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Zawada SJ, Ganjizadeh A, Conte GM, Demaerschalk BM, Erickson BJ. Accelerometer-Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank. J Am Heart Assoc 2024; 13:e032965. [PMID: 38818948 PMCID: PMC11255632 DOI: 10.1161/jaha.123.032965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate-to-vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). METHODS AND RESULTS In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929-0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001-1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001-1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771-0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997-0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827-0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002-1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977-0.992]). No between-group differences were significant at subgroup analysis. CONCLUSIONS Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.
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Affiliation(s)
| | - Ali Ganjizadeh
- Mayo Clinic Artificial Intelligence LaboratoryRochesterMN
| | | | - Bart M. Demaerschalk
- Mayo Clinic College of Medicine and SciencePhoenixAZ
- Mayo Clinic Division of Stroke and Cerebrovascular DiseasesDepartment of NeurologyPhoenixAZ
- Mayo Clinic Center for Digital HealthPhoenixAZ
| | - Bradley J. Erickson
- Mayo Clinic College of Medicine and SciencePhoenixAZ
- Mayo Clinic Artificial Intelligence LaboratoryRochesterMN
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Willems I, Verbestel V, Dumuid D, Stanford TE, Calders P, Lapauw B, Bogaert L, Blom MT, den Braver NR, van der Velde JHPM, Rutters F, De Craemer M. Cross-sectional associations between 24-hour movement behaviors and cardiometabolic health among adults with type 2 diabetes mellitus: A comparison according to weight status. J Sci Med Sport 2024; 27:179-186. [PMID: 38114412 DOI: 10.1016/j.jsams.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) is a chronic disease associated with overweight and obesity. Evidence suggests that 24-hour movement behaviors (24 h-MBs) play a crucial role in cardiometabolic health. However, it is not yet known if 24 h-MBs differ between weight status groups among people with T2DM (PwT2DM) and how 24 h-MBs are associated with their cardiometabolic health. DESIGN Cross-sectional study. METHODS Cardiometabolic variables (i.e. Body Mass Index (BMI), waist circumference (WC), HbA1c, fasting glucose, triglycerides, total-cholesterol, HDL-cholesterol, LDL-cholesterol, blood pressure) and 24 h-MBs (accelerometry and sleep-diary) of 1001 PwT2DM were collected. Regression models using compositional data analysis explored differences in 24 h-MBs between weight status groups and analyzed associations with cardiometabolic variables. RESULTS The 24 h-MBs of PwT2DM being obese consisted of less sleep, light physical activity (LPA) and moderate to vigorous physical activity (MVPA) and more sedentary time (ST) per day as compared to PwT2DM being overweight or normal weight (p < 0.001). Regardless of weight status, the largest associations were found when reallocating 20 min a day from ST into MVPA for BMI (-0.32 kg/m2; [-0.55; -0.09], -1.09 %), WC (-1.44 cm, [-2.26; -0.62], -1.35 %) and HDL-cholesterol (0.02 mmol/l, [0.01, 0.02], +1.59 %), as well as from ST into LPA for triglycerides (-0.04 mmol/l, [-0.05; -0.03], -2.3 %). Moreover, these associations were different when stratifying people by short-to-average (7.7 h/night) versus long sleep (9.3 h/night) period. CONCLUSIONS This study highlights the importance of 24 h-MBs in the cardiometabolic health of PwT2DM. Shifting time from ST and/or sleep toward LPA or MVPA might theoretically benefit cardiometabolic health among relatively inactive PwT2DM, irrespective of weight status.
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Affiliation(s)
- Iris Willems
- Ghent University, Department of Rehabilitation Sciences, Belgium; Research Foundation Flanders, Belgium.
| | - Vera Verbestel
- Maastricht University, Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism & Care and Public Health Institute, the Netherlands.
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Australia.
| | - Tyman E Stanford
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Australia.
| | - Patrick Calders
- Ghent University, Department of Rehabilitation Sciences, Belgium.
| | - Bruno Lapauw
- Department of Internal Medicine and Pediatrics & Department of Endocrinology, Ghent University Hospital & Ghent University, Belgium.
| | - Lotte Bogaert
- Ghent University, Department of Rehabilitation Sciences, Belgium.
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit, the Netherlands.
| | - Nicolette R den Braver
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, the Netherlands.
| | | | - Femke Rutters
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, the Netherlands.
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Tsuda S, Honda T, Higashioka M, Hata J, Nakano T, Kitazono T, Ninomiya T. Longitudinal association of sedentary time with diabetes mellitus and markers of glucose metabolism in middle-aged and older adults: The Hisayama Study. J Diabetes Investig 2024; 15:245-246. [PMID: 37846193 PMCID: PMC10804891 DOI: 10.1111/jdi.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/19/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Affiliation(s)
- Susumu Tsuda
- Department of Epidemiology and Public HealthKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceKyushu UniversityFukuokaJapan
| | - Takanori Honda
- Department of Epidemiology and Public HealthKyushu UniversityFukuokaJapan
- Center for Cohort Studies, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Mayu Higashioka
- Department of Epidemiology and Public HealthKyushu UniversityFukuokaJapan
| | - Jun Hata
- Department of Epidemiology and Public HealthKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceKyushu UniversityFukuokaJapan
- Center for Cohort Studies, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshiaki Nakano
- Department of Medicine and Clinical ScienceKyushu UniversityFukuokaJapan
| | - Takanari Kitazono
- Department of Medicine and Clinical ScienceKyushu UniversityFukuokaJapan
- Center for Cohort Studies, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public HealthKyushu UniversityFukuokaJapan
- Center for Cohort Studies, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
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4
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Das C, Mishra B, Mondal S, Mondal H. Anticipatory Heart Rate Before Moderate- and Vigorous-Intensity Exercise Among Sedentary and Physically Active Young Adult Males. Cureus 2023; 15:e49707. [PMID: 38161957 PMCID: PMC10757437 DOI: 10.7759/cureus.49707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Anticipatory heart rate (HR) refers to an increase in HR that occurs in anticipation of a future event or activity. The anticipatory heart rate (HR) response before exercise is an important physiological indicator of exercise readiness. This study aimed to compare the anticipatory HR changes between sedentary and physically active young adult males during moderate- and vigorous-intensity exercise. Understanding these anticipatory heart rate patterns can provide insights into the physiological adaptations and cardiovascular health of individuals with varying physical activity levels. Materials and methods A total of 60 young adult males, comprising sedentary (n = 30) and physically active individuals (n = 30), participated in this study. A brisk walking for a distance of 50 m was considered moderate intensity and one minute of spot jogging at maximum effort with verbal encouragement was considered vigorous intensity exercise. The HR was recorded at baseline, just before the exercise, and on each minute up to 5 minutes after the exercise. Results The study involved 30 physically active young adult males (mean age 20.23 ± 1.43 years) and 30 sedentary adult males (mean age 20.07 ± 1.17 years). In physically active young adults, the resting HR was 76.4±10.89 bpm and just before starting moderate-intensity exercise, it was 78.83±12.98 bpm, paired t-test P = 0.22. The HR just before vigorous-intensity exercise was 80.83±11.18 bpm (paired t-test P = 0.03). In sedentary young adults, the resting HR was 82.23±12.69 bpm and just before starting moderate-intensity exercise, it was 90.13±18.69 bpm, paired t-test P = 0.0008. The HR just before vigorous-intensity exercise was 91.7±15.04 bpm (paired t-test P <0.0001). Conclusion Physically active young adults did not exhibit a significant increase in anticipatory HR before moderate-intensity exercise. However, sedentary individuals exhibit a significant anticipatory HR response. Before vigorous-intensity exercise, both exhibited significant increments in HR. The result highlights the importance of considering the anticipatory HR response as a potential marker of cardiovascular health and exercise readiness.
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Affiliation(s)
- Chinmay Das
- Physiology, Saheed Laxman Nayak Medical College and Hospital, Koraput, IND
| | | | - Shaikat Mondal
- Physiology, Raiganj Government Medical College and Hospital, Raiganj, IND
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Sayre MK, Anyawire M, Paolo B, Mabulla AZP, Pontzer H, Wood BM, Raichlen DA. Lifestyle and patterns of physical activity in Hadza foragers. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:340-356. [PMID: 37728135 PMCID: PMC10720916 DOI: 10.1002/ajpa.24846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Physically active lifestyles are associated with several health benefits. Physical activity (PA) levels are low in post-industrial populations, but generally high throughout life in subsistence populations. The Hadza are a subsistence-oriented foraging population in Tanzania known for being physically active, but it is unknown how recent increases in market integration may have altered their PA patterns. In this study, we examine PA patterns for Hadza women and men who engage in different amounts of traditional foraging. MATERIALS AND METHODS One hundred and seventy seven Hadza participants (51% female, 19-87 years) wore an Axivity accelerometer (dominant wrist) for ~6 days during dry season months. We evaluated the effects of age, sex, and lifestyle measures on four PA measures that capture different aspects of the PA profile. RESULTS Participants engaged in high levels of both moderate-intensity PA and inactivity. Although PA levels were negatively associated with age, older participants were still highly active. We found no differences in PA between participants living in more traditional "bush" camps and those living in more settled "village" camps. Mobility was positively associated with step counts for female participants, and schooling was positively associated with inactive time for male participants. CONCLUSIONS The similarity in PA patterns between Hadza participants in different camp types suggests that high PA levels characterize subsistence lifestyles generally. The sex-based difference in the effects of mobility and schooling on PA could be a reflection of the Hadza's gender-based division of labor, or indicate that changes to subsistence-oriented lifestyles impact women and men in different ways.
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Affiliation(s)
- M Katherine Sayre
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Audax Z P Mabulla
- Department of Archaeology and Heritage Studies, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Herman Pontzer
- Department of Anthropology, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Brian M Wood
- Department of Anthropology, University of California Los Angeles, Los Angeles, California, USA
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - David A Raichlen
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, California, USA
- Department of Anthropology, University of Southern California, Los Angeles, California, USA
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Salas-González MD, Bermejo LM, González-Rodríguez LG, Lozano-Estevan MDC, Ortega RM, López-Sobaler AM. Adherence to 24-h movement guidelines in Spanish schoolchildren and its association with insulin resistance: a cross-sectional study. Front Public Health 2023; 11:1146580. [PMID: 37492132 PMCID: PMC10365640 DOI: 10.3389/fpubh.2023.1146580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Being more active, being less sedentary, and sleeping enough are associated with adequate body weight and adiposity in children. However, few researchers have analyzed these different lifestyle behaviors and the adherence to 24 h movement guidelines with respect to insulin resistance (IR) at school age. Therefore, we aimed to analyse the association between the adherence to 24 h movement guidelines (physical activity, sedentary time, sleep) and IR in Spanish schoolchildren. Methods A cross-sectional study of 839 children (8-13 years, 51.1% girls) were studied. Anthropometric, biochemical, and lifestyle behavioral data were collected. IR was defined as HOMA-IR>3.16. Compliance with the 24 h movement guidelines were defined as ≥60 min/day of moderate and/or vigorous physical activity, < 120 min/day of screen time, and 9-11 h/day of sleep time. Associations between adherence to the 24 h movement guidelines and IR were performed by multivariate logistic regression analyses. Results The IR in our sample was 5.0%, being higher in girls. Compliance with physical activity or screen time, but not with sleep recommendations, was associated with lower fasting glucose, fasting insulin, and HOMA-IR values. A low adherence to 24 h movement guidelines was associated with a higher risk of IR (odds ratio (95% CI): 2.150 [1.089-4.247]), especially in girls (odds ratio (95% CI): 2.800 [1.180-6.645]). Conclusion Higher physical activity levels and lower screen times were associated with a lower risk of IR in schoolchildren, underlining the importance of adhering to as many healthy lifestyle recommendations as possible.
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Affiliation(s)
- María Dolores Salas-González
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura M. Bermejo
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Liliana G. González-Rodríguez
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - María Del Carmen Lozano-Estevan
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa M. Ortega
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana M. López-Sobaler
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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7
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Collings PJ, Backes A, Aguayo GA, Fagherazzi G, Malisoux L. Substituting device-measured sedentary time with alternative 24-hour movement behaviours: compositional associations with adiposity and cardiometabolic risk in the ORISCAV-LUX 2 study. Diabetol Metab Syndr 2023; 15:70. [PMID: 37013622 PMCID: PMC10071757 DOI: 10.1186/s13098-023-01040-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is a considerable burden of sedentary time in European adults. We aimed to quantify the differences in adiposity and cardiometabolic health associated with theoretically exchanging sedentary time for alternative 24 h movement behaviours. METHODS This observational cross-sectional study included Luxembourg residents aged 18-79 years who each provided ≥ 4 valid days of triaxial accelerometry (n = 1046). Covariable adjusted compositional isotemporal substitution models were used to examine if statistically replacing device-measured sedentary time with more time in the sleep period, light physical activity (PA), or moderate-to-vigorous PA (MVPA) was associated with adiposity and cardiometabolic health markers. We further investigated the cardiometabolic properties of replacing sedentary time which was accumulated in prolonged (≥ 30 min) with non-prolonged (< 30 min) bouts. RESULTS Replacing sedentary time with MVPA was favourably associated with adiposity, high-density lipoprotein cholesterol, fasting glucose, insulin, and clustered cardiometabolic risk. Substituting sedentary time with light PA was associated with lower total body fat, fasting insulin, and was the only time-exchange to predict lower triglycerides and a lower apolipoprotein B/A1 ratio. Exchanging sedentary time with more time in the sleep period was associated with lower fasting insulin, and with lower adiposity in short sleepers. There was no significant evidence that replacing prolonged with non-prolonged sedentary time was related to outcomes. CONCLUSIONS Artificial time-use substitutions indicate that replacing sedentary time with MVPA is beneficially associated with the widest range of cardiometabolic risk factors. Light PA confers some additional and unique metabolic benefit. Extending sleep, by substituting sedentary time with more time in the sleep period, may lower obesity risk in short sleepers.
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Affiliation(s)
- Paul J Collings
- Physical Activity, Sport and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, 1 A-B rue Thomas Edison, L-1445, Strassen, Luxembourg
| | - Anne Backes
- Physical Activity, Sport and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, 1 A-B rue Thomas Edison, L-1445, Strassen, Luxembourg
| | - Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, L-1445, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, L-1445, Strassen, Luxembourg
| | - Laurent Malisoux
- Physical Activity, Sport and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, 1 A-B rue Thomas Edison, L-1445, Strassen, Luxembourg.
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Kirchner H, Weisner L, Wilms B. When should I run-the role of exercise timing in metabolic health. Acta Physiol (Oxf) 2023; 237:e13953. [PMID: 36815281 DOI: 10.1111/apha.13953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
The prevalence of type 2 diabetes is reaching epidemic proportions. First line therapy approaches are lifestyle interventions including exercise. Although a vast amount of studies reports on beneficial effects of exercise on metabolism in humans per se, overall data are contradictory which makes it difficult to optimize interventions. Innovative exercise strategies and its underlying mechanism are needed to elucidate in order to close this therapeutic gap. The skeletal muscle produces and secretes myokines and microRNAs in response to exercise and both are discussed as mechanisms linking exercise and metabolic adaptation. Aspects of chronophysiology such as diurnal variation in insulin sensitivity or exercise as a signal to reset dysregulated peripheral clocks are of growing interest in the context of impaired metabolism. Deep insight of how exercise timing determines metabolic adaptations is required to optimize exercise interventions. This review aims to summarize the current state of research on the interaction between timing of exercise and metabolism in humans, providing insights into proposed mechanistic concepts focusing on myokines and microRNAs. First evidence points to an impact of timing of exercise on health outcome, although data are inconclusive. Underlying mechanisms remain elusive. It is currently unknown if the timed release of mykokines depends on time of day when exercise is performed. microRNAs have been found as an important mediator of processes associated with exercise adaptation. Further research is needed to evaluate their full relevance. In conclusion, it seems to be too early to provide concrete recommendations on timing of exercise to maximize beneficial effects.
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Affiliation(s)
- Henriette Kirchner
- Institute for Human Genetics, Epigenetics and Metabolism Lab, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Leon Weisner
- Institute of Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany
| | - Britta Wilms
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany
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Vetrovsky T, Kral N, Pfeiferova M, Kuhnova J, Novak J, Wahlich C, Jaklova A, Jurkova K, Janek M, Omcirk D, Capek V, Maes I, Steffl M, Ussher M, Tufano JJ, Elavsky S, Van Dyck D, Cimler R, Yates T, Harris T, Seifert B. mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): rationale and study protocol for a pragmatic randomised controlled trial. BMC Public Health 2023; 23:613. [PMID: 36997936 PMCID: PMC10064755 DOI: 10.1186/s12889-023-15513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking. METHODS We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months. DISCUSSION The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial's pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits. TRIAL REGISTRATION ClinicalTrials.gov (NCT05351359, 28/04/2022).
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.
| | - Norbert Kral
- Institute of General Practice, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marketa Pfeiferova
- Institute of General Practice, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jitka Kuhnova
- Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Novak
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Charlotte Wahlich
- Population Health Research Institute, St George's University of London, London, UK
| | - Andrea Jaklova
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Jurkova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michael Janek
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Dan Omcirk
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Vaclav Capek
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Iris Maes
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Michal Steffl
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - James J Tufano
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Steriani Elavsky
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Delfien Van Dyck
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Richard Cimler
- Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Tess Harris
- Population Health Research Institute, St George's University of London, London, UK
| | - Bohumil Seifert
- Institute of General Practice, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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10
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Ries JD, Philippou E, Devos H, Negm A, Pinto SM, Pushpalata Zanwar P, C Heyn P. Ten Reasons Why You Should Walk and How to Get Started! Arch Phys Med Rehabil 2023; 104:517-519. [PMID: 36462534 DOI: 10.1016/j.apmr.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Julie D Ries
- Marymount University, Center for Optimal Aging, Department of Physical Therapy, Arlington Virginia USA.
| | - Elena Philippou
- University of Nicosia, School of Sciences & Engineering, Department of Life & Health Sciences, Nicosia, Cyprus; King's College London, Department of Nutritional Sciences, London UK
| | - Hannes Devos
- University of Kansas Medical Center, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, Kansas City Kansas USA
| | - Ahmed Negm
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada; McMaster University, School of Rehabilitation Sciences, Hamilton Ontario Canada
| | - Shanti M Pinto
- University of Texas Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas Texas USA
| | - Preeti Pushpalata Zanwar
- Thomas Jefferson University, Applied Health Economics & Outcomes Research, Health Policy, Philadelphia, Pennsylvania USA; University of Southern California, NIA Funded Network on Life-Course and Health Dynamics & Disparities, Los Angeles California USA
| | - Patricia C Heyn
- Marymount University, Center for Optimal Aging, Arlington, Virginia USA
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11
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Rao CR, Chandrasekaran B, Ravishankar N, Rutebemberwa E, Okello D. Physical activity interventions for glycaemic control in African adults - A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102663. [PMID: 36459907 DOI: 10.1016/j.dsx.2022.102663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Growing evidence indicates that increasing physical activity may aid in regulating altered glycaemic control, thereby mitigating the risk of diabetes. However, the evidence summarising the efficacy of physical activity on glycaemic control among African adults remains unconsolidated. Our objective was to provide an amalgamated summary of the empirical evidence that explored the effectiveness of physical activity interventions on glycaemic control among African adults. METHODS A systematic search of six journal databases for the studies exploring the efficacy of physical activity on glycaemic control among African adults until March 21, 2022, was administered. Two independent reviewers screened the citations based on a priori set eligibility criteria. Data were analysed using inverse variance method and a summary of findings was synthesised using the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS Of the 14,624 citations retrieved, 26 articles with 1474 participants were included for final analysis. Most of the included trials had a high risk of bias (N = 20; 76.92%). Our review found a significant reduction in fasting blood glucose (FBG, -2.18 [ 95% CI -3.18, -1.18] mmol/L), insulin (-0.99 [-2.71, 0.74] μU/L), Glycosylated haemoglobin (HbA1C) (-0.53% [-0.88, -0.19]), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (-0.74% [-1.10, -0.38]) and insulin sensitivity (-0.90 μU/l/min [-1.75, -0.06]) following physical activity interventions. The review reports low certainty of evidence across all outcome measures. DISCUSSION AND CONCLUSION Physical activity interventions were found to improve glycaemic control among African adults. However, the optimal physical activity dose for demonstrating meaningful benefits on glucose tolerance still remains unclear due to the limited number of primary studies available.
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Affiliation(s)
- Chythra R Rao
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Baskaran Chandrasekaran
- Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - N Ravishankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of New Delhi, Delhi, India.
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
| | - David Okello
- African Centre for Global Health and Social Transformation (ACHEST), Kampala, Uganda.
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12
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Vilafranca Cartagena M, Arreciado Marañón A, Artigues-Barbera E, Tort-Nasarre G. Successful Practices in Performing and Maintaining Physical Activity in Adults with Type 2 Diabetes Mellitus: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14041. [PMID: 36360920 PMCID: PMC9658001 DOI: 10.3390/ijerph192114041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Physical activity has proven to be greatly beneficial in patients with DM2. However, few adhere to physical activity recommendations and are motivated to engage in regular physical activity and the numerous interventions conducted to change their habits tend to be unsuccessful in the long term. The objective in this research is to study patients who adhere to physical activity in order to guide patients who have not succeeded in making this change, assisted by the successful tools in the context of community nursing. A qualitative descriptive study was conducted. The sample included 10 patients with type 2 diabetes mellitus who adhered to physical activity in Catalonia, Spain, having been selected using intentional sampling. We recorded semi-structured interviews with the participants and conducted a thematic analysis. Five categories were identified and grouped into two themes: (1) Integrate physical activity as a lifestyle (meaning of DM2 and physical activity, adaptation to change and strategies on a day-to-day basis, physical activity) and (2) Find support to change physical activity (company and personal motivational strategies). In conclusion, a good adherence to physical activity was achieved thanks to motivation maintained over time related to autonomous motivation and the psychological and physiological benefits that physical activity provides patients, external support and encouragement, and the allocation of time to adhere without making great lifestyle changes.
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Affiliation(s)
- Mireia Vilafranca Cartagena
- Department of Nursing, Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
- Althaia Foundation, C/Dr Joan Soler 1-3, 08243 Manresa, Spain
| | - Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Autonomous University of Barcelona, Campus Bellaterra, 08193 Cerdanyola del Vallès, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Eva Artigues-Barbera
- Balafia Primary Care Center, Av. de Rosa Parks. Gerència Territorial Lleida, Catalan Health Institute (ICS), 08007 Barcelona, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca al’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran 44, 25007 Lleida, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, 25198 Lleida, Spain
- SAP ANOIA, Gerència Territorial Catalunya Central, Catalan Health Institute (ICS), 08007 Barcelona, Spain
- AFIN Research Group and Outreach Centre, Autonomous University of Barcelona, Campus Bellaterra, 08193 Cerdanyola del Vallès, Spain
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