Physical activity levels among overweight and obese adults in South Carolina

A Cross-Sectional Analysis of Differences in Physical Activity Levels between Stroke Belt and Non-Stroke Belt US Adults

BACKGROUND

The Stroke Belt is a region of the United States with elevated stroke incidence and prevalence of stroke risk factors. Physical inactivity is an important stroke risk factor, but little is known about whether current physical activity levels differ between Stroke Belt and non-Stroke Belt states. In this nationally representative study, we determined whether unadjusted and adjusted physical activity levels differ between the Stroke Belt region and the rest of the United States.

METHODS

Using 2017 Behavioral Risk Factor Surveillance System data, we conducted bivariate analyses to obtain unadjusted physical activity levels in Stroke Belt and non-Stroke Belt states. Logistic regressions that controlled for sociodemographic and stroke risk factors were created to estimate adjusted associations between Stroke Belt residence and physical activity.

RESULTS

A higher percentage of Stroke Belt residents were inactive (Stroke Belt: 35.3%, non-Stroke Belt: 29.4%) and failed to meet physical activity guidelines (Stroke Belt: 53.7%, non-Stroke Belt: 47.8%) compared to non-Stroke Belt residents. Stroke Belt residence was significantly associated with lower odds of meeting physical activity guidelines in a model that adjusted for sociodemographic factors only (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.78-0.91) and one that adjusted for both sociodemographic and stroke risk factors (OR: 0.87, 95% CI: 0.81-0.93).

CONCLUSIONS

The considerably lower physical activity levels and likelihood of meeting physical activity guidelines in Stroke Belt residents compared to their non-Stroke Belt counterparts demonstrates a need for clinician attention and public health interventions to increase regular physical activity as part of a stroke reduction strategy in this region.

Pilot Test of an Acceptance-Based Behavioral Intervention to Promote Physical Activity During Weight Loss Maintenance

Behavioral interventions for obesity reliably facilitate short-term weight loss, but weight regain is normative. A high level of aerobic exercise may promote weight loss maintenance. However, adopting and maintaining a high level of exercise is challenging, and experiential acceptance may be important. The aim of this study was to pilot test the feasibility and efficacy of an acceptance-based behavioral treatment to promote moderate-to-vigorous physical activity (MVPA) among individuals who had recently lost weight. Adults (n = 16) who had recently lost ≥ 5% of weight were provided with a 12-week, group-based treatment. At 12 weeks, complete analyses indicated that participants had increased activity 69% (completing an average of 198.27 minutes/week of bouted MVPA, i.e., episodes of at least 10 minutes in duration). Medium-to-large effect sizes were observed for changes in process measures, including experiential acceptance. Future research to test this approach using an experimental design, a larger sample, and a longer period of observation is warranted.

Obesity is associated with poorer range of motion and Tegner scores following hamstring autograft anterior cruciate ligament reconstruction in Asians

BACKGROUND

Current literature reporting on the impact of BMI on outcomes of orthopaedic surgical procedures is varied and inconsistent. The purpose of our study was to evaluate if body mass index (BMI) affects outcomes of primary anterior cruciate ligament reconstruction (ACLR) in an Asian population.

METHODS

We retrospectively reviewed prospectively collected data of 141 consecutive patients who underwent primary ACLR by a single surgeon, the senior author of this study. Flexion range, International Knee Documentation Committee (IKDC) score, KT-1000 translation, Tegner activity level scale, Lysholm score and satisfaction were assessed preoperatively and at 2 years postoperatively. The patients were then stratified into two groups: normal-BMI and high-BMI in accordance with WHO classification. Outcomes were then compared between the two groups. All statistical analysis were performed on IBM SPSS Statistics 20.

RESULTS

There were 81 patients in the normal-BMI group (BMI, 18.5 to 24.9) and 60 patients in the high-BMI group (BMI ≥25). Preoperatively, the only differences were in the gender proportions as well as the pre-injury Tegner score. 2-years postoperatively, patients in the normal-BMI group had better flexion (139° vs. 130°; P=0.0001), Tegner scores (5.7 vs. 4.8; P=0.005) and satisfaction rate (99% vs. 90%; P=0.041). There were no differences in graft failure or complication rates.

CONCLUSIONS

Obese patients had poorer range of motion and Tegner scores as compared to their nonobese counterparts following primary ACLR.

The mysterious case of the public health guideline that is (almost) entirely ignored: call for a research agenda on the causes of the extreme avoidance of physical activity in obesity

Physical activity and exercise guidelines for weight management call for at least 60 min of daily activity. However, these documents fail to acknowledge that almost no obese adults meet this target and that non-adherence and dropout are even higher among obese individuals than the general population. The reasons for this level of activity avoidance among obese individuals remain poorly understood, and there are no evidence-based methods for addressing the problem. Opinions among exercise scientists are polarized. Some advocate moderate intensity and long duration, whereas others call for high intensity and shorter duration. The latter approach attributes the inactivity and high dropout to limited discretionary time and the slow accrual of visible benefits. However, higher intensity has been associated with non-adherence and dropout, whereas longer duration has not. A conceptual model is then proposed, according to which obesity interacts with intensity, causing physical activity and exercise to be associated with reduced pleasure among obese individuals. We theorize that, in turn, repeated experiences of reduced pleasure lead to avoidance. On this basis, we call for a research agenda aimed at identifying the causes of activity-associated and exercise-associated displeasure in obesity and, by extension, the causes of the extreme physical inactivity among obese individuals.

Measuring the Ability to Tolerate Activity-Related Discomfort: Initial Validation of the Physical Activity Acceptance Questionnaire (PAAQ)

BACKGROUND

Physical activity (PA) is essential for health, but many adults find PA adherence challenging. Acceptance of discomfort related to PA may influence an individual's ability to begin and sustain a program of exercise. The aim of this study was to evaluate the psychometric properties of the Physical Activity Acceptance Questionnaire (PAAQ).

METHODS

The PAAQ was administered to 3 distinct samples (N = 418). Each sample completed additional self-report measures; 1 sample also wore accelerometers for 7 days (at baseline and 6 months later).

RESULTS

The PAAQ demonstrated high internal validity for its total score (α = .89) and 2 subscales (Cognitive Acceptance α = .86, Behavioral Commitment α = .85). The PAAQ also showed convergent validity with measures of mindfulness, self-reported physical activity levels, and accelerometer-verified levels of moderate-to-vigorous PA (MVPA; P-values < .05). The Cognitive Acceptance subscale showed predictive validity for objectively-verified PA levels among individuals attempting to increase PA over 6 months (P = .05). Test-retest reliability for a subset of participants (n = 46) demonstrated high consistency over 1 week (P < .0001).

CONCLUSIONS

The PAAQ demonstrates sound psychometric properties, and shows promise for improving the current understanding of PA facilitators and barriers among adults.

Exercise and the treatment of diabetes and obesity

An active lifestyle increases general health and is protects from a number of different conditions, including exercise and obesity. There is emerging evidence that exercise by itself exerts clinically beneficial effects in both lean and obese subjects, even in the absence of effects on weight.1 Recent results have brought an increasing understanding of the molecular mechanisms underlying the beneficial effects of exercise at the level of metabolism and changes in gene expression. There is a significant dose-response to the effect of exercise, and the current guidelines regarding exercise amount may need to be revised upwards. Furthermore, this treatment option should not be overlooked.

Evaluation of a questionnaire to assess sedentary and active behaviors in the Southern Community Cohort Study

BACKGROUND

Low physical activity (PA) is linked to cancer and other diseases prevalent in racial/ethnic minorities and low-income populations. This study evaluated the PA questionnaire (PAQ) used in the Southern Cohort Community Study, a prospective investigation of health disparities between African-American and white adults.

METHODS

The PAQ was administered upon entry into the cohort (PAQ1) and after 12-15 months (PAQ2) in 118 participants (40-60 year-old, 48% male, 74% African-American). Test-retest reliability (PAQ1 versus PAQ2) was assessed using Spearman correlations and the Wilcoxon signed rank test. Criterion validity of the PAQ was assessed via comparison with a PA monitor and a last-month PA survey (LMPAS), administered up to 4 times in the study period.

RESULTS

The PAQ test-retest reliability ranged from 0.25-0.54 for sedentary behaviors and 0.22-0.47 for active behaviors. The criterion validity for the PAQ compared with PA monitor ranged from 0.21-0.24 for sedentary behaviors and from 0.17-0.31 for active behaviors. There was general consistency in the magnitude of correlations between the PAQ and PA-monitor between African-Americans and whites.

CONCLUSIONS

The SCCS-PAQ has fair to moderate test-retest reliability and demonstrated some evidence of criterion validity for ranking participants by their level of sedentary and active behaviors.

Physical activity and obesity gap between black and white women in the southeastern U.S

BACKGROUND

Differences between black and white women in the associations of sedentary and active behaviors and obesity are mostly unknown.

PURPOSE

To examine associations of sedentary and active behaviors with BMI, a marker of overall obesity, in a large group of black and white women and to determine whether there are differences by race in these associations.

METHODS

Associations between time spent in sedentary and active behaviors and BMI were examined using cross-sectional data collected from 2002 to 2006 at enrollment into the Southern Community Cohort Study (SCCS) from 22,948 black and 7830 white women living in the southeastern U.S. These associations were examined using linear and polytomous logistic regression models controlling for age, race, income, education, occupational status, tobacco use, marital status, and comorbidities.

RESULTS

Time spent in sedentary behaviors was directly related to BMI whereas time spent in active behaviors such as moderate and vigorous physical activity was inversely related to BMI, with stronger associations for whites than blacks. White women in the highest quartile of sedentary behaviors were more likely to be moderately (BMI=30-39) or severely (BMI>40) obese than women in the lowest quartile (OR=2.3, 95% CI=1.8, 2.9 for moderate, and OR=4.0, 95% CI=3.1, 5.3 for severe obesity), whereas the ORs among similarly sedentary black women were modestly elevated (ORs of 1.4, 95% CI=1.2, 1.6; and 1.6, 95% CI=1.4, 1.8).

CONCLUSIONS

There are significant differences in the association of physical activity patterns and obesity between black and white women living in the southeastern U.S. Although most guidelines for prevention of obesity and maintaining weight promote increased time in moderate and vigorous physical activity, these results indicate that a reduction in sedentary behavior time may represent another useful strategy in this population.

BMI, weight stability and mortality among adults without clinical co-morbidities: a 22-year mortality follow-up in the Finnish twin cohort

AIM AND METHOD

Cause-specific mortality was studied in relation to body mass index (BMI) and weight stability (defined as less than 1 BMI unit change during a 6-year period) in 15,424 initially healthy twin subjects from the Finnish Twin Cohort, first examined in 1975, re-examined in 1981, and then followed over 22 years (1982-2003). Additionally, death discordant twin pairs were studied to assess whether body weight differences are associated with mortality independent of childhood factors and genetic background. Deaths and cause of death were ascertained from national registries. Associations with mortality were estimated by Cox proportional hazards model for all individuals and conditional logistic regression analysis for pairwise analyses.

RESULTS

Mortality increased with increasing BMI for all causes and coronary heart disease (CHD) in men, and there were no associations for all natural causes, cerebrovascular disease, and violent deaths. After adjustment for multiple co-variates and changes in co-variates between 1975 and 1981, BMI was associated with CHD mortality in all men (hazard ratio (HR) = 1.22, 95% CI 1.06-1.41) and in men with stable weight between 1975 and 1981 (HR = 1.26, 95% CI 1.03-1.55). Overall risk of death and cause-specific mortality was not associated with BMI in women.

CONCLUSION

Among clinically healthy subjects at low risk of death, BMI appears to be associated with CHD risk in men.

Exercise and the treatment of diabetes and obesity

Lifestyle intervention programs encompassing exercise and healthy diets are an option for the treatment and management of obesity and type 2 diabetes and have long been known to exert beneficial effects on whole-body metabolism, in particular leading to enhanced insulin-sensitivity. Obesity is associated with increased risk of several illnesses and premature mortality. However, physical inactivity is itself associated with a number of similar risks, independent of body-mass index, and is an independent risk factor for more than 25 chronic diseases, including type 2 diabetes and cardiovascular disease. This article addresses the debate regarding the relative effects of physical exercise itself and the effect of exercise-induced weight loss.

Body mass index-independent effect of fitness and physical activity for all-cause mortality

Both obesity and physical inactivity are associated with chronic disease and premature mortality. A review of the literature has shown that both objectively measured level of physical fitness and self-reported physical activity have a prognostic value for all-cause mortality, independently of body mass index. Furthermore, there is evidence for a dose-response effect of physical activity. In conclusion, regular exercise has health-promoting effects, which are beyond its effect on weight control.

Correlates of physical activity in a community sample of older adults in Appalachia

Although much has been learned about the global determinants of physical activity in adults, there has been a lack of specific focus on gender, age, and urban/rural differences. In this church-based community sample of Appalachian adults (N = 1,239), the primary correlates of physical activity included age, gender, obesity, and self-efficacy. Overall, 42% of all participants and 31% of adults age 65 years or older met recommended guidelines for physical activity, which suggests that most participants do not engage in adequate levels of physical activity. Of participants who met physical activity guidelines, the most common modes of moderate and vigorous activity were walking briskly or uphill, heavy housework or gardening, light strength training, and biking. These particular activities that focus on building self-efficacy might be viable targets for intervention among older adults in rural communities.

Self-reported physical activity among South Carolina adults trying to maintain or lose weight

OBJECTIVES

The obesity epidemic is related to widespread physical inactivity in the United States. This study determined the proportion of South Carolinians trying to maintain or lose weight and within that subpopulation, the number who practiced a restricted diet and engaged in physical activity.

METHODS

Data from the 2002 South Carolina Behavioral Risk Factor Surveillance System survey were used to classify adults who were trying to maintain weight or lose weight. Self-reported prevalence of restricted diet and participation in physical activity were investigated. Of those who reported weight control practices, levels of physical activity were analyzed to determine if those trying to maintain weight or lose weight were meeting the national guidelines for moderate or vigorous physical activity.

RESULTS

More than 70% of South Carolina adults reported trying to control their weight and the majority reported using physical activity for weight control. Though the majority reported use of restricted diet and physical activity, more than one-half of those individuals did not meet the minimum standards for physical activity designed for heart health.

CONCLUSIONS

Although most adults who are trying to maintain or lose weight are participating in physical activity, public health efforts need to focus on encouraging these adults to increase their levels of physical activity to meet the minimum standards for health benefits. Health care providers have an opportunity to educate and encourage patients about the recommended levels of physical activity to obtain maximum health benefits.

BMI change and leisure time physical activity (LTPA): an 11-y follow-up study in apparently healthy men aged 20–69 y with normal weight at baseline

OBJECTIVE

To study the association between self-reported leisure time physical activity (LTPA) at baseline and change in body mass index (BMI).

DESIGN

Prospective observational study with a 11-y follow-up period.

SETTING

A total population-based health survey in one county was performed in 1984-1986 (HUNT 1) and repeated in 1995-1997 (HUNT 2).

PARTICIPANTS

In total, 21 685 men participated in both surveys. In the present study, we included only apparently healthy 20-69-y-old men participating in both surveys and who had a normal body weight (BMI 18.5-24.9 kg/m(2)) at baseline-leaving 8305 men for the analyses. In all, 6945 men answered all questions about LTPA and 6749 men had complete data in the multiple analyses.

MEASUREMENTS AND MAIN RESULTS

At HUNT 1, the participants answered questions (self-reported) about the intensity, frequency and duration of LTPA. The association between change in BMI and LTPA was investigated in multiple linear regression analyses. Adjusted for smoking, education, age and BMI at baseline, the physical active cohort gained less weight than the inactive cohort. Low, moderate and high levels of LTPA showed a U-shaped effect adjusted for smoking, education, age and BMI at baseline. Adjusted for BMI and age at baseline, the high-intensity part of the physically active cohort gained less weight than the low-intensity group.

CONCLUSION

This study has demonstrated a moderate BMI effect of LTPA at the population level; however, even a high level of LTPA did not prevent weight gain during the 11-y follow-up period.