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Lifestyle risk behaviours among adolescents: a two-year longitudinal study of the impact of the COVID-19 pandemic.
Gardner, LA, Debenham, J, Newton, NC, Chapman, C, Wylie, FE, Osman, B, Teesson, M, Champion, KE
BMJ open. 2022;12(6):e060309
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The global spread of COVID-19 and subsequent lockdown measures have presented challenges worldwide. Previous research has highlighted the importance of six key lifestyle behaviours, including diet, physical activity, sleep, sedentary behaviour (including recreational screen time), alcohol use and smoking—collectively referred to as the ‘Big 6’—for the short-term and long-term health of adolescents. The aim of this study was to examine changes in the prevalence of six key chronic disease risk factors from before to during the COVID-19 pandemic, and also to explore whether differences over time are associated with gender and lockdown status. This study is a prospective cohort study among a large and geographically diverse sample of adolescents. The sample included 983 students (girls = 54.8%) from 22 schools. Results show that: - over the 2-year period, the prevalence of excessive recreational screen time, insufficient fruit intake and alcohol and tobacco use increased. - alcohol use increased more among girls compared to boys. - the prevalence of insufficient sleep reduced in the overall sample; yet, increased among girls. - being in lockdown was associated with improvements in sugar-sweetened beverages consumption and discretionary food intake. Authors conclude that supporting young people to improve or maintain their health behaviours, regardless of the course of the pandemic, is important, alongside targeted research and intervention efforts to support groups that may be disproportionately impacted, such as adolescent girls.
Abstract
OBJECTIVE To examine changes in the prevalence of six key chronic disease risk factors (the "Big 6"), from before (2019) to during (2021) the COVID-19 pandemic, among a large and geographically diverse sample of adolescents, and whether differences over time are associated with lockdown status and gender. DESIGN Prospective cohort study. SETTING Three Australian states (New South Wales, Queensland and Western Australia) spanning over 3000 km. PARTICIPANTS 983 adolescents (baseline Mage=12.6, SD=0.5, 54.8% girl) drawn from the control group of the Health4Life Study. PRIMARY OUTCOMES The prevalence of physical inactivity, poor diet (insufficient fruit and vegetable intake, high sugar-sweetened beverage intake, high discretionary food intake), poor sleep, excessive recreational screen time, alcohol use and tobacco use. RESULTS The prevalence of excessive recreational screen time (prevalence ratios (PR)=1.06, 95% CI=1.03 to 1.11), insufficient fruit intake (PR=1.50, 95% CI=1.26 to 1.79), and alcohol (PR=4.34, 95% CI=2.82 to 6.67) and tobacco use (PR=4.05 95% CI=1.86 to 8.84) increased over the 2-year period, with alcohol use increasing more among girls (PR=2.34, 95% CI=1.19 to 4.62). The prevalence of insufficient sleep declined across the full sample (PR=0.74, 95% CI=0.68 to 0.81); however, increased among girls (PR=1.24, 95% CI=1.10 to 1.41). The prevalence of high sugar-sweetened beverage (PR=0.61, 95% CI=0.64 to 0.83) and discretionary food consumption (PR=0.73, 95% CI=0.64 to 0.83) reduced among those subjected to stay-at-home orders, compared with those not in lockdown. CONCLUSION Lifestyle risk behaviours, particularly excessive recreational screen time, poor diet, physical inactivity and poor sleep, are prevalent among adolescents. Young people must be supported to find ways to improve or maintain their health, regardless of the course of the pandemic. Targeted approaches to support groups that may be disproportionately impacted, such as adolescent girls, are needed. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619000431123).
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The Dose-Effects of Caffeine on Lower Body Maximal Strength, Muscular Endurance, and Rating of Perceived Exertion in Strength-Trained Females.
Jones, L, Johnstone, I, Day, C, Le Marquer, S, Hulton, AT
Nutrients. 2021;13(10)
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Caffeine is a common ingredient in tea, coffee, chocolate, soft drinks and multi-ingredient pre-workout supplements. It is believed to elicit an ergogenic effect that enhances athletic performance. However, only very few studies have examined the effect of caffeine on women who take contraceptive pills. The aim of this double-blind, randomised, counterbalanced, crossover trial was to investigate the ergogenic effect of pre-exercise caffeine supplementation on strength performance and muscular endurance in strength-trained females taking contraceptives. Fourteen women were randomised to consume doses of 3 and 6 mg·kg−1 body mass of caffeine supplement or placebo thirty minutes prior to the exercise. Caffeine supplementation at 3 and 6 mg·kg−1 body mass significantly improved muscular endurance and total strength. No significant difference was observed between the higher and lower doses of caffeine in improving performance, indicating that the lower dose can potentially provide the same benefit without the adverse effect of the higher dose. The low dose had a similar caffeine content to that of a large coffee latte from a coffee shop, suggesting beneficial effects could be achieved through coffee/latte consumption. Caution should be applied when extrapolating the findings for eumenorrheic females with different training statuses. Healthcare practitioners can, however, use the results of this study to understand the potential benefits of caffeine for strength-trained women using hormone contraception.
Abstract
Caffeine supplementation has shown to be an effective ergogenic aid enhancing athletic performance, although limited research within female populations exists. Therefore, the aim of the investigation was to assess the effect of pre-exercise caffeine supplementation on strength performance and muscular endurance in strength-trained females. In a double-blind, randomised, counterbalanced design, fourteen strength-trained females using hormonal contraception consumed either 3 or 6 mg·kg-1 BM of caffeine or placebo (PLA). Following supplementation, participants performed a one-repetition maximum (1RM) leg press and repetitions to failure (RF) at 60% of their 1RM. During the RF test, rating of perceived exertion (RPE) was recorded every five repetitions and total volume (TV) lifted was calculated. Repeated measures ANOVA revealed that RF (p = 0.010) and TV (p = 0.012) attained significance, with pairwise comparisons indicating a significant difference between 3 mg·kg-1 BM and placebo for RF (p = 0.014), with an effect size of 0.56, and for 6 mg·kg-1 BM (p = 0.036) compared to the placebo, with an effect size of 0.65. No further significance was observed for 1RM or for RPE, and no difference was observed between caffeine trials. Although no impact on lower body muscular strength was observed, doses of 3 and 6 mg·kg-1 BM of caffeine improved lower body muscular endurance in resistance-trained females, which may have a practical application for enhancing resistance training stimuli and improving competitive performance.
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Longitudinal Weight Gain and Related Risk Behaviors during the COVID-19 Pandemic in Adults in the US.
Bhutani, S, vanDellen, MR, Cooper, JA
Nutrients. 2021;13(2)
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The Covid-19 pandemic has altered health behaviours of many individuals resulting in weight gain. This cross-sectional study of 1779 individuals aimed to determine the long-term impact of Covid-19 on health behaviours and weight gain over 5 months. The results showed that most participants (40%) body weight increased alongside increased processed food intake and snacking. 33% of the individuals who gained weight continued to gain weight and 28% maintained their higher weight after lockdown measures were lifted. Take-away meals, processed food intake and stress levels remained high post-lockdown in those who gained weight. It was concluded that lockdown measures may have impacted daily life resulting in weight gain which may perpetuate long-term. This study could be used by healthcare professionals to understand that lockdown measures may have altered eating behaviours resulting in weight gain and that these may need to be uncovered to aid long-term weight loss.
Abstract
Cross-sectional analyses have shown increased obesogenic behaviors and a potential for weight gain during COVID-19 related peak-lockdown (March-May 2020), but longitudinal data are lacking. This study assessed longitudinal changes in body weight and lifestyle behaviors in the US adults during the pandemic. METHODS We used Qualtrics survey to collect self-reported data on body weight, dietary, physical activity, and psychological variables (n = 727) during the peak-lockdown (April/May) and at post-lockdown (September/October). Peak-lockdown weight data were categorized based on the magnitude of weight gained, maintained, or lost, and behavioral differences were examined between categories at two time points. RESULTS Body weight increased (+0.62 kg; p < 0.05) at the post-lockdown period. The body mass index also increased (26.38 ± 5.98 kg/m2 vs. 26.12 ± 5.81 kg/m2; p < 0.01) at the post-lockdown period vs. peak-lockdown period. Close to 40% of participants reported gaining either 1-4 lbs or >5 lbs of body weight during the peak-lockdown, while 18.2% lost weight. Weight-gainers engaged in riskier dietary behaviors such as frequent ultra-processed food intake (p < 0.01) and snacking (p < 0.001), were less active, and reported high stress and less craving control during peak-lockdown. Of those gaining >5 lbs, 33% continued to gain weight after the lockdown eased, while 28% maintain higher body weight. In weight-gainers, takeout meal frequency increased, and high ultra-processed food intake and stress, and low craving control continued to persist after the lockdown eased. CONCLUSION We show that the COVID-19 lockdown periods disrupted weight management among many Americans and that associated health effects are likely to persist.
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An exercise-based educational and motivational intervention after surgery can improve behaviors, physical fitness and quality of life in bariatric patients.
Gallé, F, Marte, G, Cirella, A, Di Dio, M, Miele, A, Ricchiuti, R, Liguori, F, Maida, P, Liguori, G
PloS one. 2020;15(10):e0241336
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Bariatric surgery is currently the most effective method of weight loss for individuals with obesity. However sustained weight loss after surgery can be hindered by unhealthy behaviours that have sustained since before the procedure. Motivational, educational, diet and exercise programmes have been shown to help sustain weight loss following surgery. This non-randomised control trial over 12 months, aimed to assess the effects of a motivational, educational diet and exercise programme on fitness and quality of life in 82 individuals following bariatric surgery. The results showed that a diet and exercise programme improved quality of life and fitness. There was an increased daily intake of fruits and vegetables, eating behaviours were improved and there was a greater weight loss in those following the programme. It was concluded that the diet and exercise programme was responsible for behavioural changes that ensured better quality of life and sustained weight loss following surgery. Health care professionals could use this study to understand the need to recommend motivational and educationally based diet and exercise programme to patients following bariatric surgery.
Abstract
INTRODUCTION Unhealthy lifestyles may hinder bariatric surgery outcomes. This non-randomized controlled study aimed to evaluate the effects of an integrated post-operative exercise-based educational and motivational program in improving behaviors, quality of life, anthropometric features, cardiorespiratory and physical fitness in bariatric patients respect to the only surgical intervention. METHODS A group of adult sedentary bariatric patients chose to attend a 12-month exercise program integrated with diet education and motivational support, or to receive usual care. Dietary habits, binge eating disorder, physical activity, obesity-related quality of life, Body Mass Index, waist and hip circumference, VO2max, strength and flexibility were assessed at the start and at the end of the study in both groups. RESULTS On a total of 82 patients enrolled, follow-up measures were obtained from 28 (85.7% females, mean age 38.2±8.7) and 42 (71.4% females, mean age 40.2±9.5) patients included in the intervention and control group, respectively. All the behavioral and physical outcomes improved significantly in the participants to the intervention, while the control group showed lesser changes, especially regarding quality of life and physical fitness. CONCLUSIONS Notwithstanding the self-selection, these results suggest that a timely postoperative behavioral multidisciplinary program for bariatric patients may be effective in establishing healthy behaviors which can lead to better surgery outcomes.
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One- and Two-Year Effects of the Healthy Primary School of the Future on Children's Dietary and Physical Activity Behaviours: A Quasi-Experimental Study.
Bartelink, NHM, van Assema, P, Kremers, SPJ, Savelberg, HHCM, Oosterhoff, M, Willeboordse, M, van Schayck, OCP, Winkens, B, Jansen, MWJ
Nutrients. 2019;11(3)
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Diet and Physical Activity (PA) habits are formed at a young age, and unhealthy habits can lead to childhood obesity and lifelong health problems. Schools are globally recognised as having access to children across all socio-economic backgrounds and to play an important role in influencing healthy habits. This Dutch experimental longitudinal study looks at the impact Primary schools can have on the health of their students by implementing a dedicated Nutrition and PA Program called ‘Healthy Primary Schools for the Future (HPSF), modelled on an American initiative, piloted in 4 schools and 2 control schools. The study tests whether a fully implemented program (focused on Nutrition and PA - including free lunches & daily PA sessions) or a partial program (focused only on PA sessions) influences healthy change in children’s behaviours versus control schools (no program). The data from 1676 children aged 4-12 yrs was used and the study took place over 3 yrs (2015-2017) with a commitment to continue till 2019 where follow-up data could be obtained. The data was collected once a year using parental and child questionnaires. Additional movement data was obtained from accelerometers the children wore for 7 days during each annual measurement week. The results at year 3 show that a combined nutrition and PA program had greatest benefits on improving diet (variety of foods eaten), and reducing unhealthy snacking, and increasing PA. Neither the partial program or control schools displayed positive changes. The researchers reflect that the full program allowed greater involvement from all parties involved (schools, parents, children’s, educational and health partners) which led to changes becoming an integral part of the school routine. Focusing on nutrition and PA together seemed to encourage complementary behavioural changes compared to focusing only on PA.
Abstract
Schools can help to improve children's health. The 'Healthy Primary School of the Future' (HPSF) aims to sustainably integrate health and well-being into the school system. This study examined the effects of HPSF on children's dietary and physical activity (PA) behaviours after 1 and 2 years' follow-up. The study (n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA) and two partial HPSF (focus: PA), and four control schools. Accelerometers and child- and parent-reported questionnaires were used at baseline, after 1 (T1) and 2 (T2) years. Mixed-model analyses showed significant favourable effects for the full HPSF versus control schools for, among others, school water consumption (effect size (ES) = 1.03 (T1), 1.14 (T2)), lunch intake of vegetables (odds ratio (OR) = 3.17 (T1), 4.39 (T2)) and dairy products (OR = 4.43 (T1), 4.52 (T2)), sedentary time (ES = -0.23 (T2)) and light PA (ES = 0.22 (T2)). Almost no significant favourable effects were found for partial HPSF compared to control schools. We conclude that the full HPSF is effective in promoting children's health behaviours at T1 and T2 compared with control schools. Focusing on both nutrition and PA components seems to be more effective in promoting healthy behaviours than focusing exclusively on PA.
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Health Effects of 12 Weeks of Team-Sport Training and Fitness Training in a Community Health Centre for Sedentary Men with Lifestyle Diseases.
Møller, TK, Nielsen, TT, Andersen, R, Lundager, I, Hansen, HF, Ottesen, L, Krustrup, P, Randers, MB
BioMed research international. 2018;2018:1571807
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Physical activity helps to prevent and manage chronic disease, particularly in the aging population. Existing research shows physical activity programmes improve physical capacity and body composition, however participants report difficulty maintaining their training habits once the intervention is finished. The aim of this study was to produce a pragmatic, real-life setup to compare the health effects of team-sport activities with traditional fitness training among men with lifestyle disease in the community health centre context. This study took place over two years. During the first year, 32 men participated in the traditional fitness training to obtain baseline effects. For the second year, all training sessions were replaced with team-sport training and 36 men participated. This study found that team-sport activities produced comparable effects on various health parameters to the traditional fitness-training programme. Based on these results, the authors conclude that team sport activities are a worthy alternative to fitness training in community health centres.
Abstract
This study compares the effects of team-sport training, for sedentary men with lifestyle diseases, with fitness training in a pragmatic set-up in a community health centre (CHC). Thirty-two men in the fitness group (FiG) and 36 men in the team-sport group (TsG) completed the training and trained for 60-90 min, two times/week for 12-16 weeks. In FiG and TsG, mean heart rate (HR) during training was 73.2% and 74.5% of HRmax, respectively. Percentage of training time above 90%HRmax was 6 ± 9% and 10 ± 15% and the percentage of participants who spent > 10% of total training time with HR > 90%HRmax was 20% and 41%, in FiG and TsG, respectively. In FiG, total fat mass was reduced by 3.5% (P < 0.01), while performance in the 6 min walking test (6MWT) increased by 11% (P < 0.001). In TsG, total fat mass was reduced by 2.2% (P < 0.01), while 6MWT performance improved by 5% (P < 0.05). Between-group differences were observed for systolic BP (P = 0.041) and mean arterial pressure (P = 0.050) in favour of TsG and for sit-to-stand test (P = 0.031) in favour of FiG. In conclusion, small-sided team sport is a worthy alternative to fitness training since the overall health effects are comparable, for example, improved balance and reduced fat mass. Team sport elicits high heart rates and improves cardiovascular health by reducing blood pressure, while fitness training improves sit-to-stand test performance related to activity of daily living.
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Effects of Products Containing Bacillus subtilis var. natto on Healthy Subjects with Neck and Shoulder Stiffness, a Double-Blind, Placebo-Controlled, Randomized Crossover Study.
Sunagawa, Y, Okamura, N, Miyazaki, Y, Shimizu, K, Genpei, M, Funamoto, M, Shimizu, S, Katanasaka, Y, Morimoto, E, Yamakage, H, et al
Biological & pharmaceutical bulletin. 2018;41(4):504-509
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Neck and shoulder stiffness and pain are common complaints, and causative factors include muscle tension and reduced blood flow around the neck and shoulders. NKCP® is as a food supplement that contains bacillopeptidase F, a protease (enzyme) that is isolated and purified from the culture of the probiotic bacterium B. subtilis var. natto, which is used to ferment soy beans to natto, a traditional Japanese food. Various health benefits have been attributed to natto, and NKCP® has been shown to have blood thinning properties. This double-blind, placebo controlled crossover study aimed to evaluate the effects of NKCP® on healthy individuals with neck and shoulder stiffness and pain. Subjects received either NKCP® or placebo for 4 weeks, then had a 4 week washout period where they received neither test supplement, and then received the other test supplement for another 4 weeks. Shoulder and neck symptoms were assessed prior to starting the trial, and at 4, 8 and 12 weeks, through subjective reporting and a muscle hardness meter to measure muscle stiffness. Neck and shoulder stiffness and pain were improved after taking NKCP® but not significantly more than in the placebo group. Headaches improved significantly more in the NKCP® group compared to the placebo group. No significant changes were observed for lower back pain, cold hands and feet, eyestrain, and dry eye.
Abstract
Neck and shoulder stiffness is a typical subjective symptom in developed countries. This stiffness is caused by factors such as muscle tension and poor blood flow, leading to reduce work efficiency and diminish QOL. NKCP®, a natto-derived dietary food supplement whose main component is bacillopeptidase F, has antithrombotic, fibrinolytic, and blood viscosity-lowering effects. Here, we investigated the effect of NKCP® on neck and shoulder stiffness in a double-blind placebo-controlled randomized crossover study. Thirty subjects with neck and shoulder stiffness were randomly divided into 2 groups and ingested 250 mg of NKCP® or placebo daily for 4 weeks. Headache score significantly improved in the NKCP® group compared to the placebo group. Moreover, NKCP® significantly improved the score of visual analogue scale for neck and shoulder stiffness and pain, reduced muscle stiffness of the neck, and increased the skin surface temperature of neck and shoulders, compared to before ingestion. No adverse effects were observed during this study. These results suggest that NKCP® may alleviate headaches and chronic neck and shoulder stiffness and pain.
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Effective nationwide school-based participatory extramural program on adolescent body mass index, health knowledge and behaviors.
Heo, M, Jimenez, CC, Lim, J, Isasi, CR, Blank, AE, Lounsbury, DW, Fredericks, L, Bouchard, M, Faith, MS, Wylie-Rosett, J
BMC pediatrics. 2018;18(1):7
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Adolescent obesity is a major public health concern that affects health status not only during adolescence but also during adulthood. The aim of this study was to test whether the HealthCorps program would improve weight status represented by body mass index (BMI; kg/m2) z-score and obesity class. A secondary aim was to identify knowledge and health behaviour domains that would be increased with the program. The study design was a two parallel arm quasi-experimental pre-post comparison design. A total of 2279 students from 62 schools participated in the HealthCorps program. Results indicate that HealthCorps program participation resulted in BMI z-score improvement among overweight/obese female students. Participation also resulted in increased knowledge in most domains regardless of sex and improved a few behaviour domains. However, it did not improve weight status among male students. Authors conclude that the HealthCorps was effective for BMI z-score improvements among female students in addition to significant positive effects on knowledge and a few behaviors in both sexes.
Abstract
BACKGROUND Adolescent obesity is a major public health concern. Open to all high school students regardless of weight status, HealthCorps is a nationwide program offering a comprehensive high school-based participatory educational program to indirectly address obesity. We tested a hypothesis that the HealthCorps program would decrease BMI z-scores among overweight or obese students, and reduce obesity rates, and evaluated its effects on health knowledge and behaviors. METHODS HealthCorps aimed to improve student knowledge and behaviors regarding nutrition quality, physical activity, sleep, breakfast intake, and mental resilience. Participating students received through HealthCorps coordinators weekly or bi-weekly classroom lessons either for a semester or a year in addition to various during- and after-school health-promoting activities and mentorship. Self-reported height and weight were collected along with questionnaires assessing knowledge and behaviors during 2013-2014 academic year among 14 HealthCorps-participating New York City high schools. This quasi experimental two-arm pre-post trial included 611 HealthCorps and 221 comparison arm students for the analytic sample. Sex-specific analyses stratified by weight status were adjusted for age and Hispanic ethnicity with clustering effects of schools and students taken into account. RESULTS HealthCorps female overweight/obese and obese student had a significant decrease in BMI z-scores (post-pre delta BMI z-score = -0.16 (95%CI = (-0.26, -0.05), p = 0.004 for the former; and = -0.23 (-0.44, -0.03), p = 0.028, for the latter) whereas comparison female counterparts did not. The HealthCorps students, but not the comparison students, had a significant increase for all knowledge domains except for the breakfast realm, and reported a greater number of significant behavior changes including fruit and vegetable intake and physical activities. CONCLUSIONS The HealthCorps program was associated with reduced BMI z-score in overweight/obese and obese female adolescents, with enhanced health knowledge and behavior for both sexes. With its wide reach, this may be a promising program to help combat adolescent obesity in schools. TRIAL REGISTRATION This study is registered as a clinical trial at the ClinicalTrials.gov registry with trial number NCT02277496 on September 10, 2014 (Retrospectively registered).
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Dietary Intake after Weight Loss and the Risk of Weight Regain: Macronutrient Composition and Inflammatory Properties of the Diet.
Muhammad, HFL, Vink, RG, Roumans, NJT, Arkenbosch, LAJ, Mariman, EC, van Baak, MA
Nutrients. 2017;9(11)
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In 2015, 107.7 million children and 603.7 million adults worldwide were obese. Effective actions to prevent the increasing rate of obesity and to treat those who are already obese are required. The aim of the study is to investigate the influence of macronutrients composition and inflammatory properties of the diet on weight regain during a weight maintenance period after weight loss of overweight and obese individuals. The study enrolled 57 Caucasian adult participants (27 males and 30 females) who had a body mass index more than 28kg/m2. The dietary intervention program consisted of three periods i.e. weight loss period, weight stable period and follow-up period. The study shows that the macronutrient composition of the weight maintenance diet was not associated with weight regain. However, the dietary inflammatory index was positively correlated with weight regain. In fact, intake of micronutrients with anti-inflammatory properties was found to be negatively correlated with weight regain. Authors conclude that the inflammatory properties of the diet during the weight maintenance period play a role in weight regain after a diet-induced weight loss program in overweight and obese adults.
Abstract
Weight regain after successful weight loss is a big problem in obesity management. This study aimed to investigate whether weight regain after a weight loss period is correlated with the macronutrient composition and/or the inflammatory index of the diet during that period. Sixty one overweight and obese adults participated in this experimental study. Subjects lost approximately 10% of their initial weight by means of very low-calorie diet for five weeks, or a low calorie diet for 12 weeks. After that, subjects in both groups followed a strict weight maintenance diet based on individual needs for four weeks, which was followed by a nine-month weight maintenance period without dietary counseling. Anthropometrics and dietary intake data were recorded before weight loss (baseline) and during the weight maintenance period. On average, participants regained approximately half of their lost weight. We found no evidence that macronutrient composition during the weight maintenance period was associated with weight regain. The dietary inflammatory index (r = 0.304, p = 0.032) was positively correlated with weight regain and remained significant after correction for physical activity (r = 0.287, p = 0.045). Our data suggest that the inflammatory properties of diet play a role in weight regain after weight loss in overweight and obese adults.