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Fit for life
Abstract
Lack of physical activity (PA) is a highly modifiable risk factor for the development of chronic disease and premature mortality. Guidelines around the world for recommended activity levels are consistent, suggesting 150 minutes per week of moderate-intensity exercise, yet the majority of adults fail to reach this target. Regular PA causes cardiovascular, respiratory and musculoskeletal adaptations, alters the blood lipid profile and reduces systemic inflammation. These changes are thought to contribute to a reduced risk of developing chronic disease, including ischaemic heart disease, stroke, type 2 diabetes and certain cancers. Regular PA alters the course of chronic disease, conveying a survival advantage and reducing morbidity and mortality.
When counselling patients, it is advisable to formally quantify their activity levels using a rating scale, employ motivational interviewing techniques and consider the social, cultural, economic and disability-related barriers that may limit access to exercise.
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Background
The physical benefits of exercise following stroke are research evidenced and the UK stroke population is increasingly encouraged to engage with exercise interventions. A synthesis of qualitative research is required to further understand the perceived experience and psychosocial effect of exercise for people with stroke.
Objectives
To provide a systematic search and synthesis of evidence about the experiences and reported impact of participation in venue based exercise following stroke in the UK.
Data sources
Eligible studies were identified through a rigorous search of Medline, Cinahl, AMED, PsycINFO, SportDiscus, Proquest and ETHOS from January 2000 until December 2017.
Study eligibility criteria
Full text qualitative studies or service evaluations conducted in the UK which explored the reported experience of venue based exercise amongst people with stroke.
Study synthesis and appraisal
Included studies were evaluated through application of the Consolidated Criteria for Reporting Qualitative Research. Data synthesis using a thematic approach generated descriptive and analytical themes.
Results
Six research studies and one service evaluation met the inclusion criteria; methodological quality was variable. These studies highlighted that people with stroke gain confidence and renewed identity through exercise participation. Perceived improvements in physical function were reported and participants enjoyed stroke specific exercise programmes in de-medicalised venues.
Limitations
The studies only accessed people who had completed the exercise programmes; non-completers were not represented.
Conclusion
Venue based exercise programmes have a positive effect on perceived wellbeing following stroke. Further research into the reasons for discontinuation of exercise participation following stroke is required.
Systematic Review Registration Number PROSPERO 2017:CRD42017072483.
Rationale & Objective
Data suggest that exercise is beneficial for patients with chronic kidney disease (CKD) to reduce cardiovascular disease and the progression of CKD. Despite these benefits, the majority of patients with CKD remain sedentary. The purpose of this study was to identify attitudes, motivators, and barriers to exercise among individuals with CKD.
Study Design
Qualitative study.
Setting & Participants
10 focus groups (41 adult participants with CKD stages 3-4 who were not currently exercising) from the Denver Metro Area.
Analytical Approach
Thematic analysis. Clinics were purposively sampled. Focus groups were recorded and transcribed.
Results
We identified 7 themes reflecting perceptions of exercise of patients with CKD: improvement in health and quality of life; motivation from family, friends, or peers; limitations due to comorbid conditions; challenges due to environmental factors (safety, weather, and cost concerns); lack of time; family as a barrier; and lack of provider counseling on type of exercise and the benefits. Participants recognized the benefits of exercise on health, but exercise was not viewed to have a significant impact on CKD. Having a friend, family member, or group to exercise with was viewed as a significant motivator. However, particularly in Spanish-speaking participants, family was often seen as a barrier if they were not willing to exercise with the patients. Most participants expressed receiving limited information from their kidney provider regarding how exercise affected their kidney health. Spanish-speaking participants in particular expressed frustration with their nephrologist's lack of advice regarding exercise.
Limitations
Potential selection bias and inclusion of only sedentary patients with CKD.
Conclusions
Barriers and motivators to exercise were similar among participating men and women with CKD. Lack of advice from kidney providers regarding exercise was a significant barrier. Exercise interventions in patients with CKD should include not only increased patient self-efficacy and social support, but also counseling and prescribing of exercise by nephrologists.
Wearable activity trackers (WAT) are electronic monitoring devices that enable users to track and monitor their health-related physical fitness metrics including steps taken, level of activity, walking distance, heart rate, and sleep patterns. Despite the proliferation of these devices in various contexts of use and rising research interests, there is limited understanding of the broad research landscape. The purpose of this systematic review is therefore to synthesize the existing wealth of research on WAT, and to provide a comprehensive summary based on common themes and approaches. This article includes academic work published between 2013 and 2017 in PubMed, Embase, Scopus, Web of Science, ACM Digital Library, and Google Scholar. A final list of 463 articles was analyzed for this review. Topic modeling methods were used to identify six key themes (topics) of WAT research, namely: 1) Technology Focus, 2) Patient Treatment and Medical Settings, 3) Behavior Change, 4) Acceptance and Adoption (Abandonment), 5) Self-monitoring Data Centered, and 6) Privacy. We take an interdisciplinary approach to wearable activity trackers to propose several new research questions. The most important research gap we identify is to attempt to understand the rich human-information interaction that is enabled by WAT adoption.
Background
Osteoporosis and related fragility fractures are a global public health problem in which pharmaceutical agents targeting bone mineral density (BMD) are the first line of treatment. However, pharmaceuticals have no effect on improving other key fracture risk factors, including low muscle strength, power and functional capacity, all of which are associated with an increased risk for falls and fracture, independent of BMD. Targeted exercise training is the only strategy that can simultaneously improve multiple skeletal and fall-related risk factors, but it must be appropriately prescribed and tailored to the desired outcome(s) and the specified target group.
Objectives
In this review, we provide an overview of the general principles of training and specific loading characteristics underlying current exercise guidelines for the prevention of osteoporosis, and an update on the latest scientific evidence with regard to the type and dose of exercise shown to positively influence bone mass, structure and strength and reduce fracture risk in postmenopausal women.
We review evidence concerning exercise for stroke prevention. Plausible biological reasons suggest that exercise would be important in preventing stroke. While definitive randomised controlled trials evaluating the impact of physical activity (PA) and exercise on preventing stroke and mortality are lacking, observational studies, small randomised controlled trials and meta-analyses have provided evidence that PA and exercise favourably modify stroke risk factors, including hypertension, dyslipidaemia, diabetes, sedentary lifestyle, obesity, excessive alcohol consumption and tobacco use. It is, therefore, important to understand the factors associated with poststroke PA/exercise and cardiorespiratory fitness. Positively associated factors include self-efficacy, social support and quality of patients’ relationships with health professionals. Negatively associated factors include logistical barriers, medical comorbidities, stroke-related deficits, negative exercise beliefs, fear of falling, poststroke fatigue, arthropathy/pain and depression. Definitive research is needed to specify efficacious behavioural approaches to increase poststroke exercise. Effective techniques probably include physician endorsement of exercise programmesto patients, enhancement of patient–professional relationships, providing patients an exercise rationale, motivational interviewing, collaborative goal-setting with patients, addressing logistical concerns, social support in programsmes, structured exercise programming, individualised behavioural instruction, behavioural diary recording, reviewing behavioural consequences of exercise efforts, reinforcing successful exercise performance. Exercise programming without counselling may increase short-term activity; simple advice or information-giving is probably ineffective. Older patients or those with cognitive impairment may need increased structure, with emphasis on behaviour per se, versus self-regulation skills. We support the latest American Heart Association/American Stroke Association guidelines (2014) recommending PA and exercise for stroke prevention, and referral to behaviourally oriented programmes to improve PA and exercise.
Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.
Physical exercise is one of the most effective methods to help prevent cardiovascular (CV) disease and to promote CV health. Aerobic and anaerobic exercises are two types of exercise that differ based on the intensity, interval and types of muscle fibers incorporated. In this article, we aim to further elaborate on these two categories of physical exercise and to help decipher which provides the most effective means of promoting CV health.
OBJECTIVE To provide recommendations on exercise training as part of the management of hypertension in adults.Quality of evidence Evidence was found through a systematic search of PubMed, MEDLINE, EMBASE, Agency for Healthcare Research and Quality evidence-based reports, Bandolier, Clinical Evidence, the Institute for Clinical Systems Improvement guidelines, the National Guideline Clearinghouse database, UpToDate,and the Cochrane Database of Systematic Reviews (part of Ovid Evidence Based Medicine Reviews) for articles published from January 1973 to September 2013. Study types were limited to meta-analyses, randomized controlled trials, clinical trials, and reviews.
Exercise exerts an antiinflammatoryaction through the sympathetic nervous system and the hypothalamic-pituitary adrenal axis, and has direct effects on blood pressure. The resulting physiologic effects are classified as acute, postexercise, and chronic. Current treatment guidelines emphasize the role of nonpharmacologic interventions, including physical activity, in the management of mild to moderate hypertension.
Moderate intensity aerobic exercise has been proven to prevent hypertension and to help in the management of stage 1 hypertension. Dynamic resistance exercises, if done properly, contribute to lowering both systolic and diastolic blood pressures. There is insufficient evidence about the safety and efficacy of isometric resistance training to recommend it.
In order to update and improve available evidence on associations of physical activity (PA) with cardiovascular disease (CVD) by applying meta-analytic random effects modeling to data from prospective cohort studies, using high quality criteria of study selection, we searched the PubMed database from January 1980 to December 2010 for prospective cohort studies of PA and incident CVD, distinguishing occupational PA and leisure time PA, coronary heart disease (CHD) and stroke, respectively. Inclusion criteria were peer-reviewed English papers with original data, studies with large sample size (n ≥ 1,000) and substantial follow-up (≥ 5 years), available data on major confounders and on estimates of relative risk (RR) or hazard ratio (HR), with 95% confidence intervals (CI). We included 21 prospective studies in the overall analysis, with a sample size of more than 650,000 adults who were initially free from CVD, and with some 20,000 incident cases documented during follow-up. Among men, RR of overall CVD in the group with the high level of leisure time PA was 0.76 (95% CI 0.70-0.82, p < 0.001), compared to the reference group with low leisure time PA, with obvious dose-response relationship. A similar effect was observed among women (RR = 0.73, 95% CI 0.68-0.78, p < 0.001). A strong protective effect of occupational PA was observed for moderate level in both men (RR = 0.89, 95% CI 0.82-0.97, p = 0.008) and women (RR = 0.83, 95% CI 0.67-1.03, p = 0.089). No publication bias was observed. Our findings suggest that high level of leisure time PA and moderate level of occupational PA have a beneficial effect on cardiovascular health by reducing the overall risk of incident coronary heart disease and stroke among men and women by 20 to 30 percent and 10 to 20 percent, respectively. This evidence from high quality studies supports efforts of primary and secondary prevention of CVD in economically advanced as well as in rapidly developing countries.
The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.
Published data have shown that physical activity (PA) has a positive role on the primary prevention of breast cancer risk. However, the role of PA on breast cancer outcome has been controversial with inconsistent data. The lack of a meta-analysis that addresses that issue prompted the current report. A comprehensive literature search identified eight studies, of which two studies were excluded. The remaining six studies (12,108 patients with breast cancer) were included in this meta-analysis. Pre-diagnosis PA reduced all causes mortality by 18% but had no effect on breast cancer deaths. Post-diagnosis PA reduced breast cancer deaths by 34% (HR=0.66, 95% CI, 0.57-0.77, P<0.00001), all causes mortality by 41% (HR=0.59, 95% CI, 0.53-0.65, P<0.00001), and disease recurrence by 24% (HR=0.76, 95% CI, 0.66-0.87, P=0.00001). Breast cancer mortality was reduced by pre-diagnosis PA in women with body mass index (BMI)<25 kg/m2, while post-diagnosis PA reduced that risk among those with BMI≥25 kg/m2. On the other hand, post-diagnosis PA reduced all causes mortality regardless of the BMI. The analysis showed that post-diagnosis PA reduced breast cancer deaths (HR=0.50, 95% CI, 0.34-0.74, P=0.0005), and all causes mortality (HR=0.36, 95% CI, 0.12-1.03, P=0.06) among patients with estrogen receptor (ER)-positive tumor, while women with ER-negative disease showed no gain. The current meta-analysis provides evidence for an inverse relationship between PA and mortality in patients with breast cancer and supports the notion that appropriate PA should be embraced by breast cancer survivors.
The Guide to Community Preventive Service's methods for systematic reviews were used to evaluate the effectiveness of various approaches to increasing physical activity: informational, behavioral and social, and environmental and policy approaches. Changes in physical activity behavior and aerobic capacity were used to assess effectiveness. Two informational interventions ("point-of-decision" prompts to encourage stair use and community-wide campaigns) were effective, as were three behavioral and social interventions (school-based physical education, social support in community settings, and individually-adapted health behavior change) and one environmental and policy intervention (creation of or enhanced access to places for physical activity combined with informational outreach activities). Additional information about applicability, other effects, and barriers to implementation are provided for these interventions. Evidence is insufficient to assess a number of interventions: classroom-based health education focused on information provision, and family-based social support (because of inconsistent findings); mass media campaigns and college-based health education and physical education (because of an insufficient number of studies); and classroom-based health education focused on reducing television viewing and video game playing (because of insufficient evidence of an increase in physical activity). These recommendations should serve the needs of researchers, planners, and other public health decision makers.
Physically active individuals have a lower risk of developing colorectal cancer but the influence of exercise on cancer survival is unknown.
By a prospective, observational study of 573 women with stage I to III colorectal cancer, we studied colorectal cancer-specific and overall mortality according to predefined physical activity categories before and after diagnosis and by change in activity after diagnosis. To minimize bias by occult recurrences, we excluded women who died within 6 months of their postdiagnosis physical activity assessment.
Increasing levels of exercise after diagnosis of nonmetastatic colorectal cancer reduced cancer-specific mortality (P for trend = .008) and overall mortality (P for trend = .003). Compared with women who engaged in less than 3 metabolic equivalent task [MET] -hours per week of physical activity, those engaging in at least 18 MET-hours per week had an adjusted hazard ratio for colorectal cancer-specific mortality of 0.39 (95% CI, 0.18 to 0.82) and an adjusted hazard ratio for overall mortality of 0.43 (95% CI, 0.25 to 0.74). These results remained unchanged even after excluding women who died within 12 and 24 months of activity assessment. Prediagnosis physical activity was not predictive of mortality. Women who increased their activity (when comparing prediagnosis to postdiagnosis values) had a hazard ratio of 0.48 (95% CI, 0.24 to 0.97) for colorectal cancer deaths and a hazard ratio of 0.51 (95% CI, 0.30 to 0.85) for any-cause death, compared with those with no change in activity.
Recreational physical activity after the diagnosis of stages I to III colorectal cancer may reduce the risk of colorectal cancer-specific and overall mortality.
Background:
The benefits of aerobic exercise (AE) for cardiovascular disease (CVD) have been well documented. Resistance exercise (RE) has been traditionally examined for its effects on bone density, physical function, or metabolic health, yet few data exist regarding the benefits of RE, independent of and combined with AE, for CVD prevention. This randomized controlled trial, "Comparison of the Cardiovascular Benefits of Resistance, Aerobic, and Combined Exercise (CardioRACE)," is designed to determine the relative benefits of RE, AE, or combined RE plus AE training on CVD risk factors.
Methods:
Participants are 406 inactive men and women (35-70 years) with a body mass index of 25-40 kg/m2 and blood pressure (BP) of 120-139/80-89 mm Hg without taking antihypertensive medications. Participants are randomly assigned to RE only, AE only, combined RE and AE (CE), or a no exercise control group. Participants perform supervised exercise at 50%-80% of their relative maximum intensity for both AE and RE, 3 times a week for 60 minutes per session, for 1 year (all 3 groups are time matched).
Results:
The primary outcome is a composite z score including resting BP, low-density lipoprotein cholesterol (LDL-C), fasting glucose, and percent body fat, which is assessed at baseline, 6 months, and 12 months. Diet and outside physical activity are measured throughout the intervention for 1 year.
Conclusion:
CardioRACE (ClinicalTrials.govNCT03069092) will fill an important knowledge gap regarding the effects of RE, alone or in addition to the well-documented effects of AE. CardioRACE will help generate more comprehensive and synergistic clinical and public health strategies to prevent CVD.
A strong body of empirical evidence demonstrates the anxiolytic effects of exercise; however, translating these findings into an effective mental health promotion strategy for people with anxiety-related disorders (ARDs) may prove challenging as people with ARDs tend to report lower levels of participation in physical activity, including exercise. To overcome this barrier, research is needed to understand the psychological processes that fuel engagement and disengagement from exercise for people with ARDs. The purpose of this study was to use grounded theory to describe the exercise experience for people with ARDs, including the barriers and facilitators that they face. Participants were recruited via an online eligibility screener and 16 eligible participants, who met diagnostic criteria for an ARD and reported being physically inactive, completed individual face-to-face interviews. The model resulting from our study shows that people with ARDs frequently experience exercise anxiety or the cognitive (i.e., worries about exercise), physical (i.e., negative reactions to the physical sensations associated with exercise), and behavioural (i.e., avoidance) symptoms of anxiety when they think about and/or engage in exercise. The model also identifies several factors (e.g., social support, money, time) that can facilitate short-term exercise participation and explains how loss of these factors leads back to a cycle of exercise anxiety and related long-term avoidance behaviour. Our findings suggest that researchers and clinicians should consider targeting exercise anxiety, perhaps through the use of cognitive behavioural interventions, to aid people with ARDs to achieve long-term adherence and exercise-related benefits.
Executive function deficit is an indicator of Alzheimer's-type dementia and manifests as disruptions of attentional control, memory, cognitive flexibility, planning, and reasoning, among other cognitive problems. Physical exercise is suggested to have a protective effect on global cognition with aging. However, whether it influences executive function in people living with Alzheimer's-type dementia specifically is unknown. The current systematic review examined the efficacy of physical exercise on executive function performance in community-dwelling older adults living with Alzheimer's-type dementia. An electronic search of databases retrieved randomized and non-randomized controlled trials of community-dwelling older adults diagnosed with Alzheimer's-type dementia who completed a physical exercise intervention and who were assessed using an executive function outcome measure. Methodological quality of six studies meeting the inclusion criteria published between 2009 and 2016 was scored independently by two raters using the Physiotherapy Evidence Database and a Cochrane informed domain-based assessment of risk of bias. Trends toward improvement in executive function scores were seen across all six studies, and significant improvement was seen in four of the eligible studies. Future studies should explore the benefits of the American College of Sports Medicine recommended 150 minutes of physical exercise per week with select measures of executive function.
Objective
To explore African American (AA) women’s use of mind-body therapies, such as yoga and mindfulness, and factors that impact their experiences, observations and opinions.
Design
Focus groups were conducted to better understand how AA women perceive mind-body therapies and how to best bring these interventions into their community. Interviews were audiotaped and transcribed.
Setting
The urban Midwest.
Outcome measures
In addition to qualitative outcomes, descriptive measures included the Perceived Stressor Scale, Beliefs About Yoga Scale, and Determinants of Meditation Practice Inventory (DOMPI).
Results
Twenty-two, predominantly low-income (75% reported income <$50,000) and single (82%) women participated in three age stratified focus groups (18–34 years, 35–65 years, 66 years and older). Participants acknowledged life stress and shared common coping mechanisms. They recognized that yoga and mindfulness could be beneficial and discussed barriers to practice (including personal and structural). Younger women reported more time constraints as barriers, middle aged women had more experience with yoga, and older women identified the spiritual component to yoga/mindfulness as potentially conflicting with current coping strategies. Participants suggested ways to share mind-body therapies within the AA community along with solutions for engagement.
Conclusions
AA women acknowledged stress in their lives and recognized the need for additional coping measures. Although women reported interest in yoga/mindfulness they identified barriers, including limited access to convenient classes, and offered suggestions for bringing yoga and mindfulness to their communities.
Exercise has been shown to be a physiological and psychological benefit for people with epilepsy (PWE). However, barriers prevent many PWE from exercising safely and confidently. This research explored current perceived barriers to exercise and adaptation techniques used by PWE in order to maintain physical activity levels. Three focus groups (2–3 participants per group) and three semi-structured interviews were conducted (11 participants total). Constructive grounded theory was used to frame the study and analyse the findings, presenting new insight into the motivation, perceived barriers, and adaptation techniques used to exercise. The main motivator to maintain physical activity levels was the benefit of exercise on physical and mental health. This was shown in an increase in mood, higher social interaction, and perceived improvement in overall physical health as a result of exercise. Current barriers to exercise included a fear of injury, lack of social support, and exercise-induced seizures (e.g., through overheating and/or high exercise intensity level). Adaptation techniques used were self-monitoring through the use of technology, reducing exercise frequency and intensity level, and exercising at certain times of the day. The importance of social support was shown to provide increased confidence and positive encouragement to exercise, contrasting with family and friends worrying for his/her safety and medical professionals requesting termination of some physical activities. These findings provide new insight into current adaptation techniques that are used and developed by PWE to overcome common barriers to exercise. These new additions to the literature can lead to further development of such techniques as well as examine current medical professionals' knowledge of the benefits of exercise for PWE.
Objectives:
Chronic diseases are the leading cause of death and disability worldwide. They are, though, largely attributable to modifiable lifestyle risk factors, including lack of exercise. This study aims to investigate what factors predict perceptions of barriers to exercise in midlife women.
Study design:
This cross-sectional descriptive study collected data from midlife Australian women by online questionnaire. Volunteers aged between 40 and 65 years were recruited following media publicity about the study.
Main outcome measures:
The primary outcome measure was perceived exercise barriers (EBBS Barriers sub-scale). Other self-report data included: exercise, smoking, alcohol, fruit and vegetable consumption, body mass index, physical and mental health and well-being (MOS SF-12v2) and exercise self-efficacy.
Results:
On average, the 225 participants were aged 50.9 years (SD=5.9). The significant predictors of perceived barriers to exercise were perceived benefits of exercise, exercise self-efficacy, physical well-being and mental well-being. These variables explained 41% of the variance in the final model (F (8219)=20.1, p<.01) CONCLUSIONS: In midlife women, perceptions of barriers to exercise correlate with beliefs about the health benefits of exercise, exercise self-efficacy, physical and mental well-being. These findings have application to health promotion interventions targeting exercise behaviour change in midlife women.
The physiological response to exercise is dependent on the intensity, duration and frequency of the exercise as well as the
environmental conditions. During physical exercise, requirements for oxygen and substrate in skeletal muscle are increased,
as are the removal of metabolites and carbon dioxide. Chemical, mechanical and thermal stimuli affect alterations in metabolic,
cardiovascular and ventilatory function in order to meet these increased demands.
According to the 2008 Physical Activity Guidelines for Americans, adults need to engage in at least 150 minutes/week of moderate-intensity activity or its equivalent (defined as aerobically active) to obtain substantial health benefits and more than 300 minutes/week (defined as highly active) to obtain more extensive health benefits. In addition to aerobic activity, the 2008 Guidelines recommend that adults participate in muscle-strengthening activities on 2 or more days/week.
This study examined the prevalence and trends of meeting the activity criteria defined by the 2008 Guidelines among U.S. adults.
Prevalence and trends of participation in leisure-time physical activity were estimated from the 1998-2008 National Health Interview Survey (analyzed in 2010).
In 2008, 43.5% of U.S. adults were aerobically active, 28.4% were highly active, 21.9% met the muscle-strengthening guideline, and 18.2% both met the muscle-strengthening guideline and were aerobically active. The likelihood of meeting each of these four activity criteria was similar and were associated with being male, being younger, being non-Hispanic white, having higher levels of education, and having a lower BMI. Trends over time were also similar for each part of the 2008 Guidelines, with the prevalence of participation exhibiting a small but significant increase when comparing 1998 to 2008 (difference ranging from 2.4 to 4.2 percentage points).
Little progress has been made during the past 10 years in increasing physical activity levels in the U.S. There is much room for improvement in achieving recommended levels of physical activity among Americans, particularly among relatively inactive subgroups.
Despite the recognized health benefits, few older women participate in strength-training exercises.
The purpose of this study was to examine factors related to older women's adherence to strength training after participation in the StrongWomen Program, a nationally disseminated community program. Adherence was defined as > or =4 months of twice-weekly strength training. Surveys were sent to 970 program participants from 23 states and to participants' corresponding program leaders. Five-hundred fifty-seven participants responded (57%).
Of respondents who completed surveys (527), 79% (415) adhered to strength training; adherers reported a mean of 14.1 +/- 9.1 months of strength training. Logistic-regression analysis revealed that exercise adherence was positively associated with age (p = .001), higher lifetime physical activity levels (p = .045), better perceived health (p = .003), leader's sports participation (p = .028), and leader's prior experience leading programs (p = .006).
These data lend insight to factors that may be related to exercise adherence among midlife and older women.
There is evidence to support that low fitness and physical activity, excess body weight, and excess abdominal fatness are associated with increased health risk. Moreover, evidence exists to support that sufficient levels of physical activity can significantly improve body weight, fatness, and health risk. Physical activity has been shown to have a modest effect on body weight that is typically <3% of initial body weight, but has an additive effect when combined with dietary restriction. Moreover, physical activity has been shown to be an important behavioral factor for enhancing long-term weight loss and minimizing weight regain; however, this may require relatively high doses of physical activity that approach 300 min/week. Physical activity may concurrently reduce abdominal adiposity, and which may serve as a pathway by which there is also an improvement in health-related risk factors for various chronic diseases. There are important areas of research that require further investigation, with particular need to further examine the dose of physical activity that significantly affects these health outcomes. Moreover, there is a need for improved interventions to promote the adoption and long-term maintenance of physical activity, which can lead to improved weight control, abdominal adiposity, and chronic disease risk factors. Future research is also needed to understand the physiological/metabolic pathways and mechanisms that explain the influence of physical activity on long-term regulation of body weight.
This study was designed to define the effect of different levels of leisure time physical activity on cardiorespiratory fitness and progression of coronary atherosclerotic lesions in unselected patients with coronary artery disease.
It has been shown in various studies that regression of coronary atherosclerotic lesions can be achieved by means of lipid-lowering drugs, reduction of fat consumption and physical exercise.
Patients were prospectively randomized either to an intervention group (n = 29) participating in regular physical exercise or to a control group (n = 33) receiving usual care. Energy expenditure in leisure time physical activity was estimated from standardized questionnaires and from participation in group exercise sessions. After 12 months of participation, repeat coronary angiography was performed; coronary lesions were measured by digital image processing.
After 1 year, patients in the intervention group achieved an increase in oxygen uptake at a ventilatory threshold of 7% (p < 0.001) and peak exercise of 14% (p < 0.05), whereas a significant decrease was observed in patients in the control group. To achieve significant improvement in cardiorespiratory fitness, approximately 1,400 kcal/week had to be expended in the form of leisure time physical activity (p < 0.001). The mean energy expended in such activity was 1,876 +/- 163 kcal/week in the intervention group and 1,187 +/- 97 kcal/week in the control group (p < 0.001). In the intervention group, regression of coronary artery disease was noted in 8 patients (28%), progression of disease in 3 (10%) and no change in coronary morphology in 18 (62%). In contrast, coronary artery disease progressed at a significantly faster rate in patients in the control group (progression in 45%, no change in 49% and regression in 6%) (p < 0.001 vs. intervention). When the two groups were combined, the lowest level of leisure time physical activity was noted in patients with progression of disease (1,022 +/- 142 kcal/week) as opposed to patients with no change (1,533 +/- 122 kcal/week) or regression of disease (2,204 +/- 237 kcal/week) (p < 0.005).
Measurable improvement in cardiorespiratory fitness requires approximately 1,400 kcal/week of leisure time physical activity; higher work loads are necessary to halt progression of coronary atherosclerotic lesions (1,533 +/- 122 kcal/week), whereas regression of coronary lesions is observed only in patients expending an average of 2,200 kcal/week in leisure time physical activity, amounting to approximately 5 to 6 h/week of regular physical exercise.
Physical Activity Readiness Questionnaire (PARQ) clearance has been recommended prior to low-to-moderate exercise involvement. The measure, however, appears to exclude a high proportion of older adults due to false positive responses. To improve this situation, a revised PARQ was developed (rPARQ). The purpose of this study was to compare the number exclusions resulting from the PARQ and rPARQ in 60- to 69-yr-old adults. Participants were recruited from Community Nutrition Centers (97 males, 96 females; mean age = 64.82 yr, SD +/- 2.85). At random, half completed the PARQ or rPARQ on day 1 and the respective opposite instrument on day 2. There was a significant decrease in the number of exclusions resulting from the PARQ as compared to the rPARQ (146 to 128, P < 0.001). Percentage of agreement regarding exclusion/inclusion status between the two measures was 87.6% (kappa = 0.71). Responses for the six matched questions were significantly (P < 0.0001) related with contingency and phi coefficients ranging from 0.40 to 0.58 and 0.43 to 0.71, respectively. These results support the concurrent validity of the rPARQ and suggest the revisions have had their intended effect.
Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.
We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.
The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.
Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
Prescribing exercise for cardiac patients is comparable in many ways to prescribing medications; that is, one recommends an optimal dosage according to individual needs and clinical status. Recent research has shown that it is more accurate to prescribe exercise as a percentage of the oxygen uptake reserve (VO2R), which is the difference between resting and maximal or peak oxygen consumption, rather than as a percentage of the VO2 max. Moreover, it appears that a minimum of 1600 kcal/week of leisure-time physical activity may halt the progression of coronary artery disease, whereas regression may be achieved with a gross energy expenditure of 2200 kcal/week. Upper body and resistance training have also been shown to be safe and effective for clinically stable patients. Aerobic capacity serves as an independent predictor of all cause and cardiovascular mortality in patients referred to an outpatient cardiac rehabilitation program, with each 1 metabolic equivalent increase in aerobic fitness conferring an approximate 10% reduction in mortality. The goal of preventing recurrent cardiac events is, to a large extent, based on sustained compliance to multifactorial interventions, which can be influenced by numerous socioeconomic and clinical variables, and enhanced by home-based or group cardiac rehabilitation programs that are designed to circumvent or attenuate barriers to participation and adherence, so that many more individuals may realize the benefits that secondary prevention can provide.
Walking is associated with reduced diabetes incidence, but few studies have examined whether it reduces mortality among those who already have diabetes.
To estimate the association between walking and the risk for all-cause and cardiovascular disease (CVD) mortality among persons with diabetes.
Prospective cohort study of a representative sample of the US population.
Interviewer-administered survey in the general community.
We sampled 2896 adults 18 years and older with diabetes as part of the 1990 and 1991 National Health Interview Survey.
All-cause and CVD mortality for 8 years.
Compared with inactive individuals, those who walked at least 2 h/wk had a 39% lower all-cause mortality rate (hazard rate ratio [HRR], 0.61; 95% confidence interval [CI], 0.48-0.78; 2.8% vs 4.4% per year) and a 34% lower CVD mortality rate (HRR, 0.66; 95% CI, 0.45-0.96; 1.4% vs 2.1% per year). We controlled for sex, age, race, body mass index (calculated as weight in kilograms divided by the square of height in meters), smoking, and comorbid conditions. The mortality rates were lowest for persons who walked 3 to 4 h/wk (all-cause mortality HRR, 0.46; 95% CI, 0.29-0.71; CVD mortality HRR, 0.47; 95% CI, 0.24-0.91) and for those who reported that their walking involved moderate increases in heart and breathing rates (all-cause mortality HRR, 0.57; 95% CI, 0.41-0.80; CVD mortality HRR, 0.69; 95% CI, 0.43-1.09). The protective association of physical activity was observed for persons of varying sex, age, race, body mass index, diabetes duration, comorbid conditions, and physical limitations.
Walking was associated with lower mortality across a diverse spectrum of adults with diabetes. One death per year may be preventable for every 61 people who could be persuaded to walk at least 2 h/wk.
More than 18 million Americans currently have diabetes mellitus. The economic and human cost of the disease is devastating. In the United States, diabetes is the most common cause of blindness among working-age adults, the most common cause of nontraumatic amputations and end-stage renal disease, and the sixth most common cause of death. For the cohort of Americans born in 2000, the estimated lifetime risk for diabetes is more than 1 in 3. In the next 50 years, the number of diagnosed cases of diabetes is predicted to increase by 165% in the United States, with the largest relative increases seen among African Americans, American Indians, Alaska Natives, Asian and Pacific Islanders, and Hispanic/Latino persons. Compelling scientific evidence indicates that lifestyle change prevents or delays the occurrence of type 2 diabetes in high-risk groups. This body of evidence from randomized, controlled trials conducted in 3 countries has definitively established that maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk persons by about 40% to 60% over 3 to 4 years. The number of persons at high risk for type 2 diabetes is similar to the number of persons who have diabetes. This paper summarizes scientific evidence supporting lifestyle intervention to prevent type 2 diabetes and discusses major policy challenges to broad implementation of lifestyle intervention in the health system.
Exercise energy systems: a primer
- S Colberg
Cardiorespiratory fitness and stroke mortality in men
- Lee