is suggested in order to prioritise promotion efforts.
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Affiliation(s)
- Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Health Service, Bilbao, Spain
- Unidad de Investigación de Atención Primaria de Bizkaia, Osakidetza, Luis Power 18, 4a planta. 48014 – Bilbao, Spain
| | - Alvaro Sánchez
- Primary Care Research Unit of Bizkaia, Basque Health Service, Bilbao, Spain
| | - Jesús Torcal
- Basauri-Ariz Health Centre, Basque Health Service, Basauri, Spain
| | | | - Kepa Lizarraga
- Sports Medicine Service of the Bizkaia's Provincial Administration, Bilbao, Spain
| | - Javier Serra
- Sports Medicine Service of the Bizkaia's Provincial Administration, Bilbao, Spain
| | - The PEPAF Group
- Preventive Services and Health Promotion Research Network -redIAPP-, Spain
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8
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Garber CE, Allsworth JE, Marcus BH, Hesser J, Lapane KL. Correlates of the stages of change for physical activity in a population survey. Am J Public Health 2008; 98:897-904. [PMID: 18381988 DOI: 10.2105/ajph.2007.123075] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to identify variables associated with being in a particular stage of change for physical activity-a measure of behavioral intention to engage in regular physical activity. Understanding behavioral intentions can be useful in explaining why individuals are physically inactive or active. METHODS Data from the Rhode Island 2000 Behavioral Risk Factor Surveillance System were used to evaluate predictors of stage of change for physical activity. There were 3454 observations in the data set, representing a weighted population of 742636 people. Estimates were obtained from polytomous multiple logistic models. RESULTS Being a woman, Hispanic, non-Hispanic Black, and older than 55 years of age were associated with being in precontemplation and contemplation stages of change rather than maintenance. Self-perceived health status and rarely feeling healthy or full of energy were strongly predictive of stage of change. Having a health limitation was a dichotomous predictor, predicting being in action and precontemplation stages. CONCLUSIONS Several sociodemographic and health variables were associated with varying patterns of stages of change for physical activity. The complexity of individual intentions for physical activity provides evidence for the potential existence of mediating, effect-modifying, and confounding variables that differ depending on individual characteristics.
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Affiliation(s)
- Carol Ewing Garber
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Anderson RT, King A, Stewart AL, Camacho F, Rejeski WJ. Physical activity counseling in primary care and patient well-being: Do patients benefit? Ann Behav Med 2006; 30:146-54. [PMID: 16173911 DOI: 10.1207/s15324796abm3002_7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease. Benefits to health-related quality of life (HRQL) and subjective well-being may be as important and take less time to accrue. PURPOSE We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial (ACT), both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention. METHODS In ACT, 395 female and 479 male inactive patients ages 35 to 75 years were randomized to one of: physician advice, advice plus behavioral counseling during primary care visits, or advice plus behavioral counseling that also included telephone contact and behavioral classes. Participants were assessed at baseline, 6 months, and 24 months. HRQL was assessed as perceived quality of life, perceived stress, depression, and general health. Satisfaction with function and appearance, self-efficacy, and social support were also assessed. RESULTS At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only. Men had reductions in daily stress across all treatment arms. These results mirrored VO2max changes observed per group. Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months. CONCLUSIONS Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy.
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Affiliation(s)
- Roger T Anderson
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27104, USA.
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King AC, Marcus B, Ahn D, Dunn AL, Rejeski WJ, Sallis JF, Coday M. Identifying subgroups that succeed or fail with three levels of physical activity intervention: The activity counseling trial. Health Psychol 2006; 25:336-47. [PMID: 16719605 DOI: 10.1037/0278-6133.25.3.336] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.
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Affiliation(s)
- Abby C King
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, CA 94305-5705, USA.
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Kahan E, Fogelman Y, Bloch B. Correlations of work, leisure, and sports physical activities and health status with socioeconomic factors: a national study in Israel. Postgrad Med J 2005; 81:262-5. [PMID: 15811893 PMCID: PMC1743245 DOI: 10.1136/pgmj.2004.022293] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate levels of physical activities at work, leisure, and sports and to correlate them with socioeconomic and health factors. METHODS Validated questionnaire administered to a random sample of 406 adults. Items covered demographic data, health status, smoking, and duration, frequency, intensity of physical activities. Indices of physical activity at work, leisure, and sports were analysed. RESULTS Adults (both sexes) with poor self perceived health status and less than 13 years of education, regardless of their body mass index, perform no or few physical activities during their leisure time. CONCLUSIONS The correlations of physical activity with socioeconomic and health factors differ significantly for work, leisure, and sports. Physicians should differentiate physical activities by type and intensity during anamneses.
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Affiliation(s)
- E Kahan
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Fogelman Y, Bloch B, Kahan E. Assessment of participation in physical activities and relationship to socioeconomic and health factors. The controversial value of self-perception. PATIENT EDUCATION AND COUNSELING 2004; 53:95-99. [PMID: 15062910 DOI: 10.1016/s0738-3991(03)00119-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2002] [Revised: 01/28/2003] [Accepted: 03/17/2003] [Indexed: 05/24/2023]
Abstract
Physician counseling on physical activities for sedentary people is usually based on anamneses. The aim of the present study was to investigate the accuracy of self-perception of participation in physical activities, and the correlation of physical activity with background factors. A random sample of 276 individuals aged 20-65 years completed a detailed questionnaire on type and intensity of physical activity and associated socioeconomic and health factors. Physical activities were divided into work, leisure-time, and sports and rated according to Baecke's four-item index. In addition, subjects answered a yes/no item that resembled the general question regarding physical activity usually asked by physicians in a typical anamnesis. About half of the population was found to lead a sedentary life-style. The lower the level of education, the greater the physical activity at work. Males had a higher sports index than females. Interestingly, 1.3% of those with a high questionnaire score reported on the anamnesis question that they did not engage in regular physical activity, whereas 17.5% with a low questionnaire score answered "yes" to the last item. In conclusion, self-reports on physical activity may be inaccurate and to ensure proper counseling, primary care physicians must place greater weight on the patient history.
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Affiliation(s)
- Yacov Fogelman
- Department of Family Practice, Haemek Medical Center, Afula and Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42:1206-52. [PMID: 14656957 DOI: 10.1161/01.hyp.0000107251.49515.c2] [Citation(s) in RCA: 8821] [Impact Index Per Article: 420.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.
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Elley CR, Kerse NM, Arroll B. Why target sedentary adults in primary health care? Baseline results from the Waikato Heart, Health, and Activity Study. Prev Med 2003; 37:342-8. [PMID: 14507491 DOI: 10.1016/s0091-7435(03)00142-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The question of whether the public health issue of physical inactivity should be addressed in primary health care is a controversial matter. METHODS Baseline cross-sectional analysis of a physician-based physical activity intervention trial involving sedentary adults was undertaken within 42 rural and urban family practices in New Zealand to examine self-reported levels of physical activity and cardiovascular risk factors. A self-administered single question about physical activity was used to screen 40- to 79-year-old patients from waiting rooms for physical inactivity. RESULTS The positive predictive value of the screening question was 81%. Participation rates for the study were high, including 74% of family physicians (n = 117) in the region. Eighty-eight percent of consecutive patients in the age group agreed to be screened and 46% were identified as sedentary. Of those eligible, 66% (n = 878) agreed to participate in a study involving a lifestyle intervention from their family physician. Blood pressure and BMI were significantly greater than that in the general population. There were high rates of hypertension (52%), diabetes (10.5%), obesity (43%), previous cardiovascular disease (19%), and risk factors for cardiovascular disease (93%). Decreasing total energy expenditure was associated with increasing cardiovascular risk (P = 0.001). CONCLUSION Sedentary adults in primary care represent a high cardiovascular risk population. Screening for inactivity in primary care is effective and efficient. Two-thirds of sedentary adults agreed to receive a lifestyle intervention from their family physician.
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Affiliation(s)
- C Raina Elley
- Department of General Practice and Primary Health Care, University of Auckland, P.O. Box 92019, Auckland, New Zealand.
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Conn VS, Burks KJ, Pomeroy SL, Cochran JE. Are there different predictors of distinct exercise components? Rehabil Nurs 2003; 28:87-91, 97. [PMID: 12747247 DOI: 10.1002/j.2048-7940.2003.tb02039.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rehabilitation nurses often recommend to aging adults that they exercise. Despite the recommendations and the widespread evidence of its benefits, few older adults exercise. This study examined the predictors of distinct components of exercise behavior: exercise intensity, frequency per week, duration of sessions, and months per year. Social cognitive theory predictors of exercise were measured with previously developed instruments. Interviews were conducted with community-dwelling elders (N = 147). The study constructs accounted for modest to moderate amounts of variance (41% of months per year, 35% of frequency, 35% of exercise intensity, and 20% of episode duration). Self-efficacy was the most important predictor of each construct, with Beta weights ranging from .23 to .53. Barriers significantly predicted months' per year, frequency per week, and exercise intensity, but not the duration of individual exercise sessions. Outcome expectancy predicted only exercise intensity. These findings support the importance of self-efficacy and perceived barriers for most components of exercise behavior.
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Affiliation(s)
- Vicki S Conn
- S317 School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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Toobert DJ, Strycker LA, Glasgow RE, Bagdade JD. If you build it, will they come? Reach and Adoption associated with a comprehensive lifestyle management program for women with type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2002; 48:99-105. [PMID: 12401412 DOI: 10.1016/s0738-3991(02)00120-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper describes recruitment and participation of physicians and patients in a randomized study to evaluate the effects of a moderately intensive (2-year) lifestyle management intervention for post-menopausal women with type 2 diabetes at risk for coronary heart disease (CHD). The purpose of this report is to answer two practical public health questions: (1) "Will physicians refer their patients with type 2 diabetes to such an intensive lifestyle change program?" and, if so, (2) "Will these patients participate?" Results showed high (70%) acceptance among physicians. About 51% of eligible patients agreed to participate, which was encouraging given the substantial time commitment involved. Main reasons for refusal were lack of eligible patients (among physicians) and lack of time (among patients). Patient participants and non-participants did not differ significantly on age, body mass, and other demographic and medical variables. Based on these results, it appears that appropriate recruitment procedures will yield a representative sample of women willing to participate in intensive lifestyle management programs.
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Affiliation(s)
- Deborah J Toobert
- Oregon Research Institute, 1715 Franklin Blvd., 97403-1983, Eugene, OR, USA.
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Dejong G, Palsbo SE, Beatty PW, Jones GC, Knoll T, Neri MT. The organization and financing of health services for persons with disabilities. Milbank Q 2002; 80:261-301. [PMID: 12101873 PMCID: PMC2690107 DOI: 10.1111/1468-0009.t01-1-00004] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Americans with disabilities are rarely considered a distinct group of health care users in the same way as are older Americans, children, racial and ethnic minorities, and others who are perceived to have different needs and access issues. Indeed, to some extent individuals with disabilities overlap with all these groups. But they also have distinct needs with material implications for the organization, delivery, and financing of health care services. Despite the disproportionate health care needs and expenditures of many--though not all--individuals with disabilities, the mainstream health services research community has largely neglected them. This article outlines the most pressing health service research issues in addressing the health care needs of individuals with disabilities.
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Affiliation(s)
- Gerben Dejong
- Center for Health and Disability Research, National Rehabilitation Hospital and MedStar Research Institute, Suite 400, 1016 16th Street, NW, Washington, D.C. 20036, USA.
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18
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King AC, Baumann K, O'Sullivan P, Wilcox S, Castro C. Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2002; 57:M26-36. [PMID: 11773209 DOI: 10.1093/gerona/57.1.m26] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study objective was to determine the health and quality-of-life effects of moderate-intensity exercise among older women family caregivers. METHODS This 12-month randomized controlled trial involved a volunteer sample of 100 women aged 49 to 82 years who were sedentary, free of cardiovascular disease, and caring for a relative with dementia. Participants were randomized to 12 months of home-based, telephone-supervised, moderate-intensity exercise training or to an attention-control (nutrition education) program. Exercise consisted of four 30- to 40-minute endurance exercise sessions (brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate. Main outcomes were stress-induced cardiovascular reactivity levels, rated sleep quality, and reported psychological distress. RESULTS Compared with nutrition participants (NU), exercise participants (EX) showed significant improvements in the following: total energy expenditure (baseline and post-test means [SD] for EX = 1.4 [1.9] and 2.2 [2.2] kcal/kg/day; for NU = 1.2 [1.7] and 1.2 [1.6] kcal/kg/day; p <.02); stress-induced blood pressure reactivity (baseline and post-test systolic blood pressure reactivity values for EX = 21.6 [12.3] and 12.4 [11.2] mm Hg; for NU = 17.9 [10.2] and 17.7 [13.8] mm Hg; p <.024); and sleep quality (p <.05). NU showed significant improvements in percentages of total calories from fats and saturated fats relative to EX (p values <.01). Both groups reported improvements in psychological distress. Conclusions. Family caregivers can benefit from initiating a regular moderate-intensity exercise program in terms of reductions in stress-induced cardiovascular reactivity and improvements in rated sleep quality.
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Affiliation(s)
- Abby C King
- Division of Epidemiology, Department of Health Research and Policy, Center for Research on Women's Health, Reproductive Medicine, Stanford University School of Medicine, Palo Alto, California 94304-1583, USA.
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Damush TM, Stump TE, Saporito A, Clark DO. Predictors of older primary care patients' participation in a submaximal exercise test and a supervised, low-impact exercise class. Prev Med 2001; 33:485-94. [PMID: 11676591 DOI: 10.1006/pmed.2001.0919] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study is an investigation of physical activity promotion among a nonvolunteer sample of community-dwelling, older, urban primary care patients. Our primary interest was in the rates of exercise test and class participation. Of secondary interest were the medical record and baseline survey predictors of test and class participation. METHODS The first 500 nonterminally ill women ages 50 years or more with a visit at one of two predominantly African-American, inner-city primary care clinics received a physician screen, a referral to a submaximal exercise test, and, subsequently, a free, supervised exercise program located in a nearby community center. RESULTS Eighty-one percent were eligible for the exercise test per provider screen. Of these, 29% completed the exercise test and 28% attended at least one exercise class. After 1 year, 9.2% were attending the exercise classes. Higher exercise outcome expectations, not smoking, and clinic site were associated with exercise test and class participation. CONCLUSIONS Providing free, traditional exercise classes and a primary care referral to the classes resulted in limited physical activity participation among older, urban primary care patients. More development and testing of physical activity promotion programs are needed in this population.
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Affiliation(s)
- T M Damush
- Indiana University Center for Aging Research, Regenstrief Institute for Health Care, 1050 Wishard Boulevard, RG-6, Indianapolis 46202-2872, USA.
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