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ABSTRACT: OBJECTIVES: The study aims to examine whether a higher proportion of current and former smokers reported having an oral cancer screening (OCS) exam in the past year compared with never smokers in Maryland between 2002 and 2008. METHODS: Secondary analysis of the Maryland Cancer Surveys (conducted in 2002, 2004, 2006, and 2008), population-based, random-digit-dial surveys on cancer screening among adults age 40 years and older. Of 20,197 individuals who responded to the surveys, 19,054 answered questions on OCS and smoking. Results are weighted to the Maryland population. RESULTS: Self-reported OCS in the past year increased from 33 percent in 2002 to 40 percent in 2008. Screening among never and former smokers increased from about 35 percent to 42 percent and from 35 percent to 43 percent, respectively; screening among current smokers remained between 23 percent and 25 percent. In the adjusted analysis, current smokers had decreased odds of screening compared with never smokers; no significant difference was observed between former and never smokers. When the variable dental visit in the last year was included in the adjusted analysis, it became the strongest predictor of OCS. CONCLUSIONS: Between 2002 and 2008, self-reported OCS in the last year increased among former and never smokers, but remained unchanged for current smokers. A visit to a dental professional attenuated the difference in OCS between current and never smokers. Dental visit in the last year was the strongest predictor of OCS.
Journal of Public Health Dentistry 03/2013; · 1.19 Impact Factor
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ABSTRACT: INTRODUCTION: Cancer survivors are at increased risk for influenza-related complications. Racial disparities in preventive health services have not been extensively studied among cancer survivors. Our objective is to compare influenza vaccination prevalence among black and white cancer survivors METHODS: We performed a secondary data analysis of 41,346 white and black cancer survivors (excluding non-melanoma skin cancer) from the 2009 Behavioral Risk Factor Surveillance System survey. Respondents were asked whether they had received an influenza vaccination in the previous year. Multivariable logistic regression was used to estimate the odds of having influenza vaccine by race. RESULTS: Sixty-five percent of whites reported receiving the vaccine in the last year compared to 50 % of blacks. Blacks had significantly lower odds of vaccination after controlling for covariates significantly associated with the odds of influenza vaccination. Higher education, having health insurance, having a primary care provider, and having a routine check-up in the last year increased the odds of receiving an influenza vaccine. CONCLUSIONS: Our analysis supports that racial disparities in vaccine coverage persist among cancer survivors, a group strongly recommended to receive annual influenza vaccine, even when predictors significantly associated with increased vaccination are controlled for. IMPLICATIONS FOR CANCER SURVIVORS: As a nationally representative survey with a large sample size, our study provides a picture of self-reported vaccine coverage among cancer survivors in the USA and the disparity that exists between blacks and whites in this population. Care teams can use these findings to better target follow-up care for cancer survivors.
Journal of Cancer Survivorship 01/2013; · 2.63 Impact Factor
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ABSTRACT: The Unified Parkinson's Disease Rating Scale (UPDRS) is a widely applied index of disease severity. Our objective was to assess the utility of UPDRS for predicting peak aerobic capacity (VO2 peak) and ambulatory function. Participants (n = 70) underwent evaluation for UPDRS (Total and Motor ratings), VO2 peak, 6-minute walk distance (6MW), and 30-foot self-selected walking speed (SSWS). Using regression, we determined the extent to which the Total and Motor UPDRS scores predicted each functional capacity measure after adjusting for age and sex. We also tested whether adding the Hoehn and Yahr scale (H-Y) to the model changed predictive power of the UPDRS. Adjusted for age and sex, both the Total UPDRS and Motor UPDRS subscale failed to predict VO2 peak. The Total UPDRS did weakly predict 6MW and SSWS (both p < 0.05), but the Motor UPDRS subscale did not predict these ambulatory function tests. After adding H-Y to the model, Total UPDRS was no longer an independent predictor of 6MW but remained a predictor of SSWS. We conclude that Total and Motor UPDRS rating scales do not predict VO2 peak, but that a weak relationship exists between Total UPDRS and measures of ambulatory function.
The Journal of Rehabilitation Research and Development 12/2012; 49(8):1269-76. · 1.78 Impact Factor
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ABSTRACT: OBJECTIVE To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed, strength, and fitness for patients with Parkinson disease. DESIGN A comparative, prospective, randomized, single-blinded clinical trial of 3 types of physical exercise. SETTING The Parkinson's Disease and Movement Disorders Center at the University of Maryland and the Baltimore Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center. PATIENTS A total of 67 patients with Parkinson disease who had gait impairment were randomly assigned to 1 of 3 arms of the trial. INTERVENTIONS (1) A higher-intensity treadmill exercise (30 minutes at 70%-80% of heart rate reserve), (2) a lower-intensity treadmill exercise (50 minutes at 40%-50% of heart rate reserve), and (3) stretching and resistance exercises (2 sets of 10 repetitions on each leg on 3 resistance machines [leg press, leg extension, and curl]). These exercises were performed 3 times a week for 3 months. MAIN OUTCOME MEASURES The primary outcome measures were gait speed (6-minute walk), cardiovascular fitness (peak oxygen consumption per unit time [[Vdot]O2], and muscle strength (1-repetition maximum strength). RESULTS All 3 types of physical exercise improved distance on the 6-minute walk: lower-intensity treadmill exercise (12% increase; P = .001), stretching and resistance exercises (9% increase; P < .02), and higher-intensity treadmill exercise (6% increase; P = .07), with no between-group differences. Both treadmill exercises improved peak [Vdot]O2 (7%-8% increase; P < .05) more than did the stretching and resistance exercises. Only stretching and resistance improved muscle strength (16% increase; P < .001). CONCLUSIONS The effects of exercise were seen across all 3 exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease. The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation.
Archives of neurology 11/2012; · 6.31 Impact Factor
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ABSTRACT: Hot flashes affect up to 75% of women undergoing the menopausal transition. They are among the most common health problems for perimenopausal women and are associated with a decrease in quality of life. The goal of this study was to examine the associations between reproductive history variables and midlife hot flashes.
Data were analyzed from 388 perimenopausal women who participated in the Midlife Health Study, a population-based, cross-sectional study of 639 women aged 45-54 years living in the Baltimore metropolitan region.
The unadjusted analyses showed that none of the reproductive history variables analyzed, including age at menarche, number of live births, ever having been pregnant, age at first birth, age at last pregnancy, and history of oral contraceptive use, were associated with ever experiencing hot flashes. However, after adjusting for race, age group, marital status, education, employment, total family income, smoking and alcohol status, and body mass index (BMI), age at last pregnancy was significantly associated with moderate to severe hot flashes. Specifically, participants who were ≥36 years of age at last pregnancy were less likely to report moderate or severe hot flashes than those ≤35 years of age at last pregnancy (odds ratio 0.36, 95% confidence interval 0.16, 0.84).
In this study, in general, characteristics of reproductive history were not associated with midlife hot flashes. However, there are a number of potentially modifiable factors that are associated with the occurrence of hot flashes. Thus, alternatives may be available when hormone treatment is contraindicated.
Journal of Women s Health 01/2012; 21(4):433-9. · 1.57 Impact Factor
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ABSTRACT: Our objective was to compare the effects of in vivo insulin on skeletal muscle glycogen synthase (GS) activity in normal (NGT) vs. impaired glucose-tolerant (IGT) obese postmenopausal women and to determine whether an increase in insulin activation of GS is associated with an improvement in insulin sensitivity (M) following calorie restriction (CR) and/or aerobic exercise plus calorie restriction (AEX + CR) in women with NGT and IGT. We did a longitudinal, clinical intervention study of CR compared with AEX + CR. Overweight and obese women, 49-76 yr old, completed 6 mo of CR (n = 46) or AEX + CR (n = 50) with Vo(2 max), body composition, and glucose tolerance testing. Hyperinsulinemic euglycemic (80 mU·m(-2)·min(-1)) clamps (n = 73) and skeletal muscle biopsies (before and during clamp) (n = 58) were performed before and after the interventions (n = 50). After 120 min of hyperinsulinemia during the clamp, GS fractional activity and insulin's effect to increase GS fractional activity (insulin - basal) were significantly lower in IGT vs. NGT (P < 0.01) at baseline. GS total activity increased during the clamp in NGT (P < 0.05), but not IGT, at baseline. CR and AEX + CR resulted in a significant 8% weight loss with reductions in total fat mass, visceral fat, subcutaneous fat, and intramuscular fat. Overall, M increased (P < 0.01), and the change in M (postintervention - preintervention) was associated with the change in insulin-stimulated GS fractional activity (partial r = 0.44, P < 0.005). In IGT, the change (postintervention - preintervention) in insulin-stimulated GS total activity was greater following AEX + CR than CR alone (P < 0.05). In IGT, insulin-stimulated GS-independent (P < 0.005) and fractional activity (P = 0.06) increased following AEX + CR. We conclude that the greatest benefits at the whole body and cellular level (insulin activation of GS) in older women at highest risk for diabetes are derived from a lifestyle intervention that includes exercise and diet.
AJP Endocrinology and Metabolism 01/2012; 302(1):E145-52. · 4.75 Impact Factor
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ABSTRACT: Changes in the biomechanics of gait may alter the energy requirements of walking in Parkinson's Disease (PD). This study investigated economy of gait during submaximal treadmill walking in 79 subjects with mild to moderate PD and the relationship between gait economy and 6-minute walk distance (6 MW). Oxygen consumption (VO(2)) at the self-selected treadmill walking speed averaged 64% of peak oxygen consumption (VO(2) peak). Submaximal VO(2) levels exceeded 70% of VO(2) peak in 30% of the subjects. Overall the mean submaximal VO(2) was 51% higher than VO(2) levels expected for the speed and grade consistent with severe impairment in economy of gait. There was an inverse relationship between economy of gait and 6MW (r = -0.31, P < 0.01) and with the self-selected walking speed (r = -0.35, P < 0.01). Thus, the impairment in economy of gait and decreased physiologic reserve result in routine walking being performed at a high percentage of VO(2) peak.
Parkinson's disease. 01/2012; 2012:241754.
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ABSTRACT: Complete colonoscopy for cancer screening requires cecal intubation. Failure to reach and examine the cecum may result in missed right colon pathology. We developed and validated a novel classification scheme for the endoscopic appearance of the normal appendiceal orifice (AO). We analyzed 1,456 AO images and grouped them into four categories based on distinguishing features: “diverticuloid,” “umbilicoid,” “crescent,” and “linear.” An expert panel classified the images and modified these categories, combining crescent and linear categories into “curvilinear.” A 100-image subset was classified twice by a validation cohort consisting of gastroenterology faculty and fellows. Inter-observer agreement among the expert panel, and intra- and inter-observer agreement among the validation cohort were analyzed using Fleiss' kappa statistic. The distribution of AO images was 67% curvilinear, 19% umbilicoid, and 10% diverticuloid; 85 images (4%) were not classifiable. There was substantial inter-observer agreement among the expert panel (κ, 0.72). Inter-observer agreement among the validation cohort was moderate (κ, 0.53 and 0.55 for the first and second viewing, respectively). Intra-observer κ values among the validation cohort were 0.69 for the overall classification, 0.65 for diverticuloid, 0.70 for umbilicoid, and 0.70 for curvilinear, indicating substantial agreement. This simple, validated classification scheme for the endoscopic appearance of the normal AO can be used both as a research and clinical tool to measure endoscopic quality, improve cecal examination, and document successful cecal intubation. Clin. Anat. 25:496–502, 2012. © 2011 Wiley Periodicals, Inc.
Clinical Anatomy 09/2011; 25(4):496 - 502. · 1.29 Impact Factor
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ABSTRACT: Blacks have the highest incidence of and death from prostate cancer in the United States. Screening with prostate-specific antigen (PSA) may decrease mortality. Repeated testing allows for the calculation of PSA velocity (change of PSA over time), which may be a more clinically useful test for prostate cancer than a single PSA measurement. The objective of this study was to examine whether blacks were as likely as whites to report having had repeated PSA testing.
The Maryland Cancer Survey 2006 was a population-based, random-digit-dialed statewide survey on cancer screening and risk behaviors of adults aged 40 years or older. We analyzed self-reported information on repeated PSA testing (2 PSA tests in the preceding 3 years) for 1,721 black and white men. We used logistic regression to estimate the effect of race and age on repeated PSA testing, adjusting for other covariates.
Sixty-five percent of men reported ever having had a PSA test; 41% had repeated PSA testing in the past 3 years. Blacks aged 40 to 49 were more likely to report having repeated PSA testing than whites in this age group (adjusted odds ratio [AOR], 3.3; 95% confidence interval [CI], 1.6-6.5). Blacks aged 60 to 69 were less likely to report repeated PSA testing than whites (AOR, 0.4, 95% CI, 0.2-0.8). No difference was seen by race among men aged 50 to 59 and men aged 70 or older. Repeated PSA testing was associated with living in an urban area and with having higher education, health insurance, a family history of prostate cancer, and having discussed cancer screening with a doctor.
Self-reported repeated PSA testing differed by age and race, being higher among blacks aged 40 to 49 and lower among blacks aged 60 to 69, compared with whites in their respective age groups.
Preventing chronic disease 09/2011; 8(5):A114. · 1.82 Impact Factor
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ABSTRACT: Maximal or peak aerobic capacity (VO(2peak)) during a maximal-effort graded exercise test is considered by many to be the "gold standard" outcome for assessing the effect of exercise training on cardiorespiratory fitness. The reliability of this measure in Parkinson disease (PD) has not been established, where the degree of motor impairment can vary greatly and is influenced by medications. This study examined the reliability of VO(2peak) during a maximal-effort graded exercise test in subjects with PD.
Seventy healthy middle-aged and older subjects with PD Hoehn and Yahr stage 1.5-3 underwent a screening/acclimatization maximal-effort treadmill test followed by two additional maximal-effort treadmill tests with repeated measurements of VO(2peak). A third VO(2peak) test was performed in a subset of 21 subjects.
The mean VO(2peak) measurement was 2.4% higher in the second test compared with the first test (21.42 ± 4.3 vs 21.93 ± 4.50 mL·kg(-1)·min(-1), mean ± SD, P = 0.03). The intraclass correlation coefficients (ICC) for VO(2peak) expressed either as milliliters per kilogram per minute or as liters per minute were highly reliable, with ICC of 0.90 and 0.94, respectively. The maximum HR (ICC of 0.91) and final speed achieved during the tests (ICC of 0.94) were also highly reliable, with the respiratory quotient being the least reliable of the parameters measured (ICC of 0.65).
Our results demonstrate that measurement of VO(2peak) is reliable and repeatable in subjects with mild to moderate PD, thereby validating use of this parameter for assessing the effects of exercise interventions on cardiorespiratory fitness.
Medicine and science in sports and exercise 05/2011; 43(12):2381-7. · 3.71 Impact Factor
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Krisann K Oursler,
Joseph L Goulet,
Stephen Crystal,
Amy C Justice,
Kristina Crothers,
Adeel A Butt,
Maria C Rodriguez-Barradas,
Knachelle Favors,
David Leaf,
Leslie I Katzel, John D Sorkin
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ABSTRACT: HIV clinical care now involves prevention and treatment of age-associated comorbidity. Although physical function is an established correlate to comorbidity in older adults without HIV infection, its role in aging of HIV-infected adults is not well understood. To investigate this question we conducted cross-sectional analyses including linear regression models of physical function in 3227 HIV-infected and 3240 uninfected patients enrolled 2002-2006 in the Veterans Aging Cohort Study-8-site (VACS-8). Baseline self-reported physical function correlated with the Short Form-12 physical subscale (ρ = 0.74, p < 0.001), and predicted survival. Across the age groups decline in physical function per year was greater in HIV-infected patients (β(coef) -0.25, p < 0.001) compared to uninfected patients (β(coef) -0.08, p = 0.03). This difference, although statistically significant (p < 0.01), was small. Function in the average 50-year old HIV-infected subject was equivalent to the average 51.5-year-old uninfected subject. History of cardiovascular disease was a significant predictor of poor function, but the effect was similar across groups. Chronic pulmonary disease had a differential effect on function by HIV status (Δβ(coef) -3.5, p = 0.03). A 50-year-old HIV-infected subject with chronic pulmonary disease had the equivalent level of function as a 68.1-year-old uninfected subject with chronic pulmonary disease. We conclude that age-associated comorbidity affects physical function in HIV-infected patients, and may modify the effect of aging. Longitudinal research with markers of disease severity is needed to investigate loss of physical function with aging, and to develop age-specific HIV care guidelines.
AIDS patient care and STDs 01/2011; 25(1):13-20. · 2.68 Impact Factor
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ABSTRACT: To determine the relationship between BMI and Medicare expenditure for adults 65-years and older and determine whether this relationship changes after accounting for misclassification due to age-related height loss. Using a cross sectional study design, the relationship between BMI and fee-for-service Medicare expenditure was examined among beneficiaries who completed the Medicare Current Beneficiary Survey (MCBS) in 2002, were not enrolled in Medicare Health Maintenance Organization, had a self-reported height and weight, and were 65 and older (n = 7,706). Subjects were classified as underweight, normal weight, overweight, obese (obese I), and severely obese (obese II/III). To adjust BMI for the artifactual increase associated with age-related height loss, the reported height was transformed by adding the sex-specific age-associated height loss to the reported height in MCBS. The main outcome variable was total Medicare expenditure. There was a significant U-shaped pattern between unadjusted BMI and Medicare expenditure: underweight $4,581 (P < 0.0003), normal weight $3,744 (P < 0.0000), overweight $3,115 (reference), obese I $3,686 (P < 0.0039), and obese II/III $4,386 (P < 0.0000). This pattern persisted after accounting for height loss: underweight $4,640 (P < 0.0000), normal weight $3,451 (P < 0.0507), overweight $3,165 (reference), obese I $3,915 (P < 0.0010), and obese II/III $4,385 (P < 0.0004) compared to overweight. In older adults, minimal cost is not found at "normal" BMI, but rather in overweight subjects with higher spending in the obese and underweight categories. Adjusting for loss-of-height with aging had little affect on cost estimates.
Obesity 01/2011; 19(1):204-11. · 4.28 Impact Factor
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ABSTRACT: To examine the association between depressive symptoms and fast-food intake in midlife women.
Data were analyzed from a cross-sectional study of 626 women aged 45-54 years conducted from 2000 to 2004 in Baltimore, Maryland. The presence of depressive symptoms was measured using the Center for Epidemiologic Studies-Depression scale and defined as a score of 16 or greater. The frequency of fast-food intake was assessed using self-reported questionnaire data, and was categorized as "at least weekly", "at least monthly, but less than weekly" and "less than monthly".
Approximately 25% of the study sample reported depressive symptoms; 14% consumed fast-food "at least weekly," and 27% "at least monthly, but less than weekly". Compared to their counterparts, women with depressive symptoms had significantly greater odds of reporting higher fast-food intake (confounder-adjusted odds ratio: 1.54; 95% confidence interval: 1.06-2.25). Other covariates associated with a higher frequency of fast-food intake included black race and body mass index ≥30 kg/m(2).
Findings from this study indicate that the presence of depressive symptoms is positively associated with fast-food intake in midlife women. These results may have important health implications given that both depression and dietary consumption patterns are risk factors for a number of diseases.
Preventive Medicine 01/2011; 52(3-4):254-7. · 3.22 Impact Factor
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ABSTRACT: In animal studies, testosterone decreases, whereas estrogen increases, cortisol production. In one clinical study, short-term testosterone replacement attenuated corticotrophin-releasing hormone-stimulated cortisol secretion during leuprolide-induced hypogonadism in young men. The effects of longer term testosterone treatment on spontaneous cortisol secretion in younger or older men are unknown. In a randomized, double-masked placebo-controlled study, we assessed the effects of testosterone supplementation (100 mg intramuscular every 2 week) for 26 weeks on nocturnal cortisol secretory dynamics in healthy older men. Testosterone administration increased early morning serum concentrations of free testosterone by 34%, decreased sex hormone-binding globulin by 20%, and did not alter early morning concentrations of cortisol-binding globulin or cortisol compared with placebo treatment. Testosterone did not significantly alter nocturnal mean and integrated cortisol concentrations, cortisol burst frequency, mass/burst, basal secretion, pulsatile cortisol production rate, pattern regularity, or approximate entropy. We conclude that low-dose testosterone supplementation for 26 weeks does not affect spontaneous nocturnal cortisol secretion in healthy older men.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 11/2010; 65(11):1185-92. · 4.60 Impact Factor
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ABSTRACT: This randomized controlled trial tests the efficacy of bilateral arm training with rhythmic auditory cueing (BATRAC) versus dose-matched therapeutic exercises (DMTEs) on upper-extremity (UE) function in stroke survivors and uses functional magnetic resonance imaging (fMRI) to examine effects on cortical reorganization.
A total of 111 adults with chronic UE paresis were randomized to 6 weeks (3×/week) of BATRAC or DMTE. Primary end points of UE assessments of Fugl-Meyer UE Test (FM) and modified Wolf Motor Function Test Time (WT) were performed 6 weeks prior to and at baseline, after training, and 4 months later. Pretraining and posttraining, fMRI for UE movement was evaluated in 17 BATRAC and 21 DMTE participants.
The improvements in UE function (BATRAC: FM Δ = 1.1 + 0.5, P = .03; WT Δ = -2.6 + 0.8, P < .00; DMTE: FM Δ = 1.9 + 0.4, P < .00; WT Δ = -1.6 + 0.7; P = .04) were comparable between groups and retained after 4 months. Satisfaction was higher after BATRAC than DMTE (P = .003). BATRAC led to significantly higher increase in activation in ipsilesional precentral, anterior cingulate and postcentral gyri, and supplementary motor area and contralesional superior frontal gyrus (P < .05). Activation change in the latter was correlated with improvement in the WMFT (P = .01).
BATRAC is not superior to DMTE, but both rehabilitation programs durably improve motor function for individuals with chronic UE hemiparesis and with varied deficit severity. Adaptations in brain activation are greater after BATRAC than DMTE, suggesting that given similar benefits to motor function, these therapies operate through different mechanisms.
Neurorehabilitation and neural repair 10/2010; 25(2):118-29. · 4.49 Impact Factor
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Jesse B Mez,
John W Cole,
Timothy D Howard,
Leah R Macclellan,
Oscar C Stine,
Jeffery R O'Connell,
Marcella A Wozniak,
Barney J Stern, John D Sorkin,
Braxton D Mitchell,
Steven J Kittner
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ABSTRACT: Population-based association studies are used to identify common susceptibility variants for complex genetic traits. These studies are susceptible to confounding from unknown population substructure. Here we apply a model-based clustering approach to our case-control study of stroke among young women to examine if self-reported ethnicity can serve as a proxy for genetic ancestry.
A population-based case-control study of stroke among women aged 15-49 identified 361 cases of first ischemic stroke and 401 age-comparable control subjects. Thirty single nucleotide polymorphisms (SNPs) throughout the genome unrelated to stroke risk and with established ancestry-based allele frequency differences were genotyped in all participants. The Structure program was used to iteratively evaluate for K = 1 to 5 potential genetic-based subpopulations. Evaluating the population as a whole, the Structure output plateaued at K = 2 clusters. 98% of self-reported Caucasians had an estimated probability >/=50% of belonging to Cluster 1, while 94% of self-reported African-Americans had an estimated probability >/=50% of belonging to Cluster 2. Stratifying the participants by self-reported ethnicity and repeating the analyses revealed the presence of two clusters among Caucasians, suggesting that potential substructure may exist.
Among our combined sample of African-American and Caucasian participants there is no large unknown subpopulation and self-reported ethnicity can serve as a proxy for genetic ancestry. Ethnicity-specific analyses indicate that population substructure may exist among the Caucasian participants indicating that further studies are warranted.
BMC Research Notes 12/2009; 2:260.
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ABSTRACT: To investigate factors related to cardiorespiratory fitness in older human immunodeficiency virus (HIV)-infected patients and to explore the utility of 6-minute walk distance (6-MWD) in measuring fitness.
Cross-sectional study in clinic-based cohort.
Veterans Affairs Medical Center, Baltimore, Maryland.
Forty-three HIV-infected men, median age 57 (range 50-82), without recent acquired immunodeficiency syndrome-related illness and receiving antiretroviral (ARV) therapy.
Peak oxygen utilization (VO(2)peak) according to treadmill graded exercise testing, 6-MWD, grip strength, quadriceps maximum voluntary isometric contraction, cross-sectional area, muscle quality, and muscle adiposity.
There was a moderate correlation between VO(2)peak (mean +/- SD; 18.4 +/- 5.6 mL/kg per minute) and 6-MWD (514 +/- 91 m) (r=0.60, P<.001). VO(2)peak was lower in subjects with hypertension (16%, P<.01) and moderate anemia (hemoglobin 10-13 gm/dL; 15%, P=.09) than in subjects without these conditions. CD4 cell count (median 356 cells/mL, range 20-1,401) and HIV-1 viral load (84% nondetectable) were not related to VO(2)peak. Among muscle parameters, only grip strength was an independent predictor of VO(2)peak. Estimation of VO(2)peak using linear regression, including age, 6-MWD, grip strength, and hypertension as independent variables, explained 61% of the variance in VO(2)peak.
Non-AIDS-related comorbidity predicts cardiorespiratory fitness in older HIV-infected men receiving ARV therapy. The 6-MWD is a valuable measure of fitness in this patient population, but a larger study with diverse subjects is needed.
Journal of the American Geriatrics Society 09/2009; 57(11):2055-61. · 3.74 Impact Factor
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ABSTRACT: With aging, GH, IGF-I, and sex steroid concentrations and glucose tolerance decrease, and body fat and serum lipids increase.
The aim of the study was to assess GH and/or sex steroid administration effects on serum glucose, insulin, insulin sensitivity, and lipids in older individuals.
A double-masked, 2 x 2 factorial, placebo-controlled, double-dummy design was used for the study.
GH and/or sex steroid [transdermal estradiol plus oral medroxyprogesterone acetate in women (HRT); testosterone enanthate (T) in men] were administered for 6 months.
Healthy, community-dwelling women (n = 57) and men (n = 74) ages 65-88 yr (mean, 72 yr) participated in the study.
We measured serum glucose, insulin, and insulin sensitivity [quantitative insulin sensitivity check index (QUICKI) and insulin sensitivity index (ISI)] before and during an oral glucose tolerance test and lipid profiles.
In women, GH did not alter oral glucose tolerance test 120 min or 2-h area under the curve (AUC) glucose values, but it increased 120 min insulin and AUC insulin. There were no significant effects of HRT or GH+HRT. ISI and QUICKI decreased after GH. In men, GH increased 120 min and AUC glucose and insulin AUC. GH+T increased 120 min glucose and glucose and insulin AUCs. T alone did not affect glucose or insulin. ISI decreased after GH and GH+T, whereas QUICKI decreased after GH. GH in women and men and GH+T in men decreased QUICKI by 4 wk. In women, HRT decreased total cholesterol and low-density lipoprotein (LDL)-cholesterol, and GH decreased LDL-cholesterol. In men, total cholesterol decreased after T and GH+T. LDL-cholesterol decreased after GH and GH+T. GH increased serum triglycerides.
GH administration to healthy older individuals for 6 months increased insulin resistance with moderately beneficial effects on lipids.
The Journal of clinical endocrinology and metabolism 08/2009; 94(10):3833-41. · 6.50 Impact Factor
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ABSTRACT: Although popular diets focus on weight loss and their favorable biochemical and physiological effects, fewer investigations have evaluated the biological impact of these diets during weight maintenance. To study this issue, three popular diets-Atkins, South Beach, and Ornish-were tested in a randomized and counterbalanced crossover study between January and December 2006. Participants completed each of the three 4-week isocaloric dietary intervention phases followed by a 4-week washout period. They were weighed weekly and caloric adjustments made if weight change exceeded 1 kg. At the completion of each dietary phase, 3-day food records were analyzed, fasting blood sampled, and brachial artery reactivity testing performed. Eighteen adults completed all three isocaloric dietary phases. During the South Beach and Ornish maintenance phase, there were significant reductions in low-density lipoprotein cholesterol (11.8%; P=0.01, 16.6%; P=0.0006, respectively) compared to prediet baseline. In addition, in contrast to the Atkins maintenance phase, significant reductions in low-density lipoprotein cholesterol and apolipoprotein B levels were observed after the South Beach (P=0.003, P=0.05; repeated measures analyses of variance) and Ornish maintenance phases (P=0.0004, P=0.006, repeated measures analyses of variance). Brachial artery testing revealed an inverse correlation between flow-mediated vasodilatation and intake of saturated fat (r=-0.33; P=0.016). These data suggest that during weight maintenance, less favorable biological effects are observed during a simulated, high-fat Atkins diet when compared to the South Beach and Ornish diet. The findings support additional study in subjects with visceral obesity and the metabolic syndrome, in whom an increased risk of coronary disease at baseline may be accentuated with chronic consumption of a diet that exhibits unfavorable effects on lipids and endothelial function.
Journal of the American Dietetic Association 05/2009; 109(4):713-7. · 3.59 Impact Factor
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ABSTRACT: To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.
Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain.
After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P<.00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P<.003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P=.01).
APA-stroke appears to be safe, feasible, and efficacious in a community setting.
Neurorehabilitation and neural repair 04/2009; 23(7):726-34. · 4.49 Impact Factor
