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Morey M, Pepin MJ, Pearson MP, M Manning K, Applewhite J, Jennings SC. OPIOID, MENTAL HEALTH, CARDIAC, DIABETES AND LIPID MEDICATION USE REDUCED AFTER 1-YEAR IN GEROFIT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Morey
- Duke and VA Medical Centers, Durham, North Carolina,United States
| | - M J Pepin
- Durham VA Healthcare System, Durham, NC, USA
| | - M P Pearson
- Durham VA Healthcare System/ GRECC, Durham, NC, USA
| | - K M Manning
- Durham VA Healthcare System/ GRECC, Durham, NC, USA
| | - J Applewhite
- Durham VA Healthcare System/ GRECC, Durham, NC, USA
| | - S C Jennings
- Durham VA Healthcare System/ GRECC, Durham, NC, USA
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Cowper PA, Peterson MJ, Pieper CF, Sloane RJ, Hall KS, McConnell ES, Bosworth HB, Ekelund CC, Pearson MP, Morey MC. Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial. J Am Geriatr Soc 2017; 65:533-539. [PMID: 28152170 PMCID: PMC5357188 DOI: 10.1111/jgs.14567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/27/2022]
Abstract
OBJECTIVES To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans. DESIGN Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost. SETTING Veterans Affairs Medical Center, Durham, North Carolina. PARTICIPANTS Male veterans aged ≥70 years (n = 398). INTERVENTION An experienced health counselor provided baseline in-person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly. MEASUREMENTS Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated. RESULTS The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention, versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed. CONCLUSION Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.
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Affiliation(s)
- Patricia A Cowper
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Matthew J Peterson
- Departments of Community Health and Geriatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Carl F Pieper
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Richard J Sloane
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Katherine S Hall
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Eleanor S McConnell
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Hayden B Bosworth
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
- Health Services Research and Development Service, VA Medical Center, Durham, NC
| | - Carola C Ekelund
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Megan P Pearson
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Miriam C Morey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
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Povsic TJ, Sloane R, Pieper CF, Pearson MP, Peterson ED, Cohen HJ, Morey MC. Endothelial Progenitor Cell Levels Predict Future Physical Function: An Exploratory Analysis From the VA Enhanced Fitness Study. J Gerontol A Biol Sci Med Sci 2015; 71:362-9. [PMID: 26511012 DOI: 10.1093/gerona/glv180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 09/24/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Levels of circulating progenitor cells (CPCs) are depleted with aging and chronic injury and are associated with level of physical functioning; however, little is known about the correlation of CPCs with longer-term measures of physical capabilities. We sought to determine the association of CPCs with future levels of physical function and with changes in physical function over time. METHODS CPCs were measured in 117 participants with impaired glucose tolerance in the Enhanced Fitness clinical trial based on the cell surface markers CD34 and CD133 and aldehyde dehydrogenase (ALDH) activity at baseline, 3 months, and 12 months. Physical function was assessed using usual and rapid gait speed, 6-minute walk distance, chair stand time, and SF-36 physical functioning score and reassessed at 3 and 12 months after clinical intervention. RESULTS Higher baseline levels of CD133(+), CD34(+), CD133(+)CD34(+), and ALDH(br) were each highly predictive of faster gait speed and longer distance walked in 6 minutes at both 3 and 12 months. These associations remained robust after adjustment for age, body mass index, baseline covariates, and inflammation and were independent of interventions to improve physical fitness. Further, higher CPC levels predicted greater improvements in usual and rapid gait speed over 1 year. CONCLUSIONS Baseline CPC levels are associated not only with baseline mobility but also with future physical function, including changes in gait speed. These findings suggest that CPC measurement may be useful as a marker of both current and future physiologic aging and functional decline.
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Affiliation(s)
| | - Richard Sloane
- Claude D. Pepper Older Americans Independence Center, and Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Carl F Pieper
- Claude D. Pepper Older Americans Independence Center, and Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Megan P Pearson
- Geriatric Research, Education, and Clinical Center and Center for Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | - Harvey J Cohen
- Department of Medicine, Claude D. Pepper Older Americans Independence Center, and Geriatric Research, Education, and Clinical Center and
| | - Miriam C Morey
- Department of Medicine, Claude D. Pepper Older Americans Independence Center, and Geriatric Research, Education, and Clinical Center and Center for Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina
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Price ARG, Jaoui K, Pearson MP, Jeudy de Grissac A. An alert system for triggering different levels of coastal management urgency: Tunisia case study using rapid environmental assessment data. Mar Pollut Bull 2014; 80:88-96. [PMID: 24512758 DOI: 10.1016/j.marpolbul.2014.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
Rapid environmental assessment (REA) involves scoring abundances of ecosystems/species groups and magnitude of pressures, concurrently, using the same logarithmic (0-6) assessment scale. We demonstrate the utility of REA data for an alert system identifying different levels of coastal management concern. Thresholds set for abundances/magnitudes, when crossed, trigger proposed responses. Kerkennah, Tunisia, our case study, has significant natural assets (e.g. exceptional seagrass and invertebrate abundances), subjected to varying levels of disturbance and management concern. Using REA thresholds set, fishing, green algae/eutrophication and oil occurred at 'low' levels (scores 0-1): management not (currently) necessary. Construction and wood litter prevailed at 'moderate' levels (scores 2-4): management alerted for (further) monitoring. Solid waste densities were 'high' (scores 5-6): management alerted for action; quantities of rubbish were substantial (20-200 items m⁻¹ beach) but not unprecedented. REA is considered a robust methodology and complementary to other rapid assessment techniques, environmental frameworks and indicators of ecosystem condition.
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Affiliation(s)
- A R G Price
- Environment Department, University of York, York YO10 5DD, UK; School of Life Sciences University of Warwick, Coventry CV4 7AL, UK.
| | - K Jaoui
- Azimut, Bureau d'études en Environement & SIG (Géomatique), Montplaisir, Tunisia
| | - M P Pearson
- Brasilia 750 Dept. 242 Las Condes, Santiago, Chile
| | - A Jeudy de Grissac
- IUCN Centre for Mediterranean Cooperation, C/Marine Curie 22, 29590 Campanillas, Malaga, Spain
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Povsic TJ, Sloane R, Green JB, Zhou J, Pieper CF, Pearson MP, Peterson ED, Cohen HJ, Morey MC. Depletion of circulating progenitor cells precedes overt diabetes: a substudy from the VA enhanced fitness trial. J Diabetes Complications 2013; 27:633-6. [PMID: 24055327 PMCID: PMC3874717 DOI: 10.1016/j.jdiacomp.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND One theory of aging and disease development is that chronic injury (pathology) results in activation of regenerative processes and initial repair, with overt disease arising only after exhaustion of reparative capability leads to inadequate repair. While depletion of circulating progenitor cells (CPCs) has been noted in diabetes, the degree to which CPC depletion predates and is associated with propensity to develop overt disease is unclear. METHODS The Enhanced Fitness trial enrolled overweight/obese (body mass index >25) sedentary patients with glucose intolerance but without overt diabetes. Baseline CPCs were measured in 129 patients based on the cell surface markers CD34, CD133, and aldehyde dehydrogenase (ALDH) activity. HgbA1C, fasting insulin and glucose levels, and HOMA calculations were ascertained. RESULTS Lower counts of early angiogenic CPCs identified as CD34(+), CD34(+)CD133(+), and ALDH-bright (ALDH(br)) cells were associated with impairments in glucose homeostasis as reflected by HgbA1C, but not fasting insulin, glucose, or HOMA-IR. These associations remained when corrected for age and cardiovascular risk factors. CONCLUSIONS/INTERPRETATION The numbers of CD34(+) and ALDH(br) CPCs were significantly lower in patients with impaired glucose tolerance. Depletion of reparative capacity as reflected by loss of CPCs may presage overt disease as exemplified in this pre-diabetes model.
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Affiliation(s)
- Thomas J Povsic
- Duke Clinical Research Institute, Duke University Health Care System, Durham, NC, USA; Department of Medicine, Duke University Health Care System, Durham, NC, USA; Claude D. Pepper OAIC, Duke University Health Care System, Durham, NC, USA.
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Povsic TJ, Sloane R, Zhou J, Pieper CF, Pearson MP, Peterson ED, Green JB, Cohen HJ, Morey MC. Lower levels of circulating progenitor cells are associated with low physical function and performance in elderly men with impaired glucose tolerance: a pilot substudy from the VA Enhanced Fitness trial. J Gerontol A Biol Sci Med Sci 2013; 68:1559-66. [PMID: 23682163 DOI: 10.1093/gerona/glt067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 11/13/2022] Open
Abstract
BACKGROUND Aging is marked by a decline in physical function. Although the biological underpinnings for this remain unclear, loss of regenerative capacity has been proposed as one cause of the loss of physical function that occurs over time. The quantity of circulating progenitor cells (CPCs) may be one reflection of regenerative capability. We sought to determine whether certain specific CPC subpopulations were associated with physical function. METHODS Baseline CPCs were measured in 129 randomized participants in the Enhanced Fitness clinical trial based on the cell surface markers CD34, CD133, CD146, and CD14 and aldehyde dehydrogenase (ALDH) activity. Physical function was assessed using usual and rapid gait speed, 6-minute walk distance, chair stand time, and balance time. RESULTS Low counts of early angiogenic CPCs identified as CD34(+), CD34(+)CD133(+), and ALDH-bright (ALDH(br)) cells were associated with low usual gait speed (p < .005, p < .001, and p < .007), rapid gait speed (p < .001, p < .003, and p < .001), and 6-minute walking distance (all comparisons p < .001), and longer time required to complete five chair stands (p < .006, p < .002, and p < .004). CPC counts of mature endothelial or monocytic markers were not associated with physical function. CONCLUSIONS The numbers of CD34(+) and ALDH(br) CPCs are significantly lower in patients with impaired physical function. Further studies are needed to determine the underlying causes for this association.
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Affiliation(s)
- Thomas J Povsic
- Box 103208, Duke University Medical Center, Durham, NC 27708.
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Morey MC, Pieper CF, Edelman DE, Yancy WS, Green JB, Lum H, Peterson MJ, Sloane R, Cowper PA, Bosworth HB, Huffman KM, Cavanaugh JT, Hall KS, Pearson MP, Taylor GA. Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus. J Am Geriatr Soc 2012; 60:1655-62. [PMID: 22985140 DOI: 10.1111/j.1532-5415.2012.04119.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine whether a home-based multicomponent physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus. DESIGN Controlled clinical trial. SETTING Primary care clinics of the Durham Veterans Affairs (VA) Medical Center between September 29, 2008, and March 25, 2010. PARTICIPANTS Three hundred two overweight (body mass index 25-45 kg/m(2) ), older (60-89) outpatients with impaired glucose tolerance (fasting blood glucose 100-125 mg/dL, glycosylated hemoglobin (HbA1c) <7%) randomly assigned to a PAC intervention group (n = 180) or a usual care control group (n = 122). INTERVENTION A 12-month, home-based multicomponent PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and customized mailed materials. All study participants, including controls, received a consultation in a VA weight management program. MEASUREMENTS The primary outcome was a homeostasis model assessment of insulin resistance (HOMA-IR), calculated from fasting insulin and glucose levels at baseline and 3 and 12 months. HbA1c was the secondary indicator of glycemic control. Other secondary outcomes were anthropometric measures and self-reported physical activity, health-related quality of life, and physical function. RESULTS There were no significant differences between the PAC and control groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose (P < .001), and other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in the PAC group (P < .001) and not in the usual care group. CONCLUSION Home-based telephone counseling increased physical activity levels but was insufficient to improve glycemic indicators in older outpatients with prediabetes mellitus.
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Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina 27705, USA.
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Hall KS, Pieper CF, Edelman DE, Yancy WS, Green JB, Lum H, Peterson MJ, Sloane R, Cowper PA, Bosworth HB, Huffman KM, PhD JTC, Chapman JG, Pearson MP, Howard TA, Ekelund CC, McCraw BL, Burrell JB, Taylor GA, Morey MC. Lessons learned when innovations go awry: a baseline description of a behavioral trial-the Enhancing Fitness in Older Overweight Veterans with Impaired Fasting Glucose study. Transl Behav Med 2011; 1:573-587. [PMID: 22866170 PMCID: PMC3411119 DOI: 10.1007/s13142-011-0075-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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] [Indexed: 01/29/2023] Open
Abstract
Individuals diagnosed with impaired glucose tolerance (i.e., prediabetes) are at increased risk for developing diabetes. We proposed a clinical trial with a novel adaptive randomization designed to examine the impact of a home-based physical activity (PA) counseling intervention on metabolic risk in prediabetic elders. This manuscript details the lessons learned relative to recruitment, study design, and implementation of a 12-month randomized controlled PA counseling trial. A detailed discussion on how we responded to unforeseen challenges is provided. A total of 302 older patients with prediabetes were randomly assigned to either PA counseling or usual care. A novel adaptive design that reallocated counseling intensity based on self-report of adherence to PA was initiated but revised when rates of non-response were lower than projected. This study presents baseline participant characteristics and discusses unwelcome adaptations to a highly innovative study design to increase PA and enhance glucose metabolism when the best-laid plans went awry.
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Affiliation(s)
| | | | - David E Edelman
- />Veterans Affairs Medical Center, Durham, NC USA
- />Department of Medicine, Duke University, Durham, NC USA
| | - William S Yancy
- />Veterans Affairs Medical Center, Durham, NC USA
- />Department of Medicine, Duke University, Durham, NC USA
| | - Jennifer B. Green
- />Veterans Affairs Medical Center, Durham, NC USA
- />Department of Medicine, Duke University, Durham, NC USA
- />Clinical Research Institute, Duke University, Durham, NC USA
| | - Helen Lum
- />Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX USA
| | - Matthew J Peterson
- />Veterans Affairs Medical Center, Durham, NC USA
- />Department of Medicine, Duke University, Durham, NC USA
- />Aging Center, Duke University, Durham, NC UK
| | - Richard Sloane
- />Veterans Affairs Medical Center, Durham, NC USA
- />Aging Center, Duke University, Durham, NC UK
| | | | - Hayden B Bosworth
- />Veterans Affairs Medical Center, Durham, NC USA
- />Department of Medicine, Duke University, Durham, NC USA
- />Aging Center, Duke University, Durham, NC UK
| | - Kim M Huffman
- />Veterans Affairs Medical Center, Durham, NC USA
- />Department of Medicine, Duke University, Durham, NC USA
| | | | | | - Megan P Pearson
- />Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, NC USA
- />Center for Health Services Research and Development, Veterans Affairs Medical Center, Durham, NC USA
| | - Teresa A Howard
- />Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, NC USA
- />Center for Health Services Research and Development, Veterans Affairs Medical Center, Durham, NC USA
| | - Carola C Ekelund
- />Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, NC USA
- />Center for Health Services Research and Development, Veterans Affairs Medical Center, Durham, NC USA
| | | | | | - Gregory A Taylor
- />Veterans Affairs Medical Center, Durham, NC USA
- />Department of Medicine, Duke University, Durham, NC USA
- />Aging Center, Duke University, Durham, NC UK
- />Department of Genetics and Microbiology, Duke University, Durham, NC USA
| | - Miriam C Morey
- />Department of Medicine, Duke University, Durham, NC USA
- />Aging Center, Duke University, Durham, NC UK
- />Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, NC USA
- />Center for Health Services Research and Development, Veterans Affairs Medical Center, Durham, NC USA
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Morey MC, Peterson MJ, Pieper CF, Sloane R, Crowley GM, Cowper PA, McConnell ES, Bosworth HB, Ekelund CC, Pearson MP. The Veterans Learning to Improve Fitness and Function in Elders Study: a randomized trial of primary care-based physical activity counseling for older men. J Am Geriatr Soc 2009; 57:1166-74. [PMID: 19467149 DOI: 10.1111/j.1532-5415.2009.02301.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the effects of primary care-based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans. DESIGN Randomized controlled trial. SETTING Veterans Affairs Medical Center of Durham, North Carolina. PARTICIPANTS Three hundred ninety-eight male veterans aged 70 and older. INTERVENTION Twelve months of usual care (UC) or multicomponent PAC consisting of baseline in-person and every other week and then monthly telephone counseling by a lifestyle counselor, one-time clinical endorsement of PA, monthly automated telephone messaging from the primary care provider, and quarterly tailored mailings of progress in PA. MEASUREMENTS Gait speed (usual and rapid), self-reported PA, function, and disability at baseline and 3, 6, and 12 months. RESULTS Although no between-group differences were noted for usual gait speed, rapid gait speed improved significantly more for the PAC group (1.56 +/- 0.41 m/s to 1.68 +/- 0.44 m/s) than with UC (1.57 +/- 0.40 m/sec to 1.59 +/- 0.42 m/sec, P=.04). Minutes of moderate/vigorous PA increased significantly in the PAC group (from 57.1 +/- 99.3 to 126.6 +/- 142.9 min/wk) but not in the UC group (from 60.2 +/- 116.1 to 69.6 +/- 116.1 min/wk, P<.001). Changes in other functional/disability outcomes were small. CONCLUSION In this group of older male veterans, multicomponent PA significantly improved rapid gait and PA. Translation from increased PA to overall functioning was not observed. Integration with primary care was successful.
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Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA.
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Morey MC, Sloane R, Pieper CF, Peterson MJ, Pearson MP, Ekelund CC, Crowley GM, Demark-Wahnefried W, Snyder DC, Clipp EC, Cohen HJ. Effect of physical activity guidelines on physical function in older adults. J Am Geriatr Soc 2008; 56:1873-8. [PMID: 18800990 DOI: 10.1111/j.1532-5415.2008.01937.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa. DESIGN Pooled data. SETTING Two 6-month randomized controlled trials aimed at increasing PA in adults. PARTICIPANTS Adults aged 65 to 94 (N=357). INTERVENTION PA counseling over the telephone and through mailed materials. MEASUREMENTS Self-reported PA dichotomized at 150 minutes/week and PF using the Medical Outcomes Study 36-item Short Form Questionnaire PF subscale. RESULTS At baseline, individuals reporting 150 minutes or more of moderate PA/week had mean PF scores that were 20.3 points higher than those who did not (P<.001). Change in PA minutes from above threshold to below threshold or from below threshold to above threshold from baseline to 6 months resulted in an average change in PF of -11.18 (P<.001) and +5.10 (P=.05), respectively. CONCLUSION These findings suggest that PA is an important predictor of functional status. Older sedentary adults can improve PF by meeting recommended PA levels. Conversely, dropping below recommended PA levels has a deleterious effect on PF. Given the importance of PF in maintenance of independence and quality of life in older adults, adherence to recommended PA guidelines should be endorsed.
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Affiliation(s)
- Miriam C Morey
- Durham Veterans Affairs Medical Center/Geriatric Research, Durham, North Carolina 27705, USA.
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Morey MC, Sloane R, Pieper CF, Peterson MJ, Pearson MP, Ekelund CC, Crowley GM, Demark-Wahnefried W, Snyder DC, Clipp EC, Cohen HJ. Does Meeting The Surgeon General Guidelines For Physical Activity Confer A Functional Benefit To Elders? Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000274660.16022.4f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Morey MC, Sloane R, Ekelund CC, Pearson MP, Crowley GM, Peterson MJ, Pieper CF, McConnell E, Bosworth HB, Chapman J. Impact Of Intercurrent Illness On Functional Outcomes In A Clinical Trial To Improve Elder Fitness. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-01747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pearson MP, Ekelund CC, Sloane R, Peterson MJ, Crowley GM, Pieper CF, McConnell E, Bosworth HB, Morey MC. Recruitment of Frail Veterans into Exercise Clinical Trial. Med Sci Sports Exerc 2004. [DOI: 10.1249/00005768-200405001-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- O Craig
- Fossil Fuels and Environmental Geochemistry, NRG, University of Newcastle-upon-Tyne, UK.
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Pearson MP, Stevens ED. Size and hematological impact of the splenic erythrocyte reservoir in rainbow trout,Oncorhynchus mykiss. Fish Physiol Biochem 1991; 9:39-50. [PMID: 24214608 DOI: 10.1007/bf01987610] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/1990] [Indexed: 06/02/2023]
Abstract
Fish were sampled individually, at rest, following air exposures of up to 8 min, during recovery from a 5 min air exposure or after a 5 minute chase. The spleen was photographedin vivo at rest and following 5 min air exposure in one fish. The effect of individual versus serial sampling from the same tank and of MS222 anaesthesia was also examined. Spleen hemoglobin content (SpHb), spleen somatic index (100 × spleen weight/body weight; SSI), blood hemoglobin concentration (Hb), and hematocrit (Ht), were measured. Mean cell hemoglobin concentration (MCHC), erythrocyte reservoir size, and relative contributions of reservoir release, erythrocyte swelling, and plasma water loss to hemoconcentration were calculated. The splenic reservoir contained 0.54 g Hb/kg body (21% of total body Hb), most of which it released between 1 and 3 minutes after the onset of air exposure. The spleen released more than 95% of the erythrocytes it contained at rest within 8 min. The release accounted for 31% of the 5.65 g/dl rise in Hb and 23% of the 26.6% observed increase in Ht after 8 minutes of air exposure. The balance of the increase was caused by erythrocyte swelling and fluid shifts reducing plasma volume. Animals exercised for 5 min showed changes similar to those in fish air exposed for 5 min. Recovery of all parameters was complete in 3 to 6 h, with the exception of MCHC which recovered in 30 min. Serial sampling produced a decrease in SpHb, and R1Wt and induced a significant hemoconcentration. MS222 did not cause erythrocyte release, but failed to prevent it after handling. Many previous reports of Ht and Hb in resting fish are probably high because they were taken under conditions that would cause the spleen to release its contents.
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Affiliation(s)
- M P Pearson
- Department of Zoology and Group for the Advancement of Fish Studies, University of Guelph, N1G 2W1, Guelph, Ontario, Canada
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Woodley JD, Chornesky EA, Clifford PA, Jackson JB, Kaufman LS, Knowlton N, Lang JC, Pearson MP, Porter JW, Rooney MC, Rylaarsdam KW, Tunnicliffe VJ, Wahle CM, Wulff JL, Curtis AS, Dallmeyer MD, Jupp BP, Koehl MA, Neigel J, Sides EM. Hurricane Allen's Impact on Jamaican Coral Reefs. Science 1981; 214:749-55. [PMID: 17744383 DOI: 10.1126/science.214.4522.749] [Citation(s) in RCA: 431] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Coral reefs of north Jamaica, normally sheltered, were severely damaged by Hurricane Allen, the strongest Caribbean hurricane of this century. Immediate studies were made at Discovery Bay, where reef populations were already known in some detail. Data are presented to show how damage varied with the position and orientation of the substraturn and with the shape, size, and mechanical properties of exposed organisms. Data collected over succeeding weeks showed striking differences in the ability of organisms to heal and survive.
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