Comparing physical activity patterns of hypertensive and nonhypertensive US adults

The effects of co-designed physical activity interventions in older adults: A systematic review and meta-analysis

BACKGROUND

Physical activity (PA) declines with age despite the knowledge that physical inactivity is a leading cause of disease, death, and disability worldwide. To better tailor PA interventions to older adults, researchers are turning to the collaborative principles of co-design. The purpose of this systematic review was to compare the effectiveness of co-designed PA interventions and standard care for increasing PA and other health outcomes (i.e., physical function, quality of life, mental health, functional independence, attendance and attrition rates) in older adults.

METHODS

A search was conducted in MEDLINE, AgeLine, CINAHL, Embase, and SPORTDiscus. Records were screened by independent pairs of reviewers. Primary research studies conducted among community-dwelling older adults (age 60+) comparing co-designed PA interventions to standard care were considered for inclusion. Controls included wait-list control, usual care, sham interventions, PA interventions without the use of co-design, and no intervention. A random effects meta-analysis was conducted, and the standardized mean difference (SMD) was used to report effect estimates. Quality of evidence was rated using GRADE.

RESULTS

Of 16,191 studies screened, eight (N = 16,733) were included in this review. Most studies reported results favouring the effect of co-design on physical activity; however, only two studies (N = 433) could be pooled for meta-analysis resulting in a SMD of 0.28, (95% CI = -0.13 to 0.69; p = 0.19; I2 = 56%) immediately post-intervention. The GRADE quality of evidence was very low. The quantitative analysis of three studies reported improved physical function.

CONCLUSION

This review did not demonstrate that co-designed PA interventions are more effective than standard care for increasing PA in older adults; however, evidence was limited and of very low quality. Further well-designed trials are warranted to better understand the impacts of co-designed PA interventions and how to best implement them into practice.

TRIAL REGISTRATION

PROSPERO registration number: CRD42022314217.

Prevalence of sufficient physical activity among general adult population and sub-populations with chronic conditions or disability in the USA

BACKGROUND

Recently, the World Health Organization (WHO) released an updated global guideline on physical activity and sedentary behavior, including recommendations for sub-populations living with chronic conditions or disabilities. We aimed to examine the prevalence of meeting the WHO recommendations among these sub-populations in the USA.

METHODS

We conducted a cross-sectional study using data from the 2017 to 2018 cycle of the National Health and Nutrition Examination Survey (NHANES).

RESULTS

We revealed variations in physical activity levels among individuals with chronic conditions and disability. US adults with diabetes, hypertension or disability had a lower prevalence of recommended physical activity levels than the general population. In addition, certain demographic groups such as being female, older and having lower socioeconomic status were associated with a lower likelihood of meeting the WHO recommendations on physical activity.

CONCLUSIONS

Our findings underscore the importance of promoting physical activity levels among US adults, especially those with older age, low socioeconomic status, hypertension and disability.

Mode of Physical Activity Participation in US Adults: A Regional Perspective

OBJECTIVE

Examine the mode of physical activity (PA) participation in United States adults by US Census region.

METHODS

The study sample (N = 323,435) included adult (18 years of age and older) participants from the 2019 Behavioral Risk Factor Surveillance System. Participants reported meeting both aerobic and muscle strengthening activity (MSA) guidelines, the aerobic-only guideline, the MSA only guideline, or neither.

RESULTS

The greatest prevalence estimate of meeting the mutually exclusive aerobic and MSA guideline was found in the West Census Region (24.3, 95% confidence interval 23.6-24.9) and the greatest prevalence estimate of meeting neither aerobic nor MSA guideline was found in the South Census Region (38.1%, 95% confidence interval 37.5-38.7). Physical and mental health were found to be positively associated with PA and non-Hispanic Blacks and Hispanics reported the greatest levels of meeting neither federal PA recommendation.

CONCLUSIONS

These data suggest that mode of PA participation varies by demographics and census region in US adults. State and local health departments should communicate between and within regions and disseminate information to raise awareness of the health benefits of meeting the federal PA guidelines.

The association between daily total physical activity and risk of cardiovascular disease among hypertensive patients: a 10-year prospective cohort study in China

BACKGROUND

The effect of high levels of physical activity and relationship between daily total physical activity and the risk of cardiovascular disease (CVD) among hypertensive people were not clear. This study aimed to explore the optimum level of physical activity for CVD prevention.

METHODS

Data used in the present study was derived from the sub-study of China Kadoorie Biobank study (CKB) in Jiangsu province of China. The CKB was a prospective cohort study established during 2004-2008. At baseline, 53,259 participants aged 35-74 years were recruited for the CKB Jiangsu sub-study conducted in Wuzhong district of Suzhou City. Among those 53,259 participants, the 20,179 hypertensive individuals were our study population. The outcome events were cardiovascular diseases (CVDs), while the independent variable was total daily physical activity. The Cox proportional hazard models were introduced to investigate the association between total physical activity and CVDs, reporting as hazard ratios (HR) and 95% confidence intervals (CIs).

RESULTS

During a 10.1-year follow-up, 2419 CVD cases were identified. After adjustment for potential confounding factors, compared with participants at the lowest level of daily total physical activity, the hazard ratios for CVDs were 0.87 (95%CI: 0.79-0.97), 0.73 (95%CI: 0.65-0.83) and 0.75 (95%CI: 0.65-0.85) for participants within 2, 3 and 4 quartiles of physical activity. Such a negative association between total physical activity and CVDs were also observed among participants by gender and age-group, but within patients with stage 1 hypertension only. Moreover, the association of physical activity with CVDs was U-shape and the lowest HR (0.63, 95%CI: 0.54-0.74) was observed at 35.4 MET-h/d of total physical activity.

CONCLUSIONS

Total daily physical activity was negatively associated with CVDs among hypertensive adults in China, and this association was U-shape. It has some public health implications that community-based total physical activity intervention campaigns can be of help for CVDs prevention among hypertensive people in China.

Exercise and Hypertension

Hypertension is a fatal yet preventable risk factor for cardiovascular disease and is responsible for majority of cardiovascular mortality. Hypertension is closely associated with inactive lifestyle. Physical activity and/or exercise are shown to delay development of hypertension. Both aerobic and resistance exercise have been proven to reduce blood pressure (BP) effectively. Since brisk walking is an easy, inexpensive, simple, and effective way of exercise, this type of an aerobic workout can be recommended to society. All professional organizations and government bodies recommend moderate-intensity aerobic exercise for at least 30 min on at least 3 days of the week or resistance exercise on 2-3 days of the week. Exercise sessions can either be continuous for 30 min or be composed of at least 10 min of short exercise duration to a daily total of 30 min. After an exercise session, BP decreases, and this decline continues for up to 24 h; which is called post-exercise hypotension. Overall 5 mmHg decrease in BP with regular exercise may be ensured. With a decrease of 5 mmHg in systolic BP, mortality due to coronary heart disease decreases by 9%, mortality due to stroke decreases by 14% and all-cause mortality decreases by 7%. Regular exercise should therefore be recommended for all individuals including normotensives, prehypertensives, and hypertensives.

Favorable Outcomes Using an eHealth Approach to Promote Physical Activity and Nutrition Among Young African American Women

BACKGROUND

Internet and mobile devices are widely used and provide alternative approaches for promoting healthy lifestyles, yet less information is available describing outcomes of these approaches when used with young African American (AA) women at risk for developing hypertension.

OBJECTIVE

In this study, we evaluated a Web-based, culturally relevant lifestyle change intervention targeting AA women (referred to as the eHealth study).

METHODS

African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week study that incorporated social cognitive theory strategies. Participants were randomized to (1) lifestyle physical activity (PA) or (2) Dietary Approaches to Stop Hypertension (DASH) online education modules.

RESULTS

The 14 DASH and 12 PA participant attributes were similar at baseline. The DASH participants had a significant change in total DASH score (P = .001) and large effect sizes for DASH components (vegetables, 0.84; nonfat dairy, 0.71; fruit, 0.62). The PA participants had a favorable change (+39%) in pedometer steps (P = .055). With respect to weight change, a large effect size was observed for PA (0.84) and smaller for DASH participants (0.18). Seventy-one percent of DASH and 48% of PA participants completed program activities, corresponding to a moderate difference in program engagement between groups (d = 0.58).

CONCLUSION

Our eHealth platform provides an alternative approach for reaching young AA women and was successful with respect to improving PA and dietary behaviors. Furthermore, the eHealth approach has the potential as a powerful program for changing health behaviors for other at-risk populations.

Effect of physical activity on fasting blood glucose and lipid profile among low income housewives in the MyBFF@home study

BACKGROUND

Regular physical activity has always been strongly recommended for good cardiovascular health. This study aimed to determine the effect of physical activity on fasting blood glucose and lipid profile among low income housewives in Klang Valley.

METHODS

Data of 328 eligible housewives who participated in the MyBFF@Home study was used. Intervention group of 169 subjects were provided with an intervention package which includes physical activity (brisk walking, dumbbell exercise, physical activity diary, group exercise) and 159 subjects in control group received various health seminars. Physical activity level was assessed using short-International Physical Activity Questionnaire. The physical activity level was then re-categorized into 4 categories (active intervention, inactive intervention, active control and inactive control). Physical activity, blood glucose and lipid profile were measured at baseline, 3rd month and 6th month of the study. General Linear Model was used to determine the effect of physical activity on glucose and lipid profile.

RESULTS

At the 6th month, there were 99 subjects in the intervention and 79 control group who had complete data for physical activity. There was no difference on the effect of physical activity on the glucose level and lipid profile except for the Triglycerides level. Both intervention and control groups showed reduction of physical activity level over time.

CONCLUSION

The effect of physical activity on blood glucose and lipid profile could not be demonstrated possibly due to physical activity in both intervention and control groups showed decreasing trend over time.

The antihypertensive effects of aerobic versus isometric handgrip resistance exercise

BACKGROUND

Aerobic exercise reduces blood pressure (BP) on average 5-7 mmHg among those with hypertension; limited evidence suggests similar or even greater BP benefits may result from isometric handgrip (IHG) resistance exercise.

METHOD

We conducted a randomized controlled trial investigating the antihypertensive effects of an acute bout of aerobic compared with IHG exercise in the same individuals. Middle-aged adults (n = 27) with prehypertension and obesity randomly completed three experiments: aerobic (60% peak oxygen uptake, 30 min); IHG (30% maximum voluntary contraction, 4 × 2 min bilateral); and nonexercise control. Study participants were assessed for carotid-femoral pulse wave velocity pre and post exercise, and left the laboratory wearing an ambulatory BP monitor.

RESULTS

SBP and DBP were lower after aerobic versus IHG (4.8 ± 1.8/3.1 ± 1.3 mmHg, P = 0.01/0.04) and control (5.6 ± 1.8/3.6 ± 1.3 mmHg, P = 0.02/0.04) over the awake hours, with no difference between IHG versus control (P = 0.80/0.83). Pulse wave velocity changes following acute exercise did not differ by modality (aerobic increased 0.01 ± 0.21 ms, IHG decreased 0.06 ± 0.15 ms, control increased 0.25 ± 0.17 ms, P > 0.05). A subset of participants then completed either 8 weeks of aerobic or IHG training. Awake SBP was lower after versus before aerobic training (7.6 ± 3.1 mmHg, P = 0.02), whereas sleep DBP was higher after IHG training (7.7 ± 2.3 mmHg, P = 0.02).

CONCLUSION

Our findings did not support IHG as antihypertensive therapy but that aerobic exercise should continue to be recommended as the primary exercise modality for its immediate and sustained BP benefits.

Research Opportunities and Challenges in the Era of Healthy Living Medicine: Unlocking the Potential

Non-communicable diseases, such as cardiovascular disease (CVD), obesity, cancer, pulmonary disease, and diabetes are a very high global health concern. The health costs of risk factors for CVD, such as hypertension (HTN), is mounting and are unrelenting. As an example, it is estimated that direct and indirect costs due to HTN amounted to $46.4 billion in 2011 and projections of six-fold increases by 2030; the importance of low-cost nonpharmacological interventions involving collaborative teams of health care professionals is at a critical junction. Certainly, the data supported by research including some clinical trials for healthy living interventions support deploying health education, nutrition, smoking cessation, and physical activity(PA) in preventing CVD risk, such as HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of BP management. However, less is known about what optimization of PA/ET modalities with nutrition and lifestyle tracking with modern era technologies will bring to this equation. New research methods may need to consider how to collaborate to collect data in using teams of researchers while interacting with community centers, school systems, and in traditional health care practices. This review will discuss and present what is known about the research that support modern era healthy living medicine and how this data may be integrated in venues that support health lifestyle in the community (i.e. schools and the work place).

Exercise and Hypertension: Uncovering the Mechanisms of Vascular Control

Hypertension (HTN) has recently been determined to be the number one overall risk factor of disease. With direct and indirect costs amounting to $46.4 billion in 2011 and projections of six-fold increases by 2030, the importance of low-cost nonpharmacological interventions can be appreciated. Vascular structural changes, endothelial dysfunction, and sympathetic overstimulation are major contributing factors to the pathophysiology of HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of nonpharmacological interventions for BP control. Different ET modalities (aerobic, resistance, and concurrent training) have contributed differently to BP reduction and control, driving scientific discourse regarding the optimum ET prescription (modality, volume, and intensity) for such effects; ET results in a multitude of physiological effects, with vascular and autonomic adaptations providing major contributions to BP control. Despite widespread acceptance of the role and importance of ET for BP reduction, only 15% of US adults have been found to meet ET/physical activity recommendations. The purpose of this review is to explore BP lowering effects of aerobic and resistance ET and the underlying physiological mechanisms that result in such effects. Further research is required to enhance our understanding of the proper ET prescription for BP control across different age groups and racial ethnicities. Furthermore, research into methods of improving awareness and adherence to ET recommendations proves to be equally important.

Association of hypertension-related distress with lack of self-care among hypertensive patients

Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.

The associations between increasing degrees of homeostatic model assessment for insulin resistance and muscular strengthening activities among euglycaemic US adults

PURPOSE

To examine the associations between the homeostatic model assessment for insulin resistance and self-reported muscular strengthening activity in a nationally representative sample of euglycaemic US adults.

METHODS

Sample included euglycaemic adults (⩾20 years of age (n = 2009)) from the 1999 to 2004 National Health and Nutrition Examination Survey. Homeostatic model assessment for insulin resistance was categorized into quartiles and was the primary independent variable of interest. No reported muscular strengthening activity was the dependent variable.

RESULTS

Following adjustment for covariates, those with homeostatic model assessment for insulin resistance values in fourth (odds ratio: 2.04, 95% confidence interval: 1.35-3.06, p < 0.001) quartile were found to have significantly greater odds of reporting no muscular strengthening activity. Following further adjustment for non-muscular strengthening activity specific aerobic leisure-time physical activity, results remained significant for the fourth (odds ratio: 2.30, 95% confidence interval: 1.50-3.52, p < 0.001) quartile. A significant trend was seen across quartiles of homeostatic model assessment for insulin resistance for increasing prevalence of no muscular strengthening activity (p < 0.001).

CONCLUSION

Having a higher homeostatic model assessment for insulin resistance value is associated with greater odds of reporting no muscular strengthening activity among euglycaemic US adults. This implies that subjects with an increasing degree of insulin resistance are more likely to not engage in muscular strengthening activity, an exercise modality that has been shown to reduce the risk of several cardiometabolic diseases and improve glycaemic status.

Exercise and cardiovascular risk in patients with hypertension

Evidence for the benefits of regular exercise is irrefutable and increasing physical activity levels should be a major goal at all levels of health care. People with hypertension are less physically active than those without hypertension and there is strong evidence supporting the blood pressure-lowering ability of regular exercise, especially in hypertensive individuals. This narrative review discusses evidence relating to exercise and cardiovascular (CV) risk in people with hypertension. Comparisons between aerobic, dynamic resistance, and static resistance exercise have been made along with the merit of different exercise volumes. High-intensity interval training and isometric resistance training appear to have strong CV protective effects, but with limited data in hypertensive people, more work is needed in this area. Screening recommendations, exercise prescriptions, and special considerations are provided as a guide to decrease CV risk among hypertensive people who exercise or wish to begin. It is recommended that hypertensive individuals should aim to perform moderate intensity aerobic exercise activity for at least 30 minutes on most (preferably all) days of the week in addition to resistance exercises on 2-3 days/week. Professionals with expertise in exercise prescription may provide additional benefit to patients with high CV risk or in whom more intense exercise training is planned. Despite lay and media perceptions, CV events associated with exercise are rare and the benefits of regular exercise far outweigh the risks. In summary, current evidence supports the assertion of exercise being a cornerstone therapy in reducing CV risk and in the prevention, treatment, and control of hypertension.

Association of physical activity volume and hypercholesterolemia in US adults

BACKGROUND

Several studies illustrate the favorable association between physical activity (PA) and cholesterol levels. There is a paucity of data examining the PA patterns of individuals with and without hypercholesterolemia (HC).

AIM

To examine self-reported moderate and vigorous PA (MVPA) patterns using the most recent PA guidelines among US adults with and without HC.

DESIGN

Cross-sectional study utilizing a secondary data analysis approach.

METHODS

We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS). PA categories were based on the 2008 Department of Health and Human Services (DHHS) guidelines.

RESULTS

The age-adjusted prevalence of self-reported HC in US adults was 34%. When stratified by gender, the age-adjusted prevalence of HC was found to be significantly higher in men (36.2%; 95% CI 35.6, 36.8) compared with women (31.8%; 95% CI 31.3, 32.3). The age-adjusted prevalence of meeting the DHHS PA recommendation was 59.1% among participants reporting HC and 68.3% among participants not reporting HC (P < 0.05). Following adjustment for demographics and health history, the odds ratio for meeting the DHHS PA recommendation among participants with HC compared with those without HC was 0.86 (95% CI 0.83, 0.89).

CONCLUSION

Although a large proportion of adults reporting HC report engaging in a volume of MVPA necessary to meet national guidelines, their odds of meeting these guidelines and their MVPA volume may be significantly lower than adults who did not report HC.

[Adherence to physical activity recommendations in a hypertensive primary care population]

OBJECTIVE

To determine the prevalence of adherence to physical activity recommendations in the hypertensive population of Lerida (Spain) attended in primary care and to identify related factors.

METHODS

A cross sectional study was carried out in hypertensive adults. The dependent variable was adherence to physical activity recommendations measured with the Minnesota Questionnaire. The independent variables were sociodemographic factors, the information received, and attitudes to physical activity.

RESULTS

A total of 786 hypertensive patients participated in this study; 53.9% were women and the mean age was 66.0±10.2 years. Adherence to recommendations was found in 64.3% (95% CI: 60.9-67.6); this percentage was 65.2% in men (95% CI: 60.2-70.0) and 63.4% in women (95% CI: 58.8-67.9). Greater adherence was associated with age in men and with residence in a rural area in women. In both genders, greater adherence was associated with unpaid work and with having a favorable attitude to physical activity. No association was observed with the number of recommendations received in the last 6 months.

CONCLUSIONS

More than half the hypertensive population adhered to physical activity recommendations. To improve physical activity levels, recommendations can be tailored to the attitudes of individual patients.

Muscular strengthening activity patterns and metabolic health risk among US adults

BACKGROUND

Many studies have examined the relationship between physical activity and metabolic disorders. However, few have focused on specific associations between these disorders and muscular strengthening activity (MSA) patterns. The aim of the present study was to examine the association(s) for each metabolic syndrome criterion and MSA patterns.

METHODS

The study sample (n = 5618) consisted of adults ≥20 years of age who participated in the 1999-2004 National Health and Nutrition Examination Survey. Cut-off points for metabolic syndrome criteria were derived from the American Heart Association/National Heart, Lung, and Blood Institute definition. The aggregate of data on weight lifting, push-ups, and sit-ups was used to establish patterns of MSA. Participants reporting ≥2 days/week MSA were coded as meeting current US MSA guidelines.

RESULTS

Following adjustments, participants reporting ≥2 days/week MSA were found to be 28% (OR 0.72; 95% CI 0.62, 0.83) less likely to have dyslipidemia, 29% (OR 0.71; 95% CI 0.54, 0.93) less likely to have impaired fasting glucose, 19% (OR 0.81; 95% CI 0.65, 0.99) less likely to have prehypertension, and 43% (OR 0.57; 95% CI 0.46, 0.72) less likely to have augmented waist circumference compared with those reporting engaging in no MSA. No association was found for hypertension and MSA.

CONCLUSION

Engaging in ≥2 days/week MSA as part of an overall physical activity regimen may be prudent in preserving metabolic health. These findings strengthen the relationship between MSA and metabolic health; thus, clinicians should include MSA when discussing lifestyle approaches to better health.

Descriptive analysis of resistance exercise and metabolic syndrome

BACKGROUND

Resistance exercise (RE) is an important mode of physical activity in the management of metabolic syndrome (MetS). However, little is known about the patterns of RE participation among U.S. adults with and without MetS.

METHODS

Utilizing data from 1999-2006 National Health and Nutrition Examination Survey, we examined the association(s) between MetS and RE in a representative sample (n=7432) of the U.S. adult population.

RESULTS

U.S. adults with MetS were found to be approximately 50% less likely to report engaging in RE compared to U.S. adults without MetS. Across all demographic categories those who did not meet the criteria for MetS reported engaging in significantly greater levels of RE compared to their counterparts with MetS. Furthermore, a potential inverse dose-response relationship was seen for engaging in RE and the prevalence of MetS.

CONCLUSIONS

In a diverse representative sample, significantly fewer U.S. adults with MetS report engaging in RE compared to adults without MetS. Engaging in two or more days per week of RE may attenuate MetS prevalence and risk estimates in U.S. adults.

BMI and lifestyle changes as correlates to changes in self-reported diagnosis of hypertension among older Chinese adults

Nutrition transition theory attributes increased prevalence of high blood pressure to excess body weight associated with lifestyle changes in recent decades. We examined the association of changes in self-reported hypertension diagnoses with changes in body mass index (BMI), health-related behaviors, health status, and social risk factors among older Chinese adults from 1997 to 2006. Data from the longitudinal China Health and Nutrition Survey (CHNS) were analyzed for adults who were age 60 years and older, had a BMI exceeding 18.6 kg/m(2), and reported no diagnosis of hypertension at baseline (n = 1928). Logistic regression models identified factors contributing to staying nonhypertensive or developing hypertension over time. Approximately 17.8% (n = 324) of study participants developed self-reported hypertension, whereas 83.2% (n = 1604) remained without hypertension. Those who stayed overweight or obese or became overweight or obese were more likely to report a new hypertension diagnosis. Incident diagnoses were also observed among those who developed acute conditions, sustained memory loss, or increased their income, whereas remaining nonhypertensive was more likely among rural residents and those who became more physically active and quit drinking alcohol. Study findings provided partial support for the nutrition transition theory whereby changing demographics and lifestyle factors were associated with increases in incident hypertension.