Physical disability and obesity

Immunoneuroendocrine, Stress, Metabolic, and Behavioural Responses in High-Fat Diet-Induced Obesity

Obesity has reached global epidemic proportions, and even though its effects are well-documented, studying the interactions among all influencing factors is crucial for a better understanding of its physiopathology. In a high-fat-diet-induced obesity animal model using C57BL/6J mice, behavioural responses were assessed through a battery of tests, while stress biomarkers and systemic inflammatory cytokines were measured using an Enzyme-Linked ImmunoSorbent Assay and a Bio-Plex Multiplex System. The peritoneal macrophage microbicide capacity was analysed via flow cytometry, and crown-like structures (CLSs) in white adipose tissue (WAT) were evaluated through staining techniques. Results indicated that obese mice exhibited increased body weight, hyperglycaemia, and hyperlipidaemia after 18 weeks on a high-fat diet, as well as worse physical conditions, poorer coordination and balance, and anxiety-like behaviour. Differences in corticosterone and noradrenaline concentrations were also found in obese animals, revealing a stress response and noradrenergic dysregulation, along with a weakened innate immune response characterized by a lower microbicide capacity, and the presence of an underlying inflammation evidenced by more CLSs in WAT. Altogether, these findings indicate that obesity deteriorates the entire stress, inflammatory, metabolic, sensorimotor and anxiety-like behavioural axis. This demonstrates that jointly evaluating all these aspects allows for a deeper and better exploration of this disease and its associated comorbidities, emphasizing the need for individualized and context-specific strategies for its management.

[Disability status and consumption of sugar-sweetened beverages: analysis of a Colombian population survey]

INTRODUCTION

according to the World Health Organization (WHO), obesity has tripled in the world as a result of high caloric intake. People with disabilities are more likely to be overweight and obese.

OBJECTIVES

this study aimed to estimate the association between disability status and consumption of sugar-sweetened beverages in the population aged 18 years and older in Colombia in 2017.

METHODS

we conducted a secondary analysis of data from Colombia's 2017 National Quality of Life Survey (ECV). The dependent variable was the consumption of sugar-sweetened beverages, and the independent variable was the disability status. Additionally, confounding variables were incorporated. An ordinal logistic regression was performed to estimate the magnitude of the association. The complex sample design of the 2017 LCS was considered in all results.

RESULTS

we included data from 18,957 persons aged 18 years and older; 7.9 % had a disability, and 64.4 % consumed sugar-sweetened beverages. People with moderate and severe disability were 18 % and 41 %, respectively, less likely to have a higher consumption of sugar-sweetened beverages compared to people without disability (OR: 0.82; 95 % CI: 0.72-0.95 and OR: 0.59; 95 % CI: 0.39-0.90). When stratified by age group, this association remained only in those older than 45.

CONCLUSIONS

in Colombia, in 2017, people with disabilities older than 45 years consumed fewer sugar-sweetened beverages than people without disabilities.

Body Composition and Energy Expenditure in Youth With Spina Bifida: Protocol for a Multisite, Cross-Sectional Study

BACKGROUND

Obesity prevalence in youth with spina bifida is higher than in their typically developing peers. Obesity is associated with lifelong medical, psychological, and economic burdens. Successful prevention or treatment of obesity in individuals with spina bifida is compromised by (1) the lack of valid and reliable methods to identify body fat in a clinical setting and (2) limited data on energy expenditure that are necessary to provide daily caloric recommendations.

OBJECTIVE

The objectives of this study will be to develop 2 algorithms for use in youth with spina bifida in a clinical setting, one to model body fat and one to predict total daily energy expenditure. In addition, physical activity and dietary intake will be described for the sample.

METHODS

This multisite, prospective, national clinical study will enroll 232 youth with myelomeningocele aged 5 to 18 years (stratified by age and mobility). Participants will be enrolled for 1 week. Data obtained include 4 measures of body composition, up to 5 height measures, a ramped activity protocol, and a nutrition and physical activity screener. Participants will wear an accelerometer for the week. On the final study day, 2 samples of urine or saliva, which complete the doubly labeled water protocol, will be obtained. The analysis will include descriptive statistics, Bland-Altman plots, concordance correlation, and regression analysis.

RESULTS

The study received extramural federal funding in July 2019. Data collection was initiated in March 2020. As of April 2024, a total of 143 (female participants: n=76, 53.1%; male participants: n=67, 46.9%) out of 232 participants have been enrolled. Data collection is expected to continue throughout 2024. A no-cost extension until November 2025 will be requested for data analysis and dissemination of findings.

CONCLUSIONS

This study furthers previous pilot work that confirmed the acceptability and feasibility of obtaining alternate height, body composition, and energy expenditure measures. The findings from this study will enhance screening, prevention, and treatment of abnormal weight status by facilitating the accurate identification of youths' weight status category and recommendations of daily caloric needs for this population that is at higher risk of obesity. Furthermore, the findings have the potential to impact outcomes for youth diagnosed with disabilities other than spina bifida who experience similar challenges related to alterations in body composition or fat distribution or measurement challenges secondary to mobility issues or musculoskeletal problems.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52779.

The Metabolic Syndrome, a Human Disease

This review focuses on the question of metabolic syndrome (MS) being a complex, but essentially monophyletic, galaxy of associated diseases/disorders, or just a syndrome of related but rather independent pathologies. The human nature of MS (its exceptionality in Nature and its close interdependence with human action and evolution) is presented and discussed. The text also describes the close interdependence of its components, with special emphasis on the description of their interrelations (including their syndromic development and recruitment), as well as their consequences upon energy handling and partition. The main theories on MS's origin and development are presented in relation to hepatic steatosis, type 2 diabetes, and obesity, but encompass most of the MS components described so far. The differential effects of sex and its biological consequences are considered under the light of human social needs and evolution, which are also directly related to MS epidemiology, severity, and relations with senescence. The triggering and maintenance factors of MS are discussed, with especial emphasis on inflammation, a complex process affecting different levels of organization and which is a critical element for MS development. Inflammation is also related to the operation of connective tissue (including the adipose organ) and the widely studied and acknowledged influence of diet. The role of diet composition, including the transcendence of the anaplerotic maintenance of the Krebs cycle from dietary amino acid supply (and its timing), is developed in the context of testosterone and β-estradiol control of the insulin-glycaemia hepatic core system of carbohydrate-triacylglycerol energy handling. The high probability of MS acting as a unique complex biological control system (essentially monophyletic) is presented, together with additional perspectives/considerations on the treatment of this 'very' human disease.

Widening disparities in the national prevalence of diabetes mellitus for people with disabilities in South Korea

OBJECTIVES

In Korea, diabetes mellitus has a high disease burden, based on disability-adjusted life years. However, the disease burden is disproportionately distributed, with people with disabilities (PWD) experiencing higher rates of health disparities. Our study investigated long-term trends in diabetes prevalence and risk according to disability status, grade, and type.

STUDY DESIGN

Retrospective cohort study.

METHODS

Approximately 10 million individuals aged ≥30 years were included yearly from the National Health Information Database (NHID) and national disability registration data in Korea between 2008 and 2017, corresponding to 40 % of those aged ≥30 years in Korea. In 2017, 12, 975, 757 individuals were included; 5.5 % had disabilities. We estimated annual diabetes age-standardized prevalence and used multiple logistic regression analyses to estimate the odds of having diabetes in 2017, according to disability status, severity, and type.

RESULTS

Diabetes age-standardized prevalence consistently increased over 2008-2017 in PWD and people without disabilities. However, the prevalence increased more rapidly and was higher in all years among PWD, with widening disparities based on disability status. Additionally, diabetes prevalence was high in all years for specific subgroups, including women, individuals with intellectual or mental disabilities or autism, and individuals with severe disabilities, suggesting further disparities among PWD.

CONCLUSIONS

Our findings reveal health disparities between those with and without disabilities and among PWD subgroups. In addition to timely prevention, diabetes screening and management among PWD is vital. Public investment in improving disparities in the root causes of diabetes is essential, including health behaviours, healthcare utilization, and self-care.

Association between Sarcopenia and Reduced Bone Mass: Is Osteosarcopenic Obesity a New Phenotype to Consider in Weight Management Settings?

Sarcopenic obesity (SO) is a frequent phenotype in people with obesity; however, it is unclear whether this links with an impaired bone status. In this study, we aimed to investigate the association between SO and low bone mass, and to assess the prevalence of a new entity that combines excessive fat deposition, reduced muscle mass and strength, and low bone mass defined as osteosarcopenic obesity (OSO). Body composition was completed by a DXA scan in 2604 participants with obesity that were categorized as with or without SO, and with low or normal bone mineral content (BMC). Participants with both SO and low BMC were defined as OSO. Among the entire sample, 901 (34.6%) participants met the criteria for SO. This group showed a reduced mean BMC (2.56 ± 0.46 vs. 2.85 ± 0.57, p < 0.01) and displayed a higher prevalence of individuals with low BMC with respect to those without SO (47.3% vs. 25.9%, p < 0.01). Logistic regression analysis showed that the presence of SO increases the odds of having low BMC by 92% [OR = 1.92; 95% CI: (1.60-2.31), p < 0.05] after adjusting for age, body weight, and body fat percentage. Finally, 426 (16.4%) out of the total sample were affected by OSO. Our findings revealed a strong association between SO and reduced bone mass in adults with obesity, and this introduces a new phenotype that combines body fat, muscle, and bone (i.e., OSO) and appears to affect 16% of this population.

Diet quality, diet-related factors and disability status among male adults of reproductive age in the USA

OBJECTIVE

To examine diet quality and diet-related factors among male adults of reproductive age with and without disabilities.

DESIGN

Cross-sectional data from the National Health and Nutrition Examination Surveys, 2013-2018.

SETTING

Disability was reported as serious difficulty hearing, seeing, concentrating, walking, dressing and/or running errands due to physical, mental or emotional conditions. Diet quality was assessed by the Healthy Eating Index (HEI)-2015 and diet-related factors included self-rated diet healthfulness, food security and food assistance programmes. Multivariable linear regression estimated differences in HEI-2015 scores. Multivariable Poisson regression estimated adjusted prevalence ratios (aPR) and 95 % CI for diet-related factors.

PARTICIPANTS

In total, 3249 males, 18-44 years; of whom, 441 (13·4 %) reported having disabilities.

RESULTS

Compared with males without disabilities, those with disabilities had a 2·69-point (95 % CI: -4·18, -1·20) lower mean total HEI-2015 score and approximately one-third to half of a point lower HEI-2015 component scores for greens and beans, total protein foods, seafood and plant proteins, fatty acids and added sugars. Males with any disabilities were more likely to have low food security (aPR = 1·57; 95 % CI: 1·28, 2·92); household participation in food assistance programmes (aPR = 1·61; 95 % CI: 1·34, 1·93) and consume fast food meals during the previous week (1-3 meals: aPR = 1·11; 95 % CI: 1·01-1·21 and 4 or more meals: aPR = 1·18; 95 % CI: 1·01-1·38) compared with males with no disabilities.

CONCLUSIONS

Factors affecting diet and other modifiable health behaviours among male adults of reproductive age with disabilities require further investigation. Health promotion strategies that are adaptive to diverse populations within the disability community are needed.

Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review

BACKGROUND

People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases.

METHODS

Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device.

RESULTS

One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness.

CONCLUSION

This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.

How disability severity is associated with changes in physical activity and inactivity from adolescence to young adulthood

BACKGROUND

Disabilities may play a different role in determining people's physical activity (PA) and physical inactivity (PI) levels when they go through multiple lifetime transitions (e.g., graduation, marriage) between adolescence and young adulthood. This study investigates how disability severity is associated with changes in PA and PI engagement levels, focusing on adolescence and young adulthood, when the patterns of PA and PI are usually formed.

METHODS

The study employed data from Waves 1 (adolescence) and 4 (young adulthood) of the National Longitudinal Study of Adolescent Health, which covers a total of 15,701 subjects. We first categorized subjects into 4 disability groups: no, minimal, mild, or moderate/severe disability and/or limitation. We then calculated the differences in PA and PI engagement levels between Waves 1 and 4 at the individual level to measure how much the PA and PI levels of individuals changed between adolescence and young adulthood. Finally, we used two separate multinomial logistic regression models for PA and PI to investigate the relationships between disability severity and the changes in PA and PI engagement levels between the two periods after controlling for multiple demographic (age, race, sex) and socioeconomic (household income level, education level) variables.

RESULTS

We showed that individuals with minimal disabilities were more likely to decrease their PA levels during transitions from adolescence to young adulthood than those without disabilities. Our findings also revealed that individuals with moderate to severe disabilities tended to have higher PI levels than individuals without disabilities when they were young adults. Furthermore, we found that people above the poverty level were more likely to increase their PA levels to a certain degree compared to people in the group below or near the poverty level.

CONCLUSIONS

Our study partially indicates that individuals with disabilities are more vulnerable to unhealthy lifestyles due to a lack of PA engagement and increased PI time compared to people without disabilities. We recommend that health agencies at the state and federal levels allocate more resources for individuals with disabilities to mitigate health disparities between those with and without disabilities.

Determinants of Physical Activity among Children with Disabilities

Maintaining children's physical activity levels is crucial to preventing obesity and improving their health and well-being. However, achieving the recommended daily level of 60 min of moderate-to-vigorous intensity physical activity can be difficult for children with disabilities. Moreover, children with disabilities spend less time engaging in physical activity than their typically developing peers. This study aimed to assess the personal, environmental, and social determinants of physical activity among children with disabilities. This quantitative, cross-sectional study was conducted through an online survey of a convenient sample, including 125 parents of children with disabilities aged between 5 and 18 years from different regions in the Kingdom of Saudi Arabia. Approximately 40.8% of the participants were aged between 41 and 50 years, and 57.6% (the participants and friends of their children) did not engage in regular exercise. Statistically significant differences were observed between the perception of children's health and physical activity summary scores and the engagement of children's friends in physical activity and physical activity summary scores. Efforts should be made to reinforce parents' perceptions of their children's health regarding physical activity and to support the social determinants of physical activity that ensure their children's friends' engagement. Specialized interventional studies are needed to support parents with children.

Adapting an evidence-based physical activity questionnaire for people with physical disabilities: A methodological process

BACKGROUND

Practitioners and researchers often adapt tools, practices, and programs to meet the needs of culturally diverse population groups, but do not consider populations with disability. While there is some research on guidelines for adapting evidence-based programs, there is no systematic process for adapting survey instruments. Rather than creating separate instruments for people with physical disabilities (PWD), it is critical that instruments are designed to capture data on people with and without disabilities for comparison purposes. Given the disproportionately high rates of physical inactivity and obesity in PWD, we developed a methodology to adapt an evidence-based physical activity instrument.

OBJECTIVE

To create a methodology to adapt surveys to be inclusive of PWD and use the methodology to adapt an evidence-based physical activity survey.

METHODS

A framework was developed to adapt a physical activity survey instrument (International Physical Activity Questionnaire, IPAQ) to be inclusive of PWD. The framework, referred to as SAVe-IT, includes five steps: Step 1) Select survey instrument to adapt; Step 2) Adapt the survey instrument; Step 3) Verify adaptations with experts; Step 4) Implement pilot test; Step 5) Test the tool to confirm reliability.

RESULTS

The adapted IPAQ passed review by the expert panels and the pilot test (n = 20). Assessment of test-retest reliability (n = 30) yielded strong intraclass correlation coefficients of 0.950 for the total score for the whole sample, 0.950 for PWD (n = 15) and 0.952 for people without disability (n = 15).

CONCLUSIONS

The SAVe-IT framework resulted in the successful adaptation of the IPAQ and can be used in populations with and without physical disabilities.

Comprehensive Study of a Diabetes Mellitus Mathematical Model Using Numerical Methods with Stability and Parametric Analysis

Diabetes is sweeping the world as a silent epidemic, posing a growing threat to public health. Modeling diabetes is an effective method to monitor the increasing prevalence of diabetes and develop cost-effective strategies that control the incidence of diabetes and its complications. This paper focuses on a mathematical model known as the diabetes complication (DC) model. The DC model is analyzed using different numerical methods to monitor the diabetic population over time. This is by analyzing the model using five different numerical methods. Furthermore, the effect of the time step size and the various parameters affecting the diabetic situation is examined. The DC model is dependent on some parameters whose values play a vital role in the convergence of the model. Thus, parametric analysis was implemented and later discussed in this paper. Essentially, the Runge-Kutta (RK) method provides the highest accuracy. Moreover, Adam-Moulton's method also provides good results. Ultimately, a comprehensive understanding of the development of diabetes complications after diagnosis is provided in this paper. The results can be used to understand how to improve the overall public health of a country, as governments ought to develop effective strategic initiatives for the screening and treatment of diabetes.

Time Series Trend in High BMI and High Out-of-Pocket Expenditure Among Women With Disability

Health with disability is directly related not only to an individual's quality of life but also to national medical finance. This study focuses on trends in BMI and out-of-pocket (OOP) expenditure of both types of indirect cost exclusion and inclusion. Participants were women with disability (n = 3200) and women without disability (n = 53 082) among adults aged 19 and older from Korea Health Panel from 2009 to 2016. Women with disability had a higher BMI (23.9) than women without disability (22.7), and this time series trend was significant for 8 years (P < .0001). Annual OOP expenditures of both types were higher for women with disability than for women without disability (P < .0001): excluding indirect costs, $518.9 versus $649.4; Including indirect costs, $534.5 versus $681.8. The y-intercept of disability itself and slope of one unit of BMI for both types of annual OOP expenditure is significant (P < 0001): excluding indirect cost, $29.0 and $4.4; including indirect cost, $35.2 versus $4.6. In women with disability, annual OOP expenditure for both types were higher when they were physically inactive (P < .05): excluding indirect cost, $714.1 versus $823.1; including indirect cost, $746.2 versus $880.0. When physical inactivity and overweight and obesity interacted, it increased more than normal weight in dose response manner (P < .05): excluding indirect costs, $799.2 < $800.3 < $886.1; Including indirect costs, $860.2 < $845.9 < $927.5. These results suggest that women with disability are in relatively poor health. It is proposed that inequality of BMI for women with disability can be developed as an agenda from health policy.

Genetics of Obesity in Humans: A Clinical Review

Obesity is a complex multifactorial disorder with genetic and environmental factors. There is an increase in the worldwide prevalence of obesity in both developed and developing countries. The development of genome-wide association studies (GWAS) and next-generation sequencing (NGS) has increased the discovery of genetic associations and awareness of monogenic and polygenic causes of obesity. The genetics of obesity could be classified into syndromic and non-syndromic obesity. Prader–Willi, fragile X, Bardet–Biedl, Cohen, and Albright Hereditary Osteodystrophy (AHO) syndromes are examples of syndromic obesity, which are associated with developmental delay and early onset obesity. Non-syndromic obesity could be monogenic, polygenic, or chromosomal in origin. Monogenic obesity is caused by variants of single genes while polygenic obesity includes several genes with the involvement of members of gene families. New advances in genetic testing have led to the identification of obesity-related genes. Leptin (LEP), the leptin receptor (LEPR), proopiomelanocortin (POMC), prohormone convertase 1 (PCSK1), the melanocortin 4 receptor (MC4R), single-minded homolog 1 (SIM1), brain-derived neurotrophic factor (BDNF), and the neurotrophic tyrosine kinase receptor type 2 gene (NTRK2) have been reported as causative genes for obesity. NGS is now in use and emerging as a useful tool to search for candidate genes for obesity in clinical settings.

Time-restricted eating to improve cardiometabolic health: The New York Time-Restricted EATing randomized clinical trial - Protocol overview

Re-aligning eating patterns with biological rhythm can reduce the burden of metabolic syndrome in older adults with overweight or obesity. Time-restricted eating (TRE) has been shown to result in weight loss and improved cardiometabolic health while being less challenging than counting calories. The New York Time-Restricted EATing study (NY-TREAT) is a two-arm, randomized clinical trial (RCT) that aims to examine the efficacy and sustainability of TRE (eating window ≤10 h/day) vs. a habitual prolonged eating window (HABIT, ≥14 h/day) in metabolically unhealthy midlife adults (50-75 years) with overweight or obesity and prediabetes or type 2 diabetes (T2D). Our primary hypothesis is that the TRE will result in greater weight loss compared to HABIT at 3 months. The efficacy of the TRE intervention on body weight, fat mass, energy expenditure, and glucose is tested at 3 months, and the sustainability of its effect is measured at 12 months, with ambulatory assessments of sleep and physical activity (ActiGraph), eating pattern (smartphone application), and interstitial glucose (continuous glucose monitoring). The RCT also includes state-of-the-art measurements of body fat (quantitative magnetic resonance), total energy expenditure (doubly-labelled water), insulin secretion, insulin resistance, and glucose tolerance. Adherence to self-monitoring and reduced eating window are monitored remotely in real-time. This RCT will provide further insight into the effects of TRE on cardiometabolic health in individuals with high metabolic risk. Sixty-two participants will be enrolled, and with estimated 30% attrition, 42 participants will return at 12 months. This protocol describes the design, interventions, methods, and expected outcomes. Clinical trial registration:NCT04465721 IRB: AAAS7791.

Exploring Health and Premature Mortality of Wheelchair Users from a Medical and a Greek-Orthodox Perspective

Wheelchair users have a lower life expectancy compared to the general population. This project aims to provide a deeper understanding of the interaction between physical, psychological, social, and spiritual factors that affect the mortality and health of this target group. The methods used were qualitative. Data from phenomenological interviews, questionnaires, medical reports, and existing literature were composed to develop a grounded theory depicting the overall health of wheelchair users. The research team explored death causes, risk factors of premature death, and contributors that affect risk factors. In the discussion, we explored and analyzed specific patterns of interaction of the factors in the data and other research projects. Moreover, we attempted to analyze these patterns through the viewpoint of the Greek-Orthodox tradition. In general, the project confirmed previous research findings. The most common death causes seemed to be heart attacks and cancer. These seemed to be affected mainly by obesity, physical inactivity, unhealthy lifestyle, and inadequate preventive healthcare. Spiritual practices based on the Greek-Orthodox tradition are suggested as ways of management. The conclusions can be useful not only to health and social care professionals and clerics, but also wheelchair users themselves.

Forced Sedentariness and Sports Activity as Factors Differentiating Anthropometric Characteristics, Indices, and Body Composition in People with Disabilities

Simple Summary

People with disabilities, especially those with musculoskeletal disabilities, are prone to leading forced sedentary lifestyles due to their limitations. Inactivity or reduced physical activity affect their body composition and physique. There are also athletes among people with disabilities. The sports they practice can compensate for physical inactivity in everyday life. The aim of our study was to demonstrate that forced sedentariness and varied sports activity are factors differentiating between anthropometric characteristics, indices, and body composition of individuals with disabilities, including Polish Para athletes (track and field athletes, sitting volleyball players, and wheelchair rugby players). It was found that non-athletes had the highest levels of obesity indices compared to Para athletes. Furthermore, in the group of Polish Para athletes, sitting volleyball players had the highest values of obesity indices. The results of the present study indicate that forced sedentariness and sports activity among individuals with disabilities differentiate body structure and physique.

Abstract

Introduction: Although the assessment of physique and body composition poses methodological, technical, and interpretative difficulties, it is of great importance for the health of people with disabilities. The aim of the study was to demonstrate that sedentariness and sports activity are factors differentiating anthropometric characteristics, indices, and body composition in people with physical disabilities. Materials and methods: Fifty-eight people were examined: 48 elite Polish Para athletes, including Paralympic track and field athletes (PTF, n = 8), sitting volleyball players (SV, n = 15), wheelchair rugby players (WR, n = 25), and individuals with cervical spinal cord injury (CSCI, n = 10). Body mass (BM), body height (BH), body length (BL), waist circumference (WC), hip circumference (HC), body fat percentage (%FT), and visceral fat rating (VFR) were measured. Furthermore, BMI, BMIcorrected, and body adiposity index (BAI) were evaluated. Results: The highest WC, BAI, %FT, and VFR were found for the CSCI group. The type of sport significantly differentiated between anthropometric features, indices, and body composition of the athletes. Sitting volleyball players achieved the highest mean BM (83.9), WC (92.9), HC (103.7), BMI (24.5), BAI (23.4), and VFR (12.6). The highest %FT (28.9) was found in wheelchair rugby players. Conclusions: The results of the present study indicate that forced sedentariness and sports activity among individuals with disabilities differentiate body structure and physique.

Differences in Body Mass Index Trajectories and Their Classification, Sociodemographic Characteristics, and Health Behaviors between People with and without Disabilities Using Korea Health Panel Survey Data

A high body mass index (BMI) is an important factor that negatively affects the health of people with disabilities. In particular, since the high BMI has a cumulative effect on the occurrence of complications such as cardiovascular disease, it is required to investigate the data through longitudinal studies rather than cross-sectional studies. Therefore, we conducted a longitudinal follow-up study to examine the differences in the BMI trajectories of people in South Korea with disabilities, as well as the sociodemographic characteristics and health behaviors that classify individual trajectories into clusters. Participants aged 40 to 79 years who responded to the Korea Health Panel Survey (KHPS) from 2009 to 2018, 283 people with physical disabilities or brain lesion disorders, and 849 people without disabilities, were extracted. We found that the differences in the initial BMI between clusters were larger in 60-79-year-old people with disabilities (men 22.5 kg/m², 26.9 kg/m²; women 23.8 kg/m², 28.1 kg/m²) than in those without disabilities (men 22.1 kg/m², 23.3 kg/m²; women 24.8 kg/m², 25.6 kg/m²). Also, logistic regression analysis showed that, among the people with disabilities, women (OR = 1.94), those who lived alone (OR = 2.36), and those who were economically inactive (OR = 1.78) were more likely to be classified into the higher BMI category than those who were not. To effectively manage the BMI, it would be better to focus on women with disabilities, people with disabilities living alone, and people who are economically inactive.

The Proper Motor Control Model Revealed by Wheelchair Curling Quantification of Elite Athletes

Simple Summary

This is the first study to quantitatively explore the motor control of elite wheelchair curling athletes. It is known that, psychologically, wheelchair users are often not comfortable with their wheelchair motor skills and, therefore, hesitate to participate in sports/physical activities. For increasing exercise of this population, an effective learning/training program should firstly be developed. This study has chosen a suitable sport, i.e., wheelchair curling, and identified and described generalizable characteristics or “markers” among elite athletes. Such markers could provide effective ways of accurately identifying, evaluating, and communicating when learning the skill. Due to this being an under-investigated area, this study also shed new light on how to scientifically promote physical participation of wheelchair users.

Abstract

Background: Wheelchair users are disadvantaged when it comes to accruing the benefits of physical activities. Hence, promoting various sports is crucial for keeping this population healthy. Since wheelchair curling can be played by individuals from a wide range of ages, strengths, and endurance levels, it has potential to improve wheelchair users’ well-being. Yet, hardly any motion studies exist. This study aimed to facilitate understanding of optimized control of wheelchair curling for promoting wheelchair users’ participation. Methods: Using motion capture technology, nine national-level athletes were tested. Kinematic parameters related to segment/joint control and their coordination were quantified for both slow and fast curling. Descriptive statistics (means and standard deviations) and correlation analysis were applied for characterizing the skill. Results: (1) Curling control consists of an acceleration phase and a stabilizing delivery phase; (2) the control of trunk, shoulder, and wrist are responsible for accelerating the rock; (3) elbow control is accountable for the accurate delivery of the rock; and (4) during the slow curling, a synchronized effort of trunk, shoulder, and wrist is used for accelerating the rock, while a sequential control among the segment/joints is applied in fast curling. Conclusions: The results supply valuable motor learning markers that could have a significant positive impact on the teaching and learning of wheelchair curling, as such, the findings have great potential for the health promotion of wheelchair users.

Adolescent psychological well-being and adulthood cardiovascular disease risk: longitudinal association and implications for care quality management

Purpose

Prior research suggests that 80% of cardiovascular disease (CVD) events can be prevented by modifying certain behaviors, yet it remains the primary cause of mortality worldwide. Early detection and management of critical modifiable factors have the potential to improve cardiovascular care quality as well as the associated health outcomes. This study aims to assess the independent impact of psychological well-being in adolescence, a modifiable factor, on long-term CVD risk and promote targeted early interventions through quality management principles.

Design/methodology/approach

Data from the Add Health study, which employed a series of surveys and health tests (Wave 1 – Wave 4) on individuals for 14 years (from adolescence to adulthood), were obtained and analyzed longitudinally. Psychological well-being in adolescence was assessed using four Wave 1 survey questions, and 30-year CVD risk was estimated 14 years later with Wave 4 data. Three different logistic regression models were examined to understand the impact of adding covariates.

Findings

This study’s sample included 12,116 individuals who responded to all the relevant questions and underwent clinical risk factor measurements in Wave 1 (adolescence) and Wave 4 (young adulthood). Psychological well-being was protective with reduced risk for CVD across the three models tested. There is a statistically significant association, where increasing psychological well-being reduced the 30-year CVD risk exponentially in all the models. The analysis also suggested an exposure–response relationship, where the 30-year risk category of adulthood CVD decreased with an increase in psychological well-being.

Practical implications

This research uncovers an inverse association between adolescent psychological well-being and adulthood CVD risk. This study also identifies quality management-based preventive tools/techniques to improve psychological well-being in adolescence and therefore reduce CVD risk later in life.

Originality/value

This study is among the first to establish a long-term association between positive well-being and CVD risk. Also, unlike the existing literature, this work provides implications for improving CVD care from a quality management perspective.

Effect of Diabetes on Post-stroke Recovery: A Systematic Narrative Review

Background: Patients with stroke often have comorbid diabetes. Considering its detrimental effects on brain function, diabetes may increase the risk of poor recovery.

Methods: The aim of this review was to investigate the effect of diabetes on post-stroke recovery by a systematic review. Several specific aspects of post-stroke recovery, including activities of daily living (ADL), motor, cognitive, and quality of life (QOL) recovery, were examined. We searched the PubMed, SCOPUS, Embase, and Cochrane Library databases for relevant studies on the effect of diabetes on post-stroke recovery, published until May 26, 2021. A total of 52,051 potentially relevant articles were identified. After reading the titles and abstracts and assessing their eligibility based on full-text articles, 34 publications were included in this review.

Results: Of 29 studies that assessed ADL recovery after stroke, 22 studies suggested that diabetes had a negative effect on recovery of ADL after stroke. Regarding motor recovery, only one out of four studies showed that diabetes had some effect on motor recovery after stroke. Of the two studies on cognitive recovery, one reported that diabetes was an independent predictor of poor cognitive recovery after stroke. Three studies on QOL reported that a poor QOL after stroke was associated with the presence of diabetes.

Conclusions: The current review suggests that the post-stroke recovery of ADL seems to be poorer in patients with diabetes than patients without diabetes. Further, there are insufficient data to conclude the effect of diabetes on motor and cognitive recovery, but it may have some influence on the quality of life after stroke.

Systematic Review Registration: doi: 10.37766/inplasy2021.11.0032, identifier: INPLASY2021110032.

Nationwide trends in prevalence of underweight, overweight, and obesity among people with disabilities in South Korea from 2008 to 2017

Objectives

This study investigated the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities.

Methods

This serial cross-sectional analysis was conducted using national disability registration data with national general health checkup data from 2008 to 2017. Age-standardized prevalence of underweight and obesity were analyzed for each year, according to the presence, type, and severity of disabilities. Odds of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables using data in 2017.

Results

Over 10 million subjects in each year were included in the analysis. In 2017, 14,246,785 people with age between 19 and 110 years were included and 53.1% was men. For 10 years, age-standardized prevalence of obesity and severe obesity showed significant increases regardless of sex and presence of disability. However, age-standardized underweight prevalence in people without disability tended to decrease whereas it was an increase in 2012 and the prevalence has remained steady since in people with disability. People with disabilities had higher odds of underweight compared to those without disability (OR 1.41, 95% CI 1.38–1.44 in male and OR 1.31, 95% CI 1.28–1.34 in female), especially in those with severe disabilities (OR 2.00, 95% CI 1.94–2.06 in male and OR 1.83, 95% CI 1.77–1.89 in female). Women with disabilities are more likely to be obese than those without disabilities regardless of disability severity (OR 1.40, 95% CI 1.38–1.41). Participants with mental disorder showed the highest prevalence of obesity, followed by epilepsy and developmental disability.

Conclusions

Having a disability was associated with higher odds/probability of both obesity and underweight. The intersection of female, severe disability, and mental/developmental disabilities was associated with probability of severe obesity. Simultaneous efforts are needed to develop health policy to reduce both the prevalence of obesity and underweight.

Increased Fat Oxidation During Arm Cycling Exercise in Adult Men With Spinal Cord Injury Compared With Noninjured Controls

People with spinal cord injury (SCI) tend to be more sedentary and increase fat accumulation, which could have a negative influence on metabolic flexibility. The aim of this study was to investigate the capacity to oxidize fat in a homogenous sample of men with thoracic SCI compared with healthy noninjured men during an arm cycling incremental test. Forty-one men, 21 with SCI and 20 noninjured controls, performed an incremental arm cycling test to determine peak fat oxidation (PFO) and the intensity of exercise that elicits PFO (Fatmax). PFO was expressed in absolute values (g/min) and relative to whole-body and upper-body lean mass ([mg·min-1]·kg-1) through three different models (adjusting by cardiorespiratory fitness and fat mass). Gross mechanical efficiency was also calculated. PFO was higher in SCI than in noninjured men (0.27 ± 0.07 vs. 0.17 ± 0.07 g/min; 5.39 ± 1.30 vs. 3.29 ± 1.31 [mg·min-1]·kg-1 whole-body lean mass; 8.28 ± 2.11 vs. 5.08 ± 2.12 [mg·min-1]·kg-1 upper-body lean mass). Fatmax was found at a significantly higher percentage of VO2peak in men with SCI (33.6% ± 8.2% vs. 23.6% ± 6.4%). Differences persisted and even increased in the fully adjustment model and at any intensity. Men with SCI showed significantly higher gross mechanical efficiency at 35 and 65 W than the noninjured group. Men with SCI showed higher fat oxidation when compared with noninjured men at any intensity, even increased after full adjustment for lean mass, fat mass, and cardiorespiratory fitness. These findings suggest that SCI men could improve their metabolic flexibility and muscle mass for greater efficiency, not being affected by their fat accumulation.

Polymorphism in the HaeIII single nucleotide polymorphism of the SLC2A1 gene and cardiovascular disease in the early type 2 diabetes mellitus

INTRODUCTION

SLC2A1 polymorphism may play a role in the smooth muscle cell proliferation and extracellular matrix synthesis in vessels. However, the role of SLC2A1 polymorphism on diabetic cardiovascular disease (CVD) have not yet been identified. In this study, we aimed to investigate the association between SLC2A1 HaeIII polymorphism and CVD in Korean patients with type 2 diabetes mellitus (T2DM) according to disease duration.

METHODS

A total of 846 patients with T2DM who visited the Chungbuk National University Hospital were investigated. The HaeIII polymorphism of SLC2A1 gene was determined by real time polymerase chain reaction method. Genotyping results were presented GG, AG, or AA. Subgroup analysis was performed according to duration of T2DM (⩽10, 11-20, >20 years).

RESULTS

The AA genotype was significantly associated with higher prevalence of CVD in patients with DM duration less than 10 years (26.3% vs 9.2%, p = 0.014). There was no significant association between SLC2A1 HaeIII polymorphism and other diabetic complications including, retinopathy, nephropathy, neuropathy, cerebrovascular disease, and peripheral artery disease.

CONCLUSIONS

The SLC2A1 HaeIII polymorphism was associated with CVD in Korean patients with T2DM with short disease duration.

Predicting Cardiometabolic Risk From Visceral Abdominal Adiposity in Persons With Chronic Spinal Cord Injury

Persons with spinal cord injury (SCI) have increased adiposity that may predispose to cardiovascular disease compared to those who are able-bodied (AB). The purpose of this study was to determine the relationships between dual energy X-ray absorptiometry (DXA)-derived visceral adipose tissue (VAT) and biomarkers of lipid metabolism and insulin resistance in persons with chronic SCI. A prospective observational study in participants with chronic SCI and age- and gender-matched AB controls. The study was conducted at a Department of Veterans Affairs Medical Center and Private Rehabilitation Hospital. The quantification of DXA-derived VAT volume (VAT_vol) and blood-derived markers of lipid and carbohydrate metabolism were determined in 100 SCI and 51 AB men. The VAT_vol was acquired from a total body DXA scan and analyzed using iDXA enCore CoreScan software (GE Lunar). Blood samples were collected for the serum lipid profile and plasma and glucose concentrations, with the latter two values used to calculate a measure of insulin resistance. In the SCI and AB groups, VAT% was significantly correlated with most cardiometabolic biomarkers. The results of the binary logistic regression analysis revealed that participants who had a VAT_vol above the cutoff value of 1630 cm³ were 3.1-, 4.8-, 5.6-, 19.2-, and 16.7-times more likely to have high serum triglycerides (R²_N= 0.09, p = 0.014), low serum high density lipoprotein cholesterol (R²_N = 0.16, p < 0.001), HOMA2-IR (R²_N = 0.18, p < 0.001), metabolic syndrome (R²_N = 0.25, p < 0.001), and a 10-yr Framingham Risk Score ≥ 10% (R²_N = 0.16, p = 0.001), respectively, when compared to participants below this VAT_vol cutoff value. Our findings reveal that persons with chronic SCI have a higher VAT_vol than that of AB controls, and VAT_vol correlates directly with biomarkers of lipid and carbohydrate metabolism that are strong predictors of cardiometabolic disorders.

A Smartphone Intervention to Promote Time Restricted Eating Reduces Body Weight and Blood Pressure in Adults with Overweight and Obesity: A Pilot Study

The goal of this study was to test the feasibility of time restricted eating (TRE) in adults with overweight and obesity. Participants (n = 50) logged all eating occasions (>0 kcal) for a 2-week run-in period using a smartphone application. Participants with eating duration ≥14 h enrolled in an open label, non-randomized, prospective 90-day TRE intervention, with a self-selected reduced eating window of 10 h. No dietary counseling was provided. Changes in anthropometrics, eating patterns and adherence after TRE were analyzed using t-tests or Wilcoxon Rank-Sum Test. The mean duration of the baseline eating window was 14 h 32 m ± 2 h 36 m (n = 50) with 56% of participants with duration ≥14 h. TRE participants (n = 16) successfully decreased their eating window from 16 h 04 m ± 1 h 24 m to 11 h 54 m ± 2 h 06 m (p < 0.001), and reduced the number of daily eating occasions by half (p < 0.001). Adherence to logging and to the reduced eating window was 64% ± 22% and 47% ± 19%, respectively. TRE resulted in decreases in body weight (−2.1 ± 3.0 kg, p = 0.017), waist circumference (−2.2 ± 4.6 cm, p = 0.002) and systolic blood pressure (−12 ± 11 mmHg, p = 0.002). This study demonstrates the feasibility and efficacy of TRE administered via a smartphone, in adults with overweight and obesity.

Diabetes and obesity are associated with disability in community-dwelling stroke survivors: A cross-sectional study of 37,955 Behavioral Risk Factor Surveillance System respondents

Purpose. Stroke increases risk for disability. Obesity and diabetes also increase risk for disability in the general population, but their association with disability in stroke survivors is unknown. We examined disability risk associated with obesity and diabetes in stroke survivors across six disability types: hearing, vision, cognition, mobility, and basic and instrumental activities of daily living (ADLs).Materials and Methods. Data from 37,955 community-dwelling US stroke survivors aged ≥18 years were analyzed from the 2017 and 2018 Behavioral Risk Factor Surveillance System. Linear regression was used to calculate prevalence of each disability type. Survivors were stratified by obesity versus normal weight and diabetes vs no diabetes, and logistic regression was used to calculate adjusted odds ratios (AOR) for each disability type, adjusted for demographic information.Results. Prevalences of disability types ranged from 14.2% to 36.0%. Among survivors with obesity, odds were elevated for mobility (AOR: 1.68) and basic ADL (AOR: 1.55) disability. Among survivors with diabetes, odds were elevated for all disability types (AOR range: 1.15-1.71).Conclusion. Stroke survivors with obesity or diabetes experience increased risk for disability compared to survivors without these chronic conditions. Interventions for managing disability, obesity, and diabetes concomitantly may be warranted and deserve further consideration.

Associations between Disability and Infertility among U.S. Reproductive-Aged Women

We aim to evaluate the association between self-reported disabilities and infertility and whether disabilities are associated with decreased likelihood of seeking infertility-related care. This US nationally representative cross-sectional analysis includes 3789 non-pregnant women aged 18–49 years without history of hysterectomy or oophorectomy (NHANES, 2013–2018). Disabilities and infertility were both self-reported in personal interviews with trained interviewers. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% confidence intervals for the association between disabilities and infertility and related care seeking. Models adjusted for potential confounders and complex probability sampling. Compared to women without disabilities, women with disabilities (WWD) had higher odds of infertility (aOR: 1.78 (1.31–2.40)). Similar findings were observed for sensory (2.32 (1.52–3.52)) and cognitive disabilities (1.77 (1.28–2.44)). Among women with infertility, WWD were less likely to seek infertility-related care (0.68 (0.32–1.44)) but these estimates were not statistically significant. WWD have increased odds of reporting infertility, and if affected, are less likely to visit a health care provider for this condition. While more research is needed to understand reproductive health issues and needs among WWD, it is important to push for more equitable policies and practices to address the health needs of this underserved population.

Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments

Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

The Prevalence and Risk of Type 2 Diabetes in Adults with Disabilities in Korea

BACKGROUND

People with disabilities are at risk of secondary conditions such as diabetes. The aim of this study was to evaluate the prevalence and risk of type 2 diabetes in South Korea, especially among people with all types of disabilities.

METHODS

We conducted a cross-sectional study using data from the Korean National Health Insurance Service, with two disabilityfree controls matched for each participant with disabilities by age and sex. Information regarding the type, severity and grade of disabilities was obtained based on the National Disability Registry. Diagnosis of type 2 diabetes was defined according to the following criteria: presence of International Classification of Diseases, Tenth Revision, Clinical Modification codes E11, E12, E13, or E14 and claims for at least one oral anti-diabetic agent or insulin at baseline, or fasting glucose level ≥126 mg/dL.

RESULTS

We included 1,297,806 participants with disabilities and 2,943,719 control. Out of 4,241,525 participants, 841,990 (19.9%) were diagnosed with diabetes. The prevalence of diabetes was higher in the disability group compared with individuals without disabilities (23.1% vs. 18.4%). The odds of having diabetes was higher in the disability group compared with the control group (adjusted odds ratio, 1.34; 95% confidence interval, 1.33 to 1.34). The results showed higher prevalence of diabetes in the mildly disabled group (23.2%) than in the severely disabled group (22.7%).

CONCLUSION

The prevalence and risk of diabetes were higher in people with disabilities compared with the general population. Physicians and public health authorities should focus on people with disabilities for proper diabetes management.

Weight management for adults with mobility related disabilities: Rationale and design for an 18-month randomized trial

Adults with mobility related disabilities (MRDs) represent an underserved group with a high prevalence of overweight/obesity and limited options for weight management. We previously demonstrated clinically meaningful 12-month weight loss in adults with MRDs (-6.2%, 36% ≥5% of baseline weight) using an enhanced Stop Light Diet (eSLD) delivered using at home face-to-face behavioral sessions and optional physical activity. However, the costs/logistics associated with intervention delivery by individual home visits limits the potential for scaling and implementation of this approach. Thus, we will conduct a two-arm randomized trial in 128 overweight/obese adults with MRDs to compare weight loss (6 mos.) and maintenance (12 mos.) between interventions utilizing the eSLD, behavioral counseling, and increased physical activity delivered to individual participants in their homes or delivered to groups of participants in their homes remotely via video conferencing. The primary aim will compare weight loss between interventions arms across 6 months. Secondarily, we will compare weight loss (0-18 mos.), the proportion of participants who achieve clinically meaningful weight loss (≥5%) from 0 to 6 and 0 to18 months, and changes in quality of life from 0 to 6 and 0 to 18 months between interventions arms. We will also conduct cost, cost-effectiveness and contingent valuation comparisons and explore the influence of behavioral session attendance, compliance with the recommendations for diet and physical activity, self-monitoring of diet and physical activity, barriers to physical activity, sleep quality, and medications on weight change across 6 and 18 months. NCT REGISTRATION: NCT04046471.

Longitudinal association between adolescent negative emotions and adulthood cardiovascular disease risk: an opportunity for healthcare quality improvement

Purpose

While cardiovascular disease (CVD) is the leading cause of death globally, over 80% of the cases could be prevented through early lifestyle changes. From the perspective of quality management in healthcare, this may offer an effective prevention window if modifiable CVD risk factors are identified and treated in adolescence. The purpose of this research is to examine the negative emotions in adolescents and determine if it independently increases CVD risk later in life.

Design/methodology/approach

Longitudinal data from 12,350 participants of the Add Health study, which conducted a multi-wave survey for 14 years from adolescence (Wave 1) through adulthood (Wave 4), were used to test the research hypothesis. Four items (perception of life, self-reported depression, perceived loneliness and fearfulness) reflective of adolescent negative emotion were identified from the Wave 1 questionnaire, and factor analysis was conducted to confirm the hypothesized structure. The outcome variable, 30-year adulthood CVD risk category (high or low risk), was estimated using biomarkers, biological data and other factors collected during the 14-year follow-up in Wave 4. A logistic regression analysis was employed to assess the impact of adolescent negative emotions on adulthood CVD risk after adjusting for common risk factors such as sociodemographic characteristics, socioeconomic status and medical conditions in adolescence.

Findings

The results indicated adolescent negative emotion to be significantly associated with CVD risk category (p-value < 0.0001), even after controlling for common risk factors. A unit increase in the level of adolescent negative emotion increased the chance of being in the high CVD risk group in adulthood by 8% (odds ratio = 1.08 ± 0.03).

Practical implications

Healthcare providers and organizations could capitalize on the research findings by screening for negative emotions early in life through individual and societal interventions. The findings also provide an opportunity for implementing quality improvement initiatives to deliver robust preventive care, which, in turn, could improve the overall population health, reduce healthcare costs and improve care quality.

Originality/value

Although previous studies showed a strong link between adolescent physiological factors (e.g. obesity) and adulthood cardiovascular disease (CVD), the association between adolescent outlook/attitude (negative emotion) and CVD risk has not been examined.

The economic gradient of obesity in Mexico: Independent predictive roles of absolute and relative wealth by gender

Despite the vast literature on the economic gradient of obesity, no study investigates the independent predictive roles of absolute and relative standards of living using a large nationally representative adult sample. This gap limits our ability to discern 'material' and 'psychosocial' pathways to obesity as well as our understanding of the role played by economic inequality in the growing obesity epidemic. Using a large and nationally representative Mexican dataset, we find that absolute wealth and relative deprivation are independently related to obesity, and that such relationships are patterned by sex. Absolute wealth predicts body mass index as well as abdominal obesity according to an inverted-U shape for both sexes, and more markedly so for females. Relative deprivation predicts higher body mass index for females and higher waist circumference for both sexes, with highly relatively deprived females being 24.29% (95% CI [24.26, 24.31]) more likely to be obese and 34.46% (95% CI [34.40,34.53]) more likely to be abdominal obese, and highly relatively deprived males being 14.91% (95% CI [14.88,14.93] more likely to be abdominal obese. Our results offer a new perspective on the economic gradient of obesity and highlight the potential impact of economic inequality, especially for women. Greater awareness of the independent and sex-specific roles of the absolute and relative facets of economic status is needed to better understand and address the obesity epidemic.

Obesity and diabetes are jointly associated with functional disability in stroke survivors

BACKGROUND

Stroke is the most common cause of complex disability. Obesity and diabetes increase risk for functional disability in the general population, but their contribution to functional disability in stroke survivors is unknown.

OBJECTIVE

To investigate the joint association of obesity and diabetes with functional disability in stroke survivors.

METHODS

Cross-sectional data from 34,376 stroke survivors from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys were examined. Weighted and age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for sociodemographic characteristics) with 95% confidence intervals (CIs) were calculated to compare prevalence and odds for self-reported functional disability, stratified by obesity-diabetes status (i.e., neither condition, obesity only, diabetes only, both conditions).

RESULTS

Prevalence of functional disability increased across obesity-diabetes categories in the total sample: neither condition (45.4%, 95% CI: 43.4%-47.4%), obesity only (55.3%, 95% CI: 52.7%-58.0%), diabetes only (60.8%, 95% CI: 57.5%-64.1%), and both conditions (70.3%, 95% CI: 67.7%-72.9%). Compared to respondents with neither condition, those with both obesity and diabetes had 2.62 (95% CI: 2.23-3.08) higher odds for functional disability; odds were also increased for respondents with obesity only (1.52, 95% CI: 1.32-1.76) and diabetes only (1.71, CI: 1.45-2.01).

CONCLUSIONS

Our findings indicated a joint effect of obesity and diabetes on functional disability that exceeded either condition alone, placing stroke survivors with both health conditions at greatest risk for diminished functional capacity. Recognizing obesity and diabetes as modifiable risk factors may be useful for identifying stroke sub-populations that could benefit from lifestyle intervention.

Randomized controlled trial of SystemCHANGE™ weight management intervention in neurological conditions

OBJECTIVE

This randomized controlled pilot study examined the feasibility and efficacy of a SystemCHANGE™ (SC) weight management intervention in adults with either multiple sclerosis or stroke.

METHODS

Participants (n = 61) were randomized into two interventions: SC, which taught skills to modify personal environments, or active-control (AC), which taught health behavior guidelines. Sessions were held weekly for 12 weeks. Feasibility measures included recruitment and attrition rates. The primary outcome of body weight and secondary outcomes of emotional well-being and healthy behaviors were measured before and after the interventions.

RESULTS

Average recruitment rate was 3.6 participants per month. Attrition rate was 14.8%. On average, 9.1 sessions were completed for SC and 10.7 for AC. Differences in weight loss were non-significant between interventions (P = 0.182), but significantly declined across both interventions (P = 0.011). Physical activity (P = 0.002), depression (P < 0.001), anxiety (P = 0.023), and self-efficacy (P = 0.022) all significantly improved for SC compared to AC.

CONCLUSIONS

SC was feasible to implement and efficacious in improving secondary outcomes of emotional well-being and healthy behaviors, but was not efficacious in improving the primary outcome of weight loss. More research is needed to optimize SC.

PRACTICE IMPLICATIONS

SC might be an alternative approach to cognitive-behavioral therapy for promoting emotional well-being and healthy behaviors.

Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study

BACKGROUND

Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs.

OBJECTIVE

This study aimed to evaluate the usability of a high-quality, publicly available, weight management-focused mobile BIT (smartphone app) for AYA-SBs.

METHODS

Overall, 28 AYA-SBs attending a Young Men's Christian Association-based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app.

RESULTS

The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use.

CONCLUSIONS

AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs.

Influence of upper-body continuous, resistance or high-intensity interval training (CRIT) on postprandial responses in persons with spinal cord injury: study protocol for a randomised controlled trial

Background

Chronic spinal cord injury (SCI) increases morbidity and mortality associated with cardiometabolic diseases, secondary to increases in central adiposity, hyperlipidaemia and impaired glucose tolerance. While upper-body Moderate Intensity Continuous Training (MICT) improves cardiorespiratory fitness, its effects on cardiometabolic component risks in adults with SCI appear relatively modest. The aim of this study is to assess the acute effects of Continuous Resistance Training (CRT), High Intensity Interval Training (HIIT), MICT and rest (CON) on fasting and postprandial systemic biomarkers and substrate utilisation.

Methods

Eleven healthy, chronic SCI (> 1 year, ASIA A-C) men will be recruited. Following preliminary testing, each will complete four experimental conditions, where they will report to the laboratory following an ~ 10-h overnight fast. A venous blood sample will be drawn and expired gases collected to estimate resting metabolic rate (RMR). In order to ensure an isocaloric exercise challenge, each will complete CRT first, with the remaining three conditions presented in randomised order: (1) CRT, ~ 45 min of resistance manoeuvres (weight lifting) interspersed with low-resistance, high-speed arm-crank exercise; (2) CON, seated rest; (3) MICT, ~ 45 min constant arm-crank exercise at a resistance equivalent to 30–40% peak power output (PPO) and; (4) HIIT, ~ 35 min arm-crank exercise with the resistance alternating every 2 min between 10% PPO and 70% PPO. After each ~ 45-min condition, participants will ingest a 2510-kJ liquid test meal (35% fat, 50% carbohydrate, 15% protein). Venous blood and expired gas samples will be collected at the end of exercise and at regular intervals for 120 min post meal.

Discussion

This study should establish the acute effects of different forms of exercise on fasting and postprandial responses in chronic SCI male patients. Measures of glucose clearance, insulin sensitivity, lipid and inflammatory biomarker concentrations will be assessed and changes in whole-body substrate oxidation estimated from expired gases.

Trial registration

ClinicalTrials.gov, ID: NCT03545867. Retrospectively registered on 1 June 2018. 

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3583-1) contains supplementary material, which is available to authorized users.

Dietary intakes and prevalence of overweight/obesity in male non-dysvascular lower limb amputees

BACKGROUND

Lower limb amputees are at higher risk of cardiovascular disease compared to non-amputees. Dietary intake, a major determinant of cardiovascular disease risk, has not previously been studied in this group.

OBJECTIVE

The aim of this study was to investigate dietary intakes and prevalence of overweight/obesity in adult lower limb amputees.

STUDY DESIGN

A cross-sectional survey was used to investigate the dietary intake and prevalence of overweight/obesity in adults with lower limb amputations living in the United Kingdom.

METHOD

Dietary intakes of male adult lower limb amputees ( n = 46, non-dysvascular) were assessed using food frequency questionnaires and results were compared to dietary reference values in the United Kingdom. Prevalence of overweight/obesity was assessed through body mass index and waist-to-hip ratio and compared to the general population according to the Health Survey for England 2011.

RESULTS

Dietary intake risk factors for cardiovascular disease such as sugars (22.01%), total fat (34.87%), saturated fat (12.72%) and sodium (2660.10 mg/day) were significantly higher ( p < 0.001, p < 0.001, p = 0.043, p < 0.001; p < 0.001; respectively) than the dietary reference values. A high prevalence (82.8%) of overweight/obesity was found with a significantly higher body mass index and waist-to-hip ratio ( p = 0.027; p = 0.001; respectively) compared to the Health Survey for England 2011.

CONCLUSION

High intakes of sugars, dietary fats, sugars and salts, combined with high prevalence of overweight/obesity observed in lower limb amputees are concerning. These findings suggest that greater emphasis on dietary intakes should be considered for rehabilitation programmes.

CLINICAL RELEVANCE

Findings highlight poor dietary habits in lower limb amputees with respect to fat, sugar and salt intake, also high levels of overweight/obesity. Considering greater emphasis on dietary intake and including lifestyle changing interventions in rehabilitation programmes for lower limb amputees may lower the risk of obesity and CVD.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability

Aim

Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability.

Design

Empirical research ‐ qualitative.

Method

Classic grounded theory with face‐to‐face interviews, 2017–2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients.

Results

To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses’ facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person‐centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work.

Conclusions

Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi‐professional cooperation. The implication is testing the emerged theory at primary health care centres.

Impact

Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.

Rationale and design of a Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) in people with physical/mobility disabilities: a type 1 hybrid design effectiveness trial

INTRODUCTION

Rates of physical inactivity among people with physical disabilities are substantially higher than in the general population and access to home-based tailored exercise programmes is almost non-existent. Using a theory-driven eHealth platform, an innovative exercise programme referred to as movement-to-music (M2M) will be delivered as a customised, home-based exercise intervention for adults with mobility disabilities.

METHODS AND ANALYSIS

Participants are being recruited for this type 1 hybrid design based effectiveness trial through outpatient clinics at a large rehabilitation centre and randomised to one of three groups: (1) M2M, (2) M2M plus social networking (M2M^plus) and (3) attention control (AC). The intervention includes a 12-week adoption phase, 12-week transition phase and 24-week maintenance phase, at which the collection of objective measures on exercise, fitness and self-reported measures on health will be obtained at the start of each phase and at follow-up. The study compares the effectiveness of M2M and M2M^plus in increasing physical activity (primary outcome), adherence, fitness and physical functioning compared with the AC group and examines the mediators and moderators of the treatment effect.

ETHICS AND DISSEMINATION

The Institutional Review Board of The University of Alabama at Birmingham granted full approval: (IRB-160923002). Dissemination of findings will include publication in peer-reviewed journals, presentations at regional, national and/or international meetings, and the National Center on Health, Physical Activity and Disability (NCHPAD, www.nchpad.org). This study will strengthen our understanding of the potential benefits of eHealth exercise interventions for people with physical disabilities and build on strategies that aim to recruit larger samples in exercise trials.

TRIAL REGISTRATION NUMBER

NCT03024320; Pre-results.

The association of mobility disability and obesity with risk of unemployment in two cohorts from Sweden

Background

People with mobility disability (MD) or obesity often have more health problems and are less able to participate in work than individuals without these conditions. This study investigated whether people burdened with MD and obesity have a greater risk of unemployment than people with either one (MD only or obesity only) or none of these conditions.

Methods

The study included two Swedish population-based cohorts, a national cohort (n = 39,947) and a regional cohort (n = 40,088). Six exposure groups were created using baseline self-reported data on MD and body mass index from participants aged 19 to 64 years. The MD definition differed between the cohorts. Various sources of socio-demographic factors were used to address confounding. Participants’ risks of unemployment were assessed longitudinally in a nationwide register with objective data and with almost no loss of follow-up (< 1%). Cox regression was used to analyse associations of MD and/or obesity (BMI ≥ 30) with risk of any (≥1 day) and long-term unemployment (≥90 days during two consecutive years). Quantile regression was used to estimate participants’ unemployment risks as average days of unemployment. Normal-weight people without MD were used as a reference group. The Wald test was applied for specific group comparisons other than to the reference group.

Results

In summary, the groups with MD and the obese group without MD had a higher risk of becoming unemployed than the reference group (regional survey adjusted hazard ratio range: 1.30–1.59; 95% CI range: 1.06–1.90, national survey adjusted hazard ratio range: 1.11–1.34; 95% CI range: 0.88–1.81). The obese group with MD did not differ from the groups with MD only or obesity only in terms of unemployment risk.

Conclusions

People with MD and/or obesity are vulnerable groups at risk of prolonged unemployment during their working life in a country with a highly developed welfare system.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6627-2) contains supplementary material, which is available to authorized users.

The complexity of reaching and maintaining a healthy body weight - the experience from adults with a mobility disability

BACKGROUND

People with a disability affecting their mobility are more likely to be overweight or obese than those without a mobility disability. The guidelines on how to prevent and treat overweight/obese adults in the general population have not been adapted to the needs of people with a mobility disability. A reasonable useful first step in the process of adapting such guidelines is to conduct a qualitative study of the perceived needs of these people.

AIM

The aim was to explore the experienced importance of body weight among adults with a mobility disability and their perceived needs and actions to reach and maintain a healthy weight.

METHOD

This was an explorative qualitative study based on individual interviews and qualitative content analysis. An inductive analysis of the interviews formed the basis for the establishment of sub-categories, main categories and, finally, a main theme. The twenty participants included in the study have had a mobility disability for more than two years before being recruited.

RESULTS

The overall theme, "The complex trajectory to a healthy weight", included four main categories. In the category (i) Vicious circle of problems, the participants perceived that everything was harder with the combination of a mobility disability and being overweight/obese with one factor making the other worse. In (ii) Strategies based on decisions and attempts, the participants talked about different ways of attempting to reach or maintain a healthy weight. In (iii) Internal resources, they spoke of awareness and motivation as contributory factors. In (iv) External resources - experienced and required, they spoke about feelings that their weight problems were not given high priority in primary health care. They found it difficult to get advice designed for persons with a mobility disability and felt that competence was lacking among health professionals. The participants asked for a team of professionals with adequate knowledge concerning mobility disabilities.

CONCLUSIONS

People with a mobility disability combined with being overweight/obese have a complex living situation and health needs. The experiences communicated by participants may facilitate adaption of existing intervention programs or development of a new evidence-based obesity prevention program for primary health care settings.

Anthropometric cutoffs and associations with visceral adiposity and metabolic biomarkers after spinal cord injury

Background/Objectives

To examine associations of different anthropometric measurements of central adiposity to visceral adipose tissue (measured via multi-axial magnetic resonance imaging; MRI) and cardiometabolic disease risk factors in men with spinal cord injury (SCI). Additionally, to determine population-specific seated/supine waist and abdominal circumference cutoffs, which may identify men at increased risk of cardiometabolic disease.

Participants/Methods

Twenty-two men with chronic SCI underwent MRI scans, anthropometric measurements along with assessments of various cardiometabolic risk biomarkers. Pearson/part (accounting for age as a covariate) correlation coefficients were calculated to determine the associations between study variables. Abdominal and waist circumference cutoffs were extrapolated using the slope of linear regression equations.

Results

Seated/supine abdominal and waist circumferences were (P < 0.01) associated with MRI visceral fat cross-sectional area (VAT_CSA), VAT volume and CSA:Total_CSA. Low density lipoprotein, non-high-density lipoprotein and total cholesterol were positively associated with seated/supine abdominal and waist circumferences after controlling for age; r = 0.50–0.61, r = 0.46–0.58, r = 0.52–0.58, P < 0.05, respectively. Tumor necrosis factor alpha was associated with seated/supine abdominal and waist circumferences after accounting for age; r = 0.49–0.51 and r = 0.48–0.56, P < 0.05 respectively. The population-specific cutoffs were 86.5cm and 88.3cm for supine waist and abdominal circumferences, respectively, as well as 89cm and 101cm for seated waist and abdominal circumferences, respectively. After dichotomizing VAT_CSA (< or ≥ 100cm²), peak oxygen uptake, triglycerides, insulin sensitivity and glycated hemoglobin were different (P < 0.05) between groups. After dichotomizing (< or ≥ 86.5cm) supine waist circumference, VAT_CSA, triglycerides and insulin sensitivity were different (P < 0.05) between groups.

Conclusions

Seated/supine circumferences are associated with both central adiposity and biomarkers of cardiometabolic disease risk in persons with SCI. Population-specific cutoffs are proposed herein to identify central adiposity and potential cardiometabolic disease risk after SCI.

Health-related lifestyles and obesity among adults with and without disability in Australia: Implication for mental health care

BACKGROUND

Numerous studies have reported people with disabilities are more likely to be obese and engaged in unhealthy lifestyles. Few studies explored the mechanism of health-related lifestyles and obesity among people with disabilities.

OBJECTIVE

We aimed to investigate health-related lifestyles and obesity in relation to disability among Australian adults. We further aimed to explore the potential mediating effect of psychological distress for disability in relation to health related lifestyles and obesity.

METHODS

Using the National Health Survey conducted in 2015 in Australia, we considered non-institutionalised adult participants (aged 18 + years old) as our study population (n = 11,598). Study outcomes included currently smoking, smoking daily, alcohol consumption, physical exercises, and obesity. We considered high psychological distress (Kessler 10 scores ≥ 22) a potential mediator for the disability-lifestyles and disability-obesity associations. Sample weights were calculated allowing for complex survey design. Adjusted Odds Ratios and 95% Confidence Intervals were evaluated using weighted Logistic regression models.

RESULTS

Compared to their disability-free counterparts, people with disabilities were more likely to be current smokers (aOR: 1.26, 95%CI: 1.08-1.47) and have obesity problems (1.44, 1.27-1.64), and were less likely to do physical exercises (0.67, 0.58-0.77), after controlling for socio-environmental factors. In the presence of high psychological distress, the disability-smoking association was no longer significant, and associations of disability-exercise (0.72, 0.62-0.84) and disability-obesity (1.38, 1.22-1.57) were influenced but remained significant.

CONCLUSION

High psychological distress demonstrated important mediating effects. Tailored mental health care for people with disabilities might have the utility to reduce unhealthy behaviors.

Analysis of the relationship between physical activity and metabolic syndrome risk factors in adults with intellectual disabilities

The purpose of this study was to investigate the relationship between physical activities and metabolic syndrome risk factors in adults with intellectual disabilities. Seventeen adults with intellectual disabilities at a sheltered workshop wore Actical for 5 days on workdays to measure their physical activity, and blood samples were taken to measure their physical fitness factors and examine their risk factors for metabolic syndrome. The average daily physical activity was found to be 655.41± 129.36 kcal, and the average total physical activity over 5 days was 3,224.94±149.68 kcal. A positive correlation was confirmed between physical activity and muscular strength, muscular endurance, total cholesterol, low-density lipoprotein cholesterol and disability rating. Factors that predicted physical activity of adults with disabilities were disability rating (t=6.280, P<0.001) and glycated hemoglobin (t= -2.315, P<0.036), which had a 73.9% correlation (R ²=0.739) with the physical activities of adults with intellectual disabilities. In conclusion, the physical activity level of adults with intellectual disabilities was significantly lower than that of adults in similar age groups, and such low physical activity may affect their muscular strength, muscular endurance, and metabolic syndrome risk factors. Therefore, additional studies on programs to improve and enhance physical activities at sheltered workshops, where adults with intellectual disabilities are mainly supervised and active, and guidelines for continuous health management are needed.

Urban green space and obesity in older adults: Evidence from Ireland

We examine the association between living in an urban area with more or less green space and the probability of being obese. This work involves the creation of a new dataset which combines geo-coded data at the individual level from the Irish Longitudinal Study on Ageing with green space data from the European Urban Atlas 2012. We find evidence suggestive of a u-shaped relationship between green space in urban areas and obesity; those living in areas with the lowest and highest shares of green space within a 1.6 km buffer zone have a higher probability of being classified as obese (BMI [Formula: see text]). The unexpected result that persons in areas with both the lowest and highest shares of green space have a higher probability of being obese than those in areas with intermediate shares, suggests that other characteristics of urban areas may be mediating this relationship.

Health Promotion for People with Disabilities: A Primer for Rehabilitation Counsellors

To engage in the community and the workplace requires physical, mental, and social health and wellbeing. Health promotion is a crucial rehabilitation counselling function for the health and wellbeing of people living with chronic illness and disability (CID). This exploratory review seeks to examine theories and models of motivation applicable to health promotion interventions in rehabilitation counselling practice. Although no single theory can address all the potential variables affecting people with CID's health behaviours, Bandura's (1977) concept of self-efficacy and outcome expectancy appear to be the most common factors in the health promotion models we surveyed. Among theories of motivation, only self-determination theory specifically includes a motivation variable, autonomy (internal and external motivation). We developed a diagram to depict a model, including all the theories and models covered in this exploratory review and identify commonalities among their constructs. This diagram can be used by rehabilitation counsellors to apply theories and models of motivation in case conceptualisation, formulating clinical hypotheses, developing treatment plans, and selecting and implementing evidence-based health promotion interventions for their clients.