Remote delivery of a weight management intervention for adults with intellectual disabilities: Results from a randomized non-inferiority trial

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.

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

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.

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

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.

Caregivers' effect on weight management in adults with intellectual and developmental disabilities

INTRODUCTION

Caregivers of adults with IDD often play a large role in the ability of adults with IDD to lose weight.

OBJECTIVE

The purpose of this study was to determine to examine the effects of the caregivers' perceived burdens and self-efficacy and their relationship to an individual (family member or paid staff) on weight changes across a weight management intervention for adults with IDD.

METHODS

Overweight/obese adults with mild to moderate IDD, along with assigned caregivers who served as their study partner, were randomized to an 18-month weight management intervention. The living environment and caregiver relationship were assessed at baseline. Caregivers completed questionnaires regarding perceived hassles, uplifts, and self-efficacy in helping the participant follow a weight management intervention.

RESULTS

147 adults with IDD (∼57% women and ∼16% minorities) were included in data analysis. After 18 months, there were no differences in weight loss between participants who had a family member as their study partner and those who had a paid assistant as their study partner (-5.5 ± 5.2% vs. -5.6± 5.3% p = 0.16). However, paid assistants reported more hassles with following the diet intervention at 6 months (p < 0.05). Participants who had a paid assistant as their study partner were more likely to have multiple study partners during the study, which was correlated with smaller weight loss.

CONCLUSION

While caregivers are important for weight management of adults with IDD, the caregiver's relationship to the participant does not affect weight change in an intervention.

Weight management for adolescents with intellectual and developmental disabilities: Rationale and design for an 18month randomized trial

Adolescents with intellectual and developmental disabilities (IDD) are an underserved group in need of weight management. However, information regarding effective weight management for this group is limited, and is based primarily on results from small, non-powered, non-randomized trials that were not conducted in accordance with current weight management guidelines. Additionally, the comparative effectiveness of emerging dietary approaches, such as portion-controlled meals (PCMs) or program delivery strategies such as video chat using tablet computers have not been evaluated. Therefore, we will conduct an 18month trial to compare weight loss (6months) and maintenance (7-18months) in 123 overweight/obese adolescents with mild to moderate IDD, and a parent, randomized to a weight management intervention delivered remotely using FaceTime™ on an iPad using either a conventional meal plan diet (RD/CD) or a Stop Light diet enhanced with PCMs (RD/eSLD), or conventional diet delivered during face-to-face home visits (FTF/CD). This design will provide an adequately powered comparison of both diet (CD vs. eSLD) and delivery strategy (FTF vs. RD). Exploratory analyses will examine the influence of behavioral session attendance, compliance with recommendations for diet (energy intake), physical activity (min/day), self-monitoring of diet and physical activity, medications, and parental variables including diet quality, physical activity, baseline weight, weight change, and beliefs and attitudes regarding diet and physical activity on both weight loss and maintenance. We will also complete a cost and contingent valuation analysis to compare costs between RD and FTF delivery.

A virtual reality intervention (Second Life) to improve weight maintenance: Rationale and design for an 18-month randomized trial

Despite the plethora of weight loss programs available in the US, the prevalence of overweight and obesity (BMI≥25kg/m(2)) among US adults continues to rise at least, in part, due to the high probability of weight regain following weight loss. Thus, the development and evaluation of novel interventions designed to improve weight maintenance are clearly needed. Virtual reality environments offer a promising platform for delivering weight maintenance interventions as they provide rapid feedback, learner experimentation, real-time personalized task selection and exploration. Utilizing virtual reality during weight maintenance allows individuals to engage in repeated experiential learning, practice skills, and participate in real-life scenarios without real-life repercussions, which may diminish weight regain. We will conduct an 18-month effectiveness trial (6 months weight loss, 12 months weight maintenance) in 202 overweight/obese adults (BMI 25-44.9kg/m(2)). Participants who achieve ≥5% weight loss following a 6month weight loss intervention delivered by phone conference call will be randomized to weight maintenance interventions delivered by conference call or conducted in a virtual environment (Second Life®). The primary aim of the study is to compare weight change during maintenance between the phone conference call and virtual groups. Secondarily, potential mediators of weight change including energy and macronutrient intake, physical activity, consumption of fruits and vegetables, self-efficacy for both physical activity and diet, and attendance and completion of experiential learning assignments will also be assessed.

OSTEOMYELITIS OF THE HUMERUS CAUSED BY PROPIONIBACTERIUM ACNES

Propionibacterium acnes is a fastidious slow-growing anaerobic gram-positive bacillus best known for causing acne. However, it only occasionally has been isolated from invasive infections. In that setting, slow growth and low virulence may lead to indolent presentations and diagnostic delays as illustrated by the following case.

Does increased prescribed exercise alter non-exercise physical activity/energy expenditure in healthy adults? A systematic review

Prescribed physical activity/exercise training may reduce non-exercise physical activity resulting in no change in total daily energy expenditure and no or minimal exercise-induced weight loss. This systematic review evaluated cross-sectional, short-term (2-14 d), randomized and non-randomized trials which reported on the effect of prescribed physical activity/exercise on non-exercise physical activity/energy expenditure in healthy adults. PubMed and Embase were searched (from January 1990 to March 2013) for articles that presented data on the change in non-exercise physical activity/energy expenditure in response to prescribed physical activity/exercise training. Thirty-one articles were included in this review. One-hundred per cent of cross-sectional studies (n = 4), 90% of short-term studies (n = 10), 50% of non-randomized trials (n = 10) and 100% of randomized trials (n = 7) reported no reductions in non-exercise physical activity/energy expenditure in response to prescribed physical activity/exercise training. We found minimal evidence to support the hypothesis that prescribed physical activity/exercise training results in decreased non-exercise physical activity/energy expenditure in healthy adults. However, this literature is limited by the lack of adequately powered trials designed specifically to evaluate this hypothesis which have included assessments of both the energy expenditure of prescribed exercise and non-exercise energy expenditure using state-of-the-art techniques, i.e. indirect calorimetry and doubly labelled water, respectively.

Weight management for individuals with intellectual and developmental disabilities: rationale and design for an 18 month randomized trial

Weight management for individuals with intellectual and developmental disabilities (IDD) has received limited attention. Studies on weight management in this population have been conducted over short time frames, in small samples with inadequate statistical power, infrequently used a randomized design, and have not evaluated the use of emerging effective dietary strategies such as pre-packaged meals (PMs). Low energy/fat PMs may be useful in individuals with IDD as they simplify meal planning, limit undesirable food choices, teach appropriate portion sizes, are convenient and easy to prepare, and when combined with fruits and vegetables provide a high volume, low energy dense meal. A randomized effectiveness trial will be conducted in 150 overweight/obese adults with mild to moderate IDD, and their study partners to compare weight loss (6 months) and weight maintenance (12 months) between 2 weight management approaches: 1. A Stop Light Diet enhanced with reduced energy/fat PMs (eSLD); and 2. A recommended care reduced energy/fat meal plan diet (RC). The primary aim is to compare weight loss (0-6 months) and weight maintenance (7-18 months) between the eSLD and RC diets. Secondarily, changes in chronic disease risk factors between the eSLD and RC diets including blood pressure, glucose, insulin, LDL-cholesterol, and HDL-cholesterol will be compared during both weight loss and weight maintenance. Finally, potential mediators of weight loss including energy intake, physical activity, data recording, adherence to the diet, study partner self-efficacy and daily stress related to dietary change will be explored.

One set resistance training: effect on body composition in overweight young adults

AIM

This study evaluate the impact of a 6-month, 1-set RT protocol on changes in weight and body composition in overweight young adults.

METHODS

Sixty-three overweight young adults were randomized to RT or control; 55 participants (RT: N.=32; C: N.=23; BMI=27.3+2.9; age=20.7+2.7 yrs) competed the 6 month training protocol and all assessments. RT consisted of 1-set, 9 exercises, 3 times/wk., with a resistance of 3-6 repetition maximum (RM). Body composition was assessed using dual energy X-ray absorptiometry, and strength using 1RM. Participants were instructed to maintain their normal ad libitum diet and normal activities of daily living.

RESULTS

Body weight and BMI increased significantly (P<0.05) in RT and C, however; the between group difference was not significant. RT induced a mean increase in fat-free mass of 1.5 kg in both males and females with significant between groups differences for change in fat-free mass noted in the total sample, and in both males and females. Between group differences for change in fat mass were not statistically significant in the total sample, or in either gender. Significant between group differences for change in % fat were noted in the total sample (RT=-0.3%, C=+5.8%, P<0.05) and in females (RT=-3.7%, C=+3.0%, P<0.01), but not in males (RT=3.4%, C=9.8%). Significant between group differences (P<0.001) were observed for change in chest (RT=45 %, C=3%) and leg press (RT=57 %, C=9%) maximal strength.

CONCLUSION

A 6 month, 1-set RT program in overweight young adults increased fat-free mass and prevented increases in fat mass and % fat.

Active commuting to and from school and BMI in elementary school children-preliminary data

BACKGROUND

United States National Health Objectives include increasing the proportion of trips made by walking to and from school for children who live within 1.6 km to 50%. The purpose of this objective is to increase the level of physical activity among children. However, the impact of walking, bicycling or skating (active commuting) to and from school on the prevalence of overweight is unknown.

METHODS

Body mass index (BMI) was measured for 320 children (age 10.2+/-0.7 years) in September. Over 5 months, an active commuting index (SI) and daily physical activity were estimated via questionnaire. In April, BMI and body fat were measured.

RESULTS

A significant positive association was found between April BMI and SI adjusting for September BMI (partial r=0.03, P<0.05). Positive associations were found between SI and physical activity before school (r=0.17, P<0.05) and daily moderate intensity physical activity (r=0.13, P<0.05). There were no significant association between SI and BF (P>0.05).

CONCLUSIONS

This preliminary data suggests that active commuting does not appear to provide sufficient amounts of physical activity to attenuate BMI; however, it may contribute to the attainment of physical activity recommendations. Future research is needed to objectively measure the impact of active commuting on the prevalence of overweight.

Reliability and validity issues concerning large-scale surveillance of physical activity

The BRFSS is our major source of population-based information on physical activity in the United States. The top priority for the immediate future should be to make sure that the information obtained from the BRFSS in its current form is both reliable and valid. As outlined in this report, this task could be completed in relatively short time frame and at reasonable cost in terms of both financial and human resources. The development of an additional module to assess light-to-moderate activity and strength is currently underway with support from the CDC. As suggested in this report, this task may prove to be extremely difficult, or it may be difficult to develop an instrument of this type given the constraints of a population based telephone survey. The current focus on the health benefits of moderate activity and the interest in tracking this type of activity behavior on a population basis as it relates to national physical activity objectives both argue in favor of developing a physical activity assessment instrument that provides a valid and reliable measurement of moderate activity. Given the complexity and uncertainty of this task it is important to develop a procedure that will allow for periodic evaluation of progress and the potential for success to minimize the risk of making a considerable financial investment in an instrument that may be of limited utility.

Descriptive epidemiology of physical activity in African-American women

OBJECTIVES

We assessed walking for exercise and moderate and strenuous physical activity in relation to both demographic and health-related characteristics among African-American women from various parts of the United States who participate in the Black Women's Health Study.

METHODS

The data were collected in 1995 by mail questionnaire from 64,524 U.S. black women aged 21 to 69 years. The 64,101 women who provided data on physical activity are the subjects of the present report.

RESULTS

The present study revealed low levels of physical activity among the African-American women: 57% reported an hour or less per week walking for exercise, 18% reported moderate activity, and 61% reported strenuous physical activity. Strenuous physical activity increased with education. Higher levels of walking for exercise and moderate and strenuous activity were associated with higher levels of participation in strenuous exercise in high school.

CONCLUSION

Physical activity levels are low in African-American women. Based on the findings of the present study it may be suggested that educational efforts to increase levels of physical activity should start at an early age.

Physical Activity Scale for the Elderly (PASE): the relationship with activity measured by a portable accelerometer

BACKGROUND

The purpose of this study was to examine the validity of the Physical Activity Scale for the Elderly (PASE) by comparing PASE scores with physical activity assessed by a portable accelerometer.

METHODS

EXPERIMENTAL DESIGN

Correlational-mean activity level over a 3-day period was correlated with PASE scores.

SETTING

Physical activity of participants was monitored over 3 days during normal daily activity.

PARTICIPANTS

Twenty healthy adult volunteers, 67-80 years of age, participated in this study.

MEASURES

Physical activity from 09:00 to 21:00 hours was assessed over 3 consecutive weekdays (Wednesday-Friday) using a Computer Science and Applications, Inc. (CSA) portable accelerometer. Following completion of the 3-day monitoring period physical activity was assessed with the PASE.

RESULTS

PASE scores were significantly correlated with average 3-day CSA readings (r = 0.49, p < 0.05) in the total sample and in those over age 70 years (r = 0.64, p < 0.5).

CONCLUSIONS

These results add to the literature supporting the validity of the PASE as a measure of physical activity in older individuals.

High density lipoprotein cholesterol in individuals with spinal cord injury: the potential role of physical activity

STUDY DESIGN/METHODS

Literature review. Papers were selected from a literature search of both the Medline and Current Contents data bases and through extensive cross checking of references from the author's personal files.

OBJECTIVES

To evaluate the evidence for a reduced level of HDL-C in individuals with spinal cord injury and to discuss physiologic and behavioral factors that may be responsible for the observed reduction, with emphasis on the role of physical activity.

RESULTS/CONCLUSIONS

The evidence presented suggests that HDL-C may be lower in persons with SCI; however, the available data should be interpreted cautiously due to lack of control for important confounding factors such as smoking, alcohol consumption and physical activity. Results suggest a potential association between increased physical activity and increased HDL-C in persons with SCI. However, the mode, frequency, intensity and duration of activity and the physiologic mechanism responsible for this association have yet to be clearly elucidated.

The physical activity scale for the elderly (PASE): evidence for validity

We assessed the validity of the Physical Activity Scale for the Elderly (PASE) in a sample of sedentary adults (56 men, 134 women, mean age +/- [SD] 66.5+/-5.3 years) who volunteered to participate in a randomized controlled trial on the effect of aerobic conditioning on psychological function. Construct validity was established by correlating PASE scores with physiologic and performance characteristics: peak oxygen uptake, resting heart rate and blood pressure, percent body fat, and balance. The mean PASE scores were higher in men than in women (men = 145.8+/-78.0; women = 123.9+/-66.3, P<0.05), and in those age 55-64 years compared with those age 65 years and over (55-64 = 144.2+/-75.8; 65 and over = 118.9+/-63.9, P<0.05). PASE scores were also significantly higher in those who did not report a chronic health condition (cardiovascular disease, hypertension, cancer, or recent surgery). PASE scores were significantly associated (P<0.05) with peak oxygen uptake (r = 0.20), systolic blood pressure (r = -0.18) and balance score (r = 0.20). No significant associations of PASE score and diastolic blood pressure, resting heart rate, or percent body fat were noted. These results provide additional evidence for the validity of the PASE as a measure of physical activity suitable for use in epidemiology studies on the association of physical activity, health, and physical function in older individuals.

Descriptive epidemiology of physical activity in university graduates with locomotor disabilities

The descriptive epidemiology of physical activity in a sample of 577 University of Illinois graduates (1952-1991) with locomotor disabilities was assessed by mail survey. The survey requested basic demographic information, age, gender, marital status, household income. Respondents were asked to rate their current activity levels and activity levels during their college years compared to others their age on a 5 point scale: (1) much less active to (5) much more active. Completed surveys were received from 229 alumni (40%); 59 semi-ambulatory, 115 paraplegic, 55 quadriplegic. Results indicated current physical activity was associated with mobility limitation. With more severe mobility limitations the percentage reporting being less/much less active increased (42.4% semi-ambulatory, 56.5% paraplegic, 66.7% quadriplegic, P < 0.001) and the percentage reporting being more active decreased (20.3% semi-ambulatory, 16.5% paraplegic, 13.0% quadriplegic, P < 0.001). Current physical activity was significantly lower (P < 0.05) with increasing age, lower self-rated health, higher disability severity and among those who were sedentary during college. Physical activity did not differ by gender, marital status or household income. Multiple regression analysis indicated that health status was a significant predictor of current physical activity in all mobility categories (P < 0.001) after controlling for age, gender, income, disability severity and college activity. Among both paraplegics and quadriplegics physical activity during college was significantly associated (P < 0.001 paraplegic; P < 0.01 quadriplegic) with current physical activity. These results document a low level of physical activity in a well-educated sample of individuals with locomotor disabilities and suggest that exposure to physical activity in an educational setting may be an effective technique for increasing physical activity in individuals with locomotor disabilities.

Training physicians to conduct physical activity counseling

BACKGROUND

In accordance with the U.S. Preventive Services Task Force recommendations, the current pilot study tests the feasibility and efficacy of a physician-delivered physical activity counseling intervention.

METHODS

A sequential comparison group design was used to examine change in self-reported physical activity between experimental (counseling and self-help materials) and control (usual care) patients at base-line and 6 weeks after the initial office visit. Patients in both groups were contacted by telephone 2 weeks after their office visit and asked about the physical activity counseling at their most recent physician visit. Experimental patients also received a follow-up appointment to discuss physical activity with their physician 4 weeks after their initial visit.

RESULTS

Counseling was feasible for physicians to do and produced short-term increases in physical activity levels. Both groups increased their physical activity, but the increase in physical activity was greater for patients who reported receiving a greater number of counseling messages.

CONCLUSIONS

Physician-delivered physical activity interventions may be an effective way to achieve wide-spread improvements in the physical activity of middle-aged and older adults.

Contribution of vascular catheter material to the pathogenesis of infection: depletion of complement by silicone elastomer in vitro

We previously have shown that vascular catheters made of silicone elastomer carry a greater risk of subcutaneous infection with Staphylococcus aureus than do polyurethane (PU), polyvinylchloride (PVC), or Teflon catheters. We further have shown that there is greater inflammation surrounding silicone catheters than there is surrounding catheters made of the other materials, suggesting that silicone produces a greater chemotactic gradient than do the other materials. This study used a functional complement opsonization assay and radioimmunoassays to compare the relative abilities of silicone, polyurethane, and polyvinylchloride to activate complement. Serum incubated in silicone catheters for 24 h had less than 30% of the opsonizing ability of fresh serum while > or = 78% of the opsonizing ability remained with serum incubated in PU or PVC catheters. Measurement of C3a des Arg, C4a des Arg, C5a des Arg, and SC5b-9 demonstrated that the loss of opsonizing ability was due to 10-fold greater alternate pathway complement activation by silicone than by PU or PVC. This finding suggests that excessive complement activation by silicone may explain the greater inflammation seen around silicone catheters in vivo and also might play a role in silicone's creating a greater risk of infection.

High-frequency S-layer protein variation in Campylobacter fetus revealed by sapA mutagenesis

Campylobacter fetus utilizes paracrystalline surface (S-) layer proteins that confer complement resistance and that undergo antigenic variation to facilitate persistent mucosal colonization in ungulates. C. fetus possesses multiple homologues of sapA, each of which encode full-length S-layer proteins. Disruption of sapA by a gene targeting method (insertion of kanamycin (km) resistance) caused the loss of C. fetus cells bearing full-length S-layer proteins and their replacement by cells bearing a 50 kDa truncated protein that was not exported to the cell surface. After incubation of the mutants with serum, the survival rate was approximately 2 x 10(-2). Immunoblots of survivors showed that phenotypic reversion involving high-level production of full-length (98, 127 or 149 kDa) S-layer proteins had occurred. Revertants were serum resistant but caused approximately 10-fold less bacteraemia in orally challenged mice than did the wild-type strain. Southern hybridizations of the revertants showed rearrangement of sapA homologues and retention of the km marker. These results indicate that there exists high-frequency generation of C. fetus sapA antigenic variants, and that intracellular mechanisms acting at the level of DNA reciprocal recombination play key roles in this phenomenon.

The Physical Activity Scale for the Elderly (PASE): development and evaluation

A Physical Activity Scale for the Elderly (PASE) was evaluated in a sample of community-dwelling, older adults. Respondents were randomly assigned to complete the PASE by mail or telephone before or after a home visit assessment. Item weights for the PASE were derived by regressing a physical activity principal component score on responses to the PASE. The component score was based on 3-day motion sensor counts, a 3-day physical activity dairy and a global activity self-assessment. Test-retest reliability, assessed over a 3-7 week interval, was 0.75 (95% CI = 0.69-0.80). Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68). Construct validity was established by correlating PASE scores with health status and physiologic measures. As hypothesized, PASE scores were positively associated with grip strength (r = 0.37), static balance (r = +0.33), leg strength (r = 0.25) and negatively correlated with resting heart rate (r = -0.13), age (r = -0.34) and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42). The PASE is a brief, easily scored, reliable and valid instrument for the assessment of physical activity in epidemiologic studies of older people.

Leisure time physical activity: are there black/white differences?

BACKGROUND

Behavioral risk factor surveillance survey data collected during 1984 and 1985 in South Carolina were analyzed.

METHODS

This article is based on telephone interviews conducted with 2,005 individuals (431 black, 1574 white), mean age, 45.1 years, selected by random-digit dialing. Information on the type, frequency, and duration of leisure time physical activity was used to estimate leisure time energy expenditure (kcal/week) averaged over the previous month. The median level of leisure time energy expenditure differed significantly (all P less than 0.001) by gender (men = 741, women = 421), age (six categories; youngest, 18-29 years = 780; oldest, 70+ = 301), annual household income (four categories; lowest, less than or equal to $10,000 = 300; highest, greater than $35,000 = 870), body mass index (kg/m2, less than or equal to 24.1 = 601, greater than or equal to 30.1 = 180), and race (black = 301, white = 601).

RESULTS

Leisure time energy expenditure generally decreased with increasing age and body mass index and increased with increasing levels of education and income among all race/gender groups. Logistic regression analyses revealed that after adjustment for gender (if applicable), age, income, and body mass index, the variable race made a statistically significant contribution to the model, in the total sample (P less than .03) and for women P less than .001), but not for men.

CONCLUSIONS

Our results suggest that blacks living in the South, particularly black women, have lower levels of leisure time physical activity compared with their white counterparts after control for several important confounders.

Physical activity behaviors in lower and higher socioeconomic status populations

Few data on physical activity habits among populations of low socioeconomic status have been published. The authors studied physical activity habits--leisure-time physical activity, job-related physical activity, household physical activity, and walking--among 172 lower socioeconomic status women and 84 lower socioeconomic status men and compared their habits with those of 208 higher socioeconomic status women and 95 higher socioeconomic status men. All subjects resided in the greater Pittsburgh, Pennsylvania, area. Data collection occurred throughout 1986. Lower socioeconomic status women, the least active group, averaged 1,536 +/- 1,701 minutes/week (+/- standard deviation) of total physical activity, whereas higher socioeconomic status women, the most active group, averaged 2,079 +/- 1,807 minutes/week (p less than 0.0001). Higher socioeconomic status men averaged 1,952 +/- 1,799 minutes/week, and lower socioeconomic status men averaged 1,948 +/- 1,916 minutes/week. Higher socioeconomic status women spent significantly more time each week in leisure-time physical activity, job-related physical activity, and household physical activity than did lower socioeconomic status women. Lower socioeconomic status men spent significantly more time each week walking and doing household chores, whereas higher socioeconomic status men tended to be more active in leisure-time physical activity. These data suggest important quantitative and qualitative differences in physical activity among population subgroups. In view of the important role of physical activity in promoting physical and mental health, reasons for the differences among groups of varying socioeconomic status must be examined and elucidated.

Reliability and physiologic correlates of the Harvard Alumni Activity Survey in a general population

The reliability of the Harvard Alumni Activity Survey (HAAS) and its association with physiologic measures was assessed in a large sample of men and women aged 25-65 years residing in the Boston metropolitan area in 1987. Reliability was estimated by comparing HAAS energy expenditure reports (kcal/week) from two separate interviews conducted 7-12 weeks apart. The test-retest reliability coefficient was 0.58 for the entire sample, but was considerably higher (r = 0.69) for those whose activity patterns had not changed from one interview to the next. HAAS self-reports were compared to two physiologic measures known to be affected by physical activity: high density lipoprotein cholesterol (HDLC) and body mass index (BMI). The natural logarithm of weekly HAAS expenditures was positively correlated with HDLC (r = 0.14, p less than 0.01) and negatively correlated with BMI (r = 0.13, p less than 0.01) for all respondents. These statistically significant associations persisted when adjusted for other covariates influencing physiologic status. The reliability coefficients and physiologic correlations for the HAAS in this sample are comparable to those reported for physical activity instruments requiring more intensive data collection and scoring procedures.

Physical activity, stress, and type A behavior in blacks

We assessed the relationship between potential risk factors for coronary heart disease, including type A behavior, leisure time physical activity, and stress in a young black adult population. The study population consisted of 192 black college freshmen at the University of Pittsburgh. The mean age of male subjects was 18.4; the mean age of female subjects was 18.5 years. No significant sex differences were noted for body mass index, type A behavior, stress, or physical activity levels. For both men and women, type A (Framingham) was positively correlated with stress. Only among women was there a positive association between type A (Bortner) and physical activity.

The validity of self-reported exercise-induced sweating as a measure of physical activity

The validity of self-reported hours in which one engages in activities strenuous enough to produce sweating was assessed as a measure of physical activity. Respondents were 732 randomly selected adults between the ages of 25 and 65 years from the Boston, Massachusetts, metropolitan area who participated in a field trial of health risk appraisal instruments in 1987. A total of 68% of the men and 57% of the women in the sample were involved in sweat-inducing activities at least once per week. The correlation between the natural logarithm of reported sweat hours per week and energy expenditure measured by the Harvard Alumni Activity Survey was 0.39. Following a logarithmic transformation and adjustment for age and sex, sweat hours was significantly correlated with high density lipoprotein cholesterol (r = 0.11, p less than 0.05). However, these associations were not as strong as those found for the age- and sex-adjusted log of the Harvard Alumni Activity Survey score (r = 0.19 and r = -0.15 for high density lipoprotein cholesterol and body mass index (weight (kg)/height(m)2), respectively) and are considerably weaker than those reported in other studies using sweat episodes (days per week on which sweating occurred) as an indicator of physical activity. These results suggest that the utility of self-reported sweat hours may be limited to distinguishing active from inactive subjects in epidemiologic surveys.

The objective assessment of physical activity in an occupationally active group

Thirty-five male United States postal carriers, mean age (+/-SD) 46.1 +/- 11.4 years, mean distance walked on the job 5.3 +/- 3.3 miles day-1, participated in this study to determine the efficacy of two movement sensors for the assessment of daily physical activity. Subjects wore both a Large Scale Integrated Activity Monitor (LSI) and a Caltrac portable accelerometer on a belt for 3 days (2 work days, 1 non-work day) for 2 separate trials separated by a 3 month interval. Both monitors indicated similar mean levels of physical activity over the 2 work days with a significant decrease on the non-work day. Test-retest reliability within one trial over the 2 work days (LSI, r = 0.64; Caltrac, r = 0.58) and and between 2 trials (LSI, r = 0.58, Caltrac, r = 0.57), were similar for both monitors. The mean values for the LSI and Caltrac over the 2 trials were highly related (r = 0.75). Analysis of variance indicated a high percentage of the total variance in physical activity was accounted for by interindividual differences for both monitors (LSI = 77.4%, Caltrac = 77.7%). These results suggest that both the LSI and the Caltrac provide a reliable index of physical activity and can detect inter-individual differences in activity level in occupationally active individuals.

Physical activity assessment for epidemiologic research: the utility of two simplified approaches

We assessed the utility of two simplified approaches for the assessment of physical activity in a random sample of 348 college students (218 white, 130 black), mean age 19.3 years. Self-assessment of physical activity level was obtained from the response (4-point scale) to the question "Compared with others your age and sex would you consider yourself to be" (I) much more active to (IV) somewhat less active. In addition, the frequency of exercise-induced sweating (days/week) was assessed. Responses were compared with measurements of resting heart rate, triceps skinfolds, and physical activity as assessed by the Harvard Alumni Survey. Results for the self-assessment question indicated significantly lower resting heart rates (beats/min) (73.0 vs 64.6, P less than 0.01), triceps skinfolds (mm) (10.9 vs 20.4, P less than 0.001), and higher Harvard Survey scores (kcal/week) (5,654 vs 1,310, P less than 0.001) for those responding (i) compared with (iv). Similar results were noted for the sweat-episode question. Those reporting 5-7 sweat episodes per week had significantly lower resting heart rates (67.0 vs 74.8, P less than 0.01), triceps skinfolds (14.7 vs 17.3, P less than 0.01), and higher Harvard Survey scores (5,717 vs 1,453, P less than 0.001) than those reporting 0-1 sweat episodes per week. The results suggest that these simplified approaches may provide useful indices of physical activity for epidemiologic research and warrant further investigation in other populations.

Physical activity and high-density lipoprotein cholesterol and subfractions among young black adults

Limited information is available regarding the relationship between physical activity and blood lipids in black populations. To assess the association, the authors measured high-density lipoprotein cholesterol (HDL-C) and subfractions (HDL(2)-C, HDL(3)-C), physical activity (Harvard Alumni Survey), height, weight, cigarette, alcohol, and oral contraceptive use (questionnaire) in a sample of 173 black freshmen college students at the University of Pittsburgh (59 male, 55 female) and Paine and Augusta colleges in Georgia (14 male, 18 female).Results indicated HDL-C, HDL(2)-C, and HDL(3)-C were significantly higher among women compared with men after adjustment for age, body mass index, alcohol consumption, physical activity, and oral contraceptive use. No significant sex differences were noted for physical activity, however a significantly greater proportion of women reported low physical activity levels (<2000 kcal/wk, 54 percent female, 31 percent male, P < .05). Physical activity was univariately associated with HDL-C (r = .32, P < .01) and HDL(2)-C (r = .29, P < .05) among women. No significant correlations among physical activity and lipid variables were noted among men. The results from stepwise multiple linear regression models (variables included were age, body mass index, physical activity, and oral contraceptive use) revealed that among women physical activity was the only significant independent predictor of both HDL-C and HDL(2)-C explaining 11 and 9 percent of the variance in HDL-C and HDL(2)-C, respectively. Physical activity was not a significant predictor of any of the lipid variables among men.If confirmed, the study finding of a significant association between physical activity and HDL-C and HDL(2)-C among black women suggests that increased physical activity may be an important intervention for the reduction of cardiovascular risk in this high-risk group.

Cardiovascular responses to moderate facial cooling in men and women

Experiments were conducted on a group of 20 healthy men and women to determine the pattern of cardiovascular response to moderate facial cooling (4.0 degrees C at 5.0 m X s-1) for 10 min. Data were collected each minute during exposure. During the course of exposure, both heart rate and forearm blood flow decreased significantly, 4.9 beats X min-1 (-9.2%) and -1.1 ml X 100 ml-1 X min-1 (-28.9%), respectively, while mean arterial blood pressure increased significantly +3.7 mm Hg (+4.0%) from pre-exposure values (p less than 0.05). There were no significant differences found in cardiovascular responses between men and women. There was considerable within-group variation for each recorded cardiovascular variable, but their ranges of variability remained relatively constant throughout exposure. These results indicate that moderate facial cooling precipitates significant cardiovascular responses in healthy subjects and the range of response may depend, in part, on individual factors.

Behavioral factors and blood pressure in black college students

The relationship of behavioral factors and resting blood pressure was assessed in a random sample of 192 young middle class black adults. Framingham Type A behavior was positively associated with diastolic blood pressure (r = 0.17, p less than 0.05) among the women. Also, anger-in and trait anxiety were positively correlated with diastolic blood pressure for the women, r = 0.20, p less than 0.05 and r = +0.28 and p less than 0.01, respectively. After control for body mass index, trait anxiety and anger-in remained independent predictors of diastolic blood pressure among the women. For men, marijuana use was positively associated with blood pressure. Marijuana use was an independent predictor for systolic blood pressure after adjusting for body mass index among the males. The present study demonstrated a sex difference related to behavioral factors and blood pressure in young middle class blacks.

Echocardiographic left ventricular mass and physical activity: quantification of the relation in spinal cord injured and apparently healthy active men

To assess the relation of echocardiographic left ventricular (LV) mass to reported physical activity, 2 groups of subjects with widely different physical activity levels were evaluated: 50 men with spinal cord injuries and 166 apparently healthy, active men. Multivariate analysis revealed that reported physical activity was a significant independent predictor of LV mass index (LV mass/body surface area) in both injured patients and healthy, active subjects after controlling for age and blood pressure. The relation between LV mass index and physical activity (linear regression) was similar for both groups; LV mass index = 0.00321 (physical activity) + 82.8 and LV mass index = 0.00335 (physical activity) +88.4 for patients and healthy active subjects, respectively. These results suggest that physical activity as assessed by self-report is associated with echocardiographically detectable differences in LV mass in groups with widely divergent physical activity levels. In addition, for each of these groups 1,000 kcal/week of physical activity apparently results in a change of approximately 3 g/m2 in LV mass index. This information may have practical use for correction of LV mass for the effects of physical activity.

Chronic low level physical activity as a determinant of high density lipoprotein cholesterol and subfractions

Physical activity has been associated with reduced risk of coronary heart disease. A mechanism for the reduced risk may be through increased high density lipoprotein cholesterol (HDL-C) and subfractions, in particular HDL2-C. Research associated with increased physical activity investigating HLD-C have assessed the effects of intense aerobic activity. The current research evaluated the relationship between low intensity, long duration activity to HDL-C and subfractions in 35 active postal carriers. Measurements of physical activity via the Large Scale Integrated monitor and reported miles walked, and lipoproteins were assessed at 3-month intervals over a 1-year period. Reported miles walked/day (5.3) was significantly correlated with HLD2-C (r = 0.50, P = 0.003) and approached significance for HDL-C (r = 0.29, P = 0.06). The Large Scale Integrated measures were correlated with HDL-C (r = 0.44, P = 0.008) and HDL2-C (r = 0.44, P = 0.007). Controlling for either age, alcohol consumption, body mass index, or leisure time activity did not reduce the relationship between reported miles walked or Large Scale Integrated readings and HDL2-C, suggesting that the increased HDL-C was the result of long duration, low intensity physical activity.

Cardiovascular response to static contraction in borderline hypertension

Nine young males with borderline hypertension (BH) (mean age +/- SD, 25 +/- 5 yr) and 13 young male normotensive controls (NT) (24 +/- 3 yr) were studied to determine their cardiovascular responses to small and large muscle static contractions. The subjects performed one-arm handgrip and two-leg extension in a randomly assigned order for 3 min at 30% of maximal voluntary contraction. Mean intra-arterial blood pressure (MABP), heart rate (HR), and tension were measured throughout the contractions. Borderline hypertensive patients had a higher MABP at rest (p less than 0.005) and at the end of both types of static contractions (p less than 0.05). The average increases in MABP from rest to the end of exercise (delta MABP) were slightly greater for the BH patients (6 mmHg), but these differences were not significant (p greater than 0.1). However, a greater percentage of BH patients were hyperreactive to handgrip (delta BP greater than 35 mmHg) and leg extension (delta BP greater than 40 mmHg) when compared to controls. These data indicate that, in general, young men with borderline hypertension demonstrate normal cardiovascular regulation in response to static contraction, but that a portion of this population may be hyperreactive to this type of circulatory stress.

Peak oxygen uptake during arm cranking for men and women

To determine upper body peak O2 uptake (VO2) in a group of young females and to obtain information on possible sex differences, 40 subjects, 20 females and 20 males, mean age 26 +/- 4 (SD) and 31 +/- 6 yr, respectively, were studied during maximal arm-cranking exercise. Peak values for power output, VO2, minute ventilation (VE), and heart rate (HR) were determined for each subject. In addition, arm-shoulder volume (A-SV) was measured before exercise. Significant differences between males and females (P less than 0.05) were found for peak power output (134 +/- 18 vs. 86 +/- 13 W), peak VO2 expressed in liters per minute (2.55 +/- 0.45 vs. 1.81 +/- 0.36) and milliliters per kilogram per minute (34.2 +/- 5.3 vs. 29.2 +/- 4.9), peak VE (95.4 +/- 14.5 vs. 70.1 +/- 19.2 1 X min-1), and A-SV (3,126 +/- 550 vs. 2,234 +/- 349 ml), whereas peak HR was not significantly different between the two groups (174 +/- 14 vs. 174 +/- 36 beats X min-1). However, when peak VO2 was corrected for arm and shoulder size there was no significant difference between the groups (0.82 +/- 0.13 vs. 0.78 +/- 0.13 ml X ml A-SV-1 X min-1). These results suggest that the observed differences between men and women for peak VO2 elicited during arm cranking when expressed in traditional terms (1 X min-1 and ml X kg-1 X min-1) are a function of the size of the contracting muscle mass and are not due to sex-related differences in either O2 delivery or the O2 utilization capacity of the muscle itself.

Similarity of cardiovascular response to upper and lower body static contraction in endurance-trained and untrained males

The purpose of this study was to investigate the cardiovascular response to upper and lower body static contraction in endurance-trained (ET) and untrained (UT) males (both groups N = 6). The groups were similar in age, height, and weight. However, the ET group exhibited a markedly higher (P less than 0.01) VO2 max during treadmill running than the UT group (65.4 +/- 4.8 vs 49.9 +/- 2.8 ml X kg-1 X min-1, mean +/- SD). Both groups performed static handgrip and leg extension in a randomly assigned order at 30% of maximal voluntary contraction for 3 min. Heart rate and mean intra-arterial blood pressure (MABP) were measured at rest and throughout contraction. At rest, differences between the two groups were not significant for heart rate (54 +/- 10 vs 66 +/- 8 beats X min-1) or MABP (93 +/- 4 vs 91 +/- 5 mm Hg). During handgrip, the increases in heart rate (24 +/- 12 vs 15 +/- 6) and MABP (24 +/- 10 vs 27 +/- 12) were not significantly different between the two groups. During leg extension, the magnitude of the increases in heart rate (44 +/- 21 vs 46 +/- 27) and MABP (37 +/- 11 vs 41 +/- 10) were again not different for the two groups. These results suggest that cardiovascular regulation during static contraction is similar in endurance-trained and untrained individuals, even during contraction involving the trained musculature.