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Inactive Lifestyles Among Young Children With Innocent Murmurs or Congenital Heart Disease, Regardless of Disease Severity or Treatment.
Longmuir, PE, Wang, S, Timmons, BW, Mondal, T, Cinanni, NL, Di Cristofaro, NA, Dillenburg, R, Adamo, K, Tremblay, MS, Lee, S
The Canadian journal of cardiology. 2022;(1):59-67
Abstract
BACKGROUND Sedentary lifestyle morbidities are common among children with congenital heart disease (CHD). Understanding the physical activity trajectory from early childhood could enhance timing and effectiveness of interventions. METHODS We recruited 154 children (56% male) at 12 to 47 months of age for this prospective, longitudinal, observational study. Physical activity and sedentary behaviour (7-day accelerometry) and motor skill (Peabody Developmental Motor Scales-2) were assessed every 8 months until 5 years of age and then annually. Mixed-effect repeated measures regression models described outcome trajectories across study assessments. RESULTS Children had innocent heart murmurs (n = 28), CHD with insignificant hemodynamics not requiring treatment (n = 47), CHD treated by catheterization or surgery without cardiopulmonary bypass (n = 31), or CHD treated surgically with bypass (n = 48). Motor skill was age appropriate (Peabody 49.0 ± 8.4), but participants had lower physical activity (143 ± 41 minutes per day) and higher sedentary time (598 ± 89 minutes per day) than healthy peers, starting at 18 months of age. Movement behaviours were not related to treatment group (P > 0.10), and physical activity was below the recommended 180 minutes per day. Over time, physical activity, sedentary time, and motor skills were primarily related to the baseline measure of each outcome (P < 0.001). CONCLUSIONS Children with simple or complex CHD or innocent heart murmurs have increased risk for sedentary lifestyles. Their physical activity and sedentary behaviours are established before 2 years of age, persist until school age, and are unrelated to motor skills. These results emphasize the need for interventions targeting the youngest children seen in cardiac clinics, regardless of diagnoses of CHD or innocent murmur.
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Association between physical activity and inflammatory markers in community-dwelling, middle-aged adults.
Cho, SMJ, Lee, H, Shim, JS, Jeon, JY, Kim, HC
Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2021;(7):828-836
Abstract
Physical activity has been known to deter inflammatory process; yet, the evidence is scarce in healthy, middle-aged population. We assessed the association between physical activity and inflammatory biomarkers, including high sensitivity (hs) C-reactive protein, interleukin (IL)-1α, -1β, and -6, tumor necrosis factor (TNF) -α and -β, and monocyte chemotactic protein (MCP) -1 and -3. Functional and leisure-time physical activity was assessed by the International Physical Activity Questionnaire. Inflammatory biomarkers were measured by multiplex enzyme-linked immunosorbent assay. Compared with highly physically active participants based on total metabolic equivalent of task, the most sedentary group had significantly higher odds ratio and [95% confidence interval] for ≥75th percentile of TNF-α (1.64 [1.10-2.44]), TNF-β (1.50 [1.09-2.07]), IL-1β (2.14 [1.49-3.09]), hsIL-1β (1.72 [1.15-2.58]), IL-6 (1.84 [1.24-1.73]), hsIL-6 (2.05 [1.35-3.12]), and MCP-1 (1.91 [1.28-2.87]) levels. Results for IL-1α and MCP-3 were inconsistent, as the least active group had lower odds for above the median IL-1α (0.65 [0.49-0.95]) and MCP-3 (0.71 [0.54-0.93]) yet higher odds for ≥75th percentile IL-1α (2.36 [1.63-3.42]) and MCP-3 (2.44 [1.63-3.64]) levels. Based on duration of moderate-to-vigorous physical activity, sedentary participants had significantly higher odds for above median (1.40 [1.13-1.73]) and ≥75th percentile (1.33 [1.00-1.77]) IL-1β compared with those fulfilling the guideline recommendation. Subgroup analyses showed minimal sex differences. Routine inflammatory assessment may help to achieve primordial prevention of cardiovascular and metabolic diseases. Novelty: Healthy, middle-aged adults with physically active lifestyle were generally at lower odds for elevated inflammatory status. The associations persisted regardless of sex, age, comorbidities, adiposity, and diet.
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Association of Diet, Physical Activity Guidelines and Cardiometabolic Risk Markers in Children.
Gil-Campos, M, Pérez-Ferreirós, A, Llorente-Cantarero, FJ, Anguita-Ruiz, A, Bedoya-Carpente, JJ, Kalén, A, Moreno, LA, Bueno, G, Gil, Á, Aguilera, CM, et al
Nutrients. 2021;(9)
Abstract
The aim was to identify different dietary and physical activity (PA) patterns in 5- to 14-year-old children with a high prevalence of overweight and obesity using cluster analysis based on their adherence to the Spanish Society of Community Nutrition dietary guidelines and levels of PA, and to determine their associations with age, sex, body composition, and cardiometabolic risk markers. In 549 children, hierarchical cluster analysis was used to identify subgroups with similar adherence to dietary recommendations and level of PA. Three clusters were identified: Cluster 1, with the lowest level of vigorous PA and adherence to dietary recommendations; Cluster 2, with the lowest levels of moderate and vigorous PA and the highest adherence to dietary recommendations; and Cluster 3, with the highest level of PA, especially vigorous PA and a medium level adherence to dietary recommendations. Cluster 3 had lower total body fat and higher lean body mass percentages than Cluster 2. Cluster 2 had lower high-density lipoprotein cholesterol and higher low-density lipoprotein cholesterol levels than Cluster 1. The results from our study suggest that it is important to consider adherence to PA recommendations together with adherence to dietary guidelines to understand patterns of obesogenic habits in pediatric populations with high prevalence of overweight and obesity.
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Dietary Intake, Eating Behavior, Physical Activity, and Quality of Life in Infertile Women with PCOS and Obesity Compared with Non-PCOS Obese Controls.
Wang, Z, Groen, H, Cantineau, AEP, van Elten, TM, Karsten, MDA, van Oers, AM, Mol, BWJ, Roseboom, TJ, Hoek, A
Nutrients. 2021;(10)
Abstract
To personalize lifestyle advice for women with polycystic ovary syndrome (PCOS) and obesity, detailed information regarding dietary intake, eating behavior, physical activity levels, and quality of life (QoL) may be useful. We aimed to investigate in a post-hoc cross-sectional analysis within a large multicenter randomized controlled trial in women with infertility whether there are significant differences in dietary intake (vegetables, fruits, sugary drinks, alcoholic beverages, savory snacks, and sweet snacks); eating behavior (emotional eating, external eating, and restricted eating); physical activity; and QoL between women with PCOS and obesity and non-PCOS obese controls. Participants were asked to complete the food frequency questionnaire (FFQ), the Dutch Eating Behavior Questionnaire (DEBQ), the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH), and the 36-item Short Form Health Survey (SF-36) at study entry (PCOS: n = 170; non-PCOS: n = 321, mean BMI: 36). Linear and binary (multinomial) logistic regressions were used, and the analyses were adjusted for age, waist-hip circumference ratio, and homeostasis model assessment of insulin resistance (HOMA-IR). No statistically significant differences in dietary intake or physical activity were observed between the two groups. The overall score of emotional eating was 34.6 ± 11.2 in the PCOS group and 34.1 ± 11.3 in the non-PCOS group (p = 0.11). QoL scores (physical and mental) did not differ between PCOS and non-PCOS women. These findings suggest that infertile women with PCOS and obesity and infertile non-PCOS obese controls do not have different dietary habits and have similar mental and physical QoL.
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The wearable activity technology and action-planning trial in cancer survivors: Physical activity maintenance post-intervention.
Hardcastle, SJ, Maxwell-Smith, C, Hince, D, Bulsara, MK, Boyle, T, Tan, P, Levitt, M, Salama, P, Mohan, GRKA, Salfinger, S, et al
Journal of science and medicine in sport. 2021;(9):902-907
Abstract
OBJECTIVES The study objective was to assess whether moderate-to-vigorous intensity physical activity (MVPA) change in cancer survivors (n = 68, mean age = 64 years) was maintained 12-weeks following the Wearable Activity Technology and Action Planning (WATAAP) intervention. Secondary aims were to assess the effects of the intervention on blood pressure (BP) and body mass index (BMI), and to explore group differences between baseline and 24-weeks. DESIGN Randomized controlled trial. METHODS MVPA and sedentary behaviour were assessed using an accelerometer at baseline, the end of the intervention (12-weeks), and at 24-weeks. Generalised linear mixed models with random effects were used to examine between-group and within-group changes in MVPA, sedentary behaviour, BP and BMI. RESULTS MVPA was significantly higher in the intervention group compared with the control group at 24-weeks following adjustment for known confounders (141.4 min/wk. (95% CI = 9.1 to 273.8), p = 0.036). At 24-weeks participants in the intervention group had maintained their increased levels of MVPA (change from 12-weeks = 8.8 min/wk.; 95% CI = -43 to 61; p = 0.74). The reduction in MVPA in the control group over the first 12-weeks was also maintained at 24-weeks (5.4 min/wk.; 95% CI = -3.6 to 4.6; p = 0.80). Secondary outcomes did not differ between groups at 24-weeks. CONCLUSIONS Our results suggest distance-based interventions using wearable technology produce increases in MVPA that endure at least 12-weeks after the intervention is completed.
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A Multicenter Pilot Randomized Clinical Trial of a Home-Based Exercise Program for Patients With Cirrhosis: The Strength Training Intervention (STRIVE).
Lai, JC, Dodge, JL, Kappus, MR, Wong, R, Mohamad, Y, Segev, DL, McAdams-DeMarco, M
The American journal of gastroenterology. 2021;(4):717-722
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Abstract
INTRODUCTION We developed the strength training intervention (STRIVE), a home-based exercise program targeting physical function in patients with cirrhosis. In this pilot study, we aimed to evaluate the safety and efficacy of STRIVE. METHODS Eligible were adult patients with cirrhosis at 3 sites. Patients were randomized 2:1-12 weeks of STRIVE, a 30-minute strength training video plus a health coach or standard of care (SOC). Physical function and quality of life were assessed using the Liver Frailty Index (LFI) and Chronic Liver Disease Questionnaire (CLDQ), respectively. RESULTS Fifty-eight and 25 were randomized to STRIVE and SOC arms, respectively: 43% women, median age was 61 years, MELDNa, Model for End-Stage Liver Disease Sodium was 14, and 54% were Child-Pugh B/C. Baseline characteristics were similar in the STRIVE vs SOC arms except for rates of hepatic encephalopathy (19 vs 36%). LFI @ 12 weeks was available in 43 STRIVE and 20 SOC participants. After 12 weeks, the median LFI improved from 3.8 to 3.6 (ΔLFI -0.1) in the STRIVE arm and 3.7 to 3.6 (ΔLFI -0.1) in the SOC arm (P = 0.65 for ΔLFI difference). CLDQ scores improved from 4.6 to 5.2 in STRIVE participants (ΔCLDQ 0.38) and did not change in SOC participants (4.2-4.2; ΔCLDQ -0.03) (P = 0.09 for ΔCLDQ difference). One patient died (SOC arm) of bleeding. Only 14% of STRIVE participants adhered to the strength training video for 10-12 weeks. No adverse events were reported by STRIVE participants. DISCUSSION STRIVE, a home-based structured exercise program for patients with cirrhosis, was safely administered at 3 sites, but adherence was low. Although all participants showed minimal improvement in the LFI, STRIVE was associated with a substantial improvement in quality of life.
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Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC a multicentre, double-blind, placebo-controlled, randomised parallel group study.
Pavitt, MJ, Tanner, RJ, Lewis, A, Buttery, S, Mehta, B, Jefford, H, Curtis, KJ, Banya, WAS, Husain, S, Satkunam, K, et al
Thorax. 2020;(7):547-555
Abstract
RATIONALE Dietary nitrate supplementation has been proposed as a strategy to improve exercise performance, both in healthy individuals and in people with COPD. We aimed to assess whether it could enhance the effect of pulmonary rehabilitation (PR) in COPD. METHODS This double-blind, placebo-controlled, parallel group, randomised controlled study performed at four UK centres, enrolled adults with Global Initiative for Chronic Obstructive Lung Disease grade II-IV COPD and Medical Research Council dyspnoea score 3-5 or functional limitation to undertake a twice weekly 8-week PR programme. They were randomly assigned (1:1) to either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate), or placebo nitrate-deplete BRJ, consumed 3 hours prior to undertaking each PR session. Allocation used computer-generated block randomisation. MEASUREMENTS The primary outcome was change in incremental shuttle walk test (ISWT) distance. Secondary outcomes included quality of life, physical activity level, endothelial function via flow-mediated dilatation, fat-free mass index and blood pressure parameters. RESULTS 165 participants were recruited, 78 randomised to nitrate-rich BRJ and 87 randomised to placebo. Exercise capacity increased more with active treatment (n=57) than placebo (n=65); median (IQR) change in ISWT distance +60 m (10, 85) vs +30 m (0, 70), estimated treatment effect 30 m (95% CI 10 to 40); p=0.027. Active treatment also impacted on systolic blood pressure: treatment group -5.0 mm Hg (-5.0, -3.0) versus control +6.0 mm Hg (-1.0, 15.5), estimated treatment effect -7 mm Hg (95% CI 7 to -20) (p<0.0005). No significant serious adverse events or side effects were reported. CONCLUSIONS Dietary nitrate supplementation appears to be a well-tolerated and effective strategy to augment the benefits of PR in COPD. TRIAL REGISTRATION NUMBER ISRCTN27860457.
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Association between maximal oxygen consumption and physical activity and sedentary lifestyle in metabolic syndrome. Usefulness of questionnaires.
Tojal, L, Alonso-Gómez, A, Alberich, S, Wärnberg, J, Sorto, C, Portillo, MP, Schröder, H, Salas-Salvadó, J, Arós, F
Revista espanola de cardiologia (English ed.). 2020;(2):145-152
Abstract
INTRODUCTION AND OBJECTIVES To analyze whether variations in physical activity (PA) and sedentary behaviors are accompanied by differences in maximal oxygen consumption (VO2max). METHODS We conducted a prospective cross-sectional study of 243 participants (82 women), aged 65.0±4.9 years old, with metabolic syndrome and overweight/obesity who performed a maximal exercise test with expired gas analysis. PA was evaluated using subjective methods, the REGICOR and RAPA 1 self-reported questionnaires, and objective methods, the chair test and accelerometry. Sedentariness was analyzed with the Nurses' Health Study questionnaire and accelerometry. RESULTS VO2max was higher in participants who reported they adhered to the recommendations of the PA guidelines in the REGICOR questionnaire (21.3±4.6 vs 18.0±4.4 mL/kg/min; P <.001) and was 18% higher in those who reported more PA in the RAPA 1 questionnaire than the less active group (P <.001). The chair test (> 15 vs ≤ 15 repetitions) also showed significant differences in VO2max (21.2±4.8 vs 18.7±4.5 ml/kg/min; P <.001). Correlations between PA variables and VO2max were significant but low (r: 0.2 to 0.4). Sedentary activities showed less relationship with VO2max. CONCLUSIONS Participants with metabolic syndrome and overweight/obesity who reported adhering to PA recommendations achieved higher VO2max. The self-reported questionnaires and the chair test identified significant variations in VO2max. Sedentary activities do not appear to modify VO2max.
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Effects of the Active Smarter Kids (ASK) physical activity intervention on cardiometabolic risk factors in children: A cluster-randomized controlled trial.
Stavnsbo, M, Aadland, E, Anderssen, SA, Chinapaw, M, Steene-Johannessen, J, Andersen, LB, Resaland, GK
Preventive medicine. 2020;:105868
Abstract
The onset of cardiometabolic diseases are recognized to occur in childhood. We aimed to investigate the effect of a school-based cluster-randomized controlled trial of physical activity (PA) on single and clustered cardiometabolic risk factors. We included 1129 fifth-grade children from 57 schools (≥seven children in each class) in Sogn and Fjordane County, Norway, randomized to 28 intervention schools and 29 control schools. The PA intervention was conducted between November 2014 and June 2015. Cardiometabolic risk factors were waist circumference (WC), systolic blood pressure (SBP), total cholesterol (TC):high-density lipoprotein (HDL)-ratio, triglycerides (TG), homeostatic model assessment (HOMA)-score, and cardiorespiratory fitness (CRF). PA was measured by accelerometry. No significant intervention effects were found for single or clustered cardiometabolic risk factors. However, in children with the less favorable baseline values, beneficial effects were found for SBP (p = 0.07 for group ∗ tertile interaction), TC:HDL ratio (p = 0.03 for group ∗ tertile interaction) and the clustered cardiometabolic risk score (p = 0.01 for group ∗ tertile interaction). Compared to boys, girls had a greater effect of the intervention on WC (p = 0.03 for group ∗ sex interaction) and CRF (p < 0.001 for group ∗ sex interaction). The majority of the children had high PA levels, thus limited potential for change, and we found no effects of the PA intervention on cardiometabolic risk in the total sample. However, the intervention had a significantly enhanced effect on fatness and fitness of girls compared to boys. Furthermore, the data suggest that children with the least favorable cardiometabolic risk profile and therefore most in need of change can benefit from school-based PA interventions. Trial registration number: Clinicaltrials.gov ID no.: NCT02132494.
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A novel scaling methodology to reduce the biases associated with missing data from commercial activity monitors.
O'Driscoll, R, Turicchi, J, Duarte, C, Michalowska, J, Larsen, SC, Palmeira, AL, Heitmann, BL, Horgan, GW, Stubbs, RJ
PloS one. 2020;(6):e0235144
Abstract
BACKGROUND Commercial physical activity monitors have wide utility in the assessment of physical activity in research and clinical settings, however, the removal of devices results in missing data and has the potential to bias study conclusions. This study aimed to evaluate methods to address missingness in data collected from commercial activity monitors. METHODS This study utilised 1526 days of near complete data from 109 adults participating in a European weight loss maintenance study (NoHoW). We conducted simulation experiments to test a novel scaling methodology (NoHoW method) and alternative imputation strategies (overall/individual mean imputation, overall/individual multiple imputation, Kalman imputation and random forest imputation). Methods were compared for hourly, daily and 14-day physical activity estimates for steps, total daily energy expenditure (TDEE) and time in physical activity categories. In a second simulation study, individual multiple imputation, Kalman imputation and the NoHoW method were tested at different positions and quantities of missingness. Equivalence testing and root mean squared error (RMSE) were used to evaluate the ability of each of the strategies relative to the true data. RESULTS The NoHoW method, Kalman imputation and multiple imputation methods remained statistically equivalent (p<0.05) for all physical activity metrics at the 14-day level. In the second simulation study, RMSE tended to increase with increased missingness. Multiple imputation showed the smallest RMSE for Steps and TDEE at lower levels of missingness (<19%) and the Kalman and NoHoW methods were generally superior for imputing time in physical activity categories. CONCLUSION Individual centred imputation approaches (NoHoW method, Kalman imputation and individual Multiple imputation) offer an effective means to reduce the biases associated with missing data from activity monitors and maximise data retention.