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Ptomey LT, Washburn RA, Sherman JR, Mayo MS, Krebill R, Szabo-Reed AN, Honas JJ, Helsel BC, Bodde A, Donnelly JE. Remote delivery of a weight management intervention for adults with intellectual disabilities: Results from a randomized non-inferiority trial. Disabil Health J 2024; 17:101587. [PMID: 38272776 PMCID: PMC10999321 DOI: 10.1016/j.dhjo.2024.101587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Remote delivery of multi-component weight management interventions results in clinically meaningful weight loss in adults without intellectual disabilities (ID), but the effectiveness of remotely delivered weight management interventions in adults with ID has not previously been evaluated. OBJECTIVE To determine if a weight management intervention delivered remotely could achieve weight loss (kg) at 6 months that is non-inferior to in-person visits in adults with ID and overweight or obesity (BMI ≥25 kg/m2). METHODS Participants were randomized to a 24-mo. trial (6 mos weight loss,12 mos weight maintenance, 6 mos. no-contact follow up) to compare weight loss achieved with the same multicomponent intervention delivered to individual participants in their home either remotely (RD) or during face-to-face home visits (FTF). RESULTS One hundred twenty adults with ID (∼32 years of age, 53 % females) were randomized to the RD (n = 60) or the FTF arm (n = 60). Six-month weight loss in the RD arm (-4.9 ± 7.8 kg) was superior to 6-month weight loss achieved in the FTF arm (-2.1 ± 6.7 kg, p = 0.047). However, this may be partially attributed to the COVID-19 pandemic, since weight loss in the FTF arm was greater in participants who completed the intervention entirely pre-COVID (n = 33,-3.2 %) compared to post-COVID (n = 22, -0.61 %). Weight loss across did not differ significantly between intervention arms at 18 (p = 0.33) or 24 months (p = 0.34). CONCLUSION Our results suggest that remote delivery is a viable option for achieving clinically relevant weight loss and maintenance in adults with ID. NCT REGISTRATION NCT03291509.
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Affiliation(s)
- L T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - R A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - J R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - M S Mayo
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - R Krebill
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - A N Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - J J Honas
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - B C Helsel
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - A Bodde
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - J E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Gorczyca AM, Washburn RA, Ptomey LT, Mayo MS, Krebill R, Sullivan DK, Gibson CA, Stolte S, Donnelly JE. Weight management in rural health clinics: Results from the randomized midwest diet and exercise trial. Obes Sci Pract 2024; 10:e753. [PMID: 38660371 PMCID: PMC11042259 DOI: 10.1002/osp4.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team. Methods Rural living adults with overweight/obesity (n = 187, age ∼ 50 years 82% female, body mass index ∼35 kg/m2) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly ∼ 45 min sessions with 7-14 participants (n = 71), IP, which included weekly ∼ 15 min individual sessions (n = 80), or EUC, which included one-45 min in-person session at baseline. Results Weight loss at 6 months was clinically relevant, that is, ≥5% in the GP (-11.4 kg, 11.7%) and the IP arms (-9.1 kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6 month weight loss was significantly greater in the IP versus EUC arms (-6.5 kg. p ≤ 0.025) but did not differ between the GP and IP arms (-2.4 kg, p > 0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively. Conclusions Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6 months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Richard A. Washburn
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Lauren T. Ptomey
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Matthew S. Mayo
- Department of Biostatistics & Data ScienceThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Ron Krebill
- Department of Biostatistics & Data ScienceThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Debra K. Sullivan
- Department of Dietetics and NutritionThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Cheryl A. Gibson
- Department of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Sarah Stolte
- Department of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
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Frank L, Helsel B, Dodd D, Bodde AE, Danon JC, Sherman JR, Forsha DE, Szabo-Reed A, Washburn RA, Donnelly JE, Ptomey LT. The association between cardiovascular health and cognition in adults with Down syndrome. J Neurodev Disord 2023; 15:43. [PMID: 38057709 PMCID: PMC10699046 DOI: 10.1186/s11689-023-09510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Evidence in the general population suggests that predictors of cardiovascular health such as moderate to vigorous physical activity (MVPA), cardiorespiratory fitness, and systolic blood pressure are associated with cognitive function. Studies supporting these associations in adults with Down syndrome (DS) are limited. The purpose of this study was to examine the associations between systolic blood pressure, cardiorespiratory fitness, and MVPA on cognition in adults with DS. METHODS This is a cross-sectional analysis using baseline data from a trial in adults with DS. Participants attended a laboratory visit where resting blood pressure, cardiorespiratory fitness (VO2 Peak), and cognitive function (CANTAB® DS Battery) were obtained. The cognitive battery included tests measuring multitasking, episodic memory, and reaction time. Physical activity (accelerometer) was collected over the week following the laboratory visit. Pearson correlations and linear regressions were used to measure the impact of systolic blood pressure, cardiorespiratory fitness, and MVPA on cognitive outcomes. RESULTS Complete data was available for 72 adults with DS (26.8 ± 9.3 years of age, 57% female). At baseline, VO2 Peak (21.1 ± 4.2 ml/kg/min) and MVPA were low (14.4 ± 14.4 min/day), and systolic blood pressure was 118.3 ± 13.3 mmHg. VO2 Peak was correlated with simple movement time (rho = - 0.28, p = 0.03) but was not significant using a linear regression controlling for age and sex. Systolic blood pressure was significantly associated with episodic memory (first attempt memory score: β = - 0.11, p = 0.002; total errors: β = 0.58, p = 0.001) and reaction time (five-choice movement time: β = 4.11, p = 0.03; simple movement time: β = 6.14, p = 0.005) using age- and sex-adjusted linear regressions. No associations were observed between MVPA and multitasking, episodic memory, or reaction time. CONCLUSION Predictors of cardiovascular health, including cardiorespiratory fitness and systolic blood pressure, were associated with some aspects of cognition in adults with DS. While future research should examine the role of improved cardiovascular health on delaying decreases in cognitive function and dementia in adults with DS, we recommend that health care providers convey the importance of exercise and cardiovascular health to their patients with DS. TRIAL REGISTRATION NCT04048759, registered on August 7, 2019.
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Affiliation(s)
- Lauren Frank
- School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Brian Helsel
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Danica Dodd
- School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Amy E Bodde
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Jessica C Danon
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Joseph R Sherman
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Daniel E Forsha
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Amanda Szabo-Reed
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Richard A Washburn
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA.
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Dodd D, Helsel B, Bodde AE, Danon JC, Sherman JR, Donnelly JE, Washburn RA, Ptomey LT. The association of increased body mass index on cardiorespiratory fitness, physical activity, and cognition in adults with down syndrome. Disabil Health J 2023; 16:101497. [PMID: 37407386 PMCID: PMC10680094 DOI: 10.1016/j.dhjo.2023.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Obesity is a significant risk factor for Alzheimer's disease; however, this association has not been explored in adults with Down syndrome. OBJECTIVE To examine the association of obesity, assessed by body mass index (BMI), with factors related to Alzheimer's disease risk including cardiorespiratory fitness, physical activity, and cognition in adults with Down syndrome. METHODS Adults with Down syndrome attended a laboratory visit where BMI, cardiorespiratory fitness (VO2 peak), and cognitive function (CANTAB® DS Battery) were obtained. Physical activity (accelerometer) was collected over the week following the laboratory visit. Wilcoxon rank sum tests were used to evaluate differences in cardiorespiratory fitness, sedentary time, moderate-to-vigorous physical activity (MVPA), and cognition between adults with obesity (BMI≥ 30 kg/m2) and those with healthy weight or overweight (BMI <30 kg/m2). Spearman correlations and linear regressions were used to measure the impact of BMI on cardiorespiratory fitness, MVPA, sedentary time, and cognition. RESULTS Data was collected for 79 adults with Down syndrome (26.7 ± 9.0 years of age, 54% female, 54% with obesity). VO2 peak was significantly lower in participants with obesity (18.4 ± 2.5 ml/kg/min) compared to those with healthy weight or overweight (22.9 ± 4.0 ml/kg/min, p < 0.001). BMI was negatively associated with cardiorespiratory fitness (rho = -0.614, p < 0.001). No associations were observed between BMI and physical activity or cognition. CONCLUSIONS Lower BMI was associated with improved cardiorespiratory fitness. However, no associations were observed between BMI and cognition or physical activity. NCT REGISTRATION NCT04048759.
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Affiliation(s)
- Danica Dodd
- School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA; Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Brian Helsel
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Amy E Bodde
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Jessica C Danon
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Joseph R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
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Helsel BC, Foster RNS, Sherman J, Ptomey LT, Montgomery RN, Washburn RA, Donnelly JE. A Remotely Delivered Yoga Intervention for Adolescents with Autism Spectrum Disorder: Feasibility and Effectiveness for Improving Skills Related to Physical Activity. J Autism Dev Disord 2023; 53:3958-3967. [PMID: 35939186 PMCID: PMC10124171 DOI: 10.1007/s10803-022-05702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
This study evaluated the feasibility of remotely delivered yoga for improving four physical activity-related skills: motor skills, strength, balance, and flexibility in adolescents with autism spectrum disorder (ASD). Nineteen of 20 participants enrolled (age 13.2 ± 2.2 years; 60% male) completed the 12-week intervention and attended 83% of the scheduled yoga sessions. Overall, physical activity-related skills improved pre to post intervention (Φ = 0.90, p = 0.005, 95% CI 0.72-1.0). Specifically, significant increases in leg strength (12.5%, p = 0.039), flexibility (40.3%, p = 0.008), and dynamic balance on the right (11.1%, p = 0.001) and left legs (8.1%, p = 0.003) were observed across 12 weeks. These results demonstrate the feasibility and potential effectiveness of yoga to improve physical activity-related skills in adolescents with ASD.
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Affiliation(s)
- Brian C Helsel
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Rachel N S Foster
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
- Department of Applied Behavioral Science, University of Kansas, Kansas City, USA
| | - Joseph Sherman
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Lauren T Ptomey
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Robert N Montgomery
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
- Department of Biostatistics & Data Science, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Richard A Washburn
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Joseph E Donnelly
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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Haligheri G, Johnson T, Kathol M, Kuzava L, Goth N, Staggs VS, Donnelly JE, Ptomey LT, Forsha D. Early cardiac dysfunction in obese adolescents with Down syndrome or autism. Cardiol Young 2023; 33:1678-1685. [PMID: 36184834 DOI: 10.1017/s1047951122003158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Obesity in adolescents with intellectual and developmental disabilities) occurs at twice the frequency as their typically developing peers. Typically developing adolescents with obesity have abnormal cardiac function (as measured by strain echocardiography) and cardiac mass, but the effects of obesity on cardiac health in adolescents with Down syndrome or autism spectrum disorder are unknown. The purpose of this study was to evaluate the impact of body mass index on cardiac function in adolescents with Down syndrome or autism. METHODS Adolescents (age 12-21 years) with Down syndrome (n = 28), autism (n = 33), and age-/sex-matched typically developing controls (n = 15) received an echocardiogram optimised for strain analysis at a single timepoint. Measures of ventricular function, mass, and size were collected. Regression modelling evaluated the impact of body mass index and intellectual and developmental disabilities diagnosis on these cardiac measures. RESULTS In regression modelling, an elevated body mass index z-score was associated with diminished systolic biventricular function by global strain (left ventricular longitudinal strain β 0.87, P < 0.001; left ventricular circumferential strain β 0.57, p 0.003; right ventricular longitudinal strain β 0.63, P < 0.001). Diminished left ventricular diastolic function by early diastolic strain rate was also associated with elevated body mass index (global longitudinal end-diastolic strain rate β -0.7, P < 0.001). No association was found between traditional (non-strain) measures of systolic and diastolic ventricular function and body mass index z-score. CONCLUSIONS Obesity in adolescents with Down syndrome or autism negatively impacts cardiac function as measured by echocardiographic strain analysis that was not detected by traditional parameters.
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Affiliation(s)
- Geetha Haligheri
- Children's Mercy Hospital, Department of Pediatric Cardiology, Kansas City, MO, USA
- University of Missouri - Kansas City, Department of Pediatrics, Kansas City, MO, USA
| | - Tyler Johnson
- Children's Mercy Hospital, Department of Pediatric Cardiology, Kansas City, MO, USA
| | - Melanie Kathol
- Children's Mercy Hospital, Department of Pediatric Cardiology, Kansas City, MO, USA
| | - Laura Kuzava
- Children's Mercy Hospital, Department of Pediatric Cardiology, Kansas City, MO, USA
| | - Natalie Goth
- Children's Mercy Hospital, Department of Pediatric Cardiology, Kansas City, MO, USA
| | - Vincent S Staggs
- Children's Mercy Hospital, Department of Pediatric Cardiology, Kansas City, MO, USA
| | | | | | - Dan Forsha
- Children's Mercy Hospital, Department of Pediatric Cardiology, Kansas City, MO, USA
- University of Missouri - Kansas City, Department of Pediatrics, Kansas City, MO, USA
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Koon LM, Hall JP, Arnold KA, Donnelly JE, Heinrich KM. High-Intensity Functional Training: Perceived Functional and Psychosocial Health-Related Outcomes from Current Participants with Mobility-Related Disabilities. Sports (Basel) 2023; 11:116. [PMID: 37368566 DOI: 10.3390/sports11060116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND People with mobility-related disabilities (MRDs) experience many personal and environmental barriers to engagement in community-based exercise programs. We explored the experiences of adults with MRD who currently participate in high-intensity functional training (HIFT), an inclusive and accessible community-based exercise program. METHODS Thirty-eight participants completed online surveys with open-ended questions, with ten individuals also participating in semi-structured interviews via telephone with project PI. Surveys and interviews were designed to examine changes to perceived health, and the elements of HIFT that promote sustained participation. RESULTS Thematic analysis revealed themes related to health changes following HIFT participation including improved physical, functional, and psychosocial health outcomes. Other themes emerged within the HIFT environment that promoted adherence for participants such as accessible spaces and equipment, and inclusive HIFT sessions and competitions. Additional themes included participants' advice for the disability and healthcare communities. The resulting themes are informed by the World Health Organization's International Classification of Functioning, Disability, and Health. CONCLUSION The findings provide initial data on the potential effects of HIFT on multiple dimensions of health outcomes and contribute to the growing literature on community-based programs that are adaptable and inclusive for people with MRD.
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Affiliation(s)
- Lyndsie M Koon
- Research and Training Center on Independent Living, Life Span Institute, University of Kansas, 1000 Sunnyside Ave., Room 1052, Lawrence, KS 66045, USA
| | - Jean P Hall
- Research and Training Center on Independent Living, Life Span Institute, University of Kansas, 1000 Sunnyside Ave., Room 1052, Lawrence, KS 66045, USA
- Institute for Health and Disability Policy Studies (KU-IHDPS), Life Span Institute, University of Kansas, 1000 Sunnyside Ave., Room 1052, Lawrence, KS 66045, USA
| | - Kristen A Arnold
- Department of Special Education, School of Education, University of Kansas, 1122 W. Campus Rd., Lawrence, KS 66045, USA
| | - Joseph E Donnelly
- Division of Physical Activity and Weight Management (DPAWM), Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard Mailstop 1007, Kansas City, KS 66160, USA
| | - Katie M Heinrich
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, KS 66506, USA
- Department of Research and Evaluation, The Phoenix, Denver, CO 64035, USA
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Gibson CA, Sullivan DK, Ptomey LT, Rice AM, Donnelly JE. Interviews with parents of adolescents with intellectual and developmental disabilities in a weight management study. J Appl Res Intellect Disabil 2023; 36:289-299. [PMID: 36453027 DOI: 10.1111/jar.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/05/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Adolescents and young adults with intellectual and developmental disabilities are at risk of obesity. Parents influence their diet and physical activity behaviours and therefore, can play important roles in weight management. The aims of this qualitative study were to explore parents' experiences assisting their son or daughter to participate in a weight management study. METHODS Interviews were completed at 6 months with 27 parents whose adolescent or young adult had completed the weight loss portion of an 18-month weight management study. Interviews were recorded, transcribed and thematic analysis performed. RESULTS Parents shared insights about how well program components worked with their family, and what strategies worked best to adopt healthier dietary choices and become more physically active. The importance of meeting regularly with someone outside the family to encourage healthier habits was stressed. CONCLUSIONS Future weight management studies should involve parents and their adolescents to help tailor strategies and adapt intervention approaches.
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Affiliation(s)
- Cheryl A Gibson
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anna M Rice
- Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas, USA
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Szabo-Reed AN, Martin LE, Savage CR, Washburn RA, Donnelly JE. Pre-post intervention exploring cognitive function and relationships with weight loss, intervention adherence and dropout. Health Psychol Behav Med 2023; 11:2162528. [PMID: 36632603 PMCID: PMC9828788 DOI: 10.1080/21642850.2022.2162528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the association between baseline cognitive function, intervention dropout, adherence and 3-month weight loss (WL) when controlling for confounding demographic variables. Methods 107 (Mage = 40.9 yrs.), BMI in the overweight and obese range (BMI = 35.6 kg/m2), men (N = 17) and women (N = 90) completed a 3-month WL intervention. Participants attended weekly behavioral sessions, comply with a reduced calorie diet, and complete 100 min of physical activity (PA)/wk. Cognitive function tasks at baseline included Flanker (attention), Stroop (executive control) and working memory, demographics, body weight and cardiovascular fitness were assessed at baseline. Session attendance, adherence to PA and diet were recorded weekly. Results Baseline attention was positively correlated with age (p < .05), education (p < .05), attendance (p < .05), diet (p < .05) and PA (p < .05). Baseline executive control (p < .05) and working memory (p < .05) were each associated with % WL. Baseline executive control (p < .01) and working memory (p < .001) were also each associated with education. ANOVA indicated that baseline attention (p < .01) was associated with WL, specifically for comparing those who achieved 5-10% WL (p < .01) and those who achieved greater than 10% WL (p < .01) to those who dropped. Significance Results suggest that stronger baseline attention is associated with completion of a 3-mo. WL intervention. Executive control and working memory are associated with amount of WL achieved. NCT registration US NIH Clinical Trials, NCT01664715.
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Affiliation(s)
- Amanda N. Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, USA, Amanda N. Szabo-Reed Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas, KS66160, USA
| | - Laura E. Martin
- Department of Population Health, University of Kansas Medical Center, Kansas, KS, USA
| | - Cary R. Savage
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Richard A. Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, USA
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Ptomey LT, Washburn RA, Goetz JR, Sullivan DK, Gibson CA, Mayo MS, Krebill R, Gorczyca AM, Honas JJ, Rice AM, Helsel BC, Lee RH, Donnelly JE. A randomized trial comparing diet and delivery strategies for weight management in adolescents with intellectual disabilities. Pediatr Obes 2023; 18:e12972. [PMID: 36054481 PMCID: PMC9940267 DOI: 10.1111/ijpo.12972] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The literature evaluating multi-component interventions for long-term weight loss in adolescents with intellectual disabilities (ID) is extremely limited. OBJECTIVES To compare the effectiveness of two delivery strategies, face-to-face (FTF) or remote delivery (RD), and two diets, enhanced Stop Light diet (eSLD) or conventional diet (CD) on weight change across 12 and 18 months. in response to an 18 months. weight management intervention (6 months Weight loss/12 months. Weight maintenance) in adolescents with ID. METHODS Adolescents with ID were randomized to one of three arms: FTF /CD, RD/CD, RD/eSLD and asked to attend individual education sessions with a health educator which were delivered during FTF home visits or remotely using video conferencing. The CD followed the US dietary guidelines. The eSLD utilized the Stop Light guide and was enhanced with portion-controlled meals. Participants were also asked to increase their physical activity (PA) and to self-monitor diet, PA and body weight across the 18-month. INTERVENTION RESULTS Weight was obtained from 92(84%) and 89(81%) randomized adolescents at 12 and 18 months, respectively. Weight change across 12 months. Differed significantly by diet (RD/eSLD: -7.0% vs. RD/CD: -1.1%, p = 0.002) but not by delivery strategy (FTF/CD: +1.1% vs. RD/CD: -1.1%, p = 0.21). Weight change across 18 months. Was minimal in all intervention arms and did not differ by diet (RD/eSLD: -2.6% vs. RD/CD: -0.5%; p = 0.28) or delivery strategy (FTF/CD: +1.6% vs. RD/CD: -0.5%; p = 0.47). CONCLUSIONS Additional research is required to identify effective strategies to improve long-term weight loss in adolescents with ID.
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Affiliation(s)
- Lauren T. Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Richard A. Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeannine R. Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, Rainbow City, Kansas, USA
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, Rainbow City, Kansas, USA
| | - Cheryl A. Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthew S. Mayo
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ron Krebill
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anna M. Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffery J. Honas
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anna M. Rice
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian C. Helsel
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert H. Lee
- Department of Population Health, The University of Kansas Medical Center, Rainbow City, Kansas, USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
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11
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Bodde AE, Helsel BC, Hastert M, Suire KB, Washburn RA, Donnelly JE, Ptomey LT. The prevalence of obesity and lifestyle behaviors of parents of youth with intellectual and developmental disabilities. Disabil Health J 2022:101430. [PMID: 36604240 DOI: 10.1016/j.dhjo.2022.101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/21/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Parents of youth with intellectual and developmental disabilities (IDD) may have a higher prevalence of overweight and obesity and poorer weight management behaviors compared to the general population. OBJECTIVE To describe the prevalence of overweight/obesity and related socioeconomic and lifestyle factors including diet quality, physical activity, and reported health habits in parents of youth with IDD. METHODS We assessed: BMI (kg/m2), moderate-to-vigorous physical activity (MVPA), fruit and vegetable intake (FVI), parental diet and physical activity habits, and socioeconomic characteristics. Associations of BMI on MVPA and FVI were assessed with Spearman's correlation; differences in BMI by parental diet and physical activity habits were assessed with Kruskall-Wallis tests; and the relationships of BMI to household income, race, and education were assessed with Kendall Tau-b and Mann Whitney U tests. RESULTS Data was obtained from 110 parents (97.3% female) who were study partners for their adolescents/young adults with IDD participating in a weight loss clinical trial. Approximately 81% of parents were overweight or obese (25.7% overweight, 55.1% obese), with 46.3% and 20% meeting the recommended U.S. guidelines for MVPA and FVI, respectively. Higher FVI and higher income were significantly associated with lower parent BMI. BMI was significantly lower in parents who reported to be physically active and choose healthy food. CONCLUSION We observed a high prevalence of overweight/obesity, low FVI and low levels of MVPA in parents of adolescents with IDD. These observations suggest that interventions designed to address these factors have the potential to improve the health and wellbeing of both parents and adolescents with IDD. CLINICAL TRIALS NUMBER NCT02561754.
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Affiliation(s)
- Amy E Bodde
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Brian C Helsel
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Mary Hastert
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA; Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Kameron B Suire
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Gorczyca AM, Washburn RA, Smith P, Montgomery RN, Koon LM, Hastert M, Suire KB, Donnelly JE. Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities. Int J Environ Res Public Health 2022; 19:9902. [PMID: 36011535 PMCID: PMC9408158 DOI: 10.3390/ijerph19169902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0-6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Six-month weight loss was not different between groups (CE-Zoom® = -5.99 ± 8.0 kg, -5.4%, FB = -1.68 ± 3.3 kg, -1.6% p = 0.13). Participants achieving ≥5% weight loss was greater in the CE-Zoom® (44%) compared with the FB group (7%, p = 0.04). Participants achieving the NDPP program goal for physical activity (≥150 min/week) did not differ (CE-Zoom® = 75%, FB = 67%, p = 0.91). This pilot trial demonstrated the potential feasibility and effectiveness of the NDPP delivered by CE personnel in a group remote format (Zoom®) to adults with prediabetes living in rural areas.
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Richard A. Washburn
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Patricia Smith
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Robert N. Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Lyndsie M. Koon
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS 66045, USA
| | - Mary Hastert
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kameron B. Suire
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Gorczyca AM, Steger FL, Ptomey LT, Montgomery RN, Mickelsen R, Smith P, Donnelly JE, Marsh CA. The impact of a group based, remotely delivered weight loss intervention in women with polycystic ovary syndrome on ovulation, quality of life and body composition. Front Reprod Health 2022; 4:940945. [PMID: 36303658 PMCID: PMC9580823 DOI: 10.3389/frph.2022.940945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Obesity and visceral adiposity are associated with anovulation. The most common cause of anovulatory infertility in women of reproductive age is polycystic ovary syndrome (PCOS). We conducted this formative study to examine the effects of a remotely delivered, group-based lifestyle program for women with overweight/obesity and PCOS on ovulation, PCOS related quality of life (PCOSQ) and body composition. Methods Women with anovulatory infertility caused by PCOS (N = 12) were enrolled in a 6-month high-intensity weight management intervention. Participants were asked to attend 45 min., group behavioral lifestyle sessions, delivered remotely by a registered dietitian weekly across the 6-mo. study and comply with a reduced energy diet, increased physical activity (225 min/wk.), and self-monitoring of weight, physical activity and diet. Diets consisted of five portion-controlled meals (three shakes + two entrees), at least five servings of fruits/vegetables, and ad libitum non-caloric beverages daily. Wilcoxon signed-rank tests were used to assess changes in outcomes across the intervention. Results Twelve women received the weight loss intervention (mean age = 32.7 ± 4.2 yrs., BMI = 36.8 ± 4.5 kg/m2, 92% college educated), and 8 completed the intervention. Eight (67%) women reported ovulating during the intervention with an average time to ovulation of 57 ± 45 days. Women lost an average of 3.85 ± 5.94 kg (p = 0.02), decreased their BMI (−1.61 ± 1.09 kg/m2; p = 0.04), and waist circumference (−4.54 ± 3.03 cm; p = 0.04) over the 6-mo. intervention. Additionally, self-reported menstrual problems measured by PCOSQ significantly improved over the study (p = 0.03). Conclusion A multicomponent group-based, remotely delivered, lifestyle intervention delivered remotely is a feasible and potentially scalable option to achieve clinically relevant (>3%) weight loss in women with PCOS. Clinical trial registration www.clinicaltrials.gov, identifier: NCT03677362.
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
- *Correspondence: Anna M. Gorczyca
| | - Felicia L. Steger
- Division of Endocrinology, Diabetes and Clinical Pharmacology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Lauren T. Ptomey
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Robert N. Montgomery
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Riley Mickelsen
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Patricia Smith
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Courtney A. Marsh
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, MO, United States
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14
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Ptomey LT, Lee J, White DA, Helsel BC, Washburn RA, Donnelly JE. Changes in physical activity across a 6-month weight loss intervention in adolescents with intellectual and developmental disabilities. J Intellect Disabil Res 2022; 66:545-557. [PMID: 34915594 PMCID: PMC9469505 DOI: 10.1111/jir.12909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/22/2021] [Accepted: 11/24/2021] [Indexed: 05/30/2023]
Abstract
BACKGROUND Adolescents and young adults with intellectual and developmental disabilities (IDD) have high rates of obesity and low levels of physical activity. This analysis examined changes in light, moderate-to-vigorous physical activity (MVPA) and sedentary time, and the association between changes in MVPA and weight loss in adolescents and young adults with IDD and overweight and obesity participating in a 6-month multi-component weight loss intervention. METHODS Adolescents and young adults with IDD and overweight or obesity (body mass index ≥ 85 percentile, n = 110, age ~16 years, 52.7% female) and a parent were randomised to one of three intervention groups: face-to-face delivery/conventional reduced energy diet (n = 36), remote delivery (RD)/conventional reduced energy diet (n = 39), or RD/reduced energy enhanced stop light diet (eSLD) (n = 35.) Participants were asked to engage in 60 min/day of MVPA on 5 or more days/wk. Participants and a parent attended twice monthly education/behavioural counselling sessions with a health educator to assist participants in complying with dietary and MVPA recommendations. Education/counselling in the RD arms was delivered remotely using video conferencing, and self-monitoring of MVPA and daily steps was completed using a wireless activity tracker. Education/counselling in the face-to-face arm was delivered during home-visits and self-monitoring of MVPA and daily steps was completed by self-report using paper tracking forms designed for individuals with IDD. MVPA, light activity, and sedentary time were assessed over 7 days at baseline and 6 months using a portable accelerometer (ActiGraph wGT3x-BT). RESULTS Mixed modelling analysis completed using participants with valid accelerometer data (i.e. ≥4-10 h days) at baseline (n = 68) and 6 months (n = 30) revealed no significant changes in light, moderate- MVPA, or sedentary time across the 6-month intervention (all P > 0.05). Participants obtained 15.2 ± 21.5 min/day of MVPA at baseline and 19.7 ± 19.7 min/day at 6 months (P = 0.119). Mixed modelling indicated no significant effects of group (P = 0.79), time (P = 0.10), or group-by-time interaction (P = 0.21) on changes in MVPA from baseline to 6 months. Correlational analysis conducted on participants with valid accelerometer data at both baseline and 6 months (n = 24) revealed no significant associations between baseline sedentary time (r = 0.10, P = 0.40) and baseline MVPA (r = -0.22, P = 0.30) and change in MVPA across the 6-month intervention. Additionally, attendance at education/counselling sessions (r = 0.26, P = 0.22) and frequency of self-monitoring of MVPA were not significantly associated with change in MVPA from baseline to 6 months (r = 0.26, P = 0.44). Baseline MVPA (r = 0.02, P = 0.92) and change in MVPA from baseline to 6 months (r = 0.13, P = 0.30) were not associated with changes in body weight across the 6-month intervention. CONCLUSION We observed a non-significant increase in MVPA (30%), which was not associated with the magnitude of weight loss in a sample of adolescents and young adults with IDD who participated in a 6-month multi-component weight loss intervention. Additional strategies to increase MVPA in adolescents and young adults with IDD participating in weight loss interventions need to be developed and evaluated.
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Affiliation(s)
- Lauren T. Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jaehoon Lee
- Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, 2500 Broadway, Lubbock, TX, 79409 USA
| | - David A. White
- Ward Family Heart Center, Children’s Mercy Hospital Kansas City, Kansas City, MO USA
| | - Brian C. Helsel
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Richard A. Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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15
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Ptomey LT, Helsel BC, White DA, Lee J, Sherman JR, Washburn RA, Gorczyca AM, Donnelly JE. Intrapersonal, interpersonal and environmental correlates of moderate to vigorous physical activity and sedentary time in adolescents with intellectual and developmental disabilities. J Intellect Disabil Res 2022; 66:503-516. [PMID: 35191124 PMCID: PMC9450913 DOI: 10.1111/jir.12920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 01/28/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Although correlates of physical activity (PA) have been extensively examined in both children and adolescents who are typically developing, little is known about correlates of moderate to vigorous physical activity (MVPA) and sedentary time in adolescents with intellectual and developmental disabilities (IDD). Therefore, we examined intrapersonal, interpersonal and environmental factors and their association with device-based MVPA and sedentary time in adolescents with IDD. METHODS MVPA and sedentary time was assessed using a hip-worn ActiGraph model wGT3x-BT tri-axial accelerometer across a 7-day period in adolescents with IDD and one of their parents. Pearson and point-biserial correlations were calculated to inspect the associations of PA (MVPA, sedentary time) with intrapersonal factors (demographic characteristic, BMI, waist circumference, motor ability, muscle strength, grip strength, cardiovascular fitness and self-efficacy for PA), interpersonal factors (parent demographics, parent BMI, parent MVPA and sedentary time, family social support for PA, parent barriers and support for PA, parent's beliefs/attitudes towards PA and number of siblings), and environmental factors (meteorologic season and COVID-19). Ordinary least squares regression was used to estimate the unique contributions of key factors to PA after controlling for participants' age, sex, race, waist circumference and total wear time. RESULTS Ninety-two adolescents (15.5 ± 3.0 years old, 21.7% non-White, 6.5% Hispanic, 56.5% female) provided valid accelerometer data. Average sedentary time was 494.6 ± 136.4 min/day and average MVPA was 19.8 ± 24.2 min/day. Age (r = 0.27, P = 0.01), diagnosis of congenital heart disease (r = -0.26, P = 0.01) and parent sedentary time (r = 0.30, P = 0.01) were correlated with sedentary time. BMI (r = -0.24, P = 0.03), waist circumference (r = -0.28, P = 0.01), identifying as White (r = -0.23, P = 0.03) and parent MVPA (r = 0.56, P < 0.001) were correlated with MVPA. After adjusting for the adolescent's age, sex, race, waist circumference, and total wear time, the association between parent and adolescent MVPA remained significant (b = 0.55, P < 0.01, partial η2 = 0.11). CONCLUSION The results of this study provide evidence that race, waist circumference and parental MVPA may influence the amount of MVPA in adolescents with IDD. The limited available information and the potential health benefits of increased MVPA highlight the need to evaluate the effectiveness of multi-component interventions targeting both intrapersonal and interpersonal levels to promote increased PA in adolescents with IDD.
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Affiliation(s)
- Lauren T. Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Brian C. Helsel
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - David A. White
- Ward Family Heart Center, Children’s Mercy Hospital Kansas City, Kansas City, MO USA
| | - Jaehoon Lee
- Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, 2500 Broadway, Lubbock, TX, 79409 USA
| | - Joseph R. Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Richard A. Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Anna M Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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16
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Papini NM, Foster RNS, Lopez NV, Ptomey LT, Herrmann SD, Donnelly JE. Examination of three-factor eating questionnaire subscale scores on weight loss and weight loss maintenance in a clinical intervention. BMC Psychol 2022; 10:101. [PMID: 35428328 PMCID: PMC9013121 DOI: 10.1186/s40359-022-00806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study is to examine three-factor eating questionnaire (TFEQ) scores at baseline and post-intervention (6 months) on successful weight loss and weight maintenance in an 18-month behavioral weight management intervention for adults with overweight and obesity. Methods TFEQ and weight were assessed at baseline, 6, and 18 months. Logistic regression models were used to examine scores at baseline on disinhibition, restraint, and perceived hunger factors in the TFEQ on 5% body weight loss at 6 months and 6-month scores to predict 5% weight maintenance at 18 months while controlling for age, sex, and baseline weight.
Results Participants (n = 287; age = 43.8 ± 10.36 years; female = 64.1%; weight = 222.5 ± 39.02 pounds; BMI = 34.73 ± 4.56) were included for analysis. Dietary restraint at baseline was the only significant predictor of 5% weight loss at 6 months. None of the TFEQ subscale scores at 6 months predicted 5% weight maintenance at 18 months. The model examining weight loss at 6 months accounted for 7% of the variance of the outcome and 11% of the variance of weight maintenance at 18 months. Conclusion Dietary restraint is a unique eating behavior associated with weight loss at 6 months beyond other eating behaviors measured by the TFEQ in an adult sample enrolled in a weight loss intervention. No other subscale scores were significant at 6 months or at 18 months. Future research should consider how to promote flexible control and discourage adoption of rigid restraint behaviors since the latter is associated with disordered eating patterns.
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Roberts SB, Das SK, Sayer RD, Caldwell AE, Wyatt HR, Mehta TS, Gorczyca AM, Oslund JL, Peters JC, Friedman JE, Chiu CY, Greenway FL, Donnelly JE, Dao MC, Cuevas AG, Affuso O, Wilkinson LL, Thomas D, Al-Ozairi E, Yannakoulia M, Khazrai YM, Manalac RJ, Bachiashvili V, Hill JO. Technical report: an online international weight control registry to inform precision approaches to healthy weight management. Int J Obes (Lond) 2022; 46:1728-1733. [PMID: 35710944 PMCID: PMC9201790 DOI: 10.1038/s41366-022-01158-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Personalizing approaches to prevention and treatment of obesity will be a crucial aspect of precision health initiatives. However, in considering individual susceptibility to obesity, much remains to be learned about how to support healthy weight management in different population subgroups, environments and geographical locations. SUBJECTS/METHODS The International Weight Control Registry (IWCR) has been launched to facilitate a deeper and broader understanding of the spectrum of factors contributing to success and challenges in weight loss and weight loss maintenance in individuals and across population groups. The IWCR registry aims to recruit, enroll and follow a diverse cohort of adults with varying rates of success in weight management. Data collection methods include questionnaires of demographic variables, weight history, and behavioral, cultural, economic, psychological, and environmental domains. A subset of participants will provide objective measures of physical activity, weight, and body composition along with detailed reports of dietary intake. Lastly, participants will be able to provide qualitative information in an unstructured format on additional topics they feel are relevant, and environmental data will be obtained from public sources based on participant zip code. CONCLUSIONS The IWCR will be a resource for researchers to inform improvements in interventions for weight loss and weight loss maintenance in different countries, and to examine environmental and policy-level factors that affect weight management in different population groups. This large scale, multi-level approach aims to inform efforts to reduce the prevalence of obesity worldwide and its associated comorbidities and economic impacts. TRIAL REGISTRATION NCT04907396 (clinicaltrials.gov) sponsor SB Roberts; Tufts University IRB #13075.
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Affiliation(s)
- Susan B. Roberts
- grid.429997.80000 0004 1936 7531Energy Metabolism, Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA 02111 USA
| | - Sai Krupa Das
- grid.429997.80000 0004 1936 7531Energy Metabolism, Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA 02111 USA
| | - R. Drew Sayer
- grid.265892.20000000106344187Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Ann E. Caldwell
- grid.430503.10000 0001 0703 675XDivision of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Holly R. Wyatt
- grid.265892.20000000106344187Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Tapan S. Mehta
- grid.265892.20000000106344187Department of Family and Community Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35233 USA
| | - Anna M. Gorczyca
- grid.412016.00000 0001 2177 6375Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160 USA
| | - Jennifer L. Oslund
- grid.429997.80000 0004 1936 7531Energy Metabolism, Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA 02111 USA
| | - John C. Peters
- grid.430503.10000 0001 0703 675XDivision of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - James E. Friedman
- grid.265892.20000000106344187Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Chia-Ying Chiu
- grid.265892.20000000106344187Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35233 USA
| | - Frank L. Greenway
- grid.410428.b0000 0001 0665 5823Clinical Trials Unit, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808 USA
| | - Joseph E. Donnelly
- grid.412016.00000 0001 2177 6375Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160 USA
| | - Maria Carlota Dao
- grid.167436.10000 0001 2192 7145Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, Durham, NH 03824 USA
| | - Adolfo G. Cuevas
- grid.429997.80000 0004 1936 7531Department of Community Health, Tufts University, Medford, MA 02155 USA
| | - Olivia Affuso
- grid.265892.20000000106344187Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Larrell L. Wilkinson
- grid.265892.20000000106344187Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Diana Thomas
- grid.419884.80000 0001 2287 2270Department of Mathematical Sciences, United States Military Academy, West Point, NY 10996 USA
| | - Ebaa Al-Ozairi
- grid.452356.30000 0004 0518 1285Clinical Research Unit, Dasman Diabetes Institute, 15462 Kuwait City, Kuwait
| | - Mary Yannakoulia
- grid.15823.3d0000 0004 0622 2843Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, 176 71 Kallithea, Greece
| | - Yeganeh M. Khazrai
- grid.9657.d0000 0004 1757 5329Department of Food Science and Human Nutrition, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, RM Italy
| | - Raoul J. Manalac
- grid.64337.350000 0001 0662 7451Bariatric & Metabolic Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA USA
| | - Vasil Bachiashvili
- grid.265892.20000000106344187Department of Family and Community Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35233 USA
| | - James O. Hill
- grid.265892.20000000106344187Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294 USA
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White DA, Willis EA, Ptomey LT, Gorczyca AM, Donnelly JE. Weekly Frequency of Meeting the Physical Activity Guidelines and Cardiometabolic Health in Children and Adolescents. Med Sci Sports Exerc 2022; 54:106-112. [PMID: 34334716 PMCID: PMC8678143 DOI: 10.1249/mss.0000000000002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aimed to examine the association of the frequency component of the weekly PA guidelines on CmH in youth. METHODS Cross-sectional accelerometer data from the 2003-2006 National Health and Nutrition Examination Survey included youth age 6-18 yr with ≥4 d, ≥10 h of wear time, and averaging ≥60 min·d-1 of MVPA (n = 656). Participants were categorized into quartiles based on the proportion of days where they met the guidelines (≥60 min of MVPA). CmH variables were categorized as weight status/body anthropometrics, blood pressure, cholesterol, and fasting serum laboratory results. Propensity score weighting was applied to quartiles, and general linear modeling was used to compare associations of quartiles with CmH variables. RESULTS Results are displayed as percent of days meeting guidelines (DMG; 95% confidence interval): MVPA in minutes per week: Q1 (n = 156; DMG = 45.8% (43.4%-48.1%); MVPA 467.5, min·wk-1), Q2 (n = 165; DMG = 62.6% (61.6%-63.7%); MVPA, 474.4 min·wk-1), Q3 (n = 148; DMG = 75% (74.1%-75.8%); MVPA, 446.5 min·wk-1), Q4 (n = 187; DMG = 92.2% (87.7%-96.6%); MVPA, 453.2 min·wk-1). After adjusting for confounders and multiple comparisons, there were no clinically significant differences in weight status/body anthropometrics, blood pressure, cholesterol, or fasting serum laboratory results between DMG quartiles. CONCLUSIONS We found no association between the proportion of DMG and CmH in children and adolescents. Our study suggests that achieving an overall weekly average of 60 min·d-1 of MVPA seems to be sufficient for CmH regardless of the 7 d·wk-1 frequency requirement of the PA guideline.
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Affiliation(s)
- David A. White
- Ward Family Heart Center, Children’s Mercy Hospital Kansas City, Kansas City, MO
- School of Medicine, University of Missouri Kansas City, Kansas City, MO
| | - Erik A. Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NO
| | - Lauren T. Ptomey
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Anna M. Gorczyca
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
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19
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Ptomey LT, Bodde AE, Hastert M, Suire KB, Helsel BC, Gorczyca AM, Washburn RA, Rice AM, Donnelly JE. Weight loss in adolescents with down syndrome compared to adolescents with other intellectual disabilities enrolled in an 18-month randomized weight management trial. Front Pediatr 2022; 10:1022738. [PMID: 36405842 PMCID: PMC9666888 DOI: 10.3389/fped.2022.1022738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is limited information on the efficacy of weight management interventions in adolescents with Down Syndrome (DS). OBJECTIVE To compare weight change and intervention compliance between adolescents with DS compared to adolescents with non-DS related intellectual disabilities (ID) who were enrolled in an 18-month weight management trial. METHODS Participants were adolescents (13-21 years) with mild to moderate ID and overweight or obesity. Participants were randomized in a 1:1:1 allocation to one of 3 intervention arms for an 18-month weight management trial: face-to-face/conventional diet (FTF/CD), remote delivery/conventional diet (RD/CD), or remote delivery/enhanced Stop Light Diet (RD/eSLD). Anthropometrics were assessed at baseline 6, 12, and 18 months by staff blinded to the intervention, and self-monitoring data was collected across the 18-month study. As an unpowered, post-hoc, secondary analysis, two-sample t-tests were used to compare the weight change across 6,12, and 18 mos. and compliance across 18 mos. between adolescents with and without DS randomized to each intervention arm. RESULTS Adolescents with ID (n = 110) were randomized to one of three intervention arms: FTF/CD (n = 36, DS = 17, other ID = 19), RD/CD (n = 39, DS = 21, other ID = 18) or RD/eSLD (n = 35, DS = 15, other ID = 20). Body weight at 18 months was obtained from 82%, 76% and 73% of participants with DS and 84%, 83% and 75% of participants with other ID randomized to the FTF/CD, RD/CD, and RD/eSLD arms, respectively Weight change across 18 months was -0.2 ± 8.8 kg (-0.5%), -0.3 ± 5.3 kg (-0.7%), and -2.6 ± 5.0 kg (-4.0%) in adolescents with DS randomized to the FTF/CD, RD/CD and RD/eSLD arms, respectively. There were no significant differences in change in body weight or BMI across 18 months between adolescents with DS or those with other ID in any of the 3 intervention arms (all p > 0.05). Additionally, there were no significant differences in intervention compliance between adolescents with and without DS across 18 mos. (all p > 0.05). CONCLUSIONS Adolescents with DS respond to a multi-component weight management intervention similar to those with others ID.
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Affiliation(s)
- Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States
| | - Amy E Bodde
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States
| | - Mary Hastert
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States.,Department of Dietetics and Nutrition, The University of Kansas Medical Center, Rainbow, KS, United States
| | - Kameron B Suire
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States
| | - Brian C Helsel
- Department of Neurology, The University of Kansas Medical Center, Rainbow, KS, United States
| | - Anna M Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States
| | - Annie M Rice
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, United States
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20
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Hastert M, Goetz JR, Sullivan DK, Hull HR, Donnelly JE, Ptomey LT. Calcium, fiber, iron, and sodium intake in adolescents with intellectual and developmental disabilities and overweight and obesity. Disabil Health J 2021; 14:101155. [PMID: 34210641 PMCID: PMC8448970 DOI: 10.1016/j.dhjo.2021.101155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents with intellectual and developmental disabilities (IDD) and overweight or obesity (OW/OB) are a nutritionally vulnerable group with increased risk of nutritional deficiencies. However, there are limited data examining micronutrient intake in adolescents with IDD and OW/OB. OBJECTIVE The purpose of this study was to assess the adequacy of calcium, iron, fiber, and sodium intake referenced against the United States Dietary Reference Intakes in adolescents with IDD and OW/OB. METHODS Three-day image-assisted food records were used to assess dietary intake of 64 adolescents with IDD and OW/OB. A mean ± standard deviation was calculated for mean intake of calcium (mg), fiber (g/1000 kcals energy), iron (mg), and sodium (mg). RESULTS A total of 157 nutrient intake observations were completed by 64 participants (56% female, 16.3 ± 2.3 years). Calcium intake for participants ages 14-18 years (n = 57) was 1027.4 ± 607.5 mg, which is below the EAR of 1050 mg. Calcium intake for participants ages ≥19 years (n = 7) was 921.1 ± 596.4 mg, which is greater than the EAR of 840 mg. Fiber intake was 8.4 ± 3.6 g/1000 kcals, which is below the AI of 14 g/1000 kcals. Iron intake for all participants exceeded their respective EARs. Sodium intake was 3180.9 ± 975.9 mg, which above the AI of 2300 mg. CONCLUSION Calcium intake was adequate for participants ≥19 years of age, but inadequate for participants 14-18 years. For all participants, iron and sodium intake exceeded the DRI while fiber intake was below the DRI.
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Affiliation(s)
- Mary Hastert
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA; Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA.
| | - Jeannine R Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Holly R Hull
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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21
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Ptomey LT, Washburn RA, Goetz JR, Sullivan DK, Gibson CA, Mayo MS, Krebill R, Gorczyca AM, Montgomery RN, Honas JJ, Helsel BC, Donnelly JE. Weight Loss Interventions for Adolescents With Intellectual Disabilities: An RCT. Pediatrics 2021; 148:peds.2021-050261. [PMID: 34413247 PMCID: PMC8477713 DOI: 10.1542/peds.2021-050261] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES In this randomized trial, we compared the effectiveness of 2 diets (enhanced stop light diet [eSLD] versus conventional meal plan diet [CD]) and 2 delivery strategies (face-to-face [FTF] versus remote delivery [RD]) on weight loss across 6 months in adolescents with intellectual and developmental disabilities who were overweight or obese. METHODS Participants were randomly assigned to 1 of 3 arms (FTF/CD, RD/CD, or RD/eSLD) and asked to attend one-on-one sessions with a health educator every 2 weeks to aid in maintaining compliance with recommendations for a reduced-energy diet and increased physical activity. The CD followed the US dietary guidelines. The eSLD used the stop light guide and was enhanced with portion-controlled meals. The FTF arm was delivered during in-person home visits. The RD arms were delivered by using video conferencing. RESULTS A total of 110 adolescents with intellectual and developmental disabilities (aged ∼16 years, 53% female, BMI 33) were randomly assigned to the FTF/CD (n = 36), RD/CD (n = 39), or RD/eSLD (n = 35) group. Body weight at 6 months was obtained from 97%, 100%, and 86% of participants in the FTF/CD, RD/CD, and RD/eSLD arms, respectively. The eSLD elicited significantly greater weight loss than the CD: RD/eSLD (-5.0 ± 5.9 kg; -6.4%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) (P = .01). However, weight loss did not differ by delivery strategy: FTF/CD (-0.3 ± 5.0 kg; -0.2%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) (P = .20). CONCLUSIONS The eSLD elicited significantly greater 6-month weight loss compared with a CD when both interventions were delivered remotely. Minimal 6-month weight loss, which did not differ significantly between FTF delivery and RD, was observed with a CD.
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Affiliation(s)
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jeannine R. Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow City, KS, 66160 USA
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow City, KS, 66160 USA
| | - Cheryl A. Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Matthew S. Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Ron Krebill
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Anna M. Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Robert N. Montgomery
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jeffery J. Honas
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Brian C Helsel
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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22
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Steger FL, Donnelly JE, Hull HR, Li X, Hu J, Sullivan DK. Intermittent and continuous energy restriction result in similar weight loss, weight loss maintenance, and body composition changes in a 6 month randomized pilot study. Clin Obes 2021; 11:e12430. [PMID: 33305526 PMCID: PMC9361403 DOI: 10.1111/cob.12430] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 12/14/2022]
Abstract
Poor adherence is a barrier to successful weight control. Intermittent energy restriction (IER) provides an alternative approach to those for whom daily energy restriction is not ideal. This study assessed changes in weight, body composition, and macronutrient intake for an IER and a continuous energy restriction (CONT) approach within a multicomponent weight management intervention. We randomized 35 adults with overweight/obesity (BMI = 31.2 ± 2.4 kg/m2 ) to CONT or IER for 24 weeks (12-week weight loss intervention and 12 weeks of weight loss maintenance). Diets were delivered within a multimodal weight management program including weekly group meetings with a registered dietitian, increased physical activity, and a comprehensive lifestyle change program. Retention and adherence were similar for CONT and IER. Weight, BMI, fat mass, percentage body fat, waist circumference, hip circumference, blood pressure, and heart rate all decreased after 24 weeks (all, P < .01), but there were no main effects of group (all, P > .27). Weight loss was clinically relevant in both CONT (11.38 ± 7.9%) and IER (9.37 ± 9.7%), and the proportion of each group achieving 5% weight loss was 82 and 61% (P = .16), respectively. Participant satisfaction was high in both groups. The results from this study (a) support the feasibility of IER as an alternative for weight loss and weight loss maintenance, (b) indicate that IER is an effective alternative to CONT for weight control and improvements in body composition, and (c) emphasize the importance of intensive lifestyle interventions with ongoing support for effective behaviour modification.
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Affiliation(s)
- Felicia L. Steger
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Joseph E. Donnelly
- Center for Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas
| | - Holly R. Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Xinyang Li
- Center for Research in Leadership and Education, Texas Tech University, Lubbock, Texas
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
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23
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Abstract
Behavioral weight loss programs combining energy restriction and increased physical activity (PA) are generally successful in producing clinically significant weight loss (≥5%) over 3-6 mos. However, weight maintenance (≥ 2 yrs.) continues to be problematic, due in part to an inability of individuals to continue adherence to diet and PA recommendations. It is hypothesized that neurocognitive processes, specifically executive functions (EFs, i.e., inhibition, working memory, mental flexibility), underlie self-regulation, self-efficacy, and are essential for the adoption and maintenance of health behaviors. Behavioral weight loss programs generally attempt to improve self-regulation; however, these skills are difficult to implement long-term. Strengthening EFs through cognitive training may improve weight maintenance by improving self-efficacy and self-regulation, resulting in improved program attendance and improved adherence to dietary and PA recommendations. Although randomized trials have not been conducted to specifically evaluate this hypothesis, results from the available literature suggest the potential for cognitive training to improve weight maintenance.
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Affiliation(s)
- Amanda N Szabo-Reed
- Department of Weight Management, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E Donnelly
- Department of Weight Management, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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24
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Washburn RA, Szabo-Reed AN, Gorczyca AM, Sullivan DK, Honas JJ, Mayo MS, Krebill R, Goetz J, Ptomey LT, Lee J, Donnelly JE. A Randomized Trial Evaluating Exercise for the Prevention of Weight Regain. Obesity (Silver Spring) 2021; 29:62-70. [PMID: 34494375 PMCID: PMC9260853 DOI: 10.1002/oby.23022] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of three levels of exercise on weight regain subsequent to clinically meaningful weight loss (WL). METHODS Adults with overweight or obesity (n = 298) initiated a 3-month behavioral WL intervention, which included reduced energy intake, increased exercise, and weekly behavioral counseling. Participants achieving ≥5% WL (n = 235) began a 12-month behavioral WL maintenance intervention and were randomized to 150 min/wk (n = 76), 225 min/wk (n = 80), or 300 min/wk (n = 79) of partially supervised moderate-to-vigorous-intensity exercise. RESULTS Participants randomized to 150, 225, and 300 minutes of exercise completed 129 ± 30, 153 ± 49 and 179 ± 62 min/wk of exercise (supervised + unsupervised), respectively. Mean WL at 3 months (9.5 ± 3.1 kg) was similar across randomized groups (P = 0.68). Weight change across 12 months was 1.1 ± 6.5 kg, 3.2 ± 5.7 kg, and 2.8 ± 6.9 kg in the 150, 225, and 300 min/wk groups, respectively. Intent-to-treat analysis revealed no significant overall trend across the three treatment groups (P = 0.09), effects for group (P = 0.08), or sex (P = 0.21). CONCLUSIONS This study found no evidence for an association between the volume of moderate-to-vigorous-intensity exercise and weight regain across 12 months following clinically relevant WL. Further, results suggest that exercise volumes lower than those currently recommended for WL maintenance, when completed in conjunction with a behavioral weight-maintenance intervention, may minimize weight regain over 12 months.
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Affiliation(s)
- Richard A. Washburn
- Department of Internal Medicine, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Amanda N. Szabo-Reed
- Department of Internal Medicine, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Anna M. Gorczyca
- Department of Internal Medicine, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Jeffery J. Honas
- Department of Internal Medicine, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Matthew S. Mayo
- Department of Biostatistics & Data Science, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Ronald Krebill
- Department of Biostatistics & Data Science, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Jeannine Goetz
- Department of Dietetics and Nutrition, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Lauren T. Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, Texas, USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
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25
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Affiliation(s)
- Nicolaas P. Pronk
- Human Performance Laboratory, Department of Health and Physical Education, Kearney State College, Kearney, Nebraska
| | - Joseph E. Donnelly
- Human Performance Laboratory, Department of Health and Physical Education, Kearney State College, Kearney, Nebraska
| | - Stephanie J. Pronk
- Human Performance Laboratory, Department of Health and Physical Education, Kearney State College, Kearney, Nebraska
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26
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Ptomey LT, Szabo-Reed AN, Vidoni ED, Washburn RA, Gorczyca AM, Little TD, Lee J, Helsel BC, Williams KN, Donnelly JE. A dyadic approach for a remote physical activity intervention in adults with Alzheimer's disease and their caregivers: Rationale and design for an 18-month randomized trial. Contemp Clin Trials 2020; 98:106158. [PMID: 32979515 PMCID: PMC7686020 DOI: 10.1016/j.cct.2020.106158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Adults with Alzheimer's disease and related dementia (ADRD) and their caregivers represent a sizeable and underserved segment of the population with low levels of moderate physical activity (MPA). Options for increasing MPA in community dwelling adults with ADRD and their caregivers are limited. A home-based physical activity intervention delivered remotely via video conferencing to groups of adults with ADRD and their caregivers (RGV), represents a potentially effective approach for increasing MPA in this group. We will conduct an 18-month randomized trial (6 mos. Active intervention, 6 mos. Maintenance, 6 mos. no contact) to compare the effectiveness of the RGV approach with usual care, enhanced with caregiver support (EUC), for increasing MPA in 100 community dwelling adults with ADRD and their caregiver. The primary aim is to compare MPA (min/wk.), assessed by accelerometer, across the 6-mo. active intervention in adults with ADRD randomized to RGV or EUC. Secondarily, we will compare adults with ADRD and their caregivers randomized to RGV or ECU on the following outcomes across 18 mos.: MPA (min/wk.), sedentary time (min/wk.), percentage meeting 150 min/wk. MPA goal, functional fitness, activities of daily living, quality of life, residential transitions, cognitive function, and caregiver burden. Additionally, we will evaluate the influence of age, sex, BMI, attendance (exercise/support sessions), use of recorded sessions, self-monitoring, peer interactions during group sessions, caregiver support, type and quality of dyadic relationship, and number of caregivers on changes in MPA in adults with ADRD and their caregiver across 18 mos.
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Affiliation(s)
- Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Amanda N Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Eric D Vidoni
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Anna M Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Todd D Little
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - Brian C Helsel
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Kristine N Williams
- School of Nursing, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
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27
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Ptomey LT, Szabo-Reed AN, Martin LE, Mayo MS, Washburn RA, Gorczyca AM, Lepping RJ, Lee P, Forsha DE, Sherman JR, Danon JC, Donnelly JE. The promotion of physical activity for the prevention of Alzheimer's disease in adults with Down Syndrome: Rationale and design for a 12 Month randomized trial. Contemp Clin Trials Commun 2020; 19:100607. [PMID: 32642594 PMCID: PMC7334572 DOI: 10.1016/j.conctc.2020.100607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022] Open
Abstract
Nearly all individuals with Down Syndrome (DS) display pathology associated with Alzheimer's disease (AD) beginning as early as age 30. Previous research in typically developed adults suggests that increased moderate-to-vigorous physical activity (MVPA) may improve cognitive function and protect against age-related structural and functional changes in the brain; however, the potential impact of increased MVPA on the development of AD in adults with DS has not been evaluated. Despite the potential positive impact of MVPA on cognition and AD risk, participation in MVPA among young adults with DS is low. The limited research evaluating strategies for increasing MVPA in adults with DS has been unsuccessful in increasing MVPA. Results from our preliminary investigation where we remotely delivered real-time MVPA, led by a trained health educator, to groups of adults with DS in their homes via video conferencing on a tablet computer demonstrated high attendance, increased MVPA during group sessions, and improvements in cognitive function. However, the sustainability, impact on total daily MVPA, optimal session frequency, and potential impacts on cognitive function and brain health of remotely delivered group MVPA sessions in adults with DS are unknown. Therefore, we will conduct a trial in 80 non-demented adults with DS to determine the feasibility and potential efficacy of remotely delivered group MVPA sessions to increase daily MVPA, relative to a usual care control. Secondarily we will assess the impact of MVPA on cardiovascular fitness, quality of life, cognitive function and brain parameters related to AD. NCT REGISTRATION NCT04048759.
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Affiliation(s)
- Lauren T. Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Amanda N. Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Laura E. Martin
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Matthew S. Mayo
- Department of Biostatistics & Data Science, University of Kansas Medical Center, USA
| | - Richard A. Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Anna M. Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Phill Lee
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Daniel E. Forsha
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Joseph R. Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Jessica C. Danon
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Washburn RA, Ptomey LT, Gorczyca AM, Smith PR, Mayo MS, Lee R, Donnelly JE. Weight management for adults with mobility related disabilities: Rationale and design for an 18-month randomized trial. Contemp Clin Trials 2020; 96:106098. [PMID: 32768682 DOI: 10.1016/j.cct.2020.106098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Adults with mobility related disabilities (MRDs) represent an underserved group with a high prevalence of overweight/obesity and limited options for weight management. We previously demonstrated clinically meaningful 12-month weight loss in adults with MRDs (-6.2%, 36% ≥5% of baseline weight) using an enhanced Stop Light Diet (eSLD) delivered using at home face-to-face behavioral sessions and optional physical activity. However, the costs/logistics associated with intervention delivery by individual home visits limits the potential for scaling and implementation of this approach. Thus, we will conduct a two-arm randomized trial in 128 overweight/obese adults with MRDs to compare weight loss (6 mos.) and maintenance (12 mos.) between interventions utilizing the eSLD, behavioral counseling, and increased physical activity delivered to individual participants in their homes or delivered to groups of participants in their homes remotely via video conferencing. The primary aim will compare weight loss between interventions arms across 6 months. Secondarily, we will compare weight loss (0-18 mos.), the proportion of participants who achieve clinically meaningful weight loss (≥5%) from 0 to 6 and 0 to18 months, and changes in quality of life from 0 to 6 and 0 to 18 months between interventions arms. We will also conduct cost, cost-effectiveness and contingent valuation comparisons and explore the influence of behavioral session attendance, compliance with the recommendations for diet and physical activity, self-monitoring of diet and physical activity, barriers to physical activity, sleep quality, and medications on weight change across 6 and 18 months. NCT REGISTRATION: NCT04046471.
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Affiliation(s)
- Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Anna M Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Patricia R Smith
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Matthew S Mayo
- Department of Biostatistics and Data Science, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Robert Lee
- Department of Population Health, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
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Szabo‐Reed AN, Martin LE, Hu J, Yeh H, Powell J, Lepping RJ, Patrician TM, Breslin FJ, Donnelly JE, Savage CR. Modeling interactions between brain function, diet adherence behaviors, and weight loss success. Obes Sci Pract 2020; 6:282-292. [PMID: 32523717 PMCID: PMC7278911 DOI: 10.1002/osp4.403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Obesity is linked to altered activation in reward and control brain circuitry; however, the associated brain activity related to successful or unsuccessful weight loss (WL) is unclear. METHODS Adults with obesity (N = 75) completed a baseline functional magnetic resonance imaging (fMRI) scan before entering a WL intervention (ie,3-month diet and physical activity [PA] program). We conducted an exploratory analysis to identify the contributions of baseline brain activation, adherence behavior patterns, and the associated connections to WL at the conclusion of a 3-month WL intervention. Food cue-reactivity brain regions were functionally identified using fMRI to index brain activation to food vs nonfood cues. Food consumption, PA, and class attendance were collected weekly during the 3-month intervention. RESULTS The left middle frontal gyrus (L-MFG, BA 46) and right middle frontal gyrus (R-MFG; BA 9) were positively activated when viewing food compared with nonfood images. Structural equation modeling with bootstrapping was used to investigate a hypothesized path model and revealed the following significant paths: (1) attendance to 3-month WL, (2) R-MFG to attendance, and (3) indirect effects of R-MFG through attendance on WL. CONCLUSION Findings suggest that brain activation to appetitive food cues predicts future WL through mediating session attendance, diet, and PA. This study contributes to the growing evidence of the importance of food cue reactivity and self-regulation brain regions and their impact on WL outcomes.
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Affiliation(s)
- Amanda N. Szabo‐Reed
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansas
| | - Laura E. Martin
- Department of Population Health HealthUniversity of Kansas Medical CenterKansas CityKansas
- Hoglund Brain Imaging CenterUniversity of Kansas Medical CenterKansas CityKansas
| | - Jinxiang Hu
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Hung‐Wen Yeh
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Joshua Powell
- Graduate School of Social WorkUniversity of DenverDenverColorado
| | - Rebecca J. Lepping
- Hoglund Brain Imaging CenterUniversity of Kansas Medical CenterKansas CityKansas
| | - Trisha M. Patrician
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Florance J. Breslin
- Center for Brain, Biology and BehaviorUniversity of Nebraska‐LincolnLincolnNebraska
| | - Joseph E. Donnelly
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansas
| | - Cary R. Savage
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
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Ptomey LT, Willis EA, Sherman JR, White DA, Donnelly JE. Exploring the effectiveness of an 18-month weight management intervention in adults with Down syndrome using propensity score matching. J Intellect Disabil Res 2020; 64:221-233. [PMID: 31944472 PMCID: PMC8451028 DOI: 10.1111/jir.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/02/2019] [Accepted: 01/06/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Down syndrome (DS) is one of the most common birth defects in the USA associated with high levels of overweight and obesity. Unique characteristics of adults with DS that may contribute to the high levels of obesity are high rates of hypothyroidism, poor muscle tone, altered gait and lower resting metabolic rate. Due to these factors, it is unknown if the same weight management interventions that are effective in adults with intellectual or developmental disability (IDD) without DS are as effective in those with DS. Therefore, the purpose of this secondary analysis was to compare changes in weight, diet and physical activity between participants with DS-related and non-DS-related IDD participating in an 18-month weight management trial. METHODS We used propensity score methods to adjust baseline variables of overweight/obese adults with and without DS participating in an 18-month effectiveness trial with 6 months weight loss and 12 months weight maintenance. Participants followed one of two reduced calorie diet plans, obtained 150 min of moderate-vigorous intensity physical activity (MVPA) per week, and logged dietary intake daily. A health educator held monthly at-home visits with participants and a caregiver to give feedback on intervention compliance. RESULTS Out of the 124 participants that met the criteria for inclusion, 21 were diagnosed with DS and 103 with non-DS-related IDD. Twenty out of 21 participants with DS were successfully matched. Clinically significant weight loss was seen at 18 months in participants with DS (-5.2%) and non-DS-related IDD (-6.8%), with no difference between groups (P = 0.53). Significant reductions in energy intake were seen across the 18-month intervention in both DS and non-DS-related IDD groups with between-group differences at 12 months only (1119 vs. 1492 kcal/day, respectively; P = 0.003). Although MVPA did not increase in either group across the intervention, those with non-DS-related IDD had higher levels of MVPA compared with those with DS across 18 months. CONCLUSION Participants with DS lost a clinically significant amount of weight across the 18-month intervention. Compared with those with non-DS-related IDD, those with DS lost similar amounts of weight, had similar decreases in energy intake and participated in less MVPA across the 18-month intervention. Although individuals with DS have physiological factors that may contribute to obesity, weight management interventions designed for individuals with IDD may be equally effective in this population.
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Affiliation(s)
- L T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - E A Willis
- Center for Health Promotions and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - D A White
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO
| | - J E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
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Szabo-Reed AN, Washburn RA, Greene JL, Ptomey LT, Gorczyca A, Lee RH, Little TD, Lee J, Honas J, Donnelly JE. Physical activity across the curriculum (PAAC3): Testing the application of technology delivered classroom physical activity breaks. Contemp Clin Trials 2020; 90:105952. [PMID: 32006633 DOI: 10.1016/j.cct.2020.105952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 01/28/2023]
Abstract
Only 43% of children in the U.S., ages 6-11 yrs., meet current physical activity (PA) guidelines. To satisfy the MVPA requirement, schools have begun incorporating MVPA in the form of activity breaks or MVPA academic lessons. We completed two, 3 academic-yr. cluster randomized trials (DK61489, DK85317) called "Physical Activity Across the Curriculum" (PAAC) which involved increasing MVPA in the classroom. Across 3-yrs. teachers in PAAC schools delivered ~60 min/wk. (12 min/day) of MVPA. Although short of our MVPA goal (20 min/d), the PAAC approach substantially increased in-school MVPA. Teacher reluctance to devote additional time to develop and integrate PA lessons into their curriculum was the overwhelming barrier to meeting the MVPA goal. Therefore, to reduce barriers to delivery of classroom PA we developed a 3-academic yr. cluster randomized trial (2 yrs. active intervention, 1 yr. follow-up) to compare the effectiveness and sustainability of technology delivered (PAAC-R) and classroom teacher delivered (PAAC-T) activity breaks for increasing classroom MVPA in elementary school students in grades 2 and 3 at baseline who will progress to grades 4-5. NCT registration: NCT03493139.
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Affiliation(s)
- Amanda N Szabo-Reed
- Weight Management, Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Richard A Washburn
- Weight Management, Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J Leon Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA.
| | - Lauren T Ptomey
- Weight Management, Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Anna Gorczyca
- Weight Management, Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Robert H Lee
- Department of Health Policy and Management, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Todd D Little
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway Street, Lubbock, TX 79409, USA.
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway Street, Lubbock, TX 79409, USA.
| | - Jeff Honas
- Weight Management, Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Weight Management, Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Ptomey LT, Washburn RA, Lee J, Greene JL, Szabo-Reed AN, Sherman JR, Danon JC, Osborne LN, Little TD, Donnelly JE. Individual and family-based approaches to increase physical activity in adolescents with intellectual and developmental disabilities: Rationale and design for an 18 month randomized trial. Contemp Clin Trials 2019; 84:105817. [PMID: 31344519 PMCID: PMC6721974 DOI: 10.1016/j.cct.2019.105817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 01/23/2023]
Abstract
Adolescents with intellectual and developmental disabilities (IDD) are less physically active and have lower cardiovascular fitness compared with their typically developing peers. This population faces additional barriers to participation in moderate-to-vigorous physical activity (MVPA) such as reliance on parents, lack of peer-support, and lack of inclusive physical activity opportunities. Previous interventions to increase MVPA in adolescents with IDD have met with limited success, at least in part due to requiring parents to transport their adolescent to an exercise facility. We recently developed a remote system to deliver MVPA to groups of adolescents with IDD in their homes via video conferencing on a tablet computer. This approach eliminates the need for transportation and provides social interaction and support from both a health coach and other participants. We will conduct a 18-mo. trial (6 mos. active, 6 mos. maintenance, 6 mos. no-contact follow-up) to compare changes in objectively assessed MVPA in 114 adolescents with IDD randomized to a single level intervention delivered only to the adolescent (AO) or a multi-level intervention delivered to both the adolescent and a parent (A + P). Our primary aim is to compare increases in MVPA (min/d) between the AO and A + P groups from 0 to 6 mos. Secondarily we will compare changes in MVPA, sedentary time, cardiovascular fitness, muscular strength, motor ability, quality of life, and the percentage of adolescents achieving the US recommendation of 60 min. MVPA/d across 18 mos. We will also explore the influence of process variables/participant characteristics on changes in MVPA across 18 mos. NCT registration: NCT03684512.
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Affiliation(s)
- L T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - R A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J Lee
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - J L Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA.
| | - A N Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J C Danon
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - L N Osborne
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - T D Little
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - J E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Ptomey LT, Vidoni ED, Montenegro-Montenegro E, Thompson MA, Sherman JR, Gorczyca AM, Greene JL, Washburn RA, Donnelly JE. The Feasibility of Remotely Delivered Exercise Session in Adults With Alzheimer's Disease and Their Caregivers. J Aging Phys Act 2019; 27:670–677. [PMID: 30747564 PMCID: PMC6891121 DOI: 10.1123/japa.2018-0298] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Adults with Alzheimer's disease (AD) and their caregivers represent a segment of the population with low levels of moderate-intensity physical activity (MPA) and limited options for increasing MPA. The purpose of this study was to evaluate the feasibility of a group video conference approach for increasing MPA in adults with AD and their caregivers. Adults with AD and their caregivers attended 30-min group exercise sessions three times per week for 12 weeks. Exercise sessions and support sessions were delivered in their homes on a tablet computer over video conferencing software. Nine adults with AD/caregiver dyads enrolled, and seven completed the 12-week intervention. Adults with AD attended 77.3% of the group exercise sessions, and caregivers attended 79.2% of group exercise sessions. Weekly MPA increased in both adults with AD (49%) and caregivers (30%). Exercise delivered by group video conferencing is a feasible and potentially effective approach for increasing MPA in adults with AD and their caregivers.
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Affiliation(s)
- Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Eric D Vidoni
- University of Kansas Alzheimer’s Disease Center, The University of Kansas Medical Center, Kansas City, KS, 66160 USA
| | - Esteban Montenegro-Montenegro
- Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, 2500 Broadway; Lubbock, TX, 79409 USA
| | - Michael A Thompson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Anna M Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - JL Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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Willis EA, Creasy SA, Honas JJ, Melanson EL, Donnelly JE. The effects of exercise session timing on weight loss and components of energy balance: midwest exercise trial 2. Int J Obes (Lond) 2019; 44:114-124. [PMID: 31289334 PMCID: PMC6925313 DOI: 10.1038/s41366-019-0409-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/17/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022]
Abstract
Background/objectives Circadian physiology has been linked to body weight regulation and obesity. To date, few studies have assessed the association between exercise timing and weight related outcomes. The aim of this secondary analysis was to explore the impact of exercise timing (i.e., 24 h clock time of exercise session) on weight loss and components of energy balance. Subjects/methods Overweight/obese (BMI 25.0–39.9 kg/m2), physically inactive, young adults (~51% female) completed a 10-month supervised exercise program (400 or 600 kcal/session for 5 days/week) or served as non-exercise controls (CON). Participants were categorized based on the time of day in which they completed exercise sessions (Early-Ex: >50% of sessions completed between 7:00 and 11:59 am; (n = 21), Late-Ex: >50% of sessions completed between 3:00 and 7:00 pm; (n = 25), Sporadic-Ex: <50% of sessions completed in any time category; (n = 24), and CON; (n = 18)). Body weight, energy intake (EI; digital photography), and non-exercise physical activity (NEPA; accelerometer) were assessed at baseline, 3.5, 7, and 10 months. Total daily energy expenditure (TDEE; doubly labeled water), was assessed at baseline and 10 months. Results At month 10, weight loss was significantly greater in both Early-EX (−7.2 ± 1.2%; p < 0.001) and Sporadic-EX (− 5.5 ± 1.2%; p = 0.01) vs CON (+0.5 ± 1.0%), and Early-EX vs Late-EX (−2.1 ± 1.0%; p < 0.001). There were no between group differences for change in TDEE, EI, and non-exercise energy expenditure (P > 0.05). A significant group × time interaction (p = 0.02) was observed for NEPA (counts/min), however, after adjusting for multiple comparisons, group effects were no longer significant. Conclusions Despite minimal differences in components of energy balance, Early-EX lost significantly more weight compared with Late-Ex. Although the mechanisms are unclear, the timing of exercise may be important for body weight regulation.
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Affiliation(s)
- Erik A Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. .,Division of Epidemiology and Genetics, Metabolic Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA.
| | - Seth A Creasy
- Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Campus, University of Colorado Aurora, Aurora, CO, USA
| | - Jeffery J Honas
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Campus, University of Colorado Aurora, Aurora, CO, USA.,Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
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Szabo-Reed AN, Willis EA, Lee J, Hillman CH, Washburn RA, Donnelly JE. The Influence of Classroom Physical Activity Participation and Time on Task on Academic Achievement. Transl J Am Coll Sports Med 2019; 4:84-95. [PMID: 31576376 DOI: 10.1249/tjx.0000000000000087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives Determine the impact of classroom-based physically active lessons on time-on-task. Secondarily, determine the relationship of time-on-task with academic achievement controlling for key demographic variables. Methods Seventeen elementary schools were cluster randomized to receive classroom physical activity (A+PAAC, N=9) or control (i.e., no physical activity, N=8) for a 3-year trial. Teachers were trained to deliver physically active lessons with moderate-to-vigorous intensity targeting 100 minutes per week. Outcome measures included academic achievement (Weschler Individual Achievement Test-III), administered at baseline and repeated each spring for 3 years, time spent in moderate-to-vigorous physical activity (MVPA), and time spent on task (TOT) pre- and post-physical activity. Multilevel modeling was utilized to estimate the impacts of percent time spent in MVPA and percent TOT post-lesson on academic achievement and the change in these impacts over 3 years, accounting for dependency among observations and covariates including age, gender, race, free or reduced lunch, BMI, and fitness. Results A greater percentage of time performing MVPA were each significantly associated with higher math scores (p=.034) and spelling scores (p<.001), but not reading scores. Academic achievement was not associated with TOT. Conclusion Findings suggest that a greater percentage of time spent participating in MVPA results in higher math scores and spelling scores, but not reading scores, independent of TOT. Future studies should continue to evaluate the influence of physically active classroom lessons on time spent on task and its impact on academic achievement. Furthermore, strategies are needed to maximize impact and to determine the sustainability of physical activity's effect on classroom behavior and academic achievement.
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Affiliation(s)
- Amanda N Szabo-Reed
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Erik A Willis
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway Street; Lubbock, TX 79409 USA
| | - Charles H Hillman
- Department of Psychology, Department of Physical Therapy, Movement, & Rehabilitation Sciences, Northeastern University, 125 NI, 360 Huntington Avenue, Boston, MA, 02115 USA
| | - Richard A Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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Ptomey LT, Steger FL, Willis EA, Sullivan DK, Honas JJ, Donnelly JE, Washburn RA. The Association of Protein Intake and Change in Lean Mass During 9-mos. of Resistance Training. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562856.65962.2c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ptomey LT, Washburn RA, Mayo MS, Greene JL, Lee RH, Szabo-Reed AN, Honas JJ, Sherman JR, Donnelly JE. Remote delivery of weight management for adults with intellectual and developmental disabilities: Rationale and design for a 24 month randomized trial. Contemp Clin Trials 2018; 73:16-26. [PMID: 30145269 PMCID: PMC6176482 DOI: 10.1016/j.cct.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 01/28/2023]
Abstract
Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0-6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.
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Affiliation(s)
- Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Matthew S Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J Leon Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA.
| | - Robert H Lee
- Department of Health Policy and Management, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Amanda N Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Jeffery J Honas
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Joseph R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Ptomey LT, Szabo AN, Willis EA, Gorczyca AM, Greene JL, Danon JC, Donnelly JE. Changes in cognitive function after a 12-week exercise intervention in adults with Down syndrome. Disabil Health J 2018; 11:486-490. [PMID: 29501470 PMCID: PMC6005720 DOI: 10.1016/j.dhjo.2018.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Between 250,000 and 400,000 individuals in the United States are diagnosed with Down syndrome (DS). Nearly all adults with DS will develop Alzheimer's disease pathology starting in their thirties. Recent studies suggest that increased physical activity (PA) may be important for maintaining components of cognition, including memory. OBJECTIVE The purpose of this study was to evaluate changes in cognitive function after completion of a 12-week exercise intervention in adults with DS. METHODS Participants were randomized to attend 30-minute group exercise sessions 1 or 2 times a week for 12 weeks. The exercise sessions were delivered via video conferencing on a tablet computer to groups of 5-8 participants. Sessions consisted of aerobic based exercises such as walking and jogging to music, dancing, as well as strength based exercises such as vertical jumps, bicep curls, and squats. Cognitive function was measured at baseline and end of study using the Cantab Dementia Battery for iPads, which assessed the cognitive domains of memory, attention, and reaction time. RESULTS Twenty-seven participants (27.9 ± 7.1 years of age, 40.7% female) enrolled and completed the 12-week intervention. Participants randomized to 1 session/week averaged 26.6 ± 3.0 min/week of PA from the group exercise session. Participants randomized to 2 sessions/week averaged 57.7 ± 15.3 min/week of PA from the group exercise sessions. Participants improved their performance on the two memory variables (p = 0.048 and p = 0.069). CONCLUSION Increased exercise may have positive changes on memory and other cognitive functions.
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Affiliation(s)
- Lauren T Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Amanda N Szabo
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Erik A Willis
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Anna M Gorczyca
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - J Leon Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, 66045, USA.
| | - Jessica C Danon
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Joseph E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
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Szabo-Reed AN, Donnelly JE, Washburn RA, Sullivan DK, Honas JJ, Mayo MS, Krebill R, Gorzyca A, Goetz J. Volume Of Exercise For Prevention Of Weight Regain (MET POWeR). Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535279.76127.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gorczyca AM, Washburn R, Steger FL, Marsh C, Donnelly JE. Weight Loss, Physical Activity, And Conception In Obese Infertile Women. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536614.49670.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ptomey LT, Gorczyca AM, Szabo AN, Steger FS, Krebill R, Mayo MS, Sullivan DK, Washburn RA, Donnelly JE. Change in Energy Intake and Health Eating Index in Response to Exercise During Weight Maintenance. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536388.06705.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ptomey LT, Szabo AN, Willis EA, Greene JL, Danon JC, Washburn RA, Forsha DE, Donnelly JE. Remote Exercise for Adults with Down Syndrome. Transl J Am Coll Sports Med 2018; 3:60-65. [PMID: 29930988 PMCID: PMC6005664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Adults with Down syndrome are less physically active than their typically developed peers. The purpose of this study was to assess the feasibility of delivering moderate-to- vigorous exercise sessions, led by a trained health educator using real-time video conferencing, to groups of young adults with Down syndrome in their homes. METHODS Participants were randomized to 30-minute group exercise sessions either 1 or 2 times a week delivered on an iPad mini tablet computer using the Zoom video conferencing application, and were asked to attend individual support/education sessions once a week using FaceTime® on the iPad, for 12 weeks. Minutes of MVPA during all group sessions were assessed using a Fitbit Charge HR activity/heart rate monitor. Participants were also asked to complete weekly homework assignments involving MVPA. RESULTS Twenty-seven participants (n = 14,1 session·wk-1, n =13, 2 sessions·wk-1), mean age 27.9 ± 7.1 yrs., ~ 41% female, enrolled in and completed the 12-wk. intervention. Attendance at group exercise and individual support/education sessions did not differ significantly between those randomized to 1 (exercise sessions =89.9 ± 8.8%, support/education sessions = 81.2 ±18.7%) or 2 sessions·wk-1 (exercise sessions = 88.8 ± 7.7%; p=0.79, support/education sessions= 86.0 ± 20.9%; p=0.87). Participants averaged 27.7 ± 5.7 mins·session-1 of MVPA with no significant difference between the 1 (26.6 ± 3.0 mins·session-1) and 2 session·wk-1 groups (28.8 ± 7.7 mins·session-1, p=0.16). The completion rate for homework assignments did not differ significantly between the 1 (21.4 ± 26.3%) and 2 session·wk-1 groups (37.7 ± 21.7%, p=0.28). CONCLUSION Exercise delivered by group video conferencing may be a feasible and potentially effective approach for increasing MVPA in adults with Down syndrome.
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Affiliation(s)
- Lauren T. Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Amanda N. Szabo
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Erik A. Willis
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - J. Leon Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS
| | - Jessica C. Danon
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Richard A. Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Daniel E. Forsha
- Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO
| | - Joseph E. Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
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Bosak KA, Papa VB, Brucks MG, Savage CR, Donnelly JE, Martin LE. Novel Biomarkers of Physical Activity Maintenance in Midlife Women: Preliminary Investigation. Biores Open Access 2018; 7:39-46. [PMID: 29682403 PMCID: PMC5908419 DOI: 10.1089/biores.2018.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The precision health initiative is leading the discovery of novel biomarkers as important indicators of biological processes or responses to behavior, such as physical activity. Neural biomarkers identified by magnetic resonance imaging (MRI) hold promise to inform future research, and ultimately, for transfer to the clinical setting to optimize health outcomes. This study investigated resting-state and functional brain biomarkers between midlife women who were maintaining physical activity in accordance with the current national guidelines and previously acquired age-matched sedentary controls. Approval was obtained from the Human Subjects Committee. Participants included nondiabetic, healthy weight to overweight (body mass index 19-29.9 kg/m2) women (n = 12) aged 40-64 years. Control group data were used from participants enrolled in our previous functional MRI study and baseline resting-state MRI data from a subset of sedentary (<500 kcal of physical activity per week) midlife women who were enrolled in a 9-month exercise intervention conducted in our imaging center. Differential activation of the inferior frontal gyrus (IFG) and greater connectivity with the dorsolateral prefrontal cortex (dlPFC) was identified between physically active women and sedentary controls. After correcting for multiple comparisons, these differences in biomarkers of physical activity maintenance did not reach statistical significance. Preliminary evidence in this small sample suggests that neural biomarkers of physical activity maintenance involve activations in the brain region associated with areas involved in implementing goal-directed behavior. Specifically, activation of the IFG and connectivity with the dlPFC is identified as a neural biomarker to explain and predict long-term physical activity maintenance for healthy aging. Future studies should evaluate these biomarker links with relevant clinical correlations.
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Affiliation(s)
- Kelly A Bosak
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas
| | - Vlad B Papa
- Hoglund Brain Imaging Center G001, University of Kansas Medical Center, Kansas City, Kansas
| | - Morgan G Brucks
- Hoglund Brain Imaging Center G001, University of Kansas Medical Center, Kansas City, Kansas
| | - Cary R Savage
- Center for Brain, Biology and Behavior, University of Nebraska, Lincoln, Nebraska
| | - Joseph E Donnelly
- Cardiovascular Research Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Laura E Martin
- Structure and Function Unit, Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
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Gorczyca AM, Washburn RA, Ptomey L, Mayo MS, Sullivan DK, Gibson CA, Lee R, Stolte S, Donnelly JE. Weight management in rural health clinics: The Midwest diet and exercise trial. Contemp Clin Trials 2018; 67:37-46. [PMID: 29454140 DOI: 10.1016/j.cct.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 01/26/2023]
Abstract
Obesity prevalence is higher in rural compared to urban residents. Rural health clinics offer a potential venue for delivery of weight management. However, traditional programs require travel to attend on-site meetings which is impractical or inconvenient for rural residents. Clinic staff in most rural settings are unlikely to be trained to provide effective weight management. Remote delivery using group phone conferences (GP) or individual phone calls (IP), by staff associated with rural clinics eliminates the need for travel to attend on-site meetings. The effectiveness of these approaches will be the focus of this trial. Staff at five primary care clinics, serving primarily rural residents, will be trained to deliver GP and IP interventions and an enhanced usual care (EUC), (i.e., individual face-to-face meetings (~45 min) at clinic site, four times across 18 mos.). Two hundred overweight/obese adults (BMI ≥ 25.0-45.0 kg/m2, age ≥ 21 yrs.) will be recruited through each clinic and randomized to GP (n = 80), IP (n = 80), or EUC (n = 40) to compare weight loss (0-6 mos.), weight maintenance (7-18 mos.), and weight change during a 6 mo. no contact follow-up (19-24 mos.) between intervention arms. The GP and IP interventions will be identical in lesson plan content, diet, and physical activity. The only difference between groups will be the delivery format (group vs. individual) and session duration (GP ~45 min/session; IP ~15 min/session). Primary (body weight) and secondary outcomes (waist circumference, energy/macronutrient intake, physical activity) will be assessed at baseline, 6, 12, 18 and 24 mos. Cost and contingent valuation analyses will also be completed. NCT REGISTRATION NCT02932748.
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Affiliation(s)
- Anna M Gorczyca
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Richard A Washburn
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Lauren Ptomey
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Matthew S Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Cheryl A Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Robert Lee
- Department of Health Policy and Management, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Sarah Stolte
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
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Szabo-Reed AN, Willis EA, Lee J, Hillman CH, Washburn RA, Donnelly JE. Impact of Three Years of Classroom Physical Activity Bouts on Time-on-Task Behavior. Med Sci Sports Exerc 2018; 49:2343-2350. [PMID: 28614194 DOI: 10.1249/mss.0000000000001346] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Participation in classroom physical activity (PA) may improve time-on-task (TOT); however, the influence of sustained moderate-to-vigorous PA (MVPA) on TOT is unknown. PURPOSE To explore the influence of classroom PA delivered with academic lessons on TOT, determine if the relationship between classroom PA and TOT differs by age, sex, race/ethnicity, weight or baseline fitness, and identify the influence of MVPA on TOT when controlling for demographic variables. METHODS Teachers in intervention schools were asked to deliver two 10-min PA lessons per day, 5 d·wk. PA was observed in both intervention and control schools to determine the amount and intensity of PA. Time-on-task was observed before and immediately after PA. Anthropometrics and fitness were assessed at baseline and end of the school year for 3 yr. Multilevel modeling was used to estimate overall group difference, change over the study, and group difference in change while accounting for covariates. RESULTS Students who participated in PA lessons engaged in significantly more MVPA than those in the control schools in all 3 yr (all P < 0.001). There was a significant linear increase in the percent of TOT before PA lessons for both control and intervention groups over the 3-yr period (P < 0.001), with no group difference. The intervention group spent significantly more TOT (P = 0.01) after PA than the control group. The percent of time spent in MVPA was significantly associated with the percent of TOT (P < 0.01). CONCLUSIONS Results indicate that children who received PA lessons participated in significantly more MVPA than those who did not and that PA was significantly associated with more TOT. These findings provide support for classroom PA as a means of increasing TOT in elementary age children.
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Affiliation(s)
- Amanda N Szabo-Reed
- 1Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS; 2Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, TX; and 3Department of Psychology, Department of Health Sciences, Northeastern University, Boston, MA
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Donnelly JE, Hillman CH, Castelli D, Etnier JL, Lee S, Tomporowski P, Lambourne K, Szabo-Reed AN. Physical Activity, Fitness, Cognitive Function, and Academic Achievement in Children: A Systematic Review. Med Sci Sports Exerc 2017; 48:1223-4. [PMID: 27182987 DOI: 10.1249/mss.0000000000000966] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Avery JA, Powell JN, Breslin FJ, Lepping RJ, Martin LE, Patrician TM, Donnelly JE, Savage CR, Simmons WK. Obesity is associated with altered mid-insula functional connectivity to limbic regions underlying appetitive responses to foods. J Psychopharmacol 2017; 31:1475-1484. [PMID: 28944718 PMCID: PMC6527420 DOI: 10.1177/0269881117728429] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obesity is fundamentally a disorder of energy balance. In obese individuals, more energy is consumed than is expended, leading to excessive weight gain through the accumulation of adipose tissue. Complications arising from obesity, including cardiovascular disease, elevated peripheral inflammation, and the development of Type II diabetes, make obesity one of the leading preventable causes of morbidity and mortality. Thus, it is of paramount importance to both individual and public health that we understand the neural circuitry underlying the behavioral regulation of energy balance. To this end, we sought to examine obesity-related differences in the resting state functional connectivity of the dorsal mid-insula, a region of gustatory and interoceptive cortex associated with homeostatically sensitive responses to food stimuli. Within the present study, obese and healthy weight individuals completed resting fMRI scans during varying interoceptive states, both while fasting and after a standardized meal. We examined group differences in the pre- versus post-meal functional connectivity of the mid-insula, and how those differences were related to differences in self-reported hunger ratings and ratings of meal pleasantness. Obese and healthy weight individuals exhibited opposing patterns of eating-related functional connectivity between the dorsal mid-insula and multiple brain regions involved in reward, valuation, and satiety, including the medial orbitofrontal cortex, the dorsal striatum, and the ventral striatum. In particular, healthy weight participants exhibited a significant positive relationship between changes in hunger and changes in medial orbitofrontal functional connectivity, while obese participants exhibited a complementary negative relationship between hunger and ventral striatum connectivity to the mid-insula. These obesity-related alterations in dorsal mid-insula functional connectivity patterns may signify a fundamental difference in the experience of food motivation in obese individuals, wherein approach behavior toward food is guided more by reward-seeking than by homeostatically relevant interoceptive information from the body.
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Affiliation(s)
| | - Joshua N. Powell
- Laureate Institute for Brain Research, Tulsa, OK,Center for Health Behavior Neuroscience, University of Kansas Medical Center, Kansas City, KS,Graduate School of Social Work, University of Denver, Denver, CO
| | - Florence J. Breslin
- Laureate Institute for Brain Research, Tulsa, OK,Center for Health Behavior Neuroscience, University of Kansas Medical Center, Kansas City, KS
| | - Rebecca J. Lepping
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS
| | - Laura E. Martin
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS
| | | | - Joseph E. Donnelly
- Center for Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, KS
| | - Cary R. Savage
- Center for Health Behavior Neuroscience, University of Kansas Medical Center, Kansas City, KS,Center for Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, KS
| | - W. Kyle Simmons
- Laureate Institute for Brain Research, Tulsa, OK,Banner Alzheimer’s Institute, Phoenix, AZ
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Ptomey LT, Willis EA, Greene JL, Danon JC, Chumley TK, Washburn RA, Donnelly JE. The Feasibility of Group Video Conferencing for Promotion of Physical Activity in Adolescents With Intellectual and Developmental Disabilities. Am J Intellect Dev Disabil 2017; 122:525-538. [PMID: 29115872 DOI: 10.1352/1944-7558-122.6.525] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Physical activity (PA) rates of adolescents with intellectual and developmental disabilities (IDD) are low and effective strategies for increasing PA are limited. The purpose of this study was to assess the feasibility of a group-based PA intervention that was delivered remotely to adolescents with IDD. Participants attended 30-min group PA sessions 3 times a week. PA sessions were delivered in their homes by video conferencing on a tablet computer. Thirty-one participants enrolled and 29 completed the 12-week intervention. Participants attended 77.2% ± 20.8% of scheduled sessions and averaged 26.7 ± 2.8 min of PA/session, with 11.8 ± 4.8 min at moderate- to vigorous intensity. Group-based PA delivered remotely may be a feasible approach for the promotion of PA in adolescents with IDD.
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Affiliation(s)
- Lauren T Ptomey
- Lauren T. Ptomey and Erik A. Willis, Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center
| | - Erik A Willis
- Lauren T. Ptomey and Erik A. Willis, Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center
| | - J Leon Greene
- J. Leon Greene, Department of Health, Sport, and Exercise Sciences, University of Kansas
| | - Jessica C Danon
- Jessica C. Danon, Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center
| | - Tara K Chumley
- Tara K. Chumley, Department of Educational Psychology, University of Kansas
| | - Richard A Washburn
- Richard A. Washburn and Joseph E. Donnelly, Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center
| | - Joseph E Donnelly
- Richard A. Washburn and Joseph E. Donnelly, Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center
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Donnelly JE, Hillman CH, Castelli D, Etnier JL, Lee S, Tomporowski P, Lambourne K, Szabo-Reed AN. Physical Activity, Fitness, Cognitive Function, and Academic Achievement in Children: A Systematic Review. Med Sci Sports Exerc 2017; 48:1197-222. [PMID: 27182986 DOI: 10.1249/mss.0000000000000901] [Citation(s) in RCA: 775] [Impact Index Per Article: 110.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relationship among physical activity (PA), fitness, cognitive function, and academic achievement in children is receiving considerable attention. The utility of PA to improve cognition and academic achievement is promising but uncertain; thus, this position stand will provide clarity from the available science. OBJECTIVE The purpose of this study was to answer the following questions: 1) among children age 5-13 yr, do PA and physical fitness influence cognition, learning, brain structure, and brain function? 2) Among children age 5-13 yr, do PA, physical education (PE), and sports programs influence standardized achievement test performance and concentration/attention? STUDY ELIGIBILITY CRITERIA This study used primary source articles published in English in peer-reviewed journals. Articles that presented data on, PA, fitness, or PE/sport participation and cognition, learning, brain function/structure, academic achievement, or concentration/attention were included. DATA SOURCES Two separate searches were performed to identify studies that focused on 1) cognition, learning, brain structure, and brain function and 2) standardized achievement test performance and concentration/attention. PubMed, ERIC, PsychInfo, SportDiscus, Scopus, Web of Science, Academic Search Premier, and Embase were searched (January 1990-September 2014) for studies that met inclusion criteria. Sixty-four studies met inclusion criteria for the first search (cognition/learning/brain), and 73 studies met inclusion criteria for the second search (academic achievement/concentration). STUDY APPRAISAL AND SYNTHESIS METHODS Articles were grouped by study design as cross-sectional, longitudinal, acute, or intervention trials. Considerable heterogeneity existed for several important study parameters; therefore, results were synthesized and presented by study design. RESULTS A majority of the research supports the view that physical fitness, single bouts of PA, and PA interventions benefit children's cognitive functioning. Limited evidence was available concerning the effects of PA on learning, with only one cross-sectional study meeting the inclusion criteria. Evidence indicates that PA has a relationship to areas of the brain that support complex cognitive processes during laboratory tasks. Although favorable results have been obtained from cross-sectional and longitudinal studies related to academic achievement, the results obtained from controlled experiments evaluating the benefits of PA on academic performance are mixed, and additional, well-designed studies are needed. LIMITATIONS Limitations in evidence meeting inclusion criteria for this review include lack of randomized controlled trials, limited studies that are adequately powered, lack of information on participant characteristics, failure to blind for outcome measures, proximity of PA to measurement outcomes, and lack of accountability for known confounders. Therefore, many studies were ranked as high risk for bias because of multiple design limitations. CONCLUSIONS The present systematic review found evidence to suggest that there are positive associations among PA, fitness, cognition, and academic achievement. However, the findings are inconsistent, and the effects of numerous elements of PA on cognition remain to be explored, such as type, amount, frequency, and timing. Many questions remain regarding how to best incorporate PA within schools, such as activity breaks versus active lessons in relation to improved academic achievement. Regardless, the literature suggests no indication that increases in PA negatively affect cognition or academic achievement and PA is important for growth and development and general health. On the basis of the evidence available, the authors concluded that PA has a positive influence on cognition as well as brain structure and function; however, more research is necessary to determine mechanisms and long-term effect as well as strategies to translate laboratory findings to the school environment. Therefore, the evidence category rating is B. The literature suggests that PA and PE have a neutral effect on academic achievement. Thus, because of the limitations in the literature and the current information available, the evidence category rating for academic achievement is C.
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Ptomey LT, Willis EA, Lee J, Washburn RA, Gibson CA, Honas JJ, Donnelly JE. The feasibility of using pedometers for self-report of steps and accelerometers for measuring physical activity in adults with intellectual and developmental disabilities across an 18-month intervention. J Intellect Disabil Res 2017; 61:792-801. [PMID: 28707359 PMCID: PMC5546616 DOI: 10.1111/jir.12392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 03/22/2017] [Accepted: 06/01/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND Improving physical activity in adults with intellectual and developmental disabilities (IDDs) is recommended to improve weight loss and general health. However, in order to determine the success of physical activity interventions, identification of feasible methods for assessment of physical activities is necessary. The purpose of this study is to assess the feasibility of adults with IDD to track daily steps and wear an accelerometer. METHODS Overweight/obese adults with mild to moderate IDD followed a diet and physical activity program for 18 months. All participants were asked to wear a pedometer and track steps daily by using a pedometer and to provide accelerometer data for 7 days at baseline, 6, 12 and 18 months. Adherence to the pedometer protocol and plausibility of the number of recorded steps were assessed, and these measures along with average wear time of the accelerometer were recorded. RESULTS Data were collected from 149 participants (36.5 ± 12.2 years of age, 57% female). Participants recorded a step value on 81.5% of days across the 18-month study, with 40.9% of written days classified as plausible. When wearing the accelerometer, 26.8% of participants met the recommended 4-day/10-h wear time criterion at baseline, and 22.6, 24.8 and 18.8% met the criterion at 6, 12 and 18 months, respectively. CONCLUSIONS Adults with IDD will adhere reasonably well to wearing a pedometer long term, but may be unable to record the step data accurately. Furthermore, adults with IDD have poor compliance with accelerometer protocols, and future studies should determine if a shorter wear time protocol would produce valid data in this population.
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Affiliation(s)
- L T Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - E A Willis
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - J Lee
- Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, Lubbock, TX, USA
| | - R A Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - C A Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - J J Honas
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - J E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
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