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Amar D, Gay NR, Jean-Beltran PM, Bae D, Dasari S, Dennis C, Evans CR, Gaul DA, Ilkayeva O, Ivanova AA, Kachman MT, Keshishian H, Lanza IR, Lira AC, Muehlbauer MJ, Nair VD, Piehowski PD, Rooney JL, Smith KS, Stowe CL, Zhao B, Clark NM, Jimenez-Morales D, Lindholm ME, Many GM, Sanford JA, Smith GR, Vetr NG, Zhang T, Almagro Armenteros JJ, Avila-Pacheco J, Bararpour N, Ge Y, Hou Z, Marwaha S, Presby DM, Natarajan Raja A, Savage EM, Steep A, Sun Y, Wu S, Zhen J, Bodine SC, Esser KA, Goodyear LJ, Schenk S, Montgomery SB, Fernández FM, Sealfon SC, Snyder MP, Adkins JN, Ashley E, Burant CF, Carr SA, Clish CB, Cutter G, Gerszten RE, Kraus WE, Li JZ, Miller ME, Nair KS, Newgard C, Ortlund EA, Qian WJ, Tracy R, Walsh MJ, Wheeler MT, Dalton KP, Hastie T, Hershman SG, Samdarshi M, Teng C, Tibshirani R, Cornell E, Gagne N, May S, Bouverat B, Leeuwenburgh C, Lu CJ, Pahor M, Hsu FC, Rushing S, Walkup MP, Nicklas B, Rejeski WJ, Williams JP, Xia A, Albertson BG, Barton ER, Booth FW, Caputo T, Cicha M, De Sousa LGO, Farrar R, Hevener AL, Hirshman MF, Jackson BE, Ke BG, Kramer KS, Lessard SJ, Makarewicz NS, Marshall AG, Nigro P, Powers S, Ramachandran K, Rector RS, Richards CZT, Thyfault J, Yan Z, Zang C, Amper MAS, Balci AT, Chavez C, Chikina M, Chiu R, Gritsenko MA, Guevara K, Hansen JR, Hennig KM, Hung CJ, Hutchinson-Bunch C, Jin CA, Liu X, Maner-Smith KM, Mani DR, Marjanovic N, Monroe ME, Moore RJ, Moore SG, Mundorff CC, Nachun D, Nestor MD, Nudelman G, Pearce C, Petyuk VA, Pincas H, Ramos I, Raskind A, Rirak S, Robbins JM, Rubenstein AB, Ruf-Zamojski F, Sagendorf TJ, Seenarine N, Soni T, Uppal K, Vangeti S, Vasoya M, Vornholt A, Yu X, Zaslavsky E, Zebarjadi N, Bamman M, Bergman BC, Bessesen DH, Buford TW, Chambers TL, Coen PM, Cooper D, Haddad F, Gadde K, Goodpaster BH, Harris M, Huffman KM, Jankowski CM, Johannsen NM, Kohrt WM, Lester B, Melanson EL, Moreau KL, Musi N, Newton RL, Radom-Aizik S, Ramaker ME, Rankinen T, Rasmussen BB, Ravussin E, Schauer IE, Schwartz RS, Sparks LM, Thalacker-Mercer A, Trappe S, Trappe TA, Volpi E. Temporal dynamics of the multi-omic response to endurance exercise training. Nature 2024; 629:174-183. [PMID: 38693412 PMCID: PMC11062907 DOI: 10.1038/s41586-023-06877-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/16/2023] [Indexed: 05/03/2024]
Abstract
Regular exercise promotes whole-body health and prevents disease, but the underlying molecular mechanisms are incompletely understood1-3. Here, the Molecular Transducers of Physical Activity Consortium4 profiled the temporal transcriptome, proteome, metabolome, lipidome, phosphoproteome, acetylproteome, ubiquitylproteome, epigenome and immunome in whole blood, plasma and 18 solid tissues in male and female Rattus norvegicus over eight weeks of endurance exercise training. The resulting data compendium encompasses 9,466 assays across 19 tissues, 25 molecular platforms and 4 training time points. Thousands of shared and tissue-specific molecular alterations were identified, with sex differences found in multiple tissues. Temporal multi-omic and multi-tissue analyses revealed expansive biological insights into the adaptive responses to endurance training, including widespread regulation of immune, metabolic, stress response and mitochondrial pathways. Many changes were relevant to human health, including non-alcoholic fatty liver disease, inflammatory bowel disease, cardiovascular health and tissue injury and recovery. The data and analyses presented in this study will serve as valuable resources for understanding and exploring the multi-tissue molecular effects of endurance training and are provided in a public repository ( https://motrpac-data.org/ ).
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Fanning J, Brooks AK, Irby MB, N’Dah KW, Rejeski WJ. Associations Between Patterns of Daily Stepping Behavior, Health-Related Quality of Life, and Pain Symptoms Among Older Adults with Chronic Pain: A Secondary Analysis of Two Randomized Controlled Trials. Clin Interv Aging 2024; 19:459-470. [PMID: 38500497 PMCID: PMC10946442 DOI: 10.2147/cia.s453336] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose One's amount, intensity, and distribution of physical activity may have implications for whether it has positive or negative effects on pain and quality of life for older adults living with chronic pain. Thus, we investigated baseline patterns of stepping related to pain symptoms and health-related quality of life at baseline and over a 12-week follow-up period. Patients and Methods Participants were low-active older adults (69.54±6.74 years) with obesity and chronic pain who enrolled in one of two randomized controlled trials. Participants completed measures of pain intensity, interference, and health-related quality of life and wore an accelerometer for 7 days at baseline and week 12. Functional principal components analysis identified patterns of within-day stepping behavior at baseline, and linear regressions were used to investigate how these component scores related to pain and health-related quality of life at baseline and over 12 weeks. Results Two patterns were extracted; one describing more vs less stepping and the second capturing movement later vs earlier in the day. More baseline stepping was associated with better physical functioning (B=0.148, p<0.001) and energy (B=0.073, p=0.033), while a later start in the day was associated with worse social functioning (B=-0.193, p=0.031). More stepping at baseline predicted positive changes in physical functioning (B=0.094, p=0.019), emotional role limitations (B=0.132, p=0.049), energy (B=0.112, p<0.001), social functioning (B=0.086, p=0.043), pain (B=0.086, p=0.009), general health (B=0.081, p=0.003) and pain intensity (B=-0.039, p=0.003). A later start to the day was associated with worsening physical functioning (B=-0.229, p<0.001), physical (B=-0.282, p=0.047) and emotional role limitations (B=-0.254, p=0.048), general health (B=-0.108, p=0.041), and pain interference (B=0.055, p=0.043). Conclusion Findings suggest there is value in activity patterns as an indicator for additional behavioral intervention, as those who move little and/or delay daily movement are likely to experience subsequent decrements in quality of life and pain symptoms.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Amber Keller Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Megan Bennett Irby
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Kindia Williams N’Dah
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
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3
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Thangada ND, Xu S, Tian L, Zhao L, Criqui MH, Ferrucci L, Rejeski WJ, Leeuwenburgh C, Manini T, Spring B, Treat-Jacobson D, Forman DE, Bazzano L, Guralnik J, Sufit R, Polonsky T, Kibbe MR, McDermott MM. Hospitalizations during home-based walking exercise interventions in peripheral artery disease: Results from two randomized clinical trials. Vasc Med 2023; 28:583-585. [PMID: 37622748 DOI: 10.1177/1358863x231191909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Neela D Thangada
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shujun Xu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Todd Manini
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Daniel E Forman
- Department of Medicine (Geriatrics and Cardiology), University of Pittsburgh, Pittsburgh, PA, USA
- Geriatrics, Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Lydia Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tamar Polonsky
- Department of Medicine, Medical School, University of Chicago, Chicago, IL, USA
| | - Melina R Kibbe
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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4
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Thangada ND, Zhang D, Tian L, Zhao L, Rejeski WJ, Ho KJ, Ferrucci L, Spring B, Kibbe MR, Polonsky TS, Criqui MH, McDermott MM. Home-Based Walking Exercise and Supervised Treadmill Exercise in Patients With Peripheral Artery Disease: An Individual Participant Data Meta-Analysis. JAMA Netw Open 2023; 6:e2334590. [PMID: 37733346 PMCID: PMC10514734 DOI: 10.1001/jamanetworkopen.2023.34590] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/01/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Importance Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear. Objective To study whether home-based walking exercise improves 6-minute walk (6MW) more than supervised treadmill exercise in people with PAD (defined as Ankle Brachial Index ≤0.90). Data Sources Data were combined from 5 randomized clinical trials of exercise therapy for PAD using individual participant data meta-analyses, published from 2009 to 2022. Study Selection Of the 5 clinical trials, 3 clinical trials compared supervised treadmill exercise to nonexercise control (N = 370) and 2 clinical trials compared an effective home-based walking exercise intervention to nonexercise control (N = 349). Data Extraction and Synthesis Individual participant-level data from 5 randomized clinical trials led by 1 investigative team were combined. The 5 randomized clinical trials included 3 clinical trials of supervised treadmill exercise and 2 effective home-based walking exercise interventions. Main Outcomes and Measures Change in 6MW distance, maximum treadmill walking distance, and Walking Impairment Questionnaire at 6-month follow-up. The supervised treadmill exercise intervention consisted of treadmill exercise in the presence of an exercise physiologist, conducted 3 days weekly for up to 50 minutes per session. Home-based walking exercise consisted of a behavioral intervention in which a coach helped participants walk for exercise in or around home for up to 5 days per week for 50 minutes per session. Results A total of 719 participants with PAD (mean [SD] age, 68.8 [9.5] years; 46.5% female) were included (349 in a home-based exercise clinical trial and 370 in a supervised exercise trial). Compared with nonexercise control, supervised treadmill exercise was associated with significantly improved 6MW by 32.9 m (95% CI, 20.6-45.6; P < .001) and home-based walking exercise was associated with significantly improved 6MW by 50.7 m (95% CI, 34.8-66.7; P < .001). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (between-group difference: 23.8 m [95% CI, 3.6, 44.0; P = .02]) but significantly less improvement in maximum treadmill walking distance (between-group difference:-132.5 m [95% CI, -192.9 to -72.1; P < .001]). Conclusions and Relevance In this individual participant data meta-analyses, compared with supervised exercise, home-based walking exercise was associated with greater improvement in 6MW in people with PAD. These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD.
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Affiliation(s)
- Neela D. Thangada
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Karen J. Ho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, Maryland
| | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melina R. Kibbe
- Department of Surgery, University of Virginia School of Medicine, Charlottesville
- Editor, JAMA Surgery
| | - Tamar S. Polonsky
- Department of Medicine, Medical School, University of Chicago, Chicago, Illinois
| | - Michael H. Criqui
- Department of Family Medicine and Public Health University of California San Diego, La Jolla
| | - Mary M. McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Deputy Editor, JAMA
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Whipple MO, Pfammatter AF, Spring B, Rejeski WJ, Treat‐Jacobson D, Domanchuk KJ, Dressler EV, Ferrucci L, Gildea L, Guralnik JM, Harvin L, Leeuwenburgh C, Polonsky TS, Reynolds E, Stowe CL, Sufit R, Van Horn L, Walkup MP, Ambrosius WT, McDermott MM. Study Design, Rationale, and Methodology for Promote Weight Loss in Patients With Peripheral Artery Disease Who Also Have Obesity: The PROVE Trial. J Am Heart Assoc 2023; 12:e031182. [PMID: 37642035 PMCID: PMC10547361 DOI: 10.1161/jaha.123.031182] [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: 06/19/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
Background Overweight and obesity are associated with adverse functional outcomes in people with peripheral artery disease (PAD). The effects of weight loss in people with overweight/obesity and PAD are unknown. Methods The PROVE (Promote Weight Loss in Obese PAD Patients to Prevent Mobility Loss) Trial is a multicentered randomized clinical trial with the primary aim of testing whether a behavioral intervention designed to help participants with PAD lose weight and walk for exercise improves 6-minute walk distance at 12-month follow-up, compared with walking exercise alone. A total of 212 participants with PAD and body mass index ≥25 kg/m2 will be randomized. Interventions are delivered using a Group Mediated Cognitive Behavioral intervention model, a smartphone application, and individual telephone coaching. The primary outcome is 12-month change in 6-minute walk distance. Secondary outcomes include total minutes of walking exercise/wk at 12-month follow-up and 12-month change in accelerometer-measured physical activity, the Walking Impairment Questionnaire distance score, and the Patient-Reported Outcomes Measurement Information System mobility questionnaire. Tertiary outcomes include 12-month changes in perceived exertional effort at the end of the 6-minute walk, diet quality, and the Short Physical Performance Battery. Exploratory outcomes include changes in gastrocnemius muscle biopsy measures of mitochondrial cytochrome C oxidase activity, mitochondrial biogenesis, capillary density, and inflammatory markers. Conclusions The PROVE randomized clinical trial will evaluate the effects of exercise with an intervention of coaching and a smartphone application designed to achieve weight loss, compared with exercise alone, on walking performance in people with PAD and overweight/obesity. Results will inform optimal treatment for the growing number of patients with PAD who have overweight/obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04228978.
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Affiliation(s)
| | | | - Bonnie Spring
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - W. Jack Rejeski
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNC
| | | | | | - Emily V. Dressler
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of HealthBaltimoreMD
| | - Lois Gildea
- School of NursingUniversity of MinnesotaMinneapolisMN
| | | | - Lea Harvin
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | | | | | - Eric Reynolds
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | - Cynthia L. Stowe
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | - Robert Sufit
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Linda Van Horn
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Michael P. Walkup
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNC
| | - Walter T. Ambrosius
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
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6
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Fanning J, Brooks AK, Robison JT, Irby MB, Ford S, N’Dah K, Rejeski WJ. Associations between patterns of physical activity, pain intensity, and interference among older adults with chronic pain: a secondary analysis of two randomized controlled trials. Front Aging 2023; 4:1216942. [PMID: 37564194 PMCID: PMC10411520 DOI: 10.3389/fragi.2023.1216942] [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] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023]
Abstract
Background: Clinical management of chronic pain often includes recommendations to engage in physical activity (PA), though there are little data on the interplay between pain symptoms and key aspects of PA participation (e.g., intensity and bout duration) among older adults. Herein we investigate the longitudinal relationships between changes in PA behavior and changes in pain intensity and interference among low-active older adults with obesity and chronic pain. Methods: Participants (N = 41) were enrolled in two randomized pilot trials wherein they were assigned to an intervention focused on participation in frequent PA across the day, or to a low-contact control. Participants completed the 3-item PROMIS pain intensity scale and 8-item PROMIS pain interference scale before and after the interventions. Participants also wore an ActivPAL accelerometer for 7 days before and during the final week of the interventions. Results: A series of linear regression analyses demonstrated that increased time spent stepping at a high-light intensity in very short bouts was associated with increased pain intensity scores. By contrast, increased time spent stepping at a high-light intensity in bouts of 5-20 min was associated with reductions in pain intensity and interference scores. Increased time spent stepping at a moderate intensity overall was associated with reduced pain intensity scores, and time spent stepping at a moderate intensity for 10-20 min associated with reduced pain interference. Conclusion: These findings suggest older adults with chronic pain may benefit by moving at high-light or moderate intensities in brief bouts of at least 5 min in duration.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Justin T. Robison
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Megan B. Irby
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Kindia N’Dah
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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7
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Laurienti PJ, Miller ME, Lyday RG, Boyd MC, Tanase AD, Burdette JH, Hugenschmidt CE, Rejeski WJ, Simpson SL, Baker LD, Tomlinson CE, Kritchevsky SB. Associations of physical function and body mass index with functional brain networks in community-dwelling older adults. Neurobiol Aging 2023; 127:43-53. [PMID: 37054493 PMCID: PMC10227726 DOI: 10.1016/j.neurobiolaging.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/17/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/15/2023]
Abstract
Deficits in physical function that occur with aging contribute to declines in quality of life and increased mortality. There has been a growing interest in examining associations between physical function and neurobiology. Whereas high levels of white matter disease have been found in individuals with mobility impairments in structural brain studies, much less is known about the relationship between physical function and functional brain networks. Even less is known about the association between modifiable risk factors such as body mass index (BMI) and functional brain networks. The current study examined baseline functional brain networks in 192 individuals from the Brain Networks and mobility (B-NET) study, an ongoing longitudinal, observational study in community-dwelling adults aged 70 and older. Physical function and BMI were found to be associated with sensorimotor and dorsal attention network connectivity. There was a synergistic interaction such that high physical function and low BMI were associated with the highest network integrity. White matter disease did not modify these relationships. Future work is needed to understand the causal direction of these relationships.
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Affiliation(s)
- Paul J Laurienti
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Michael E Miller
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert G Lyday
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Madeline C Boyd
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alexis D Tanase
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jonathan H Burdette
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Sean L Simpson
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laura D Baker
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Chal E Tomlinson
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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8
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Madrid DA, Beavers KM, Walkup MP, Ambrosius WT, Rejeski WJ, Marsh AP, Weaver AA. Effect of exercise modality and weight loss on changes in muscle and bone quality in older adults with obesity. Exp Gerontol 2023; 174:112126. [PMID: 36796657 PMCID: PMC10033433 DOI: 10.1016/j.exger.2023.112126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/08/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Little is known about the effect of exercise modality during a dietary weight loss program on muscle size and quality, as measured by computed tomography (CT). Even less is known about how CT-derived changes in muscle track with changes in volumetric bone mineral density (vBMD) and bone strength. METHODS Older adults (66 ± 5 years, 64 % women) were randomized to 18-months of diet-induced weight loss (WL), WL with aerobic training (WL + AT), or WL with resistance training (WL + RT). CT-derived muscle area, radio-attenuation and intermuscular fat percentage at the trunk and mid-thigh were determined at baseline (n = 55) and 18-month follow-up (n = 22-34), and changes were adjusted for sex, baseline value, and weight lost. Lumbar spine and hip vBMD and finite element-derived bone strength were also measured. RESULTS After adjustment for the weight lost, muscle area losses at the trunk were -7.82 cm2 [-12.30, -3.35] for WL, -7.72 cm2 [-11.36, -4.07] for WL + AT, and -5.14 cm2 [-8.65, -1.63] for WL + RT (p < 0.001 for group differences). At the mid-thigh, decreases were -6.20 cm2 [-10.39, -2.02] for WL, -7.84 cm2 [-11.19, -4.48] for WL + AT, and -0.60 cm2 [-4.14, 2.94] for WL + RT; this difference between WL + AT and WL + RT was significant in post-hoc testing (p = 0.01). Change in trunk muscle radio-attenuation was positively associated with change in lumbar bone strength (r = 0.41, p = 0.04). CONCLUSIONS WL + RT better preserved muscle area and improved muscle quality more consistently than WL + AT or WL alone. More research is needed to characterize the associations between muscle and bone quality in older adults undertaking weight loss interventions.
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Affiliation(s)
- Diana A Madrid
- Department of Biomedical Engineering, Wake Forest University School of Medicine, United States
| | - Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, United States
| | - Michael P Walkup
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, United States
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, United States
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, United States
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, United States.
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9
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Peterson H, Rejeski WJ, Fanning J, Porges SW, Heilman KJ, Laurienti PJ, Gauvin L. Differential Momentary Reports of Stress and Affect Associated With Alcohol Consumption in Middle-Aged Versus Younger Adults. Subst Use Misuse 2023; 58:666-675. [PMID: 36852426 PMCID: PMC10089298 DOI: 10.1080/10826084.2023.2177967] [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] [Indexed: 03/01/2023]
Abstract
Background: Stress is a motivator to consume alcohol, a well-documented relapse risk, and is known to differentially affect biological and psychological processes as people age.Objectives: Because alcohol consumption is known to acutely decrease stress and increase affect, this study examined differences in ratings of stress and affect in middle-aged versus younger adults who regularly consume alcohol.Methods: A sample of younger (n = 17) and middle-aged (n = 18) drinkers was studied during a 3-day period of typical alcohol consumption. Resting levels of respiratory sinus arrhythmia (RSA) were measured during a baseline study visit since RSA is a well-documented biomarker of stress and is known to decrease with age. Ecological momentary assessment (EMA) survey ratings (n = 1,598) were modeled using hierarchical regression to assess differences in stress and affect throughout the day between the two age groups.Results: As anticipated, middle-aged participants had lower RSA than those who were younger. Although the middle-aged adults showed overall lower stress, generally they also experienced higher affect than the younger adults. Middle-aged adults experienced a significant reduction in stress following drinking while no such effect was observed in the younger adults.Conclusions: To our knowledge, this is the first investigation using EMA methodology to examine stress and affect between younger and middle-aged adults who habitually consume alcohol. These cross-sectional data suggest potential momentary stress relief to engaging with moderate alcohol consumption in a middle-aged population. Future work must address this important motivational process in curtailing maintenance of alcohol consumption and preventing escalation of consumption.
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Affiliation(s)
- Hope Peterson
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, USA
- Laboratory for Complex Brain Networks, Wake Forest Health Sciences, Winston-Salem, USA
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, USA
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, USA
| | - Stephen W. Porges
- Kinsey Institute Taumatic Stress Research Consortium, Indiana University, Bloomington, USA
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, USA
| | - Keri J. Heilman
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, USA
| | - Paul J. Laurienti
- Laboratory for Complex Brain Networks, Wake Forest Health Sciences, Winston-Salem, USA
- Department of Radiology, Wake Forest School of Medicine, Wisnton-Salem, USA
| | - Lise Gauvin
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du CHUM, Montréal, Canada
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10
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Hsieh KL, Neiberg RH, Beavers KM, Rejeski WJ, Messier SP, Nicklas BJ, Beavers DP. Effect of Baseline BMI and IL-6 Subgroup Membership on Gait Speed Response to Caloric Restriction in Older Adults with Obesity. J Nutr Health Aging 2023; 27:285-290. [PMID: 37170436 PMCID: PMC10804887 DOI: 10.1007/s12603-023-1909-1] [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: 05/13/2023]
Abstract
BACKGROUND Prior work shows caloric restriction (CR) can improve physical function among older adults living with obesity. However, the contribution of starting weight and inflammatory burden to CR-associated functional improvements is unclear. The primary purpose of this study was to determine if CR-associated gait speed change varied by body mass index (BMI) and plasma interleukin 6 (IL-6) at baseline and secondarily to determine the contribution of BMI change and IL-6 change to gait speed change. DESIGN, SETTING, PARTICIPANTS Data from eight randomized control trials were pooled, with 1184 participants randomized to CR (n=661) and No CR (n=523) conditions. All studies assessed outcomes before and five or six months after assignment to CR or No CR. MEASUREMENTS BMI and IL-6 were assessed at baseline using standard procedures. Gait speed was assessed with the six-minute walk test or 400m walk test. Baseline BMI/IL-6 subgroups were constructed using BMI≥35 kg/m2 and IL-6>2.5 pg/mL thresholds. Participants with BMI≥35 kg/m2 were grouped into class 2+ obesity and BMI<35 kg/m2 into class 1- obesity; IL-6>2.5 pg/mL were grouped into high IL-6, and <2.5 pg/mL as low IL-6 (class 2+ obesity/high IL-6: n=288, class 2+ obesity/low IL-6: n=143, class 1- obesity/high IL-6: n=354, or class 1- obesity/low IL-6: n=399). All analyses used adjusted general linear models. RESULTS Gait speed significantly improved with CR versus non-CR [mean difference: +0.02 m/s (95% CI: 0.01, 0.04)]. CR assignment significantly interacted with BMI/IL-6 subgroup membership (p=0.03). Greatest gait speed improvement was observed in the class 2+ obesity/high IL-6 subgroup [+0.07 m/s (0.03, 0.10)]. No other subgroups observed significant gait speed change. For each unit decrease in BMI, gait speed change increased by +0.02 m/s (p<0.001; R2=0.26), while log IL-6 change did not significantly affect gait speed change [+0.01 m/s (p=0.20)]. CONCLUSIONS Only the class 2+ obesity/high IL-6 subgroup significantly improved gait speed in response to CR. Improvement in gait speed in this subgroup was driven by a larger decrease in BMI, but not IL-6, in response to CR. Individuals with class 2+ obesity and high IL-6 are most likely to show improved gait speed in response to CR, with improvement predominantly driven by reductions in BMI.
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Affiliation(s)
- K L Hsieh
- Katherine L. Hsieh, Department of Physical Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, USA, Phone: 336-758-3106,
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11
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Fanning J, Miller ME, Chen SH, Davids C, Kershner K, Rejeski WJ. Is Wrist Accelerometry Suitable for Threshold Scoring? A Comparison of Hip-Worn and Wrist-Worn ActiGraph Data in Low-Active Older Adults With Obesity. J Gerontol A Biol Sci Med Sci 2022; 77:2429-2434. [PMID: 34791237 PMCID: PMC9923693 DOI: 10.1093/gerona/glab347] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hip- and wrist-worn ActiGraph accelerometers are widely used in research on physical activity as they offer an objective assessment of movement intensity across the day. Herein we characterize and contrast key structured physical activities and common activities of daily living via accelerometry data collected at the hip and wrist from a sample of community-dwelling older adults. METHODS Low-active, older adults with obesity (age 60+ years) were fit with an ActiGraph GT3X+ accelerometer on their nondominant wrist and hip before completing a series of tasks in a randomized order, including sitting/standing, sweeping, folding laundry, stair climbing, ambulation at different intensities, and cycling at different intensities. Participants returned a week later and completed the tasks once again. Vector magnitude counts/second were time-matched during each task and then summarized into counts/minute (CPM). RESULTS Monitors at both wear locations similarly characterized standing, sitting, and ambulatory tasks. A key finding was that light home chores (sweeping, folding laundry) produced higher and more variable CPM values than fast walking via wrist ActiGraph. Regression analyses revealed wrist CPM values were poor predictors of hip CPM values, with devices aligning best during fast walking (R2 = 0.25) and stair climbing (R2 = 0.35). CONCLUSIONS As older adults spend a considerable portion of their day in nonexercise activities of daily living, researchers should be cautious in the use of simply acceleration thresholds for scoring wrist-worn accelerometer data. Methods for better classifying wrist-worn activity monitor data in older adults are needed.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Michael E Miller
- Department of Biostatistical and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shyh-Huei Chen
- Department of Biostatistical and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carlo Davids
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Kyle Kershner
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
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12
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Peterson H, Laurienti PJ, Rejeski WJ, Fanning J, Gauvin L. Childhood neglect is associated with low affect and high stress in habitual alcohol drinkers. Int J Alcohol Drug Res 2022; 10:3-14. [PMID: 36875154 PMCID: PMC9979972 DOI: 10.7895/ijadr.399] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Adverse childhood experiences, ranging from childhood trauma to neglect or mistreatment, show associations with alcohol dependence in adulthood. Alcohol researchers have not yet clearly demonstrated the potential impact of childhood maltreatment on everyday drinking in alcohol consumers who do not have an alcohol use disorder (AUD). This study examined whether a history of childhood neglect results in differential ratings of stress, affect, and desire to drink, during typical alcohol consumption in moderate to heavy drinkers without an AUD. METHODS The parent study from which these analyses were generated recruited overall healthy, albeit moderate to heavy alcohol users who fell above National Institute on Alcohol Abuse and Alcoholism (NIAAA) classifications for low-risk drinking. Childhood Trauma Questionnaire (CTQ) responses were collected, and real-time surveys were collected in participants' natural environments approximately every three hours between 9 a.m. and 9 p.m. using iPhones equipped with a study-created application probing stress, affect, and desire for alcohol, while participants followed their typical drinking routine (3 days) and during a brief period of imposed abstinence (3 days). RESULTS Thirty-six participants averaging 41 years of age and consuming an average of 17 (±5) drinks per week participated in this study. CTQ responses showed low prevalence of childhood abuse, but moderate to high emotional (M = 17.39, SD = 6.77) and physical neglect (M = 11.11, SD = 3.31) scores. Multilevel modeling revealed significantly higher stress and lower affect ratings among participants reporting higher physical neglect. Alcohol consumption was significantly associated with decreased stress, and increased affect and desire for alcohol. A significant interaction showed that as childhood physical neglect ratings increased, the benefits observed following drinking (of decreased stress, and increased affect and desire for alcohol) were reduced. CONCLUSIONS These results suggest that moderate to heavy healthy daily drinkers with histories of greater childhood physical neglect experience poorer mood and higher stress on a daily basis, with smaller improvement experienced from drinking alcohol. Among moderate to heavy daily drinkers without an AUD, those with greater childhood physical neglect experience poorer mood and higher stress on a daily basis, and have smaller improvements in stress, affect and desire while/following drinking alcohol than those with less childhood physical neglect.
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Affiliation(s)
- Hope Peterson
- Neuroscience Graduate Program, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157 USA
- Laboratory for Complex Brain Networks, Wake Forest Health Sciences, Medical Center Blvd, Winston-Salem, NC, 27157 USA
| | - Paul J. Laurienti
- Laboratory for Complex Brain Networks, Wake Forest Health Sciences, Medical Center Blvd, Winston-Salem, NC, 27157 USA
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157 USA
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, 1834 Wake Forest Rd, Winston-Salem, NC, 27106 USA
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, 1834 Wake Forest Rd, Winston-Salem, NC, 27106 USA
| | - Lise Gauvin
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, P.O. Box 6128, Downtown Station, Montréal, H3C 3J5, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du CHUM, 850 rue Saint-Denis, S01-118, Montreal, H2X 0A9, Canada
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13
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Stathi A, Withall J, Greaves CJ, Thompson JL, Taylor G, Medina-Lara A, Green C, Snowsill T, Johansen-Berg H, Bilzon J, Gray S, Cross R, Western MJ, Koning JLD, Ladlow P, Bollen JC, Moorlock SJ, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. A group-based exercise and behavioural maintenance intervention for adults over 65 years with mobility limitations: the REACT RCT. Public Health Res 2022. [DOI: 10.3310/mqbw6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background
Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality.
Objective
The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation.
Design
A multicentre, pragmatic, two-arm, parallel-group randomised controlled trial with parallel process and health economic evaluations.
Setting
Urban and semi-rural locations across three sites in England.
Participants
Physically frail or pre-frail older adults (aged ≥ 65 years; Short Physical Performance Battery score of 4–9). Recruitment was primarily via 35 primary care practices.
Interventions
Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal exercise and behavioural maintenance programme delivered in fitness and community centres. Randomisation was stratified by site and used a minimisation algorithm to balance age, sex and Short Physical Performance Battery score. Data collection and analyses were blinded.
Main outcome measures
The primary outcome was change in lower limb physical function (Short Physical Performance Battery score) at 24 months, analysed using an intention-to-treat analysis. The economic evaluation adopted the NHS and Personal Social Services perspective.
Results
Between June 2016 and October 2017, 777 participants (mean age 77.6 years, standard deviation 6.8 years; 66% female; mean Short Physical Performance Battery score 7.37, standard deviation 1.56) were randomised to the intervention arm (n = 410) or the control arm (n = 367). Data collection was completed in October 2019. Primary outcome data at 24 months were provided by 628 (80.8%) participants. At the 24-month follow-up, the Short Physical Performance Battery score was significantly greater in the intervention arm (mean 8.08, standard deviation 2.87) than in the control arm (mean 7.59, standard deviation 2.61), with an adjusted mean difference of 0.49 (95% confidence interval 0.06 to 0.92). The difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Self-reported physical activity significantly increased in the intervention arm compared with the control arm, but this change was not observed in device-based physical activity data collected during the trial. One adverse event was related to the intervention. Attrition rates were low (19% at 24 months) and adherence was high. Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness and enjoyment and perceived physical, social and mental well-being benefits. The intervention plus usual care was cost-effective compared with care alone over the 2 years of REACT; the price year was 2019. In the base-case scenario, the intervention saved £103 per participant, with a quality-adjusted life-year gain of 0.04 (95% confidence interval 0.006 to 0.074) within the 2-year trial window. Lifetime horizon modelling estimated that further cost savings and quality-adjusted life-year gains were accrued up to 15 years post randomisation.
Conclusion
A relatively low-resource, 1-year multimodal exercise and behavioural maintenance intervention can help older adults to retain physical functioning over a 24-month period. The results indicate that the well-established trajectory of declining physical functioning in older age is modifiable.
Limitations
Participants were not blinded to study arm allocation. However, the primary outcome was independently assessed by blinded data collectors. The secondary outcome analyses were exploratory, with no adjustment for multiple testing, and should be interpreted accordingly.
Future work
Following refinements guided by the process evaluation findings, the REACT intervention is suitable for large-scale implementation. Further research will optimise implementation of REACT at scale.
Trial registration
This trial is registered as ISRCTN45627165.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | | | - Colin Green
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Tristan Snowsill
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Rosina Cross
- Department for Health, University of Bath, Bath, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - Jessica C Bollen
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Worrell Professional Centre, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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14
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Fanning J, Brooks AK, Ford S, Robison JT, Irby MB, Rejeski WJ. A remote group-mediated daylong physical activity intervention for older adults with chronic pain: Results of the MORPH-II randomized pilot trial. Front Digit Health 2022; 4:1040867. [PMID: 36405417 PMCID: PMC9666366 DOI: 10.3389/fdgth.2022.1040867] [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: 09/09/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023] Open
Abstract
Chronic pain is a debilitating condition that affects many older adults who often have limited access to non-pharmacological pain management strategies. One potentially effective and novel lifestyle medicine for chronic pain involves increasing physical activity through frequent movement across the day, thereby also decreasing the presence of extended sedentary bouts. The MORPH-II pilot randomized controlled refinement trial iterated on the MORPH trial, which was a first-of-its-kind group-mediated daylong physical activity (DPA) intervention for older adults with chronic pain rooted in social cognitive and self-determination theories and supported by an mHealth toolset designed to foster social connection and awareness of physical activity patterns. MORPH-II was delivered fully remotely via videoconference software and supported by a technology kit comprising an iPad, activity monitor, and wireless weight scale. It was also implemented a refined coaching model designed to help participants better understand their own patterns of activity. A total of 44 participants were randomized to receive the 12-week group-mediated DPA intervention or to a low-contact control. Qualitative interviews suggest the program was well-received by participants and that participants developed an understanding of how patterns of physical activity related to their pain symptoms. Participants also highlighted several additional areas for refinement related to the coaching model and feedback provided within the mHealth app. Analyses of covariance, controlling for baseline values, revealed a small effect (η 2 = 0.01) on pain intensity favoring the intervention condition, though both groups improved during the study period. There was a large effect favoring the intervention condition on ActivPAL-assessed average daily steps (η 2 = 0.23) and postural shifts (η 2 = 0.24). Control participants spent less time in short sedentary bouts (η 2 = 0.09), and there was a small effect (η 2 = 0.02) indicating intervention participants spent less time in extended sedentary bouts. Finally, relative to control, intervention participants demonstrated a moderate improvement in autonomy satisfaction (η 2 = 0.05), relatedness frustration (η 2 = 0.05), and competence frustration (η 2 = 0.06), and a large magnitude improvement in competence satisfaction (η 2 = 0.22). These findings indicate that the MORPH-II intervention was feasible and acceptable, and may positively impact steps, postural breaks, and several key domains of basic psychological needs detailed in self-determination theory.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Justin T. Robison
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Megan B. Irby
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
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15
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Fanning J, Nicklas B, Furlipa J, Rejeski WJ. The impact of Dietary Weight loss, Aerobic Exercise, and Daylong Movement on Social Cognitive Mediators of Long-term Weight loss. J Behav Med 2022:10.1007/s10865-022-00359-6. [PMID: 36215000 PMCID: PMC9548422 DOI: 10.1007/s10865-022-00359-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
Abstract
This report contrasts the impact of a dietary weight loss intervention (WL) paired with aerobic exercise (EX) and/or sitting less and moving throughout the day (SL) on self-efficacy for walking (hereafter walking self-efficacy) and satisfaction with physical functioning (hereafter satisfaction). Additional analyses examined dose-response associations between change in weight and changes in these key outcomes. Older adults (N = 112; age = 70.21[Formula: see text]4.43) were randomized to 6 months of WL+EX, WL+SL, or WL+EX+SL followed by a 12-month maintenance period. All groups reported increases in walking self-efficacy at month 6 with greater improvements in WL+EX and WL + EX+SL. Only WL+SL demonstrated improved walking self-efficacy at month 18. All conditions demonstrated improved satisfaction scores at both time points. Changes in walking self-efficacy and satisfaction were negatively associated with change in weight over the 6-month intervention and after the maintenance period. These results support the utility of WL + SL for improving key social cognitive outcomes in aging.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
| | - Barbara Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Joy Furlipa
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC USA
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC USA
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16
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Rejeski WJ, Laurienti PJ, Bahrami M, Fanning J, Simpson SL, Burdette JH. Aging and Neural Vulnerabilities in Overeating: A Conceptual Overview and Model to Guide Treatment. PCN Rep 2022; 1:e39. [PMID: 36589860 PMCID: PMC9797202 DOI: 10.1002/pcn5.39] [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] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/25/2022] [Indexed: 01/05/2023]
Abstract
Given the vulnerability of older adults to chronic disease and physical disability, coupled with the threat that obesity poses to healthy aging, there is an urgent need to understand the causes of positive energy balance and the struggle that many older adults face with intentional weight loss. This paper focuses on neural vulnerabilities related to overeating in older adults, and moderating variables that can have either favorable or unfavorable effect these vulnerabilities. Research from our laboratory on older adults with obesity suggests that they are prone to similar neural vulnerabilities for overeating that have been observed in younger and middle-aged populations. In addition, following brief postabsorptive states, functional brain networks both in the resting state and in response to active imagery of desired food are associated with 6-month weight loss. Data reviewed suggest that the sensorimotor network is a central hub in the process of valuation and underscores the central role played by habits in overeating. Finally, we demonstrate how research on the neural vulnerabilities for overeating offers a useful framework for guiding clinical decision-making in weight management.
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Affiliation(s)
- W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
- Section on Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Laboratory for Complex Brain Networks, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Paul J. Laurienti
- Laboratory for Complex Brain Networks, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mohsen Bahrami
- Laboratory for Complex Brain Networks, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Sean L. Simpson
- Laboratory for Complex Brain Networks, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jonathan H. Burdette
- Laboratory for Complex Brain Networks, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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17
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Hammond MM, Spring B, Rejeski WJ, Sufit R, Criqui MH, Tian L, Zhao L, Xu S, Kibbe MR, Leeuwenburgh C, Manini T, Forman DE, Treat‐Jacobson D, Polonsky TS, Bazzano L, Ferrucci L, Guralnik J, Lloyd‐Jones DM, McDermott MM. Effects of Walking Exercise at a Pace With Versus Without Ischemic Leg Symptoms on Functional Performance Measures in People With Lower Extremity Peripheral Artery Disease: The LITE Randomized Clinical Trial. J Am Heart Assoc 2022; 11:e025063. [PMID: 35894088 PMCID: PMC9375509 DOI: 10.1161/jaha.121.025063] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background In people with peripheral artery disease, post hoc analyses of the LITE (Low Intensity Exercise Intervention in Peripheral Artery Disease) randomized trial were conducted to evaluate the effects of walking exercise at a pace inducing ischemic leg symptoms on walking velocity and the Short Physical Performance Battery, compared with walking exercise without ischemic leg symptoms and compared with a nonexercising control group. Methods and Results Participants with peripheral artery disease were randomized to: home-based walking exercise that induced ischemic leg symptoms; home-based walking exercise conducted without ischemic leg symptoms; or a nonexercising control group for 12 months. Outcomes were change of walking velocity over 4 m and change of the Short Physical Performance Battery (0-12, with 12=best) at 6- and 12-month follow-up. A total of 264 participants (48% women, 61% Black race) were included. Compared with walking exercise without ischemic symptoms, walking exercise that induced ischemic symptoms improved change in usual-paced walking velocity over 4 m at 6-month (0.056 m/s [95% CI, 0.019-0.094 m/s]; P<0.01) and 12-month follow-up (0.084 m/s [95% CI, 0.049-0.120 m/s]; P<0.01), change in fast-paced of walking velocity over 4 m at 6-month follow-up (P=0.03), and change in the Short Physical Performance Battery at 12-month follow-up (0.821 [95% CI, 0.309-1.334]; P<0.01). Compared with control, walking exercise at a pace inducing ischemic symptoms improved change in usual-paced walking velocity over 4 m at 6-month follow-up (0.066 m/s [95% CI, 0.021-0.111 m/s]; P<0.01). Conclusions In people with peripheral artery disease, those who walked for exercise at a comfortable pace without ischemic leg symptoms slowed their walking speed during daily life and worsened the Short Physical Performance Battery score, a potentially harmful effect, compared with people who walked for exercise at a pace inducing ischemic leg symptoms. Compared with a control group who did not exercise, home-based walking exercise at a pace inducing ischemic leg symptoms significantly improved change of walking velocity over 4 m at 6-month follow-up, but this benefit did not persist at 12-month follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02538900.
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Affiliation(s)
| | - Bonnie Spring
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | - W. Jack Rejeski
- Departments of Health and Exercise Science and Geriatric MedicineWake Forest UniversityWinston SalemNC
| | - Robert Sufit
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | | | - Lu Tian
- Department of Biomedical Data ScienceStanford UniversityPalo AltoCA
| | - Lihui Zhao
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | - Shujun Xu
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | | | | | | | - Daniel E. Forman
- University of Pittsburgh, Department of Medicine, Geriatric ResearchEducation, and Clinical CenterPittsburghPA
| | | | | | | | - Luigi Ferrucci
- National Institute on Aging Division of Intramural ResearchBethesdaMD
| | - Jack Guralnik
- Department of EpidemiologyUniversity of MarylandBaltimoreMD
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18
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Ip EH, Chen SH, Rejeski WJ, Bandeen-Roche K, Hayden KM, Hugenschmidt CE, Pierce J, Miller ME, Speiser JL, Kritchevsky SB, Houston DK, Newton RL, Rapp SR, Kitzman DW. Gradient and Acceleration of Decline in Physical and Cognitive Functions in Older Adults: A Disparity Analysis. J Gerontol A Biol Sci Med Sci 2022; 77:1603-1611. [PMID: 35562076 PMCID: PMC9373944 DOI: 10.1093/gerona/glac109] [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: 08/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Substantive previous work has shown that both gait speed and global cognition decline as people age. Rates of their decline, as opposed to cross-sectional measurements, could be more informative of future functional status and other clinical outcomes because they more accurately represent deteriorating systems. Additionally, understanding the sex and racial disparity in the speed of deterioration, if any, is also important as ethnic minorities are at an increased risk of mobility disability and dementia. METHOD Data from 2 large longitudinal intervention studies were integrated. Rates of decline were derived from individual-level measures of gait speed of 400-m walk and scores on the Modified Mini Mental State Examination (3MSE). We also assessed age-associated declines and accelerations in changes across the ages represented in the studies (age range 53-90). RESULTS The mean rate of decline in 400-m gait speed across individuals was 0.03 m/s per year, and multivariable analysis showed a significant acceleration in decline of -0.0013 m/s/y2 (p < .001). Both race and sex moderated the rate of decline. For global cognition, the mean rate of decline was 0.05 of a point per year on the 3MSE scale, and acceleration in the rate of decline was significant (-0.017 point/y2, p < .001), but neither sex nor race moderated the decline. CONCLUSION Rate of decline in physical but not cognitive function appears moderated by sex and race. This finding, as well as rates and accelerations of decline estimated herein, could inform future intervention studies. CLINICAL TRIALS REGISTRATION NUMBER NCT00017953 (Look AHEAD); NCT01410097 (Look AHEAD ancillary); NCT00116194 (LIFE).
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Affiliation(s)
- Edward H Ip
- Address correspondence to: Edward H. Ip, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina 27157, USA. E-mail:
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - June Pierce
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jaime L Speiser
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert L Newton
- Population and Public Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Dalane W Kitzman
- Sections of Cardiovascular and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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19
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Beavers DP, Hsieh KL, Kitzman DW, Kritchevsky SB, Messier SP, Neiberg RH, Nicklas BJ, Rejeski WJ, Beavers KM. Estimating heterogeneity of physical function treatment response to caloric restriction among older adults with obesity. PLoS One 2022; 17:e0267779. [PMID: 35511858 PMCID: PMC9070937 DOI: 10.1371/journal.pone.0267779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Clinical trials conventionally test aggregate mean differences and assume homogeneous variances across treatment groups. However, significant response heterogeneity may exist. The purpose of this study was to model treatment response variability using gait speed change among older adults participating in caloric restriction (CR) trials. Eight randomized controlled trials (RCTs) with five- or six-month assessments were pooled, including 749 participants randomized to CR and 594 participants randomized to non-CR (NoCR). Statistical models compared means and variances by CR assignment and exercise assignment or select subgroups, testing for treatment differences and interactions for mean changes and standard deviations. Continuous equivalents of dichotomized variables were also fit. Models used a Bayesian framework, and posterior estimates were presented as means and 95% Bayesian credible intervals (BCI). At baseline, participants were 67.7 (SD = 5.4) years, 69.8% female, and 79.2% white, with a BMI of 33.9 (4.4) kg/m2. CR participants reduced body mass [CR: -7.7 (5.8) kg vs. NoCR: -0.9 (3.5) kg] and increased gait speed [CR: +0.10 (0.16) m/s vs. NoCR: +0.07 (0.15) m/s] more than NoCR participants. There were no treatment differences in gait speed change standard deviations [CR–NoCR: -0.002 m/s (95% BCI: -0.013, 0.009)]. Significant mean interactions between CR and exercise assignment [0.037 m/s (95% BCI: 0.004, 0.070)], BMI [0.034 m/s (95% BCI: 0.003, 0.066)], and IL-6 [0.041 m/s (95% BCI: 0.009, 0.073)] were observed, while variance interactions were observed between CR and exercise assignment [-0.458 m/s (95% BCI: -0.783, -0.138)], age [-0.557 m/s (95% BCI: -0.900, -0.221)], and gait speed [-0.530 m/s (95% BCI: -1.018, -0.062)] subgroups. Caloric restriction plus exercise yielded the greatest gait speed benefit among older adults with obesity. High BMI and IL-6 subgroups also improved gait speed in response to CR. Results provide a novel statistical framework for identifying treatment heterogeneity in RCTs.
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Affiliation(s)
- Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- * E-mail:
| | - Katherine L. Hsieh
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Dalane W. Kitzman
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Stephen B. Kritchevsky
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America
| | - Rebecca H. Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Barbara J. Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America
| | - Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America
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20
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Fanning J, Rejeski WJ, Leng I, Barnett C, Lovato JF, Lyles MF, Nicklas BJ. Response to "The problems hiding in the self-report basis in a weight loss maintenance trial". Obesity (Silver Spring) 2022; 30:798. [PMID: 35244340 DOI: 10.1002/oby.23402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science & Internal Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science & Internal Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Iris Leng
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Cheyenne Barnett
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - James F Lovato
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Mary F Lyles
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Barbara J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
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21
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Burdette JH, Bahrami M, Laurienti PJ, Simpson S, Nicklas BJ, Fanning J, Rejeski WJ. Longitudinal relationship of baseline functional brain networks with intentional weight loss in older adults. Obesity (Silver Spring) 2022; 30:902-910. [PMID: 35333443 PMCID: PMC8969753 DOI: 10.1002/oby.23396] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The goal of this study was to determine whether the degree of weight loss after 6 months of a behavior-based intervention is related to baseline connectivity within two functional networks (FNs) of interest, FN1 and FN2, in a group of older adults with obesity. METHODS Baseline functional magnetic resonance imaging data were collected following an overnight fast in 71 older adults with obesity involved in a weight-loss intervention. Functional brain networks in a resting state and during a food-cue task were analyzed using a mixed-regression framework to examine the relationships between baseline networks and 6-month change in weight. RESULTS During the resting condition, the relationship of baseline brain functional connectivity and network clustering in FN1, which includes the visual cortex and sensorimotor areas, was significantly associated with 6-month weight loss. During the food-cue condition, 6-month weight loss was significantly associated with the relationship between baseline brain connectivity and network global efficiency in FN2, which includes executive control, attention, and limbic regions. CONCLUSION These findings provide further insight into complex functional circuits in the brain related to successful weight loss and may ultimately aid in developing tailored behavior-based treatment regimens that target specific brain circuitry.
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Affiliation(s)
- Jonathan H. Burdette
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
- Department of RadiologyWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Mohsen Bahrami
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
- Department of Biomedical EngineeringVirginia Tech‐Wake Forest School of Biomedical Engineering and SciencesWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Paul J. Laurienti
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
- Department of RadiologyWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Sean L. Simpson
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Barbara J. Nicklas
- Section on Geriatric MedicineDepartment of Internal MedicineWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Jason Fanning
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - W. Jack Rejeski
- Section on Geriatric MedicineDepartment of Internal MedicineWake Forest School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
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22
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Fanning J, Brooks AK, Hsieh KL, Kershner K, Furlipa J, Nicklas BJ, Rejeski WJ. The Effects of a Pain Management-Focused Mobile Health Behavior Intervention on Older Adults' Self-efficacy, Satisfaction with Functioning, and Quality of Life: a Randomized Pilot Trial. Int J Behav Med 2022; 29:240-246. [PMID: 34018138 PMCID: PMC8136759 DOI: 10.1007/s12529-021-10003-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This report investigates the impact of a remote physical activity intervention on self-efficacy, satisfaction with functioning, and health-related quality of life (HRQOL) as assessed by the SF-36 in obese older adults with chronic pain. The intervention was group-mediated in nature and based in social cognitive theory and mindfulness-based relapse prevention. METHODS Participants (N = 28; 70.21 ± 5.22 years) were randomly assigned to receive either the active intervention, which focused on reducing caloric intake and increasing steps across the day or to a waitlist control condition. RESULTS Over 12 weeks, intervention participants reported a moderate, positive improvement in self-efficacy for walking relative to control. They also reported large magnitude improvements in satisfaction for physical functioning as well as improvements on pain and the physical functioning subscales of the SF-36. CONCLUSIONS These findings expand on previous research showing similar effects in response to structured exercise, this time via a protocol that is likely to be scalable and sustainable for many older adults. Additional work on larger and more diverse samples is warranted.
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Affiliation(s)
- J Fanning
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC, USA.
| | - A K Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - K L Hsieh
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - K Kershner
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - J Furlipa
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - B J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - W J Rejeski
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC, USA
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Stathi A, Greaves CJ, Thompson JL, Withall J, Ladlow P, Taylor G, Medina-Lara A, Snowsill T, Gray S, Green C, Johansen-Berg H, Sexton CE, Bilzon JLJ, deKoning J, Bollen JC, Moorlock SJ, Western MJ, Demnitz N, Seager P, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (Retirement in Action) randomised controlled trial. Lancet Public Health 2022; 7:e316-e326. [PMID: 35325627 PMCID: PMC8967718 DOI: 10.1016/s2468-2667(22)00004-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults already at increased risk of mobility limitation. METHODS In this pragmatic, multicentre, two-arm, single-blind, parallel-group, randomised, controlled trial, we recruited older adults (aged 65 years or older and who are not in full-time employment) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4-9) from 35 primary care practices across three sites (Bristol and Bath; Birmingham; and Devon) in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity (64 1-h exercise sessions) and behavioural maintenance (21 45-min sessions) programme delivered by charity and community or leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance groups by age, sex, and SPPB score, using a centralised, online, randomisation algorithm. Researchers involved in data collection and analysis were masked but participants were not because of the nature of the intervention. The primary outcome was change in SPPB score at 24 months, analysed by intention to treat. This trial is registered with ISRCTN, ISRCTN45627165. FINDINGS Between June 20, 2016, and Oct 30, 2017, 777 participants (mean age 77·6 [SD 6·8] years; 66% female; mean SPPB score 7·37 [1·56]) were randomly assigned to the intervention (n=410) and control (n=367) groups. Primary outcome data at 24 months were provided by 628 (81%) participants (294 in the control group and 334 in the intervention group). At the 24-month follow-up, the SPPB score (adjusted for baseline SPPB score, age, sex, study site, and exercise group) was significantly greater in the intervention group (mean 8·08 [SD 2·87]) than in the control group (mean 7·59 [2·61]), with an adjusted mean difference of 0·49 (95% CI 0·06-0·92; p=0·014), which is just below our predefined clinically meaningful difference of 0·50. One adverse event was related to the intervention; the most common unrelated adverse events were heart conditions, strokes, and falls. INTERPRETATION For older adults at risk of mobility limitations, the REACT intervention showed that a 12-month physical activity and behavioural maintenance programme could help prevent decline in physical function over a 24-month period. FUNDING National Institute for Health Research Public Health Research Programme (13/164/51).
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janet Withall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Department for Health, University of Bath, Bath, UK
| | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Tristan Snowsill
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England (UWE) Bristol, Bristol, UK
| | - Colin Green
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heidi Johansen-Berg
- Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Claire E Sexton
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Jessica C Bollen
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah J Moorlock
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Naiara Demnitz
- Danish Research Centre for Magnetic Resonance, Centre for Functional Diagnostic Imaging and Research, Copenhagen University Hospital -Amager and Hvidovre, Hvidovre, Denmark
| | - Poppy Seager
- Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Focht BC, Rejeski WJ, Hackshaw K, Ambrosius WT, Groessl E, Chaplow ZL, DeScenza VR, Bowman J, Fairman CM, Nesbit B, Dispennette K, Zhang X, Fowler M, Haynam M, Hohn S. The Collaborative Lifestyle Intervention Program in Knee Osteoarthritis Patients (CLIP-OA) trial: Design and methods. Contemp Clin Trials 2022; 115:106730. [DOI: 10.1016/j.cct.2022.106730] [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] [Received: 11/19/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
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Fanning J, Rejeski WJ, Leng I, Barnett C, Lovato JF, Lyles MF, Nicklas BJ. Intervening on exercise and daylong movement for weight loss maintenance in older adults: A randomized, clinical trial. Obesity (Silver Spring) 2022; 30:85-95. [PMID: 34932885 PMCID: PMC8711609 DOI: 10.1002/oby.23318] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to determine the impact of dietary weight loss (WL) plus aerobic exercise (EX) and a "move more, more often" approach to activity promotion (SitLess; SL) on WL and maintenance. METHODS Low-active older adults (age 65-86 years) with obesity were randomized to WL+EX, WL+SL, or WL+EX+SL. Participants received a social-cognitive group-mediated behavioral WL program for 6 months, followed by a 12-month maintenance period. EX participants received guided walking exercise with the goal of walking 150 min/wk. SL attempted to achieve a step goal by moving frequently during the day. The primary outcome was body weight at 18 months, with secondary outcomes including weight regain from 6 to 18 months and objectively assessed physical activity and sedentary behavior at each time point. RESULTS All groups demonstrated significant WL over 6 months (p < 0.001), with no group differences. Groups that received SL improved total activity time (p ≤ 0.05), and those who received EX improved moderate-to-vigorous activity time (p = 0.003). Over the 12-month follow-up period, those who received WL+EX demonstrated greater weight regain (5.2 kg; 95% CI: 3.5-6.9) relative to WL+SL (2.4 kg; 95% CI: 0.8-4.0). CONCLUSIONS Pairing dietary WL with a recommendation to accumulate physical activity contributed to similar WL and less weight regain compared with traditional aerobic exercise.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Iris Leng
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Cheyenne Barnett
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - James F Lovato
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Mary F Lyles
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Barbara J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
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Fanning J, Brooks A, Nicklas B, Rejeski WJ. Delivering a Group-Mediated Weight Loss and Activity Program to Older Adults With Chronic Pain in the MORPH Study. Innov Aging 2021. [PMCID: PMC8679296 DOI: 10.1093/geroni/igab046.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chronic pain in aging is a potent cause and consequence of obesity, inactivity, and prolonged sedentary behavior, making these especially important targets for behavioral intervention. This study aimed to refine a theory-based group-mediated diet and sedentary behavior intervention for older adults with chronic pain. Participants (N=28) attended 12 weekly group meetings generally in home via WebEx and used an mHealth self-monitoring app as they attempted to move more often and reduce caloric intake. Relative to a control condition, the program produced improvements in physical function (η^2=.08), pain intensity (η^2=.12), sedentary time (η^2=.07), and weight loss (η^2=.21). Key findings related to effective remote group intervention delivery included: (1) the importance of a self-efficacy-enhancing technology orientation; (2) the value of small group bonding activities to seed communication; and (3) the impact of software choice on interpersonal communication. We will discuss the value of these findings for future remote intervention design.
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Affiliation(s)
- Jason Fanning
- Wake Forest University, Winston Salem, North Carolina, United States
| | - Amber Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, North Carolina, United States
| | - Barbara Nicklas
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, North Carolina, United States
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Weaver A, Madrid D, Greene K, Walkup M, Ambrosius W, Marsh A, Rejeski WJ, Beavers K. Exercise Modality Affects Older Adult CT-Derived Muscle and Bone Loss During Caloric Restriction. Innov Aging 2021. [PMCID: PMC8681193 DOI: 10.1093/geroni/igab046.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Caloric restriction (CR) can exacerbate muscle and bone loss. We examined 18-month changes in computed tomography (CT)-derived trunk muscle, and volumetric bone mineral density (vBMD) and finite element-estimated bone strength of the spine and hip in 55 older adults randomized to CR alone or CR plus aerobic (CR+AT) or resistance (CR+RT) training. Trunk muscle area loss trended higher with CR+AT [−16.8 cm2 (95% CI: −26.4, −7.1) vs CR: -6.7 (−12.8, −0.5), CR+RT: −9.0 (−14.5, −3.4)]. Spine vBMD loss trended higher with CR+AT [−0.014 g/cm3 (−0.027,−0.001) vs. CR: −0.005 (−0.022,0.012), CR+RT: −0.004 (−0.019,0.011)], and similarly for vertebral bone strength. Hip vBMD losses trended lower with CR+RT [−0.015 g/cm3 (−0.024,−0.006) vs. CR: −0.027 (−0.036,−0.019), CR+AT: −0.029 (−0.037,−0.020)]. Hip vBMD and trunk muscle losses were positively correlated (r=0.53), and spine vBMD loss tended to increase with trunk muscle loss (r=0.21) and fat infiltration (r=0.17). Collectively, aerobic training was less effective at preserving muscle-bone health during CR.
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Affiliation(s)
- Ashley Weaver
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Diana Madrid
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Katelyn Greene
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Michael Walkup
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Walter Ambrosius
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Anthony Marsh
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, North Carolina, United States
| | - Kristen Beavers
- Wake Forest University, Winston Salem, North Carolina, United States
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28
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Fanning J, Nicklas BJ, Rejeski WJ. Intervening on physical activity and sedentary behavior in older adults. Exp Gerontol 2021; 157:111634. [PMID: 34826574 DOI: 10.1016/j.exger.2021.111634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/05/2021] [Revised: 10/21/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
Participating in sufficient levels of physical activity is important for sustaining health and quality of life across the age span. The United States Physical Activity Guidelines recommend individuals of all ages "move more, more often" by frequently engaging in aerobic activity while avoiding prolonged bouts of sitting. This is indicative of a slow shift in focus in the study of active aging that has occurred in the last two decades. Historically, researchers interested in the influence of physical activity on older adults' health and quality of life focused on discrete sustained bouts of intense activity (i.e., structured exercise). More recently the widespread usage of accelerometers contributed to a large body of evidence demonstrating that long periods spent sedentary were associated with a host of negative health outcomes ranging from poorer cardiometabolic health to poorer physical functioning and elevated risk of death. These findings often persisted when controlling for time spent in higher-intensity physical activity, spurring separate fields of intervention research concerned with promoting exercise or reducing sedentary time. Novel data emerging in recent years on the importance of an individual's overall activity profile (i.e., amount and patterning of light and moderate-to-vigorous activity) has driven yet another shift in focus toward interventions focused explicitly on movement profiles. In this narrative review, we discuss the evolution of thought regarding older adults' physical activity behaviors. We highlight successes and challenges in first promoting structured and prolonged exercise, later in targeting sedentary behavior, and most recently in attempting to intervene on activity profiles. We end our review by highlighting current gaps in research and important future directions.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, Winston-Salem, NC 27109, USA.
| | - Barbara J Nicklas
- Department of Internal Medicine Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, Winston-Salem, NC 27109, USA.
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Tse KK, Neiberg RH, Beavers DP, Kritchevsky SB, Nicklas BJ, Kitzman DW, Rejeski WJ, Messier SP, Beavers KM. Predictors of Clinically Meaningful Gait Speed Response to Caloric Restriction among Older Adults Participating in Weight Loss Interventions. J Gerontol A Biol Sci Med Sci 2021; 77:2110-2115. [PMID: 34694401 DOI: 10.1093/gerona/glab324] [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: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine whether select baseline characteristics influenced the likelihood of an overweight/obese, older adult experiencing a clinically meaningful gait speed response (±0.05 m/s) to caloric restriction (CR). METHODS Individual level data from 1188 older adults participating in eight, five/six-month, weight loss interventions were pooled, with treatment arms collapsed into CR (n=667) or no CR (NoCR; n=521) categories. Exercise assignment was equally distributed across groups (CR: 65.3% versus NoCR: 65.4%) and did not interact with CR (p=0.88). Poisson risk ratios (95% CI) were used to examine whether CR assignment baseline characteristic subgroups: age (≥65 years), sex (female/male), race (black/white), body mass index (BMI; ≥35 kg/m 2), comorbidity (diabetes, hypertension, cardiovascular disease) status (yes/no), gait speed (<1.0 m/s), or inflammatory burden (C-reactive protein ≥3 mg/L, interleukin-6 ≥2.5 pg/mL) to influence achievement of ±0.05 m/s fast-paced gait speed change. Main effects were also examined. RESULTS The study sample (69.5% female, 80.1% white) was 67.6±5.3 years old with a BMI of 33.8±4.4 kg/m 2. Average weight loss achieved in the CR versus NoCR group was -8.3±5.9% versus -1.1±3.8%; p<0.01. No main effect of CR was observed on the likelihood of achieving a clinically meaningful gait speed improvement [RR: 1.09 (95% CI: 0.93,1.27)] or gait speed decrement [RR: 0.77 (95% CI: 0.57,1.04)]. Interaction effects were non-significant across all subgroups. CONCLUSION The proportion of individuals experiencing a clinically meaningful gait speed change was similar for CR and NoCR conditions. This finding is consistent across several baseline subgroupings.
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Affiliation(s)
- Ka Ki Tse
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | | | - Daniel P Beavers
- Department of Biostatistics and Data Science and Internal Medicine
| | | | | | - Dalane W Kitzman
- Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Stephen P Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
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George SM, Chen H, Miller ME, Rejeski WJ, Stowe CL, Webb C, Kraus WE, Musi N, Jakicic JM. Rapid report on using data to make standardized decisions about enrollment during the COVID-19 pandemic: perspectives from the MoTrPAC study. Ann Epidemiol 2021; 62:19-21. [PMID: 33957248 PMCID: PMC8089030 DOI: 10.1016/j.annepidem.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/22/2021] [Accepted: 04/18/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Stephanie M George
- Division of Extramural Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD.
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael E Miller
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Cynthia L Stowe
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christopher Webb
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - William E Kraus
- Duke Molecular Physiology Institute and Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Nicolas Musi
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio, San Antonio, TX
| | - John M Jakicic
- University of Pittsburgh, Healthy Lifestyle Institute, Pittsburgh, PA
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31
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Speiser JL, Callahan KE, Houston DK, Fanning J, Gill TM, Guralnik JM, Newman AB, Pahor M, Rejeski WJ, Miller ME. Machine Learning in Aging: An Example of Developing Prediction Models for Serious Fall Injury in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:647-654. [PMID: 32498077 DOI: 10.1093/gerona/glaa138] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 02/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advances in computational algorithms and the availability of large datasets with clinically relevant characteristics provide an opportunity to develop machine learning prediction models to aid in diagnosis, prognosis, and treatment of older adults. Some studies have employed machine learning methods for prediction modeling, but skepticism of these methods remains due to lack of reproducibility and difficulty in understanding the complex algorithms that underlie models. We aim to provide an overview of two common machine learning methods: decision tree and random forest. We focus on these methods because they provide a high degree of interpretability. METHOD We discuss the underlying algorithms of decision tree and random forest methods and present a tutorial for developing prediction models for serious fall injury using data from the Lifestyle Interventions and Independence for Elders (LIFE) study. RESULTS Decision tree is a machine learning method that produces a model resembling a flow chart. Random forest consists of a collection of many decision trees whose results are aggregated. In the tutorial example, we discuss evaluation metrics and interpretation for these models. Illustrated using data from the LIFE study, prediction models for serious fall injury were moderate at best (area under the receiver operating curve of 0.54 for decision tree and 0.66 for random forest). CONCLUSIONS Machine learning methods offer an alternative to traditional approaches for modeling outcomes in aging, but their use should be justified and output should be carefully described. Models should be assessed by clinical experts to ensure compatibility with clinical practice.
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Affiliation(s)
- Jaime Lynn Speiser
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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32
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Handing EP, Rapp SR, Chen SH, Rejeski WJ, Wiberg M, Bandeen-Roche K, Craft S, Kitzman D, Ip EH. Heterogeneity in Association Between Cognitive Function and Gait Speed Among Older Adults: An Integrative Data Analysis Study. J Gerontol A Biol Sci Med Sci 2021; 76:710-715. [PMID: 32841312 PMCID: PMC8011698 DOI: 10.1093/gerona/glaa211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing evidence shows that cognition and gait speed are associated and are important measures of health among older adults. However, previous studies have used different methods to assess these 2 outcomes and lack sufficient sample size to examine heterogeneity among subgroups. This study examined how the relationship between global cognitive function and gait speed are influenced by age, gender, and race utilizing an integrated data analysis approach. METHOD Data on cognition (Montreal Cognitive Assessment [MoCA], Mini-Mental Status Examination [MMSE], and Modified Mini-Mental State Examination [3MSE]) and gait speed (range: 4-400 m) were acquired and harmonized from 25 research studies (n = 2802) of adults aged 50+ from the Wake Forest Older American Independence Center. Multilevel regression models examined the relationship between predicted values of global cognitive function (MoCA) and gait speed (4-m walk), including heterogeneity by age, race, and gender. RESULTS Global cognitive function and gait speed exhibited a consistent positive relationship among whites with increasing age, while this was less consistent for African Americans. That is, there was a low correlation between global cognitive function and gait speed among African Americans aged 50-59, a positive correlation in their 60s and 70s, then a negative correlation thereafter. CONCLUSION Global cognition and gait speed exhibited a curvilinear U-shaped relationship among whites; however, the association becomes inverse in African Americans. More research is needed to understand this racial divergence and could aid in identifying interventions to maintain cognitive and gait abilities across subgroups.
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Affiliation(s)
- Elizabeth P Handing
- Department of Internal Medicine, Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Marie Wiberg
- Department of Statistics, USBE, Umeå University, Sweden
| | | | - Suzanne Craft
- Department of Internal Medicine, Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dalane Kitzman
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward H Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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33
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Fanning J, Brooks AK, Hsieh KL, Kershner K, Furlipa J, Nicklas BJ, Rejeski WJ. Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial. JMIR Res Protoc 2021; 10:e29013. [PMID: 34279241 PMCID: PMC8329761 DOI: 10.2196/29013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults' chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program's scalability and potential efficacy. OBJECTIVE The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. METHODS The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory-based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. RESULTS Recruitment is ongoing as of January 2021. CONCLUSIONS Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/29013.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Amber K Brooks
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - Kyle Kershner
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Joy Furlipa
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | | | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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34
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Slysz JT, Rejeski WJ, Treat-Jacobson D, Bazzano LA, Forman DE, Manini TM, Criqui MH, Tian L, Zhao L, Zhang D, Guralnik JM, Ferrucci L, Kibbe MR, Polonsky TS, Spring B, Sufit R, Leeuwenburgh C, McDermott MM. Sustained physical activity in peripheral artery disease: Associations with disease severity, functional performance, health-related quality of life, and subsequent serious adverse events in the LITE randomized clinical trial. Vasc Med 2021; 26:497-506. [PMID: 33829920 DOI: 10.1177/1358863x21989430] [Citation(s) in RCA: 1] [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] [Indexed: 11/16/2022]
Abstract
This study investigated cross-sectional associations of peripheral artery disease (PAD) severity (defined by the ankle-brachial index (ABI)) and amounts of daily sustained physical activity (PA) (defined as > 100 activity counts per minute lasting 5 consecutive minutes or more). This study also investigated associations of amounts of daily sustained PA with 6-minute walk (6MW) distance and the Short Form-36 physical functioning domain (SF-36 PF) score in cross-sectional analyses and with serious adverse events (SAEs) in longitudinal analyses of people with PAD. PA was measured continuously for 10 days using a tri-axial accelerometer at baseline in 277 participants with PAD randomized to the LITE clinical trial. In regression analyses, each 0.15 lower ABI value was associated with a 5.67% decrease in the number of daily bouts of sustained PA (95% CI: 3.85-6.54; p < 0.001). Every additional bout of sustained PA per day was associated with a 4.56-meter greater 6MW distance (95% CI: 2.67-6.46; p < 0.0001), and a 0.81-point improvement in SF-36 PF score (95% CI: 0.34-1.28; p < 0.001). Participants with values of daily bouts of sustained PA below the median had higher rates of SAEs during follow-up, compared to participants above the median (41% vs 24%; p = 0.002). In conclusion, among participants with PAD, lower ABI values were associated with fewer bouts of daily sustained PA. A greater number of bouts of daily sustained PA were associated with better 6MW performance and SF-36 PF score, and, in longitudinal analyses, lower rates of SAEs. Clinicaltrials.gov ID: NCT02538900.
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Affiliation(s)
- Joshua T Slysz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science and Geriatric Medicine, Wake Forest University, Winston Salem, NC, USA
| | | | - Lydia A Bazzano
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Daniel E Forman
- School of Medicine, University of Pittsburgh, Pittsburg, PA, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, Baltimore, MD, USA
| | - Luigi Ferrucci
- National Institute of Aging, The Intramural Research Program, Baltimore, MD, USA
| | - Melina R Kibbe
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | | | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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35
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McDermott MM, Spring B, Tian L, Treat-Jacobson D, Ferrucci L, Lloyd-Jones D, Zhao L, Polonsky T, Kibbe MR, Bazzano L, Guralnik JM, Forman DE, Rego A, Zhang D, Domanchuk K, Leeuwenburgh C, Sufit R, Smith B, Manini T, Criqui MH, Rejeski WJ. Effect of Low-Intensity vs High-Intensity Home-Based Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease: The LITE Randomized Clinical Trial. JAMA 2021; 325:1266-1276. [PMID: 33821898 PMCID: PMC8025122 DOI: 10.1001/jama.2021.2536] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [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] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Supervised high-intensity walking exercise that induces ischemic leg symptoms is the first-line therapy for people with lower-extremity peripheral artery disease (PAD), but adherence is poor. OBJECTIVE To determine whether low-intensity home-based walking exercise at a comfortable pace significantly improves walking ability in people with PAD vs high-intensity home-based walking exercise that induces ischemic leg symptoms and vs a nonexercise control. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial conducted at 4 US centers and including 305 participants. Enrollment occurred between September 25, 2015, and December 11, 2019; final follow-up was October 7, 2020. INTERVENTIONS Participants with PAD were randomized to low-intensity walking exercise (n = 116), high-intensity walking exercise (n = 124), or nonexercise control (n = 65) for 12 months. Both exercise groups were asked to walk for exercise in an unsupervised setting 5 times per week for up to 50 minutes per session wearing an accelerometer to document exercise intensity and time. The low-intensity group walked at a pace without ischemic leg symptoms. The high-intensity group walked at a pace eliciting moderate to severe ischemic leg symptoms. Accelerometer data were viewable to a coach who telephoned participants weekly for 12 months and helped them adhere to their prescribed exercise. The nonexercise control group received weekly educational telephone calls for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was mean change in 6-minute walk distance at 12 months (minimum clinically important difference, 8-20 m). RESULTS Among 305 randomized patients (mean age, 69.3 [SD, 9.5] years, 146 [47.9%] women, 181 [59.3%] Black patients), 250 (82%) completed 12-month follow-up. The 6-minute walk distance changed from 332.1 m at baseline to 327.5 m at 12-month follow-up in the low-intensity exercise group (within-group mean change, -6.4 m [95% CI, -21.5 to 8.8 m]; P = .34) and from 338.1 m to 371.2 m in the high-intensity exercise group (within-group mean change, 34.5 m [95% CI, 20.1 to 48.9 m]; P < .001) and the mean change for the between-group comparison was -40.9 m (97.5% CI, -61.7 to -20.0 m; P < .001). The 6-minute walk distance changed from 328.1 m at baseline to 317.5 m at 12-month follow-up in the nonexercise control group (within-group mean change, -15.1 m [95% CI, -35.8 to 5.7 m]; P = .10), which was not significantly different from the change in the low-intensity exercise group (between-group mean change, 8.7 m [97.5% CI, -17.0 to 34.4 m]; P = .44). Of 184 serious adverse events, the event rate per participant was 0.64 in the low-intensity group, 0.65 in the high-intensity group, and 0.46 in the nonexercise control group. One serious adverse event in each exercise group was related to study participation. CONCLUSIONS AND RELEVANCE Among patients with PAD, low-intensity home-based exercise was significantly less effective than high-intensity home-based exercise and was not significantly different from the nonexercise control for improving 6-minute walk distance. These results do not support the use of low-intensity home-based walking exercise for improving objectively measured walking performance in patients with PAD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02538900.
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Affiliation(s)
- Mary M. McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, California
| | | | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, Maryland
| | | | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamar Polonsky
- Department of Medicine, Medical School, University of Chicago, Chicago, Illinois
| | - Melina R. Kibbe
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
| | | | - Jack M. Guralnik
- Department of Epidemiology, University of Maryland, College Park
| | | | - Al Rego
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathryn Domanchuk
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brittany Smith
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Beavers DP, Kritchevsky SB, Gill TM, Ambrosius WT, Anton SD, Fielding RA, King AC, Rejeski WJ, Lovato L, McDermott MM, Newman AB, Pahor M, Walkup MP, Tracy RP, Manini TM. Elevated IL-6 and CRP levels are associated with incident self-reported major mobility disability: A pooled analysis of older adults with slow gait speed. J Gerontol A Biol Sci Med Sci 2021; 76:2293-2299. [PMID: 33822946 DOI: 10.1093/gerona/glab093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/08/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Elevated Interleukine-6 (IL-6) and C-reactive protein (CRP) are associated with aging-related reductions in physical function, but little is known about their independent and combined relationships with major mobility disability (MMD), defined as the self-reported inability to walk a quarter-mile. METHODS We estimated the absolute and relative effect of elevated baseline IL-6, CRP, and their combination on self-reported MMD risk among older adults (≥68 years; 59% female) with slow gait speed (<1.0m/s). Participants were MMD-free at baseline. IL-6 and CRP were assessed using a central laboratory. The study combined a cohort of community dwelling high-functioning older adults (Health ABC) with two trials of low-functioning adults at risk of MMD (LIFE-P, LIFE). Analyses utilized Poisson regression for absolute MMD incidence and proportional hazards models for relative risk. RESULTS We found higher MMD risk per unit increase in log IL-6 [HR=1.26 (95% CI 1.13 to 1.41)]. IL-6 meeting pre-determined threshold considered to be high (>2.5 pg/mL) was similarly associated with higher risk of MMD [HR=1.31 (95% CI: 1.12 to 1.54)]. Elevated CRP (CRP >3.0 mg/L) was also associated with increased MMD risk [HR=1.38 (95% CI: 1.10 to 1.74)]. The CRP effect was more pronounced among participants with elevated IL-6 [HR=1.62 (95% CI: 1.12 to 2.33)] compared to lower IL-6 levels [HR=1.19 (95% CI: 0.85 to 1.66)]. CONCLUSIONS High baseline IL-6 and CRP were associated with increased risk of MMD among older adults with slow gait speed. A combined biomarker model suggests CRP was associated with MMD when IL-6 was elevated.
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Affiliation(s)
- Daniel P Beavers
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Thomas M Gill
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Abby C King
- Departments of Epidemiology & Population Health and of Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, California, USA
| | - W Jack Rejeski
- Wake Forest University, Winston-Salem, North California, USA
| | - Laura Lovato
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | | | - Michael P Walkup
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Rejeski JJ, Fanning J, Nicklas BJ, Rejeski WJ. Six-month changes in ghrelin and glucagon-like peptide-1 with weight loss are unrelated to long-term weight regain in obese older adults. Int J Obes (Lond) 2021; 45:888-894. [PMID: 33526855 PMCID: PMC8005376 DOI: 10.1038/s41366-021-00754-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/19/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Weight loss (WL) and subsequent regain are complex physiologic processes, and our understanding of the hormonal changes associated with these processes continues to evolve. We aimed to examine the effects of behavioral WL on 6-month changes in ghrelin and GLP-1 and evaluate the effects of these changes in gut hormones on weight regain among older adults. SUBJECTS AND METHODS One hundred seventy-seven obese (BMI: 33.5 (3.5) kg/m2) older adults (66.9 ± 4.7 years, 71.2% female, 67.6% white) were randomized to WL (WL; n = 68), WL plus aerobic training (n = 79), or WL plus resistance training (n = 75) for 18 months. Ghrelin, GLP-1, power of food scale (PFS), and weight were measured at baseline, 6 months, and 18 months. RESULTS There was no differential treatment effect on change in either gut hormone, however, there was a significant time effect across all groups (p < 0.001), with increases in ghrelin (∆ = +106.77 pg/ml; 95% CI = + 84.82, +128.71) and decreases in GLP-1 (∆ = -4.90 pM; 95% CI = -6.27, -3.51) at 6-month. Ratings on the PFS decreased from baseline to 6-month and there was significant loss of weight from baseline to either 6- or 18-month, ∆ = -7.96 kg; 95% CI = -7.95, -8.78 and ∆ = -7.80 kg; 95% CI = -8.93, -6.65, respectively (p < 0.001). Changes in ghrelin and GLP-1 at 6-month did not predict weight regain from 6- to 18-month. DISCUSSION AND CONCLUSION Among older adults with obesity and cardiometabolic disease, the intensive phase of dietary WL results in increasing levels of ghrelin and decreasing levels of GLP-1 that are unrelated to weight regain a year later. Registered with ClinicalTrials.gov (NCT01547182).
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Affiliation(s)
- Jared J Rejeski
- Department of Internal Medicine, Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Jason Fanning
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Barbara J Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - W Jack Rejeski
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC, USA
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Fanning J, Brooks AK, Ip E, Nicklas BJ, Rejeski WJ, Nesbit B, Ford S. A Mobile Health Behavior Intervention to Reduce Pain and Improve Health in Older Adults With Obesity and Chronic Pain: The MORPH Pilot Trial. Front Digit Health 2020; 2. [PMID: 33817686 PMCID: PMC8018691 DOI: 10.3389/fdgth.2020.598456] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/13/2022] Open
Abstract
Chronic, multisite pain is a common phenomenon in aging and is associated with a host of negative health outcomes. It is a complex and multifaceted condition that may be exacerbated by weight gain and long periods of inactivity. Unfortunately, older adults suffering from chronic pain have unique barriers limiting access to center-based behavior change interventions. The MORPH study first adapted and iteratively refined an evidence-based group-mediated intervention for delivery in the home via mHealth tools (a smartphone app, teleconferencing software, wearable activity monitor, smart weight scale). This was followed by a pilot randomized controlled trial (RCT) meant to assess feasibility of the MORPH intervention, and to examine initial effects on physical function, pain, weight, and sedentary behavior. We recruited low-active and obese older adults with multisite pain to partake in a series of N-of-1 refinement studies (N = 5 total) or a 12-week pilot RCT delivered largely in the home (N = 28 assigned to active intervention or wait-list control). The refinement phase identified several key technological (e.g., selection of a new smart weight scale) and user interface (e.g., clarification of in-app phrasing) modifications that were made before initiating the RCT phase. Analyses of covariance, controlling for baseline values, sex, and age indicated effects favoring the intervention across all domains of interest: there was a substantially clinically meaningful difference in short physical performance battery scores (0.63 points, η2 = 0.08), a moderate-to-large difference in PROMIS pain intensity scores (5.52 points, η2 = 0.12), a large difference in body weight (2.90 kg, η2 = 0.207), and a moderate effect on adjusted ActivPAL-assessed sedentary time (64.90 min, η2 = 0.07) with a small effect on steps (297.7 steps, η2 = 0.01). These results suggest a largely-home delivered movement and weight loss program for older adults with pain is feasible and recommendations are provided for future programs of this nature. Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT03377634.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Amber K Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Barbara J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Beverly Nesbit
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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Burdette JH, Laurienti PJ, Miron LL, Bahrami M, Simpson SL, Nicklas BJ, Fanning J, Rejeski WJ. Functional Brain Networks: Unique Patterns with Hedonic Appetite and Confidence to Resist Eating in Older Adults with Obesity. Obesity (Silver Spring) 2020; 28:2379-2388. [PMID: 33135364 PMCID: PMC7686067 DOI: 10.1002/oby.23004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether baseline measures of hedonic hunger-the Power of Food Scale-and self-control for food consumption-the Weight Efficacy Lifestyle Questionnaire-were associated with network topology within two sets of brain regions (regions of interest [ROIs] 1 and 2) in a group of older adults with obesity. These previously identified brain regions were shown in a different cohort of older adults to be critical for discriminating weight loss success and failure. METHODS Baseline functional magnetic resonance imaging data (resting state and food cue task) were collected in a novel cohort of 67 older adults with obesity (65-85 years, BMI = 35-42 kg/m2 ) participating in an 18-month randomized clinical trial on weight regain. RESULTS The Power of Food Scale was most related to ROI 1, which includes the visual cortex and sensorimotor processing areas during only the food cue state. During both the food cue and resting conditions, the Weight Efficacy Lifestyle Questionnaire was associated with ROI 2, which includes areas of the attention network and limbic circuitry. CONCLUSIONS Our findings show critical, distinct links between brain network topology with self-reported measures that capture hedonic hunger and the confidence that older adults have in resisting the consumption of food because of both intrapersonal and social/environmental cues.
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Affiliation(s)
- Jonathan H. Burdette
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of RadiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Paul J. Laurienti
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of RadiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Laura L. Miron
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of RadiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Mohsen Bahrami
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Biomedical EngineeringVirginia Tech‐Wake Forest School of Biomedical Engineering and SciencesWinston‐SalemNorth CarolinaUSA
| | - Sean L. Simpson
- Laboratory for Complex Brain NetworksWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Barbara J. Nicklas
- Section on Geriatric MedicineDepartment of Internal MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jason Fanning
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - W. Jack Rejeski
- Section on Geriatric MedicineDepartment of Internal MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
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Callahan KE, Willard J, Foley KL, Miller ME, Houston DK, Kritchevsky SB, Williamson JD, Applegate WB, Girma F, Whitehead SE, Rejeski WJ. Promoting Active Aging: Lessons Learned in an Implementation Pilot in Primary Care. J Am Geriatr Soc 2020; 69:373-380. [PMID: 33006763 DOI: 10.1111/jgs.16838] [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: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/28/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Physical activity (PA) preserves mobility, but few practices screen older adults for mobility impairment or counsel on PA. DESIGN "Promoting Active Aging" (PAA) was a mixed-methods randomized-controlled pilot, to test the feasibility and acceptability of a video-based PA counseling tool and implementation into practice of two mobility assessment tools. SETTING Three primary care practices affiliated with Wake Forest Baptist Health. PARTICIPANTS Adults aged 65 years and older who presented for primary care follow-up and were willing and able to answer self-report questions and walk 4 meters (n = 59). INTERVENTION Video-based PA counseling intervention versus control video, "Healthy Eating." MEASUREMENTS Potential participants completed mobility assessments: self-report (Mobility Assessment Tool-short form (MAT-sf)) and performance based (4-meter walk test). We assessed PAA's implementation-feasibility, acceptability, and value-via interviews and surveys. Effectiveness was measured via participant attendance at a PA information session. RESULTS Of 92 patients approached, 89 (96.7%) agreed to mobility assessment. Eighty-nine completed MAT-sf, and 97.8% (87/89) completed 4-meter walk test. Sixty-seven (75%) met eligibility criteria, and 59 (88%) consented to be randomized either to the PA counseling intervention (Video-PA) or to active control (Video-C). Most participants viewed the walk test positively (51/59; 86.4%). Staff reported that completion of patient surveys, MAT-sf, and videos required significant staff time and support (median = 26 minutes for all), resulting in low acceptability of MAT-sf and the videos. Attendance at a PA information session did not differ by randomization group (Video-PA = 11/29 (37.9%); Video-C = 12/30 (40%); 95% confidence interval for difference in proportion = -0.29 to 0.25). CONCLUSIONS Mobility assessment, particularly a 4-meter walk test, was feasible in primary care. Tablet-based assessment (MAT-sf) and video counseling tools, selected to reduce staff effort, instead required significant time to implement. Future work to promote PA should identify effective ways to facilitate adoption of PA in sedentary older adults that do not burden staff.
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Affiliation(s)
- Kathryn E Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Willard
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristie L Foley
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Wake Forest School of Medicine, Wake Forest Translational Science Institute, Winston-Salem, North Carolina.,Cancer Prevention and Control Program, Wake Forest Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Michael E Miller
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Denise K Houston
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Wake Forest School of Medicine, Wake Forest Translational Science Institute, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William B Applegate
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Feben Girma
- Department of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sarah E Whitehead
- Paris View Family Practice, Bon Secours St. Francis Health System, Greenville, South Carolina
| | - W Jack Rejeski
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.,Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
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Beavers KM, Neiberg RH, Kritchevsky SB, Nicklas BJ, Kitzman DW, Messier SP, Rejeski WJ, Ard JD, Beavers DP. Association of Sex or Race With the Effect of Weight Loss on Physical Function: A Secondary Analysis of 8 Randomized Clinical Trials. JAMA Netw Open 2020; 3:e2014631. [PMID: 32821924 PMCID: PMC7442923 DOI: 10.1001/jamanetworkopen.2020.14631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Consideration of differential treatment effects among subgroups in clinical trial research is a topic of increasing interest. This is an especially salient issue for weight loss trials. OBJECTIVE To determine whether stratification by sex and race is associated with meaningful differences in physical function response to weight loss among older adults. DESIGN, SETTING, AND PARTICIPANTS This pooled analysis used individual-level data from 8 completed randomized clinical trials of weight loss conducted at Wake Forest University or Wake Forest School of Medicine, Winston-Salem, North Carolina. Data were housed within the Wake Forest Older Americans Independence Center data repository and provided complete exposure, outcome, and covariate information. Data were collected from November 1996 to March 30, 2017, and analyzed from August 15, 2019, to June 10, 2020. EXPOSURES Treatment arms within each study were collapsed into caloric restriction (CR [n = 734]) and non-CR (n = 583) categories based on whether caloric restriction was specified in the original study protocol. MAIN OUTCOMES AND MEASURES Objectively measured 6-month change in weight, fast-paced gait speed (meters per second), and Short Physical Performance Battery (SPPB) score. RESULTS A total of 1317 adults (mean [SD] age, 67.7 [5.4] years; 920 [69.9%] female; 275 [20.9%] Black) with overweight or obesity (mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 33.9 [4.4]) were included at baseline. Six-month weight change achieved among those randomized to CR was -7.7% (95% CI, -8.3% to -7.2%), with no difference noted by sex; however, White individuals lost more weight than Black individuals assigned to CR (-9.0% [95% CI, -9.6% to -8.4%] vs -6.0% [95% CI, -6.9% to 5.2%]; P < .001), and all CR groups lost a significantly greater amount from baseline compared with non-CR groups (Black participants in CR vs non-CR groups, -5.3% [95% CI, -6.4% to -4.1%; P < .001]; White participants in CR vs non-CR groups, -7.2% [95% CI, -7.8% to -6.6%; P < .001]). Women experienced greater weight loss-associated improvement in SPPB score (CR group, 0.35 [95% CI, 0.18-0.52]; non-CR group, 0.08 [95% CI, -0.11 to 0.27]) compared with men (CR group, 0.23 [95% CI, 0.00-0.46]; non-CR group, 0.34 [95% CI, 0.09-0.58]; P = .03). Black participants experienced greater weight loss-associated improvement in gait speed (CR group, 0.08 [95% CI, 0.05-0.10] m/s; non-CR group, 0.02 [95% CI, -0.01 to 0.05] m/s) compared with White participants (CR group, 0.07 [95% CI, 0.06-0.09] m/s; non-CR group, 0.06 [95% CI, 0.04-0.08] m/s; P = .02). CONCLUSIONS AND RELEVANCE The association of weight loss on physical function in older adults appears to differ by sex and race. These findings affirm the need to consider biological variables in clinical trial design.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Rebecca H. Neiberg
- Department of Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B. Kritchevsky
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara J. Nicklas
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dalane W. Kitzman
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel P. Beavers
- Department of Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Fanning J, Rejeski WJ, Chen SH, Nicklas BJ, Walkup MP, Axtell RS, Fielding RA, Glynn NW, King AC, Manini TM, McDermott MM, Newman AB, Pahor M, Tudor-Locke C, Miller ME. A Case for Promoting Movement Medicine: Preventing Disability in the LIFE Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2020; 74:1821-1827. [PMID: 30778518 DOI: 10.1093/gerona/glz050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/04/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The movement profile of older adults with compromised function is unknown, as is the relationship between these profiles and the development of major mobility disability (MMD)-a critical clinical outcome. We first describe the dimensions of movement in older adults with compromised function and then examine whether these dimensions predict the onset of MMD. METHODS Older adults at risk for MMD (N = 1,022, mean age = 78.7 years) were randomized to receive a structured physical activity intervention or health education control. We assessed MMD in 6-month intervals (average follow-up of 2.2 years until incident MMD), with activity assessed at baseline, 6-, 12- and 24-month follow-up via accelerometry. RESULTS A principal components analysis of 11 accelerometer-derived metrics yielded three components representing lifestyle movement (LM), extended bouts of moderate-to-vigorous physical activity (MVPA), and stationary body posture. LM accounted for the greatest proportion of variance in movement (53%). Within health education, both baseline LM (HR = 0.74; 95% CI 0.62 to 0.88) and moderate-to-vigorous physical activity (HR = 0.69; 95% CI 0.54 to 0.87) were associated with MMD, whereas only LM was associated with MMD within physical activity (HR = 0.74; 95% CI 0.61 to 0.89). There were similar nonlinear relationships present for LM in both physical activity and health education (p < .04), whereby risk for MMD was lower among individuals with higher levels of LM. CONCLUSIONS Both LM and moderate-to-vigorous physical activity should be central in treatment regimens for older adults at risk for MMD. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT01072500.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.,Department of internal medicine, section on gerontology and geriatric medicine, Winston-Salem, North Carolina
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara J Nicklas
- Department of internal medicine, section on gerontology and geriatric medicine, Winston-Salem, North Carolina
| | - Michael P Walkup
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert S Axtell
- Department of Exercise Science, Southern Connecticut State University, New Haven
| | - Roger A Fielding
- Jean Mayer USDA Human Nutrition Research Center on Aging, Nutrition, Exercise Physiology and Sarcopenia Laboratory, Tufts University, Boston, Massachusetts
| | - Nancy W Glynn
- Department of epidemiology, University of Pittsburgh, Pennsylvania
| | - Abby C King
- Department of Health Research and Policy and Stanford Prevention Research Center, Palo Alto, California
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Mary M McDermott
- Devision of General Internal medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne B Newman
- Department Epidemiology and Medicine, University of Pittsburgh, Pennsylvania
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Catrine Tudor-Locke
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Sanford JA, Nogiec CD, Lindholm ME, Adkins JN, Amar D, Dasari S, Drugan JK, Fernández FM, Radom-Aizik S, Schenk S, Snyder MP, Tracy RP, Vanderboom P, Trappe S, Walsh MJ, Adkins JN, Amar D, Dasari S, Drugan JK, Evans CR, Fernandez FM, Li Y, Lindholm ME, Nogiec CD, Radom-Aizik S, Sanford JA, Schenk S, Snyder MP, Tomlinson L, Tracy RP, Trappe S, Vanderboom P, Walsh MJ, Lee Alekel D, Bekirov I, Boyce AT, Boyington J, Fleg JL, Joseph LJ, Laughlin MR, Maruvada P, Morris SA, McGowan JA, Nierras C, Pai V, Peterson C, Ramos E, Roary MC, Williams JP, Xia A, Cornell E, Rooney J, Miller ME, Ambrosius WT, Rushing S, Stowe CL, Jack Rejeski W, Nicklas BJ, Pahor M, Lu CJ, Trappe T, Chambers T, Raue U, Lester B, Bergman BC, Bessesen DH, Jankowski CM, Kohrt WM, Melanson EL, Moreau KL, Schauer IE, Schwartz RS, Kraus WE, Slentz CA, Huffman KM, Johnson JL, Willis LH, Kelly L, Houmard JA, Dubis G, Broskey N, Goodpaster BH, Sparks LM, Coen PM, Cooper DM, Haddad F, Rankinen T, Ravussin E, Johannsen N, Harris M, Jakicic JM, Newman AB, Forman DD, Kershaw E, Rogers RJ, Nindl BC, Page LC, Stefanovic-Racic M, Barr SL, Rasmussen BB, Moro T, Paddon-Jones D, Volpi E, Spratt H, Musi N, Espinoza S, Patel D, Serra M, Gelfond J, Burns A, Bamman MM, Buford TW, Cutter GR, Bodine SC, Esser K, Farrar RP, Goodyear LJ, Hirshman MF, Albertson BG, Qian WJ, Piehowski P, Gritsenko MA, Monore ME, Petyuk VA, McDermott JE, Hansen JN, Hutchison C, Moore S, Gaul DA, Clish CB, Avila-Pacheco J, Dennis C, Kellis M, Carr S, Jean-Beltran PM, Keshishian H, Mani D, Clauser K, Krug K, Mundorff C, Pearce C, Ivanova AA, Ortlund EA, Maner-Smith K, Uppal K, Zhang T, Sealfon SC, Zaslavsky E, Nair V, Li S, Jain N, Ge Y, Sun Y, Nudelman G, Ruf-zamojski F, Smith G, Pincas N, Rubenstein A, Anne Amper M, Seenarine N, Lappalainen T, Lanza IR, Sreekumaran Nair K, Klaus K, Montgomery SB, Smith KS, Gay NR, Zhao B, Hung CJ, Zebarjadi N, Balliu B, Fresard L, Burant CF, Li JZ, Kachman M, Soni T, Raskind AB, Gerszten R, Robbins J, Ilkayeva O, Muehlbauer MJ, Newgard CB, Ashley EA, Wheeler MT, Jimenez-Morales D, Raja A, Dalton KP, Zhen J, Suk Kim Y, Christle JW, Marwaha S, Chin ET, Hershman SG, Hastie T, Tibshirani R, Rivas MA. Molecular Transducers of Physical Activity Consortium (MoTrPAC): Mapping the Dynamic Responses to Exercise. Cell 2020; 181:1464-1474. [DOI: 10.1016/j.cell.2020.06.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 12/31/2022]
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Chao AM, Wadden TA, Berkowitz RI, Blackburn G, Bolin P, Clark JM, Coday M, Curtis JM, Delahanty LM, Dutton GR, Evans M, Ewing LJ, Foreyt JP, Gay LJ, Gregg EW, Hazuda HP, Hill JO, Horton ES, Houston DK, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Kure A, Michalski KL, Montez MG, Neiberg RH, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Redmon B, Rejeski WJ, Steinburg H, Walker M, Williamson DA, Wing RR, Wyatt H, Yanovski SZ, Zhang P. Weight Change 2 Years After Termination of the Intensive Lifestyle Intervention in the Look AHEAD Study. Obesity (Silver Spring) 2020; 28:893-901. [PMID: 32320144 PMCID: PMC7437140 DOI: 10.1002/oby.22769] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study evaluated weight changes after cessation of the 10-year intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. It was hypothesized that ILI participants would be more likely to gain weight during the 2-year observational period following termination of weight-loss-maintenance counseling than would participants in the diabetes support and education (DSE) control group. METHODS Look AHEAD was a randomized controlled trial that compared the effects of ILI and DSE on cardiovascular morbidity and mortality in participants with overweight/obesity and type 2 diabetes. Look AHEAD was converted to an observational study in September 2012. RESULTS Two years after the end of the intervention (EOI), ILI and DSE participants lost a mean (SE) of 1.2 (0.2) kg and 1.8 (0.2) kg, respectively (P = 0.003). In addition, 31% of ILI and 23.9% of DSE participants gained ≥ 2% (P < 0.001) of EOI weight, whereas 36.3% and 45.9% of the respective groups lost ≥ 2% of EOI weight (P = 0.001). Two years after the EOI, ILI participants reported greater use of weight-control behaviors than DSE participants. CONCLUSIONS Both groups lost weight during the 2-year follow-up period, but more ILI than DSE participants gained ≥ 2% of EOI weight. Further understanding is needed of factors that affected long-term weight change in both groups.
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Affiliation(s)
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert I Berkowitz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Blackburn
- Division of Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Paula Bolin
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mace Coday
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeffrey M Curtis
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Linda M Delahanty
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mary Evans
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Linda J Ewing
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Linda J Gay
- Department of Psychiatry, The Miriam Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helen P Hazuda
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - James O Hill
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward S Horton
- Department of Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Denise K Houston
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - John M Jakicic
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W Jeffery
- Divisions of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Karen C Johnson
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | - William C Knowler
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Anne Kure
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | - Katherine L Michalski
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria G Montez
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Rebecca H Neiberg
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jennifer Patricio
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Columbia University, New York, New York, USA
| | - Anne Peters
- Division of Endocrinology, University of Southern California, Los Angeles, California, USA
| | - Xavier Pi-Sunyer
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Columbia University, New York, New York, USA
| | - Henry Pownall
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David Reboussin
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Bruce Redmon
- Divisions of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Jack Rejeski
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Helmut Steinburg
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Martha Walker
- Division of Endocrinology, University of Southern California, Los Angeles, California, USA
| | | | - Rena R Wing
- Department of Psychiatry, The Miriam Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Holly Wyatt
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fanning J, Rejeski WJ, Chen SH, Guralnik J, Pahor M, Miller ME. Relationships Between Profiles of Physical Activity and Major Mobility Disability in the LIFE Study. J Am Geriatr Soc 2020; 68:1476-1483. [PMID: 32196636 DOI: 10.1111/jgs.16386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/07/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the relationship between time spent in light physical activity (LPA) and in moderate to vigorous physical activity (MVPA) and the pattern of accumulation on the risk for major mobility disability (MMD) in a large multicenter study of physical activity (PA) and aging, the Lifestyle Interventions and Independence for Elders (LIFE) study. DESIGN Data were collected from individuals randomized to a PA intervention as part of the LIFE study, an eight-center single-blind randomized clinical trial conducted between February 2010 and December 2013. SETTING Lifestyle Interventions and Independence for Elders Study PARTICIPANTS: Older adult participants (78.4 years; N = 507) at risk for MMD. INTERVENTION All older adults included in these analyses were randomized to a structured PA intervention that included two center-based plus three to four home-based exercise sessions per week with a primary goal of walking for 150 minutes weekly. Participants attended the intervention for 2.5 years on average. MEASUREMENTS MMD was defined as the inability to complete a 400-m walk within 15 minutes and without assistance. Physical function was assessed via the Short Physical Performance Battery (SPPB). Actigraph accelerometers were used to quantify amount and variability in LPA and MVPA. RESULTS In an adjusted Cox proportional hazards regression, we identified a significant interaction (P = .017) between SPPB score and LPA amount and variability such that more LPA was associated with a reduced risk for MMD among those with higher initial function, as was lower variability (eg, via distributing LPA across the day). The SPPB × MVPA interaction was significant (P = .04), such that more MVPA was associated with lower MMD risk among those with lower function. Finally, greater MVPA variability was associated with lower risk for MMD. CONCLUSION A prescription of PA for older adults should account for key factors such as physical function and emphasize both amount and pattern of accumulation of PA from across the intensity continuum. J Am Geriatr Soc 68:1476-1483, 2020.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - W Jack Rejeski
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Shyh-Huei Chen
- Department of Biostatistical and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Michael E Miller
- Department of Biostatistical and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Withall J, Greaves CJ, Thompson JL, de Koning JL, Bollen JC, Moorlock SJ, Fox KR, Western MJ, Snowsill T, Medina-Lara A, Cross R, Ladlow P, Taylor G, Zisi V, Clynes J, Gray S, Agyapong-Badu S, Guralnik JM, Rejeski WJ, Stathi A. The Tribulations of Trials: Lessons Learnt Recruiting 777 Older Adults Into REtirement in ACTion (REACT), a Trial of a Community, Group-Based Active Aging Intervention Targeting Mobility Disability. J Gerontol A Biol Sci Med Sci 2020; 75:2387-2395. [PMID: 32147709 PMCID: PMC7662171 DOI: 10.1093/gerona/glaa051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 10/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Challenges of recruitment to randomized controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a United Kingdom-based multicenter RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and behavior maintenance program or to a minimal Healthy Aging control intervention. METHODS The recruitment target was 768 adults, aged 65 years and older scoring 4-9 on the Short Physical Performance Battery (SPPB). Recruitment methods include the following: (a) invitations mailed by general practitioners (GPs); (b) invitations distributed via third-sector organizations; and (c) public relations (PR) campaign. Yields, efficiency, and costs were calculated. RESULTS The study recruited 777 (33.9% men) community-dwelling, older adults (mean age 77.55 years (SD 6.79), mean SPPB score 7.37 (SD 1.56)), 95.11% white (n = 739) and broadly representative of UK quintiles of deprivation. Over a 20-month recruitment period, 25,559 invitations were issued. Eighty-eight percent of the participants were recruited via GP invitations, 5.4% via the PR campaign, 3% via word-of-mouth, and 2.5% via third-sector organizations. Mean recruitment cost per participant was £78.47, with an extra £26.54 per recruit paid to GPs to cover research costs. CONCLUSIONS REACT successfully recruited to target. Response rates were lower than initially predicted and recruitment timescales required adjustment. Written invitations from GPs were the most efficient method for recruiting older adults at risk of mobility disability. Targeted efforts could achieve more ethnically diverse cohorts. All trials should be required to provide recruitment data to enable evidence-based planning of future trials.
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Affiliation(s)
- Janet Withall
- Department for Health, University of Bath, UK,Address correspondence to: Janet Withall, PhD, Department for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK. E-mail:
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK
| | | | - Tristan Snowsill
- Institute of Health Research, College of Medicine and Health, South Cloisters, University of Exeter, St Luke’s Campus, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, UK
| | - Vasiliki Zisi
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Selena Gray
- Faculty of Health and Applied Sciences (HAS), University of the West of England (UWE Bristol), Frenchay Campus, Bristol, UK
| | - Sandra Agyapong-Badu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
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Lucas AR, Bitting RL, Fanning J, Isom S, Rejeski WJ, Klepin HD, Kritchevsky SB. Trajectories in muscular strength and physical function among men with and without prostate cancer in the health aging and body composition study. PLoS One 2020; 15:e0228773. [PMID: 32053654 PMCID: PMC7017990 DOI: 10.1371/journal.pone.0228773] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/22/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives To examine and compare changes in strength and physical function from pre- to post-diagnosis among men with prostate cancer (PC, [cases]) and matched non-cancer controls identified from the Health, Aging and Body Composition (Health ABC) study. Materials and methods We conducted a longitudinal analysis of 2 strength and 3 physical function-based measures among both cases and controls, identified from a large cohort of community living older adults enrolled in the Health ABC study. We plotted trajectories for each measure and compared cases vs. controls from the point of diagnosis onwards using mixed-effects regression models. For cases only, we examined predictors of poor strength or physical function. Results We identified 117 PC cases and 453 matched non-cancer controls (50% African Americans). At baseline, there were no differences between cases and controls in demographic factors, comorbidities or self-reported physical function; however, cases had slightly better grip strength (44.6 kg vs. 41.0 kg, p<0.01), quadriceps strength (360.5 Nm vs. 338.7 Nm, p = 0.02) and Health ABC physical performance battery scores (2.4 vs. 2.3, p = 0.01). All men experienced similar declines in strength and physical function over an equivalent amount of time. The loss of quad strength was most notable, with losses of nearly two-thirds of baseline strength over approximately 7 years of follow up. Conclusions Among both cases and controls, strength and physical function decline with increasing age. The largest declines were seen in lower body strength. Regular assessments should guide lifestyle interventions that can offset age- and treatment-related declines among men with PC.
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Affiliation(s)
- Alexander R. Lucas
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Richmond, Virginia, United States of America
- * E-mail:
| | - Rhonda L. Bitting
- Department of Internal Medicine, Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
| | - Jason Fanning
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - W. Jack Rejeski
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Heidi D. Klepin
- Department of Internal Medicine, Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
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Vaughan EM, Johnston CA, Moreno JP, Cheskin LJ, Dutton GR, Gee M, Gaussoin SA, Knowler WC, Rejeski WJ, Wadden TA, Yanovski SZ, Foreyt JP. Symptom prevalence differences of depression as measured by BDI and PHQ scales in the Look AHEAD study. Obes Sci Pract 2020; 6:28-38. [PMID: 32128240 PMCID: PMC7042097 DOI: 10.1002/osp4.378] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare depressive symptomatology as assessed by two frequently used measures, the Beck Depression Inventory (BDI-1A) and Patient Health Questionnaire (PHQ-9). METHODS Investigators conducted a cross-sectional secondary analysis of data collected as part of the follow-up observational phase of the Look AHEAD study. Rates of agreement between the BDI-1A and PHQ-9 were calculated, and multivariable logistic regression was used to examine the relationship between differing depression category classifications and demographic factors (ie, age, sex, race/ethnicity) or comorbidities (ie, diabetes control, cardiovascular disease). RESULTS A high level of agreement (κ = 0.47, 95% CI (0.43 to 0.50)) was found in the level of depressive symptomatology between the BDI-1A and PHQ-9. Differing classifications (minimal, mild, moderate, and severe) occurred in 16.8% of the sample. Higher scores on the somatic subscale of the BDI-1A were significantly associated with disagreement as were having a history of cardiovascular disease, lower health-related quality of life, and minority racial/ethnic classification. CONCLUSIONS Either the BDI-1A or PHQ-9 can be used to assess depressive symptomatology in adults with overweight/obesity and type 2 diabetes. However, further assessment should be considered in those with related somatic symptoms, decreased quality of life, and in racial/ethnic minority populations.
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Affiliation(s)
| | - Craig A. Johnston
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexas
| | - Jennette P. Moreno
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics‐NutritionBaylor College of MedicineHoustonTexas
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, College of Health and Human ServicesGeorge Mason UniversityFairfaxVirginia
- Department of Health, Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Gareth R. Dutton
- Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Molly Gee
- Department of MedicineBaylor College of MedicineHoustonTexas
| | - Sarah A. Gaussoin
- Department of Biostatistical Sciences and Data Science, Division of Public Health ServicesWake Forest School of MedicineWinston‐SalemNorth Carolina
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of HealthPhoenixArizona
| | - W. Jack Rejeski
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNorth Carolina
| | - Thomas A. Wadden
- Department of PsychiatryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvania
| | - Susan Z. Yanovski
- Division of Digestive Diseases and NutritionNational Institute of Diabetes and Digestive and Kidney DiseasesBethesdaMaryland
| | - John P. Foreyt
- Department of MedicineBaylor College of MedicineHoustonTexas
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Glynn NW, Gmelin T, Santanasto AJ, Lovato LC, Lange-Maia BS, Nicklas BJ, Fielding RA, Manini TM, Myers VH, de Rekeneire N, Spring BJ, Pahor M, King AC, Rejeski WJ, Newman AB. Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability. J Am Geriatr Soc 2019; 68:619-624. [PMID: 31867713 DOI: 10.1111/jgs.16274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/24/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study. DESIGN Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years. SETTING LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD. PARTICIPANTS Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment. MEASUREMENTS Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual-paced 400-m walk every 6 months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates. RESULTS Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD = .71; 95% confidence interval [CI] = .57-.90; P = .004) and PMMD (HR = .60; 95% CI = .44-.82; P = .001). For those with lower baseline fatigue, no group differences in MMD (P = .36) or PMMD (P = .82) were found. Results of baseline fatigue by intervention interaction was MMD (P = .18) and PMMD (P = .05). CONCLUSION A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue. J Am Geriatr Soc 68:619-624, 2020.
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Affiliation(s)
- Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J Santanasto
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura C Lovato
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Brittney S Lange-Maia
- Department of Preventive Medicine and Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Barbara J Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roger A Fielding
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Todd M Manini
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | | | | | - Bonnie J Spring
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Marco Pahor
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Abby C King
- Department of Health Research & Policy, and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Anne B Newman
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Rejeski WJ, Marsh AP, Fanning J, Ambrosius WT, Walkup MP, Nicklas BJ. Dietary Weight Loss, Exercise, and Inflammation in Older Adults with Overweight or Obesity and Cardiometabolic Disease. Obesity (Silver Spring) 2019; 27:1805-1811. [PMID: 31689007 PMCID: PMC6941888 DOI: 10.1002/oby.22600] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/01/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study aimed to examine exercise modality during weight loss on change in inflammation among older adults with overweight or obesity and cardiometabolic disease. METHODS A total of 222 older adults with a mean (SD) age of 66.9 (4.7) years and a mean (SD) BMI of 33.5 (3.5) kg/m2 were randomized to weight loss (WL; n = 68), WL plus aerobic training (WL + AT; n = 79), or WL plus resistance training (WL + RT; n = 75) for 18 months. C-reactive protein (CRP) and interleukin-6 were measured at baseline, 6 months, and 18 months. RESULTS All groups lost significant weight from baseline to 18 months, with average adjusted changes of -5.5% for WL, -9.0% for WL + AT, and -10.1% for WL + RT. WL + RT and WL + AT lost significantly more weight than WL (P < 0.05). At 18 months, CRP values in WL + RT were significantly lower than WL (2.25 pg/mL vs. 3.38 pg/mL; P = 0.004). The only difference in interleukin-6 was that at 18 months, WL + RT was lower than WL + AT (2.32 pg/mL vs. 2.75 pg/mL; P = 0.03). CONCLUSIONS The addition of RT during WL was more effective at reducing levels of CRP than WL. Although results were in the expected direction, there was no difference in CRP between WL and WL + AT.
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Affiliation(s)
- W. Jack Rejeski
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Anthony P. Marsh
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Jason Fanning
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Walter T. Ambrosius
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michel P. Walkup
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Barbara J. Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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