A Prospective Study of Physical Activity Intensity and Change in Adiposity in Middle-Aged Women

Association between obesity and common mental disorders in women: a population-based study in Southern Brazil

PURPOSE

The study aimed to investigate the relationship between obesity and common mental disorders (CMD) among women.

METHODS

This is a cross-sectional population-based study with a representative sample of 981 adult women (20-60 years of age) living in the urban area of the municipality of São Leopoldo, RS, Brazil, in 2015. The presence of CMD was assessed using the Self-Reporting Questionnaire (SRQ-20 ≥ 8). Obesity was defined by body mass index (BMI ≥ 30.0 kg/m²). Prevalence ratios (PRs) for the association between obesity and CMD were measured by Poisson regression with robust variance, including their respective 95% confidence intervals (CIs).

RESULTS

The mean age of the sample was 40.3 years (standard deviation = 11.4 years). The prevalence of CMD was 33.7% (95% CI 30.8-36.7), while obesity was 31.2% (95% CI 28.3-34.1). The occurrence of CMD was higher in women with low levels of education and belonging to lower economic class, as well as smokers and those who were insufficiently active. Obesity was more prevalent in older women (50-60 years old) with less schooling, who did not consume alcohol, and those who were insufficiently active. After adjusting for potential confounding factors, women with obesity were 22% more likely to have CMD when compared to those without obesity (PR = 1.22; 95% CI 1.02-1.45; p = 0.030).

CONCLUSIONS

This study demonstrated a significant association between obesity and the presence of CMD among women. Additionally, the prevalence of obesity and CMD were high in this population group.

Objectively determined physical activity and adiposity measures in adult women: A systematic review and meta-analysis

The prevalence of adiposity is increasing among adult women. Although emerging evidence suggest that all patterns of heightened physical activity (PA) are important to benefit adiposity, the relationship between objectively assessed intensities of PA and adiposity in women has not yet been assessed. Therefore, this systematic review and meta-analysis aims to qualitatively synthesize and quantitatively assess the evidence for any relationship between objectively measured PA and a wide range of adiposity indicators to guide PA prescription in adult women. Four databases (PubMed, Web of Science, Scopus, and the Cochrane library) were searched for eligible studies. 35 studies were included (25 observational and 10 interventional studies), with a total of 9,176 women from 20 countries included. The overall pooled correlation for random effects model (n = 1 intervention and n = 15 cross-sectional studies) revealed that the total volume of physical activity (TPA) was moderately associated with percentage body fat (%BF) (r = −0.59; 95% CI: −1.11, −0.24; p = 0.003). There was a weak but significant association between MVPA with body mass index (BMI), waist circumference (WC), and visceral adiposity. Daily steps were significantly associated with BMI, %BF, WC, and fat mass, with the strongest association with %BF (r = −0.41; 95% CI: −0.66, −0.19; p < 0.001). Walking programs resulting in increasing daily steps only had a significant effect on WC (SMD = −0.35; 95% CI: −0.65, −0.05; p = 0.02). Overall, objectively determined PA in terms of steps, TPA and MVPA were favorably associated with adiposity outcomes. The improvement in adiposity can be achieved by simply accumulating more PA than previously and adiposity is more likely to be benefited by PA performed at higher intensity. Nonetheless, these results should be interpreted with caution as there were a small number of studies included in the meta-analysis and the majority of studies included utilized cross-sectional designs.

The Impact of Step Recommendations on Body Composition and Physical Activity Patterns in College Freshman Women: A Randomized Trial

PURPOSE

Transitioning from high school to college generally results in reduced physical activity and weight gain at a rate that is higher than the general population. The purpose of this study was to examine the effects of three progressively higher step recommendations over 24 weeks on changes in body weight and body composition.

METHODS

Ninety-two freshmen college women wore a multifunction pedometer for 24 weeks after being randomly assigned to a daily step level: 10,000, 12,500, or 15,000. Pedometer data were downloaded every two weeks and participants were counseled on meeting their step recommendation. Body weight and body composition were assessed at baseline and 24 weeks. Body composition was assessed by dual X-ray absorptiometry.

RESULTS

On average, women took 10,786 ± 1501, 12,650 ± 2001, and 13,762 ± 2098 steps per day for the 10,000-, 12,500-, and 15,000-step groups, respectively (F = 15.48, P < 0.0001). Participants gained 1.4 ± 2.6, 1.8 ± 2.1, and 1.4 ± 2.1 kg for the 10,000-, 12,500-, and 15,000-step groups, respectively (F = 37.74, P < 0.0001). Weight gain was not significantly different between groups (F = 0.18, P=0.8385). There was also no difference in fat weight gain (F = 0.41, P=0.7954).

DISCUSSION

A step recommendation beyond 10,000 does not prevent weight or fat gain over the first year of college. Future research should focus on either intensity of physical activity or the addition of dietary interventions to prevent weight gain during the first year of college.

The effects of Risk Factor-Targeted Lifestyle Counselling Intervention on working-age stroke patients' adherence to lifestyle change

INTRODUCTION

Since a history of stroke or transient ischaemic attack is a major risk factor for a recurrent event, lifestyle counselling during the hospital phase is an essential component of treatment and may increase the probability of lifestyle change.

AIMS AND OBJECTIVES

To study the effect of risk factor-targeted lifestyle counselling intervention on working-age stroke patients' adherence to lifestyle changes.

DESIGN

A quasi-experimental, nonequivalent control group pretest-post-test design.

METHODS

Stroke patients in an acute neurological unit were divided into a control group (n = 75) receiving standard counselling and an experimental group (n = 75) receiving risk factor-targeted counselling. Lifestyle data and clinical outcomes were collected at hospital between January 2010 and October 2011, while data on adherence to lifestyle changes 3, 6, and 12 months after discharge.

RESULTS

The baseline lifestyle habits did not differ significantly other than in alcohol behaviour. Both groups increased their intake, but the intervention group to a lesser degree. However, the experimental group significantly lost their weight for the first 3 and 6 months; at 3 months reduction in cigarette consumption and at 6 months significant increases in smoking cessation were also achieved. All improved some of their lifestyle habits. Intervention was associated with support from nurses as well as from family and friends. Adherence scores were higher in the experimental group.

CONCLUSION

Some short-term advantages in lifestyle habits due to the intervention were noted. Participants in both groups improved some of their lifestyle habits.

Association of health-related behaviors, attitudes, and appraisals to leisure-time physical activity in middle-aged and older women

Physical activity carries immediate and long-term benefits for middle-aged and older women; however, physical activity decreases in adulthood and aging in women. In this study, the authors investigate the relation of health behaviors, health attitudes, and health appraisals to leisure-time physical activity among middle-aged and older women in a cross-sectional analysis of the second wave of the Study of Midlife Development in the United States (MIDUS2) conducted during the period from 2004 to 2006. The sample consisted of 829 women, ranging in age from 40 to 75 years of age (Mean = 56 years). In multiple logistic regression analyses, controlling for socio-demographic factors and functional restrictions, most of the psychosocial variables examined showed unique associations with physical activity, including health behaviors of having a routine checkup and not smoking, health attitudes involving commitment to health and valuing physical fitness and strength, and the health appraisal that one's health is better compared to others of the same age. Older women (aged 61-75 years) were less active, but reported greater health commitment than middle-aged women (aged 40-60 years). Neither health commitment nor any other psychosocial variable interacted with age in relation to physical activity. Understanding characteristics of middle-aged and older women who are physically active is essential in tailoring interventions to this population.

Controversies about a common etiology for eating and mood disorders

Obesity and depression represent a growing health concern worldwide. For many years, basic science and medicine have considered obesity as a metabolic illness, while depression was classified a psychiatric disorder. Despite accumulating evidence suggesting that obesity and depression may share commonalities, the causal link between eating and mood disorders remains to be fully understood. This etiology is highly complex, consisting of multiple environmental and genetic risk factors that interact with each other. In this review, we sought to summarize the preclinical and clinical evidence supporting a common etiology for eating and mood disorders, with a particular emphasis on signaling pathways involved in the maintenance of energy balance and mood stability, among which orexigenic and anorexigenic neuropeptides, metabolic factors, stress responsive hormones, cytokines, and neurotrophic factors.

Physical activity across adulthood in relation to fat and lean body mass in early old age: findings from the Medical Research Council National Survey of Health and Development, 1946-2010

Fat and lean body mass have important implications for health and physical functioning in older age, and physical activity is purported to be an important modifiable determinant. However, our evidence-based understanding of its role is limited. We examined the associations of physical activity, assessed both by self-report (using data on leisure time physical activity (LTPA) collected on 4 occasions over a 28-year period) and objectively (using 5-day heart rate and movement monitoring), with fat and lean mass at ages 60-64 years in 1,162 British participants from the Medical Research Council National Survey of Health and Development in 1946-2010. Higher objectively assessed physical activity energy expenditure (PAEE) at ages 60-64 years was associated with lower fat mass and android (abdominal):gynoid (hip) fat ratio (mean differences in fat mass per 1-standard deviation increase in PAEE were -0.79 kg/m(1.2) in men (95% confidence interval: -1.08, -0.50) and -1.79 kg/m(1.2) (95% confidence interval: -2.15, -1.42) in women). After adjustment for fat mass, higher PAEE was associated with higher appendicular lean mass. Both light and moderate-to-vigorous intensities of activity were associated with fat mass, and the latter was associated with lean mass. More frequent LTPA across adulthood was associated with lower fat mass (in women only) and higher appendicular lean mass (in both sexes, after adjustment for fat mass). These results support the promotion of LTPA across adulthood, as well as both light and moderate-to-vigorous intensities of activity among older adults.

Obesity increases risk of declining physical activity over time in women: a prospective cohort study

OBJECTIVE

Research indicates that risk of obesity increases as physical activity (PA) decreases; however, the reciprocal effect has been rarely studied. The present investigation was conducted to determine the contribution of obesity on objectively measured PA over 20 months.

DESIGN AND METHODS

A prospective cohort design with 254 middle-aged women was employed. Body fat percentage (BF%) was measured using Bod Pod, and obesity was defined as BF% ≥32%. PA was assessed objectively using 7-day accelerometry at baseline and ∼20 months later at follow-up.

RESULTS

Of the 254 subjects, 124 were obese (49%) at baseline. Mean BF% was 32.1 ± 7.8 and average age was 41.7 ± 3.1 years. Mean weekly PA was 2.79 ± 0.85 million activity counts for all participants. Over the 20-month period, PA decreased significantly more in obese women (-8.1% ± 27.1%) than in nonobese women (0.3% ± 31.7%) after adjusting for confounders (F = 5.3, P = 0.022). Moderate plus vigorous PA levels also decreased more in obese women (-28.1 ± 73.6 min/week) than in nonobese women (-5.9 ± 66.8 min/week), after adjusting for covariates (F = 7.84; P = 0.0055).

CONCLUSIONS

It appears that obese women tend to reduce PA over time at a faster rate than nonobese women. Evidently, obesity is a risk factor for decreasing PA over time in middle-aged women.

Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment

Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus-pituitary-adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.

Changes in Hip Bone Mineral Density and Objectively Measured Physical Activity in Middle-Aged Women: A 6-Year Prospective Study

Purpose.

This study was conducted to determine if physical activity volume (PAv) and intensity (PAi) at baseline influence the likelihood of gaining hip bone mineral density (BMD) over 6 years.

Design and Sample.

In a prospective study, the sample was limited to 244 female nonsmokers, ages 35 to 45 years, and was approximately 90% white.

Setting and Measures.

PAv and PAi were measured in daily living conditions using accelerometers at baseline. BMD, measured by dual energy x-ray absorptiometry, and several confounding factors were measured in the lab.

Analysis.

On the basis of BMD change scores, participants were divided into three categories: BMD loss, minimal change, and BMD gain. Risk ratios were used to show the likelihood of BMD gains over time across different levels of PAv and PAi at baseline.

Results.

Women with higher PAv were more likely to show improvements in hip BMD from baseline to follow-up than their counterparts, as indicated by the Mantel-Haenszel chi-square (χ2mh = 6.1, p = .01). Women with high PAv were 2.50 times (95% CI, 1.19–5.24) more likely to experience hip BMD gains than women with low PAv, and women with moderate PAv were 2.20 times (95% CI, 1.08–4.45) more likely. PAi was not predictive of gains in hip BMD. Adjusting for potential confounders had little influence on the results.

Conclusions.

Middle-aged women with moderate or high levels of PAv are more likely to experience BMD gains at the hip over time compared with those who have low levels of PAv. However, PAi does not appear to influence the likelihood of gaining BMD at the hip over 6 years.

Television viewing and obesity in 300 women: evaluation of the pathways of energy intake and physical activity

We assessed the roles of energy intake and physical activity in the relationships among television (TV) viewing, body composition, and obesity using high-quality measurement methods. Adult women (n = 300) reported TV viewing behavior, which was categorized into infrequent (≤ 1 h/day), moderate (2 h/day), and frequent (≥ 3 h/day) viewing. Body fat percentage (BF%) was assessed using plethysmography (Bod Pod) and BMI was calculated from height and body weight. Energy intake and physical activity, including time spent in sedentary, moderate, and vigorous physical activity (PA), were objectively measured using 7-day weighed food records and 7-day accelerometry, respectively. The mean BF% of frequent TV viewers (34.6 ± 6.9%) was significantly greater (F = 3.9, P = 0.0218) than those of moderate (31.5 ± 6.7%) and infrequent viewers (30.8 ± 7.0%); however, BMI did not differ across the TV viewing groups (F = 0.8, P = 0.4172). Controlling statistically for differences in age, education, time in sedentary activity, time in moderate activity, and energy intake, considered individually, had no influence on the relationships between TV viewing and BF%, nor TV and BMI. Moreover, the relationship between TV and BF% remained significant after adjusting for differences in BMI (F = 3.6, P = 0.0276). However, adjusting for total PA reduced the relationship between TV and BF% to nonsignificance (F = 2.5, P = 0.0810), as did time spent in vigorous PA (F = 2.2, P = 0.1307). These data suggest a strong relationship between TV viewing and BF%. This association appears to be due, in part, to differences in total PA, particularly vigorous PA, but not time spent in sedentary activity, moderate activity, or energy intake.

Recommended Levels of Physical Activity and Insulin Resistance in Middle-Aged Women

Purpose

The purpose of this study was to examine the relationship between recommended levels of physical activity (PA) and insulin resistance, as estimated by the homeostasis model assessment of insulin resistance (HOMA-IR) in middle-aged women without diabetes.

Methods

This was a cross-sectional study of 264 women located in the Mountain West region of the United States. Sedentary time and moderate- and vigorous-intensity PA were determined objectively, via accelerometry, over 7 days. HOMA-IR was calculated from fasting insulin and glucose. Body mass index (kg/m2) was calculated from measured weight and height; body fat percentage was assessed using air displacement plethysmography; and abdominal circumference was measured at the umbilicus. Moderate- and vigorous-intensity PA levels were based on recommendations for PA and health from the American College of Sports Medicine.

Results

Total time spent in sedentary activity was significantly related to insulin resistance. Time spent in moderate-intensity or vigorous-intensity activity, at recommended levels, was also significantly and inversely related to insulin resistance. However, after statistically adjusting for body fat percentage or abdominal circumference individually, the relationship between sedentary activity, moderate-intensity, or vigorous-intensity activity and HOMA-IR was eliminated.

Conclusions

Achieving recommended levels of PA is associated with lower HOMA-IR in healthy women without diabetes; however, adiposity accounts for part of this relationship.

Objectively measured physical activity and obesity prevention in children, adolescents and adults: a systematic review of prospective studies

This study aimed at synthesizing the prospective associations between measured physical activity (PA) and change in adiposity in children, adolescents and adults following from two previous reviews. Search terms were adapted and a systematic literature search was conducted (January 2000-September 2008) and later updated (up to October 2009), considering observational and intervention studies of weight gain that measured both PA and body composition. Sixteen observational studies (six comprising adults) and five trials (one comprising adults) were eligible. For consistency, whenever possible either baseline PA energy expenditure or accelerometer output (counts min(-1) ) and change in per cent body fat were the extracted exposure and outcome measures. Results of observational studies suggest that PA is not strongly prospectively related with adiposity: five studies on children and three on adults reported no association between baseline PA and change in adiposity, one study found a weak positive association and the other studies observed a weak negative association. Negative associations were more frequently observed in studies that analysed the association between change in the exposure and outcome. Intervention studies show generally no effect on either PA or adiposity. In conclusion, despite the well-established health benefits of PA, it may not be a key determinant of excessive gain in adiposity.

Exercise program affects body composition but not weight in postmenopausal women

The aim of this study was to investigate the effect of a 12-month moderate-to-vigorous exercise program combining aerobic and muscle strength training on body composition among sedentary, postmenopausal women.

METHODS

A randomized controlled trial was conducted. A total of 189 sedentary postmenopausal women (age 50-69 y, body mass index 22-40 kg/m2) were randomly assigned to an exercise (n = 96) or a control group (n = 93). Study parameters measured at baseline, 4 months, and 12 months were as follows: body weight and body height (body mass index), waist and hip circumference (body fat distribution), and dual-energy x-ray absorptiometry (total body fat and lean mass). Differences in changes in study parameters between exercise and control group were examined with generalized estimating equations analysis.

RESULTS

The exercise program did not result in significant effects on weight, body mass index, and hip circumference. The exercise group experienced a statistically significant greater loss in total body fat, both absolute (-0.33 kg) (borderline) as in a percentage (-0.43%) compared with the control group. In addition, lean mass increased significantly (+0.31 kg), whereas waist circumference (-0.57 cm) decreased significantly compared with the control group.

CONCLUSIONS

We conclude that a 12-month exercise program combining aerobic and muscle strength training did not affect weight but positively influenced body composition of postmenopausal women. Affecting body fat distribution and waist circumference may have important health implications because it is an independent risk factor in obese but also in nonobese people. Therefore, this study gives further credence to efforts of public health and general practitioners aiming to increase physical activity levels of postmenopausal women.

Increasing total fiber intake reduces risk of weight and fat gains in women

Research investigating fiber intake and changes in weight over time has not controlled for important covariates, especially physical activity. Moreover, studies have rarely examined the influence of fiber on changes in body fat, only weight. Hence, this study was conducted to determine whether changes in fiber intake (total, soluble, and insoluble) influence risk of gaining weight and body fat over time. Another objective was to examine the influence of age, energy intake, activity, season, and other potential confounders. A prospective cohort design was used and 252 women completed baseline and follow-up assessments 20 mo apart. Diet was measured using 7-d weighed food records. Fiber was expressed per 1000 kcal (4187 kJ). Body fat was assessed via the Bod Pod and physical activity was measured using accelerometers over 7 consecutive days. Across the 20 mo, almost 50% of the women gained weight and fat. For each 1 g increase in total fiber consumed, weight decreased by 0.25 kg (P = 0.0061) and fat decreased by 0.25 percentage point (P = 0.0052). Controlling for potential confounders did not affect the relationships, except changes in energy intake, which weakened the associations by 24-32%. Soluble and insoluble fibers were borderline predictors of changes in weight and fat. In conclusion, increasing dietary fiber significantly reduces the risk of gaining weight and fat in women, independent of several potential confounders, including physical activity, dietary fat intake, and others. Fiber's influence seems to occur primarily through reducing energy intake over time.

Energy expenditure does not predict weight change in either Nigerian or African American women

BACKGROUND

The relation between variation in interindividual levels of energy expenditure and weight gain remains controversial.

OBJECTIVE

To determine whether or not components of the energy budget predict weight change, we conducted an international comparative study in 2 cohorts of women from sociocultural environments that give rise to the extremes of obesity prevalence.

DESIGN

This was a prospective study with energy expenditure measured at baseline and weight measured annually for 3 y. Participants included 149 women from rural Nigeria and 172 African American women. The energy budget was determined by using respiratory gas exchange and doubly labeled water. Main outcomes included total, resting, and activity energy expenditure and physical activity level (ie, total energy expenditure/resting energy expenditure); baseline anthropometric measures; and annual weight change.

RESULTS

Mean body mass index (in kg/m(2)) was 23 among the Nigerians and 31 among the African Americans; the prevalences of obesity were 7% and 50%, respectively. After adjustment for body size, no differences in mean activity energy expenditure or physical activity level were observed between the 2 cohorts. In addition, in a mixed-effects, random-coefficient model, interindividual variation in activity energy expenditure at baseline was unrelated to the subsequent pattern of weight change.

CONCLUSIONS

These data suggest that interindividual levels of energy expended during activity do not have a large influence on age-related trends in adiposity. In addition, contrary to expectations, these data suggest that mean activity energy expenditure does not vary substantially between contemporary social groups with low and high prevalences of obesity.