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Franklin BA, Wedig IJ, Sallis RE, Lavie CJ, Elmer SJ. Physical Activity and Cardiorespiratory Fitness as Modulators of Health Outcomes: A Compelling Research-Based Case Presented to the Medical Community. Mayo Clin Proc 2023; 98:316-331. [PMID: 36737120 DOI: 10.1016/j.mayocp.2022.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
The beneficial health effects and prognostic significance of regular moderate-to-vigorous physical activity (PA), increased cardiorespiratory fitness (CRF), or both are often underappreciated by the medical community and the patients they serve. Individuals with low CRF have higher annual health care costs, higher rates of surgical complications, and are two to three times more likely to die prematurely than their fitter counterparts when matched for risk factor profile or coronary calcium score. Increased levels of habitual PA before hospitalization for acute coronary syndromes are also associated with better short-term cardiovascular outcomes. Accordingly, this review examines these relations and the potential underlying mechanisms of benefit (eg, exercise preconditioning), with specific reference to the incidence of cardiovascular, cancer, and coronavirus diseases, and the prescriptive implications and exercise thresholds for optimizing health outcomes. To assess the evidence supporting or refuting the benefits of PA and CRF, we performed a literature search (PubMed) and critically reviewed the evidence to date. In aggregate, these data are presented in the context of clarifying the impact that regular PA and/or increased CRF have on preventing and treating chronic and infectious diseases, with reference to evidence-based exercise thresholds that the medical community can embrace and promote.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation Department, Beaumont Health, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Isaac J Wedig
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA
| | - Robert E Sallis
- Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA.
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Coughlan D, Saint-Maurice PF, Carlson SA, Fulton J, Matthews CE. Leisure time physical activity throughout adulthood is associated with lower medicare costs: evidence from the linked NIH-AARP diet and health study cohort. BMJ Open Sport Exerc Med 2021; 7:e001038. [PMID: 33768963 PMCID: PMC7938970 DOI: 10.1136/bmjsem-2021-001038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/12/2023] Open
Abstract
Background There is limited information about the association between long-term leisure time physical activity (LTPA) participation and healthcare costs. The purpose of this study was to investigate the association between LTPA over adulthood with later life healthcare costs in the USA. Methods Using Medicare claims data (between 1999 and 2008) linked to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, we examined associations between nine trajectories of physical activity participation throughout adulthood with Medicare costs. Results Compared with adults who were consistently inactive from adolescence into middle age, average annual healthcare costs were significantly lower for maintainers, adults who maintained moderate (–US$1350 (95% CI: –US$2009 to –US$690) or −15.9% (95% CI: −23.6% to −8.1%)) or high physical activity levels (–US$1200 (95% CI: –US$1777 to –US$622) or −14.1% (95% CI: −20.9% to −7.3%)) and increasers, adults who increased physical activity levels in early adulthood (–US$1874 (95% CI: US$2691 to –US$1057) or −22.0% (95% CI: −31.6% to −12.4%)) or in middle age (–US$824 (95% CI: –US$1580 to –US$69 or −9.7% (95% CI −18.6% to −0.8%)). For the four trajectories where physical activity decreased, the only significant difference was for adults who increased physical activity levels during early adulthood with a decline in middle age (–US$861 (95% CI:–US$1678 to –US$45) or −10.1% (95% CI: −19.7% to −0.5%)). Conclusion Our analyses suggest the healthcare cost burden in later life could be reduced through promotion efforts supporting physical activity participation throughout adulthood.
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Affiliation(s)
- Diarmuid Coughlan
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Surveillance Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Pedro F Saint-Maurice
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Susan A Carlson
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Fulton
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Lo OY, Conboy LA, Rukhadze A, Georgetti C, Gagnon MM, Manor B, Lachman ME, Lipsitz LA, Wayne PM. In the Eyes of Those Who Were Randomized: Perceptions of Disadvantaged Older Adults in a Tai Chi Trial. THE GERONTOLOGIST 2020; 60:672-682. [PMID: 30544227 DOI: 10.1093/geront/gny165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults living in subsidized housing have typically been excluded from exercise intervention studies. We conducted a qualitative study to explore the perceived physical, psychological, social, and economic factors that influenced participation in and adherence to a year-long Tai Chi intervention within an ongoing cluster-randomized controlled trial (RCT) for older adults living within subsidized housing facilities. RESEARCH DESIGN AND METHODS Focus groups were held with participants of the RCT who were allocated to the trial's Tai Chi intervention. Individual phone interviews were conducted with those allocated to Tai Chi who had low adherence or who had withdrawn their participation from the study. Emergent themes were extracted using grounded-theory methods. RESULTS In this qualitative study, we enrolled 41 participants who were allocated to the RCT's Tai Chi intervention: 38 completed and 3 withdrew from the study. Average Tai Chi class attendance was 64.3%. Pragmatic factors that led to higher adherence and retention included: locating classes within each facility; providing programs at no cost; and deployment of a skilled research support team. In addition, the use of an accessible, simplified Tai Chi program improved confidence, social support, self-efficacy, and self-reported improvements in physical and psychological well-being. DISCUSSION AND IMPLICATIONS Perceived physical, psychological, social benefits, and self-efficacy likely enhance adherence and retention to research-based Tai Chi interventions for older adults. Delivering an on-site, no cost, and supportive program appears critical to overcoming financial and environmental barriers to participation for those living within subsidized housing.
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Affiliation(s)
- On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Lisa A Conboy
- New England School of Acupuncture, Newton, Massachusetts
| | | | - Caroline Georgetti
- New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts
| | - Margaret M Gagnon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Margie E Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Peter M Wayne
- Harvard Medical School, Boston, Massachusetts.,Osher Center for Integrative Medicine at Brigham and Women's Hospital, Boston, Massachusetts
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The Journal of Cardiopulmonary Rehabilitation and Prevention at 40 Years and Its Role in Promoting Lifestyle Medicine for Prevention of Cardiovascular Diseases. J Cardiopulm Rehabil Prev 2020; 40:131-137. [DOI: 10.1097/hcr.0000000000000514] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Myers J, de Souza E Silva CG, Doom R, Fonda H, Chan K, Kamil-Rosenberg S, Kokkinos P. Cardiorespiratory Fitness and Health Care Costs in Diabetes: The Veterans Exercise Testing Study. Am J Med 2019; 132:1084-1090. [PMID: 31047866 DOI: 10.1016/j.amjmed.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to determine the association between cardiorespiratory fitness and healthcare expenditures among individuals with and without diabetes. METHODS Health care costs were quantified among 3924 consecutive men (mean age 58 ± 11 years) referred for a maximal exercise test, and compared according to presence (n = 2457) and absence (n = 1467) of diabetes and fitness. Fitness was classified into 4 categories based on age-stratified quartiles of peak metabolic equivalents: least-fit (5.1 ± 1.5 metabolic equivalents; n = 1044), moderately-fit (7.6 ± 1.5 metabolic equivalents; n = 938), fit (9.4 ± 1.5 metabolic equivalents; n = 988), and highly-fit (12.4 ± 2.2 metabolic equivalents; n = 954). Annual costs per subject were quantified over an 8-year period. RESULTS Age, BMI, and presence of cardiovascular disease (CVD) were similar between subjects with and without diabetes. After adjusting for age and presence of CVD, annual costs per person were higher among diabetics vs. non-diabetics. Individuals with and without diabetes in the highly-fit category had annual costs (US dollars x 103) (mean ± standard deviation) that were on average $32,178 and $30,816 lower, respectively, than individuals in the least-fit category. For each 1-metabolic equivalent higher fitness, annual cost savings per person were $5,193 and $3,603 for individuals with and without diabetes, respectively. CONCLUSIONS Higher fitness is associated with lower health care costs. Cost savings associated with higher fitness are particularly evident among individuals with diabetes. The economic burden of diabetes may be reduced through interventions that target improvements in fitness.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Calif; Division of Cardiovascular Medicine, Stanford University, Calif.
| | | | - Rachelle Doom
- Veterans Affairs Palo Alto Health Care System, Calif
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Calif
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Calif
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Myers J, Fonda H, Vasanawala M, Chung K, Segall G, Chan K, Nguyen P. PCI Alternative Using Sustained Exercise (PAUSE): Rationale and trial design. Contemp Clin Trials 2019; 79:37-43. [PMID: 30797041 DOI: 10.1016/j.cct.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/09/2019] [Accepted: 02/19/2019] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) currently claims nearly one million lives yearly in the US, accounting for nearly 40% of all deaths. Coronary artery disease (CAD) accounts for the largest number of these deaths. While efforts aimed at treating CAD in recent decades have concentrated on surgical and catheter-based interventions, limited resources have been directed toward prevention and rehabilitation. CAD is commonly treated using percutaneous coronary intervention (PCI), and this treatment has increased exponentially since its adoption over three decades ago. Recent questions have been raised regarding the cost-effectiveness of PCI, the extent to which PCI is overused, and whether selected patients may benefit from optimal medical therapy in lieu of PCI. One alternative therapy that has been shown to improve outcomes in CAD is exercise therapy; exercise programs have been shown to have numerous physiological benefits, and a growing number of studies have demonstrated reductions in mortality. Given the high volume of PCI, its high cost, its lack of effect on survival and the potential for alternative treatments including exercise, the current study is termed "PCI Alternative Using Sustained Exercise" (PAUSE). The primary aim of PAUSE is to determine whether patients randomized to exercise and lifestyle intervention have greater improvement in coronary function and anatomy compared to those randomized to PCI. Coronary function and anatomy is determined using positron emission tomography combined with computed tomographic angiography (PET/CTA). Our objective is to demonstrate the utility of a non-invasive technology to document the efficacy of exercise as an alternative treatment strategy to PCI.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America.
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Minal Vasanawala
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Kieran Chung
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - George Segall
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Patricia Nguyen
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
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de Souza de Silva CG, Kokkinos P, Doom R, Loganathan D, Fonda H, Chan K, de Araújo CGS, Myers J. Association between cardiorespiratory fitness, obesity, and health care costs: The Veterans Exercise Testing Study. Int J Obes (Lond) 2018; 43:2225-2232. [PMID: 30459403 DOI: 10.1038/s41366-018-0257-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/07/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE Obesity is a chronic disease, a risk factor for other chronic conditions and for early mortality, and is associated with higher health care utilization. Annual spending among obese individuals is at least 30% higher vs. that for normal-weight peers. In contrast, higher cardiorespiratory fitness (CRF) is related to many health benefits. We sought to examine the association between CRF and health care costs across the spectrum of body mass index (BMI). METHODS Data from 3,924 men (58.1 ± 11.1 years, 29.2 ± 5.3 kg.m-2) who completed a maximal exercise test for clinical reasons and to estimate CRF were recorded prospectively at the time of testing. Cost data (USD) from each subject during a 6-year period after the exercise test were merged with the exercise database and compared according to BMI and estimated CRF (CRFe). Subjects were categorized as normal-weight (BMI < 25.0 kg.m-2), overweight (BMI 25.0-29.9 kg.m-2), and obese (BMI ≥ 30.0 kg.m-2). We also formed four CRFe categories based on age-stratified quartiles of metabolic equivalents (METs) achieved: least-fit (5.1 ± 1.5 METs; n = 1,044), moderately-fit (7.6 ± 1.5 METs; n = 938), fit (9.4 ± 1.5 METs; n = 988), and highly-fit (12.4 ± 2.2 METs; n = 954). RESULTS Average annual costs per person adjusted for age and presence of cardiovascular disease were $37,018, $40,572, and $45,683 for normal-weight, overweight, and obese subjects, respectively (p < 0.01). For each 1-MET incremental increase in CRFe, annual cost savings per person were $3,272, $4,252, and $6,103 for normal-weight, overweight, and obese subjects, respectively. Stratified by CRFe categories, annual costs for normal-weight, overweight, and obese subjects in the highest CRFe quartile were $28,028, $31,669, and $32,807 lower, respectively, compared to subjects in the lowest CRFe quartile (p < 0.01). CONCLUSION Higher CRFe is associated with lower health care costs. Cost savings were particularly evident in obese subjects, suggesting that the economic burden of obesity may be reduced through interventions that target improvements in CRF.
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Affiliation(s)
- Christina Grüne de Souza de Silva
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. .,Heart Institute Edson Saad/Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Rachelle Doom
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
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Myers J, Doom R, King R, Fonda H, Chan K, Kokkinos P, Rehkopf DH. Association Between Cardiorespiratory Fitness and Health Care Costs: The Veterans Exercise Testing Study. Mayo Clin Proc 2018; 93:48-55. [PMID: 29195922 DOI: 10.1016/j.mayocp.2017.09.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the association between cardiorespiratory fitness (CRF) and annual health care costs in Veterans. PATIENTS AND METHODS The sample included 9942 subjects (mean age, 59±11 years) undergoing a maximal exercise test for clinical reasons between January 2005 and December 2012. Cardiorespiratory fitness, expressed as a percentage of age-predicted peak metabolic equivalents (METs) achieved, was categorized in quartiles. Total and annualized health care costs, derived from the Veterans Administration Allocated Resource Center, were compared using multiple regression, controlling for demographic and clinical characteristics. RESULTS A gradient for reduced health care costs was observed as CRF increased, with subjects in the least-fit quartile having approximately $14,662 (P<.001) higher overall costs per patient per year compared with those in the fittest quartile, after controlling for potential confounding variables. Each 1-MET higher increment in fitness was associated with a $1592 annual reduction in health care costs (5.6% lower cost per MET), and each higher quartile of fitness was associated with a $4163 annual cost reduction per patient. The effect of CRF was more pronounced among subjects without cardiovascular disease (CVD), suggesting that the results were not driven by the possibility that less-fit individuals had greater CVD. Cost savings attributable to higher fitness were greatest in overweight and obese subjects, with lower savings observed among those individuals with a body mass index less than 25 kg/m2. In a model including historical, clinical, and exercise test responses, heart failure was the strongest predictor of health care costs, followed by CRF (P<.01). CONCLUSION Low CRF is associated with higher health care costs. Efforts to improve CRF may not only improve health but also result in lower health care costs.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Division of Cardiovascular Medicine, Stanford University, Stanford, CA.
| | - Rachelle Doom
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Robert King
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | | | - David H Rehkopf
- Division of Clinical Medicine & Population Health, Stanford University, Stanford, CA
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Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring. Am J Cardiol 2017; 119:658-663. [PMID: 27986262 DOI: 10.1016/j.amjcard.2016.10.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 01/24/2023]
Abstract
Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p <0.001) than their counterparts who attained <5 METs. In patients whose body mass index was ≥30 kg/m2, there were significant differences in health care costs depending on whether they achieved <5 or ≥5 METs estimated by ambulatory ECG monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved <5 METs. In conclusion, average and peak daily energy expenditures estimated from ambulatory ECG monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.
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The Call for a Physical Activity Vital Sign in Clinical Practice. Am J Med 2016; 129:903-5. [PMID: 27235007 DOI: 10.1016/j.amjmed.2016.05.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/21/2022]
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Bachmann JM, DeFina LF, Franzini L, Gao A, Leonard DS, Cooper KH, Berry JD, Willis BL. Cardiorespiratory Fitness in Middle Age and Health Care Costs in Later Life. J Am Coll Cardiol 2015; 66:1876-85. [DOI: 10.1016/j.jacc.2015.08.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 10/22/2022]
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C. Brown T, Volberding J, Baghurst T, Sellers J. Faculty/staff perceptions of a free campus fitness facility. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2014. [DOI: 10.1108/ijwhm-05-2013-0020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to determine the reason for faculty and staff (N=657; 35 percent males; M
age=45.20) at a large Southern university, for either using or not using the free fitness facilities on campus.
Design/methodology/approach
– Participants identified themselves as either current (n=306), former (n=213), or never-users (n=138) of the facilities, and completed an on-line self-report qualitative questionnaire asking them to describe their reasons for using or not using the campus fitness facilities.
Findings
– Thematic coding revealed that motives fell into three broad categories for all user types: personal (i.e. cost, location, social support), facility-specific (i.e. quality and amount of equipment, class variety, hours of operation), and motivational climate (i.e. feeling valued, welcomed, best effort was emphasized). Current users highlighted positive aspects of each category whereas former and never users described each category as a barrier to their exercise routines.
Practical implications
– The identified themes offer campus administration specific suggestions to entice more non-users and former-users to exercise in the fitness facilities available on campus.
Originality/value
– While researchers have considered barriers to exercise in past studies, the barriers identified were not specific to fitness facilities. The current work not only examines individuals’ reasons for choosing or not choosing a campus fitness facility for their exercise, but also compares the perspectives of former- and never-users to current-users.
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Myers J. New American Heart Association/American College of Cardiology guidelines on cardiovascular risk: when will fitness get the recognition it deserves? Mayo Clin Proc 2014; 89:722-6. [PMID: 24809757 DOI: 10.1016/j.mayocp.2014.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Stanford University, Stanford, CA.
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Arena R, Guazzi M, Briggs PD, Cahalin LP, Myers J, Kaminsky LA, Forman DE, Cipriano G, Borghi-Silva A, Babu AS, Lavie CJ. Promoting health and wellness in the workplace: a unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs. Mayo Clin Proc 2013; 88:605-17. [PMID: 23726400 PMCID: PMC7304414 DOI: 10.1016/j.mayocp.2013.03.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/04/2013] [Accepted: 03/11/2013] [Indexed: 12/16/2022]
Abstract
Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even so, there is wide consensus that primary prevention of CVD is an effective and worthwhile pursuit. Moreover, continual engagement with individuals who have already been diagnosed as having CVD would be beneficial. Implementing health and wellness programs in the workplace allows for the opportunity to continually engage a group of individuals with the intent of effecting a positive and sustainable change in lifestyle choices. Current evidence indicates that health and wellness programs in the workplace provide numerous benefits with respect to altering CV risk factor profiles in apparently healthy individuals and in those at high risk for or already diagnosed as having CVD. This review presents the current body of evidence demonstrating the efficacy of worksite health and wellness programs and discusses key considerations for the development and implementation of such programs, whose primary intent is to reduce the incidence and prevalence of CVD and to prevent subsequent CV events. Supporting evidence for this review was obtained from PubMed, with no date limitations, using the following search terms: worksite health and wellness, employee health and wellness, employee health risk assessments, and return on investment. The choice of references to include in this review was based on study quality and relevance.
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Affiliation(s)
- Ross Arena
- Division of Physical Therapy, Department of Orthopaedics and Rehabilitation, and the Division of Cardiology, Department of Internal Medicine, University of New Mexico, Albuquerque.
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Effects of transitory stimulation interval exercise on physical function: a randomized controlled pilot study among Japanese Subjects. J UOEH 2013; 34:297-308. [PMID: 23270253 DOI: 10.7888/juoeh.34.297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Interval training is effective for promoting aerobic capacity and general health. However, it involves repeated high-intensity activity, which could pose cardiovascular risks for the elderly or people who are less fit. We developed a transitory stimulation interval exercise (TSIE) in which the duration of strenuous exertion was reduced to 30 seconds at 75% VO2max of intensity. This pilot study aims to explore the effects of this mode of exercise. Thirty women were randomized and stratified into the TSIE group, the continuous moderate exercise (CME) group, or the no-exercise (NE) group. The two exercise groups performed exercises for 12 weeks. Significant positive changes were observed in the TSIE group compared with the NE group in the relative change ratio from baseline in body weight and VO2max, but no significant differences were observed between the CME group and the NE group. Glycated hemoglobin A1c (HbA1c) decreased significantly in both exercise groups compared with the NE group. Overall, there were few significant differences between the CME group and the TSIE group. There might not be any differences between the TSIE and the CME in a long term intervention with equalized training volumes.
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Jack S, West M, Grocott MPW. Perioperative exercise training in elderly subjects. Best Pract Res Clin Anaesthesiol 2011; 25:461-72. [PMID: 21925410 DOI: 10.1016/j.bpa.2011.07.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 01/27/2023]
Abstract
The association between physical fitness and outcome following major surgery is well described - less fit patients having a higher incidence of perioperative morbidity and mortality. This has led to the idea of physical training (exercise training) as a perioperative intervention with the aim of improving postoperative outcome. Studies have started to explore both preoperative training (prehabilitation) and postoperative training (rehabilitation). We have reviewed the current literature regarding the use of prehabilitation and rehabilitation in relation to major surgery in elderly patients. We have focussed particularly on randomised controlled trials, systematic reviews and meta-analyses. There is currently a paucity of high-quality clinical trials in this area, and the evidence base in elderly patients is particularly limited. The review indicated that prehabilitation can improve objectively measured fitness in the short time available prior to major surgery. Furthermore, for several general surgical procedures, prehabilitation using inspiratory muscle training may reduce the risk of some specific complications (e.g., pulmonary complications and predominately atelectasis), but it is unclear whether this translates into an improvement in overall surgical outcome. There is clear evidence that rehabilitation is of benefit to patients following cancer diagnoses, in terms of physical activity, fatigue and health-related quality of life. However, it is uncertain whether this improved physical function translates into increased survival and delayed disease recurrence. Prehabilitation using continuous or interval training has been shown to improve fitness but the impact on surgical outcomes remains ill defined. Taken together, these findings are encouraging and support the notion that pre- and postoperative exercise training may be of benefit to patients. There is an urgent need for adequately powered randomised control studies addressing appropriate clinical outcomes in this field.
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Affiliation(s)
- S Jack
- Aintree University Hospitals NHS Foundation Trust, Department of Respiratory Research, Clinical Science Centre, Liverpool, Merseyside L9 7A, UK.
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Franklin BA. Health implications of low cardiorespiratory fitness, too little exercise, and too much sitting time: changing paradigms and perceptions. Am J Health Promot 2011; 25:exi-v. [PMID: 21361802 DOI: 10.4278/ajhp.25.4.exi] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Barry A Franklin
- Rehabilitation and Exercise Laboratories, Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
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Zavorsky GS. Effects of exercise training intensity on pancreatic {beta}-cell function: response to Slentz et al. Diabetes Care 2010; 33:e45. [PMID: 20190293 DOI: 10.2337/dc09-1981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Gerald S. Zavorsky
- From the Department of Obstetrics, Gynecology and Women's Health, and the Department of Pharmacological and Physiological Science School of Medicine, Saint Louis University, Saint Louis, Missouri
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Abstract
Although regular physical activity plays an important role in promoting cardiovascular health, Williams(1) reported that a high level of cardiorespiratory fitness (aerobic capacity) markedly reduces one's risk of cardiovascular disease, and the reduction is greater compared with merely being physically active (Figure 1). Moreover, there appears to be an inverse relationship between cardiorespiratory fitness and complications after bariatric surgery among morbidly obese adults. Other provocative data support the hypothesis that aerobic capacity, expressed as milliliters of oxygen per kilogram of body weight per minute (mL O2/kg/min) or as metabolic equivalents (METs; 1 MET 3.5 mL O2/kg/min), is inversely associated with health care costs. Collectively, these findings and other recent reports suggest that the estimation or direct measurement of aerobic capacity can provide independent and additive data in forecasting future health outcomes.
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Affiliation(s)
- Barry A Franklin
- Cardiac Rehabilitation and Exercise Laboratories, Beaumont Hospital, Royal Oak, MI, USA.
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MANDIC SANDRA, MYERS JONATHANN, OLIVEIRA RICARDOB, ABELLA JOSHUAP, FROELICHER VICTORF. Characterizing Differences in Mortality at the Low End of the Fitness Spectrum. Med Sci Sports Exerc 2009; 41:1573-9. [DOI: 10.1249/mss.0b013e31819ca063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Haber P. [Medical therapy by training--an underestimated component of long term therapy of chronic diseases]. Wien Klin Wochenschr 2009; 121:165-7. [PMID: 19412744 DOI: 10.1007/s00508-009-1155-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Franklin BA. Fitness: the ultimate marker for risk stratification and health outcomes? ACTA ACUST UNITED AC 2007; 10:42-5; quiz 46. [PMID: 17215633 DOI: 10.1111/j.1520-037x.2007.05759.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Barry A Franklin
- Division of Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Dalman RL, Tedesco MM, Myers J, Taylor CA. AAA Disease: Mechanism, Stratification, and Treatment. Ann N Y Acad Sci 2006; 1085:92-109. [PMID: 17182926 DOI: 10.1196/annals.1383.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a common and frequently lethal disease of older Americans. No medical therapy has been proven effective in retarding progression of small AAAs prior to surgical repair. With the emerging ability of magnetic resonance (MR) flow imaging and MR-based computational analysis to define aortic hemodynamic conditions, and bio-imaging strategies to monitor aortic inflammation real time in vivo, the opportunity now exists to confirm the potential value of medical interventions such as supervised exercise training as first line therapy for small AAA disease.
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Affiliation(s)
- Ronald L Dalman
- Department of Surgery, Stanford University Medical Center, Stanford, CA 94305-5642, USA.
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Su MC, Hsieh YT, Wang YH, Lin AS, Chung YH, Lin MC. Exercise capacity and pulmonary function in hospital workers recovered from severe acute respiratory syndrome. Respiration 2006; 74:511-6. [PMID: 16960439 DOI: 10.1159/000095673] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 05/19/2006] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Persistent impaired pulmonary function and functional capacity are common among survivors of severe acute respiratory syndrome (SARS). Whether the impairment was caused by SARS or pre-existing physical condition remains unclear. OBJECTIVE This study investigated the influence of SARS on exercise capacity and pulmonary function of previously healthy medical staff. METHODS Pulmonary function tests, including spirometry and carbon monoxide diffusing capacity (DLCO), as well as symptom-limited cardiopulmonary exercise testing (CPET) with an incremental protocol using an electronically braked cycle ergometer, were performed by 13 previously healthy hospital workers 14 months after SARS recovery. Other 14 age- and sex-matched healthy medical workers completed CPET simultaneously, and exercise capacities of these two groups were compared. RESULTS Most values of spirometry performed were within normal range. Only one showed mildly restrictive abnormality with decreased forced expiratory volume in 1 s (72.2% predicted) and forced vital capacity (68.1% predicted). Eight subjects had decreased DLCO levels (mean 79.37 +/- 7.73%), and low exercise capacity was noted in 9 subjects. Discordance in impairment of the measured DLCO and exercise capacity was revealed by comparison. Besides, there was no significant difference in results of CPET between subjects recovered from SARS and those never infected. CONCLUSIONS Minor pulmonary function defects as well as decreased exercise capacity were detected in previously healthy medical staff after recovering from SARS. No significant correlation between exercise capacity and pulmonary function was found.
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Affiliation(s)
- Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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