The independent and joint associations of cardiorespiratory fitness and adiposity with cardiometabolic risk factors and metabolic syndrome in United States college students

Objective To examine the association of CRF and adiposity with cardiometabolic risk factors and metabolic syndrome among emerging adults. Participants: 5681 (60.1% Men; 21 ± 1years) college students from a large university located in the northeast of the United States. Methods: Participants completed an objective health assessment that involved the assessment cardiometabolic risk factors, CRF, and adiposity. Data of 5681 students' (60.1% Men; 21 ± 1years) who had CRF, adiposity, all risk factors necessary to determine metabolic syndrome evaluated were analyzed using logistic regression analyses. Results: Poor CRF and elevated adiposity were associated with cardiometabolic risk factors and metabolic syndrome regardless of sex, with the association between adiposity and risk factors found to be stronger compared to CRF. Conclusions: Targeted and tailored screening and interventions are urgently needed to reduce adiposity and increase CRF to avoid serious short and long-term negative health outcomes in this population.

The apparent need for better communication between clinicians and patients regarding elevated blood pressure among United States emerging adults

Objectives: To examine the discrepancy between 'told' and screened blood pressure (BP) category, and the association between body composition and told BP category. Methods: Between 08/2019-03/2020 college students (n = 1057) were asked what category they had previously been told their BP falls into prior to having their BP and body composition (waist circumference, body mass index (BMI), and body fat percentage) objectively assessed. Results: A disproportionate number (>80%) who were told that they had normal BP were categorized as having elevated BP. Men told they had borderline/high BP had less favorable body compositions than those told they had low/normal BP. Less favorable body composition was associated with increased likelihood of men being told that they had borderline/high BP. Conclusions: Better BP screening policies and procedures would ensure healthcare providers discuss elevated BP with emerging adults regardless of body composition and avoid missing opportunities to delivery of early and cost-effective interventions.

Assessing the stress-buffering effects of social support for exercise on physical activity, sitting time, and blood lipid profiles

OBJECTIVE

This study tested the hypothesized stress-buffering effects of social support on physical activity, sitting time, and blood lipid profiles.

PARTICIPANTS

537 college students.

METHODS

College students volunteered to self-report stress, social support for exercise, physical activity and sitting time, and provided blood samples to assess lipid profiles in this cross-sectional study.

RESULTS

Lower stress was associated with higher vigorous physical activity (β = -0.1, t = -2.9, p = .004). Higher social support was associated with higher moderate (β = 0.2, t = 2.0, p = .042), vigorous (β = 0.5, t = 5.4, p < .001), and total (β = 0.1, t = 3.2, p = .001) physical activity, and lower sitting time on weekdays (β = -0.1, t = -3.3, p = .001) and weekends (β = -0.2, t = -3.6, p < .001). Social support moderated the association between stress and sitting time on weekdays.

CONCLUSIONS

Stress reduction and fostering social support may be important strategies for promoting physical activity and reducing sedentary behaviors in college students. Additional strategies are needed to buffer the deleterious effects of stress.

Freshman physical activity constraints are related to the current health behaviors and outcomes of college upperclassmen

ObjectiveExamine differences in physical activity (PA) constraints experienced as freshmen among college upperclassmen based on sex, race/ethnicity, adiposity, and fitness. Participants and methods: Upperclassmen (n = 524) from self-reported demographics, PA, subjective changes in PA, and freshman PA constraints via an online survey, and had adiposity and predicted aerobic fitness objectively assessed. Results: Self-reported reductions in PA since high school and freshmen year were associated with a lack of motivation as a freshman, lower current PA levels, and poorer aerobic fitness compared to those who maintained or increased PA. Women were less active than men and reported greater constraints, while non-Hispanic white students had greater vigorous PA than minority students. Multiple regression analyses revealed that motivation constraints predicted PA regardless of sex and race/ethnicity. Conclusions: Findings highlight the importance of college administrators and health promoters alleviating freshman PA constraints, particularly among women, to promote the adoption of an active lifestyle.

Comparison of obesity classification methods among college students

The purpose of this study was to compare obesity classification methods (body mass index (BMI)), abdominal girth (AG), and body fat percentage (BF%)), among college students. College students (n=5943) completed an objective fitness assessment, where height and weight (used to calculate BMI), AG, and BF% (using Bioelectrical Impedance Analysis) were assessed. Correlation and chi-square tests for independence analyses examined relationships between variables and obesity classification methods; and, the sensitivity and specify of BMI using AG and BF% were calculated. Significant correlations were found between BMI and BF% for men (r=0.775, p<0.001) and women (r=0.849, p<0.001); BMI and AG for men (r=0.868, p<0.001) and women (r=0.858, p<0.001); and, BF% and AG for men (r=0.749, p<0.001) and women (r=0.767, p<0.001). There were significant associations between BMI, AG, and BF% for both sexes. Obesity categorization differed significantly between methods. In men and women, respectively, 47.6% and 44.1% classified as normal weight based on BF% were classified as overweight or obese based on BMI (Men: χ2=1547, p<0.001; Women: χ2=1127, p<0.001). In men and women, respectively, 48.3% and 24.0% classified as normal based on AG were classified as overweight or obese using BMI (Men: χ2=1274, p<0.001; Women: χ2=996, p<0.001). Comparing AG and BF%, 25.1% of men and 18.6% of women classified as normal based on AG were classified as overweight or obese using BF% (Men: χ2=1412, p<0.001; Women: χ2=421, p<0.001). Obesity classification differed significantly between methods, and BMI demonstrated relatively poor predictive value with respect to obesity classification. Thus, caution should be applied when using BMI to diagnose obesity among college students.

Objective vs self-report assessment of height, weight and body mass index: Relationships with adiposity, aerobic fitness and physical activity

Researchers, policymakers and clinicians commonly use height and weight to determine body mass index (BMI) and classify weight status. Self-report measures are widely used but often result in misreported height and weight and, consequentially, underestimation of BMI and-potentially-weight status misclassification. The purpose of this study was to examine differences in objective and self-reported height, weight and BMI values and to find whether discordance is associated with other anthropometric measures, fitness and physical activity. Data were collected from college students through: (a) a pre-consultation online questionnaire where participants self-reported gender, height and weight; (b) an objective fitness assessment that assessed height, weight, body fat percentage, abdominal girth and predicted aerobic fitness; and (c) a post-assessment electronic survey that assessed physical activity. Parametric and non-parametric analyses examined differences between groups. Objective and self-reported height and weight data were collected from 1061 participants, 224 of whom also provided physical activity data. Women significantly under-reported weight (P = .003, η² = 0.02), and both genders over-reported height (P < .001, η² ≥ 0.07), resulting in a significant difference between BMIs calculated using the different measures (P < .001, η² ≥ 0.07) and the weight status misclassification of ~15% of participants. Significant differences were found in anthropometrics, fitness and physical activity based on reporting differences for weight (P ≤ .015) and BMI (P ≤ .015). Students demonstrated a tendency to under-report weight and over-report height, resulting in weight status misclassification. Those who under-reported weight tended to be in poorer health as indicated by lower aerobic fitness and higher abdominal girth and body fat percentage in particular. Further research is required to establish the link between under-reporting weight and over-reporting physical activity.

Behavioral and Physiological Health-Related Risk Factors in College Students

The purpose of this study was to assess the behavioral and physiological health-related risk factors in college students. A cross-sectional study was conducted in 1620 college students (21.3 ± 1.7 years, 897 males, and 723 females). Physical activity (PA), sitting time, body composition, cardiorespiratory fitness (CRF), muscular endurance (ME), and blood test were assessed. In the total sample, 15.2% were not meeting PA guidelines, 33% were sedentary, 13.3% were obese, 10.7% had low CRF, 36.8% had poor ME, 33.7% had dyslipidemia and 5.9% presented with prediabetes. Obesity and poor CRF were more prevalent in male students, whereas inactivity was more prevalent in female students. Individuals with poor CRF were more likely to be obese (odds ratio = 5.2, 95% CI = 3.5-7.8, P = .007 for male students, and 9.4, 95% CI = 1.5-57.8, P = .021 for female students). Sitting time positively correlated with fat percentage (fat%) and inversely with lean body mass (LBM) in male students, whereas ME inversely correlated with fat% and positively with LBM in female students. Although most students were active, significant prevalence of health-related risk factors were observed. Sedentary behavior and poor fitness were associated with a compromised body composition in both sexes. Improving fitness and reducing sedentary behavior in college students could be a public health strategy for health promotion and chronic diseases prevention.

Comparison of College Student Hypertension Prevalence between the JNC7 and ACC/AHA Diagnostic Criteria

Hypertension is highly prevalent and associated with non-communicable diseases and increased premature mortality risk. However, the impact of the new hypertension diagnostic criteria on the prevalence of hypertension diagnoses has yet to be examined among college students. The purpose of this study was to compare the prevalence of hypertension between the JNC7 and the ACC/AHA hypertension diagnostic criteria among college students. The blood pressure of 5,945 college students was assessed, and chi-square tests for independence examined differences between JNC7 and ACC/AHA criteria. The mean age of participants was 21.30 ± 1.05 years, and the majority identified as men (60.5%). Men were found to have significantly higher systolic (p < .001, η 2 = .10) and diastolic (p < .001, η 2 = .04) blood pressure, so all analyses were separated by sex. Hypertension guideline changes resulted in significant changes in hypertension categorization of both men, χ 2 = 7,178, p < .001, Φ c = .816 and women, χ 2 = 4,670, p < .001, Φ c = .816. Under the JNC7 guidelines, 292 (8.2%) men and 67 (2.8%) women were hypertensive. Using the ACC/AHA guidelines, 1455 (40.5%) men and 521 (22.3%) women were hypertensive. Hypertension guideline changes resulted in a significant increase in the prevalence of hypertension among college students, highlighting the potential demand for targeted prevention programs focused on fostering healthy lifestyle behaviors, i.e. physical activity and healthy eating, among students.

College Student Work Habits are Related to Physical Activity and Fitness

Despite the known benefits of regular physical activity, research shows a significant decline in physical activity participation and an increase in sedentary behavior during young adulthood during the college years. Studies examining the relationship between academic outcomes and fitness/physical activity have not extensively examined this among college students. Therefore, the purpose of this study was to examine the relationship between fitness measures (cardiovascular endurance, muscular endurance, flexibility and body composition), physical activity, and academic outcomes in college students. This cross-sectional study had college students complete a one-time fitness assessment and survey examining their physical activity and academic factors (GPA, study habits, course load). Correlations examined relationships between fitness, physical activity and academic outcomes, t-tests compared differences for fitness and behavioral outcomes between groups by academic factors. The final sample (n=512) was 50.4% male, 78% Non-Hispanic White, and 67% upperclassmen. The majority (76%) of participants reported meeting current PA guidelines. Hours of studying and social media use were both positively associated with body fat. Course load was negatively associated with vigorous activity. Study time was negatively associated with cardiovascular endurance, positively associated with hip flexibility and sedentary behavior. Higher GPA was associated with a higher BMI and a higher credit load was associated with less vigorous physical activity. These findings indicated that academic outcomes and physical activity may have a different relationship among college students compared with younger age groups. This study provides insight for the development of future campus-based health initiatives to have a shared focus of academic outcomes and physical activity.

The Relationship of Living Environment with Behavioral and Fitness Outcomes by Sex: an Exploratory Study in College-aged Students

Although physical activity (PA) is associated with several health benefits, there is a marked decline during college years, which is an influential period for the development of health behaviors. This study examined the relationship of neighborhood and living environment with behavioral (PA and sedentary behavior) and fitness outcomes by sex. Participants were college students that participated in a fitness assessment, followed by a survey that measured self-reported exercise and perception of one's environment (sidewalks, crime, traffic, access to PA resources in their neighborhood and/or apartment complex). Pearson correlations examined the relationship between behavioral (moderate and vigorous PA, sedentary behavior, active travel) and fitness outcomes (VO2max, percent body fat, body mass index, push-ups, curl-ups, blood lipids and glucose) with environmental measures separately by sex. Among participants (n=444; female=211, male n=234) environment was significantly related to PA and fitness, with noted differences by sex. For males, seeing others exercising in the neighborhood and in their apartment complex, using neighborhood bike lanes, crime and the number of PA resources at their apartment complex were associated with behavioral and fitness outcomes. Among females, sidewalks in the neighborhood, seeing others exercising, using neighborhood bike lanes and number of PA apartment complex resources were significantly correlated with fitness and behavioral outcomes. These findings suggest a possible relationship between students' objectively measured fitness and their environment for PA. Future implications include the development of policies to create student housing that supports physical activity and expansion of campus wellness initiatives to off-campus locations.

Implementation and evaluation of an Exercise is Medicine™ on campus week

Exercise is Medicine™ (EiM) on campus targets physical activity (PA) participation on college campuses. Limited research has addressed how PA initiatives can be operationalized on college campuses.

PURPOSE

To describe the implementation of EiM on a large U.S. university campus and present preliminary outcomes on participation and awareness.

METHODS

EiM week was implemented on a large university campus. Exercise stations were set-up at campus locations to encourage brief bouts of PA and educate about the benefits of PA. Evaluation included observations of participation, surveys, and intercept surveys to assess awareness and reach.

RESULTS

EiM week was implemented during Fall 2013. Exercise stations elicited 1771 exercise bouts from participants. Surveys indicated widespread reach across the university (13 of 17 colleges); most students (50.8%) became aware of the EiM campaign by passing by the exercise stations. Campus intercept surveys 1-week post-event indicated 54% students had heard about EiM, of which 39% had heard/seen the event through messages encouraging exercise.

CONCLUSION

The current study was successful in engaging a large, diverse population on a college campus. Lessons learned from the development, implementation, and evaluation of EiM on campus activities provide insight for university campuses looking to target student health and PA participation.

Physical activity and immunity in HIV-infected individuals

The purpose of this study was to determine what relationship exists among physical activity levels and viral load and CD4+ cell count in HIV-infected individuals. Increased viral load is associated with disease progression and symptom severity. A convenience sample of 66 male and female subjects between the ages of 18 and 64 years of age (mean 39 +/- 8) was recruited from a hospital-based HIV/AIDS clinic. Components of PA were assessed for three continuous days using a mini-motion logger wrist actigraph. These components included mean PA level, and PA index and acceleration index. Pearson's correlational analysis was used to test the strength of association between PA components and viral load or CD4+ cell count. A significant inverse relationship was found between mean PA level and viral load (p=0.047). An inverse relationship was also observed between PA index and viral load (p=0.0061). Neither mean PA nor PA index scores correlated with CD4+ cell counts. Acceleration index, a measure of PA intensity, showed no correlation to viral load or CD4+ cell counts. These findings suggest that increasing levels of physical activity might have beneficial effects on viral load in HIV-infected individuals.

Spiritual well-being, sleep disturbance, and mental and physical health status in HIV-infected individuals

A growing body of evidence demonstrates a significant relationship between spirituality and health. HIV-infected individuals often find new meaning and purpose for their lives while establishing new connections and strengthening old ones. This descriptive, correlational study examined the relationships among spiritual well-being, sleep quality, and health status in 107 HIV-infected men and women. Spiritual well-being was found to be a significant factor related to both sleep quality and mental and physical health status. Every study participant reported sleep disturbance. The findings suggest that spiritual well-being and sleep quality need to be assessed so appropriate interventions can be implemented to improve health outcomes in this population.

Depression in HIV-infected patients: allopathic, complementary, and alternative treatments

OBJECTIVES

The purpose of this review article is to synthesize the current knowledge related to depression and HIV disease.

METHODS

The research literature was critically evaluated for several selected therapies that are prescribed for HIV-infected persons to treat depression. These therapies included pharmacotherapy, psychotherapy, alternative, and complementary therapies.

RESULTS

Several therapies are currently available for the treatment of depression in HIV disease. When prescribing treatments, clinicians should be aware of problems associated with diagnoses, drug-drug interactions, and the benefits of some of the new therapies that are now available. Treatment regimes should be carefully designed to meet the individual needs of the patient and will optimally include a combination of approaches including psychotherapy, pharmacotherapy, education, and/or complementary therapies.

CONCLUSIONS

Although HIV is now a treatable disease, the prevalence of depression in the HIV population remains high and should be continually addressed.

Sexually transmitted diseases in men

Sexually transmitted diseases are the most common infectious diseases in the United States. Physicians, nurses, and other health care providers are uncomfortable discussing sexual issues with their clients. Therefore many health care needs are not addressed, and many opportunities for education aimed at preventing STDs are missed. In the periodic health history, the health care provider must elicit information about sexual practices (vaginal,oral, or anal intercourse), sexual orientation (heterosexual, homosexual, or bisexual), sexual risk behaviors (ie, unprotected intercourse with multiple partners), contraceptive use (particularly condoms), and prior STDs. Based on this information, the health care practitioner moves to more specific questions regarding sexual health. The health care practitioner asks about sores on the penis, dripping or discharge from the penis, staining of the underwear, testicular pain, and scrotal swelling. For the client who engages in oral sex, the health care practitioner asks about sore throat. For the client who engages in anal intercourse ask about diarrhea, rectal bleeding, anal itching, and pain. Probe the desire phase, the arousal phase (erection), and the ejaculation phase. Ask about the desire for fatherhood and concerns about fatherhood. An important part of health care is prevention. Culturally specific and sensitive information should be available for patients. Patient education should not consist of simply handing a brochure to a man. Using the brochure as a guide for including all the necessary information and ascertaining the man's understanding may be a very effective method of patient education. For men who are at increased risk for STDs or who present with symptoms of STDs, offering diagnostic testing is necessary. Men who have multiple sexual partners especially need diagnostic testing and prevention counseling. The CDC recommends annual HIV and hepatitis C testing for men who have sex with men and other men who have increased risk for contracting HIV. Another important consideration at the periodic screening examination is the vaccinations that are to be recommended. Men who have sex with men should receive hepatitis A and hepatitis B vaccine. Additionally, it is recommended that all adolescents should receive hepatitis B vaccine.

Physiological and psychological effects of exercise interventions in HIV disease

The use of both aerobic and resistance exercise has been shown to improve physiologic parameters such as strength, endurance, time to fatigue, and body composition in the HIV-infected population. Exercise has also been used successfully to treat psychologic conditions such as depression and anxiety that are common in HIV-infected individuals. However, the effects of exercise on immune function in these individuals are uncertain because of conflicting results found among studies. Additionally, many ventures into this area have been attempted with poor research design, resulting in inconclusive evidence or poor generalizability. The focus of this paper is to review the research that has been performed using exercise as an intervention for HIV-infected persons and to determine what needs to be done next to further our understanding of how the HIV-infected body and mind respond to exercise training.

The Prevalence of Leisure-Time Physical Activity Among Diabetics in South Carolina

BACKGROUND

Diabetes is the seventh leading cause of death among South Carolinians. The benefit of physical activity on the control and prevention of diabetes has been established. This study determined the prevalence of leisure-time physical activity among South Carolinians with and without diabetes and compared the physical activity of those with diabetes between 1990 and 2000.

METHODS

Data from the South Carolina Behavioral Risk Factor Surveillance System were used to classify adults with and without diabetes into categories of physical activity.

RESULTS

Physical inactivity was higher among South Carolinians with diabetes (42%) than in those without (27%). A comparison of physical activity in diabetics between 1990 and 2000 demonstrated a slight decrease (2%) in physical inactivity.

CONCLUSION

The decrease in physical inactivity among diabetics is encouraging; however, further promotion of physical activity is recommended to encourage diabetics to engage in physical activity on a regular basis.