ArticleLiterature Review

The Escalating Pandemics of Obesity and Sedentary Lifestyle: A Call to Action for Clinicians

Authors:
  • Columbia University College of Physicians & Surgeons, United States
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Abstract

Obesity and sedentary lifestyle are escalating national and global epidemics that warrant increased attention by physicians and other health care professionals. These intricately linked conditions are responsible for an enormous burden of chronic disease, impaired physical function and quality of life, at least 300,000 premature deaths, and at least $90 billion in direct health care costs annually in the United States alone. Clinicians are on the front line of combat, yet these conditions receive minimal attention during a typical office visit. Clinicians often feel overwhelmed by these challenges and point to an absence of clear guidelines and practice tools, minimal training in behavior modification strategies, and lack of time as reasons for failing to confront them. This report provides a "call to action" with step-by-step guidelines specifically directed at the pivotal role of physicians and other health care professionals in curbing these dangerous epidemics. This blueprint for action, which requires only a few minutes of a clinician's time to implement, will facilitate more effective intervention related to obesity and inactivity and should favorably impact public health.

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... HIH and Nesidioblastosis have been reported to resolve over time in some patients and neuroglycopenia may not be evident [24]. Majority of patients suffering from HIH respond to dietary modification, such as eating frequent, small, low-carbohydrate, high protein meals. ...
... This occurrence of the dumping syndrome is a stimulus of Glucagon-Like Peptide One (GLP-1) release [23]. GLP-1 stimulates regeneration and expansion of pancreatic beta-cells by process of neo-genesis and proliferation [24]. Studies have demonstrated the proliferative and anti-apoptotic properties of GLP-1 in human and rodent beta-cells. ...
... The hypoglycemia is due to beta-cell proliferation and overactivity (Nesidioblastosis) as a result of GLP-1 stimulation [26]. Without pyloric regulation, dumping occurs, stimulating GLP-1, increasing proliferation, overactivity of Beta cells, and inhibiting programmed cell death of pancreatic islets, leading to inappropriately increased insulin-secreting cell hypertrophy [24,25]. Postprandial decreased blood glu- There was no radiologic evidence of insulinoma. ...
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Gastric bypass (GB) used to be a standard surgical procedure performed for weight loss. Delayed complications following GB may outweigh the initial benefits in some patients. As manifested in some patients with clinical symptoms of hypoglycemia, Dumping Syndrome may, over time, progress to persistent Hyper-Insulinemic Hypoglycemia (HIH) and, in some cases, with Nesidioblastosis (NB)1. The current recommended surgical treatment includes >95% pancreatectomy2 which has been shown to cause irreversible diabetes in 90% of patients. We discuss fifteen patients who underwent gastric bypass revision to duodenal switch with a resolution of hypoglycemic symptoms. In our experience, DS is a preferable operation for the correction of HIH.
... Individuals with body mass index (BMI) of 30 and above are classified as being obese, see figure 2. Obesity is a worldwide epidemic [32,20,4]. It is emerging as the most significant contributor to ill health [20], is linked to various diseases [17] and it causes premature death [24,19]. Obesity simply occurs when individuals consume more than their energy needs [17]. ...
... Some health personnel also believe that weight is a sign of a good living [32] even though many health personnel are finding it difficult to discharge their duty as a result of being obese [32]. Obesity is described as self-inflicted condition [24], a slow process which is fuelled by environmental factors [1]. ...
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Naturally, diet is one of the most important factors in human life. In this work, a novel model that uses technology to support healthy living through diet is proposed. HELT D: A Context-aware HEalthy Living Through Diet System, is a system that provides users with diet based on their condition of health and dietary needs. A high level description of the proposed system was provided and formal specification of the system was given. For the formal specification, CCA (Calculus for Context-aware Ambients) was used. The specification was implemented using ccaPL (CCA Programming Language) to execute and study the system's behaviour. The system demonstrates both context-awareness and concurrency.
... In recent years, the number of obese people has increased significantly owing to sedentary lifestyles and high-calorie diets (Manson et al., 2004). The World Health Organization (WHO) defines being overweight as having a body mass index (BMI) of 25 or more and obesity as a BMI of 30 or more (WHO Regional Office for Europe, 2022). ...
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Introduction Despite the widespread use of ephedra in various forms, including food supplements and herbal prescriptions, comprehensive studies reviewing its efficacy and safety across different countries are lacking. Methods We systematically searched 5 electronic databases and conducted a meta-analysis of 16 randomized controlled trials (RCTs) on ephedra-containing oral medications (EOMs), performing a dose–response analysis for weight loss. Results The meta-analysis results revealed a statistically significant reduction in the body mass index (BMI) (MD: 1.5 kg/m2; 95% CI: −2.46 to −0.54) and secondary outcomes like body weight (BW) and waist circumference (WC). The dose–response analysis indicated a correlation between ephedra and weight reduction. The safety analysis showed no significant difference in adverse effects between the treatment and control groups (RR = 0.99, 95% CI = 0.80 ∼ 1.21, and p = 0.90). Discussion In conclusion, EOMs demonstrated effectiveness in promoting weight loss, and the dose–response analysis indicated a correlation between ephedra and weight reduction. However, additional research is necessary due to the limited number of studies and inconsistent results among the assessment criteria. Moreover, if prescribed by traditional medicine physicians within the permissible daily ephedrine dosage range of 150 mg set by the Food and Drug Administration (FDA) and monitored by healthcare professionals, the risk of severe adverse events is likely to be minimal. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387895, identifier CRD42023387895.
... Recognizing the importance of achieving and maintaining an ideal body weight, there has been a growing acknowledgment of the diverse dietary strategies to accomplish weight control [9]. Meal replacement (MR) is one strategies and refers to prepackaged food products, beverages, or meals that are specifically formulated to substitute one or more original meals while offering a predetermined quantity of energy [10].The efficacy of the treatment of individuals with overweight or obese has been demonstrated through the integration of both partial meal replacement (PMR) and total meal replacement (TMR) into conventional lifestyle interventions [11,12]. ...
Article
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The global prevalence of obesity and overweight is a significant concern in the field of public health. Numerous interventional studies have been conducted to assess the possible meal replacements (MRs) effect on anthropometric indicators and indices and laboratory test that reflect obesity. However, there are no comprehensive results in this field. The study aim was to understand the possible effects of MRs on body weight, body mass index (BMI), fat mass, waist circumferences (WC), and leptin levels. A systematic search was conducted in five electronic databases in order to find randomized clinical trials (RCTs) that examined the possible MRs effect on obesity. Analyses were performed in R software, version 4.2.1. The random-effects model analysis was used to provide pooled mean difference and 95% confidence intervals (95% CI). Seventy studies were included. Body weight (WMD: -3.35 kg, 95% CI: -4.28 to -2.42), BMI (WMD: -1.12 kg/m2, 95% CI: -1.51 to -0.72), fat mass (WMD: -2.77 kg, 95% CI: -3.59 to -1.6), WC (WMD: -2.82 cm, 95% CI: -3.51 to -2.12) were significantly reduced after MRs compared to control. No significant effect was observed on leptin (WMD: -3.37 ng/ml, 95% CI: -8.23 to 1.49). Subgroup analyses indicated that impact of total MRs on anthropometric factors was greater in comparison to partial MRs. Considering other lifestyle factors, MRs can lead to anthropometric indicators and indices reduction. Graphical Abstract
... Recent research shows that obesity prevalence increases as people lead a more sedentary lifestyle. 31,32 Lack of physical activity is identified as a significant contributing factor to obesity because it is associated with lower energy expenditure. The past three decades have seen a rise in obesity cases as more people lead a sedentary lifestyle. ...
Article
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The last decade has seen a significant increase in obesity and overweight cases globally. The World Health Organization estimates that 1 in every 8 people globally were living with overweight and obesity in 2022. This is approximately 2.5 billion who are overweight and 890 million who are obese. The rate at which the obesity prevalence is an indication that it is ending towards being an epidemic. Considering that obesity is multifactorial, isolating the exact causes is a significant problem. As a result, there is a need to dedicate more resources towards addressing the problem. One of the ways that can be used to deal with the rising obesity prevalence is expanding the role of healthcare providers more so community pharmacists to address the problem. Community pharmacists can do more than drug management in managing the growing obesity crisis. They can be involved in weight management, guidance on lifestyle modifications, and counselling on behavior modifications. They can also be involved in community-based interventions that aim to address obesity. Keywords: obesity, obesity crisis, community pharmacists, energy intake, energy expenditure, weight management
... At the same time, we currently observe a steady trend towards physical inactivity or sedentary behavior [6] and obesity [18]. Although health research points out the many related dangers like diabetes, cardiovascular risk, bad stress regulation [7] and mental health [9,23] of constant sitting or being overweight. ...
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In a world where in-person context transitions more into remote and hybrid concepts, we should consider new concepts of interaction in health and rehabilitation and what advantages and disadvantages they bring. One of the rising topics is mixed reality, where we can use the advantages of immersive 3D, 360-degree environments. Meanwhile, physical activity is further decreasing and with it negative effects increase through sedentary behaviour or wrong and untrained movements. In this position paper, we discuss these new risks and potential benefits of mixed reality technology when used for rehabilitation and fitness. We conclude with suggesting better feedback and guidance for physical movement and tasks at home. Improving feedback and guidance for participants could be achieved through using new technologies like virtual reality and motion tracking.
... Obesity, a significant risk factor for cardiometabolic disease, may play a role in neurodegenerative diseases such as dementia [1][2][3][4]. Evidence from animal models suggests that obesity leads to increased cognitive dysfunction, particularly in hippocampaldependent processes, including learning and spatial memory [5,6]. ...
Article
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Obesity has been linked to a range of pathologies, including dementia. In contrast, regular physical activity is associated with the prevention or reduced progression of neurodegeneration. Specifically, physical activity can improve memory and spatial cognition, reduce age-related cognitive decline, and preserve brain volume, but the mechanisms are not fully understood. Accordingly, we investigated whether any detrimental effects of high-fat diet (HFD)-induced obesity on cognition, motor behavior, adult hippocampal neurogenesis, and brain-derived neurotrophic factor (BDNF) could be mitigated by voluntary exercise training in male C57Bl/6 mice. HFD-induced impairment of motor function was not reversed by exercise. Importantly, voluntary wheel running improved long-term memory and increased hippocampal neurogenesis, suggesting that regular physical activity may prevent cognitive decline in obesity.
... Thus, the health insurance industry must educate and explain policy benefits to cover as many individuals as possible. Thus, the study is crucial to understanding consumers' readiness and intent to obtain health insurance after the epidemic and the elements that increase health insurance acceptability in India (Manson et al., 2004). Henceforth, the health insurance industry must educate and explain policy benefits to cover as many individuals as possible. ...
Article
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This study aims to examine the factors influencing the adoption of health insurance and buy intention among Generation Z in India during the period after the COVID-19 pandemic. The COVID-19 pandemic has highlighted the significance of healthcare readiness and fiscal stability, hence emphasizing the crucial role of health insurance in the lives of individuals and households. Generation Z, encompassing individuals born approximately from the mid-1990s to the early 2010s, constitutes a noteworthy demographic cohort characterised by distinct inclinations and conduct. This study investigates the demographic features of individuals, their level of knowledge and awareness regarding health insurance, their attitudes towards risk, and the influence of the pandemic on their perceptions. Preliminary data suggest that the Gen Z population in India understands the significance of health insurance. However, some obstacles impede their adoption of such insurance, including a lack of comprehensive knowledge, budgetary limitations, and a tendency to prioritise immediate financial objectives. Moreover, the ongoing global pandemic has significantly impacted individuals’ perception of healthcare risks and financial planning, potentially affecting their inclination to allocate resources towards health insurance investments. This study enhances our comprehension of the changing patterns of health insurance adoption in India, specifically among the youngest cohort, and offers valuable insights for insurers, policymakers, and healthcare providers to customise their offerings and communication approaches in order to effectively address the requirements of Generation Z in the aftermath of the pandemic. In conclusion, promoting the adoption of health insurance among this particular cohort has the potential to enhance financial resilience and facilitate improved access to healthcare for future generations in India.
... societal and behavioural changes from an active to a sedentary lifestyle over the last few decades has been commonly found to be responsible for various lifestyle disorders including obesity (1). Various possible mechanisms inside our body lead to obesity. ...
Article
Obesity is a compound, unending disease with numerous causes that lead to the development of metabolic diseases. Body fat itself is not an ailment, but it can change the way it functions once it gets accumulated in excess inside the body. These changes are progressive and get worse over time and thus lead to adverse health effects. A study on obesity and its complications and dietary assessment was carried out in District Srinagar of UT J&K, using a self-structured questionnaire. A sample of 150 obese individuals from both the sexes in the age group of 25-65 years, were selected by purposive random sampling technique. The sample size was limited to 150 individuals because of the financial paucity. It was found that there were various complications associated with obesity and that the intake of energy and fats was found to be more than the recommendations (RDA) given by the Indian Council of Medical Research (ICMR). Furthermore, the intake of proteins was more or less in terms of the RDA.
... Patients and their relatives have widely utilized internet-based sources to assess their symptoms and garner additional information about their diseases, treatment outcomes, and disease prevention strategies [12]. The prevalence of joint diseases has increased appreciably worldwide for reasons such as obesity, sedentary lifestyles, and prolonged life expectancy, making osteoarthritis a notable health concern [13]. We believe that clarifying the terms related to osteoarthritis that are searched more frequently on Google will increase awareness of the condition and predict which minimally invasive treatment methods for osteoarthritis attract the public's attention. ...
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Introduction In recent years, online search engines have become a source of information about medical issues. We aimed to evaluate the public's interest in osteoarthritis and minimally invasive treatments of osteoarthritis in the last 10 years using Google Trends (GT). Methods Interventional physiatrist analyzed 14 selected terms (joint pain, joint pain treatment, joint cartilage damage, narrowing of the joint, osteoarthrosis, osteoarthritis, intra-articular injection, intra-articular steroid, intra-articular hyaluronic acid, intra-articular plasma rich platelet (PRP), essential oil for joint pain, joint pain supplements, home remedies for joint pain, and stem cell for joint) related with osteoarthritis and minimally invasive treatments of osteoarthritis in physical medicine and rehabilitation discipline. All keywords were searched in the GT application using the 'all categories,' 'web search,' and 'worldwide' filters. The last 10 years have been divided into two equal parts, each spanning five years (from January 1, 2013 to December 31, 2017, and January 1, 2018 to December 31, 2022). Public interest in the 14 keywords mentioned above was recorded for these two periods, and the GT for all 14 keywords were compared across the two five-year periods. Results Searching rates for the terms 'joint pain,' 'joint pain treatment,' 'joint cartilage damage,' 'narrowing of the joint,' 'osteoarthritis,' 'intra-articular injection,' 'intra-articular PRP,' and 'joint pain supplements' have increased significantly in the last five years (p= 0.001, p= 0.001, p= 0.005, p= 0.001, p= 0.001, p= 0.004, p= 0.001, and p= 0.001, respectively). The average Google Trends (GT) score for all terms was 40 between January 1, 2013, and December 31, 2017, and the average GT score for all terms was 48 between January 1, 2018, and December 31, 2022 (p= 0.001). Conclusion The present study stated that public interest in osteoarthritis and minimally invasive treatments for osteoarthritis has increased significantly in the last five years. Study outcomes demonstrated that public attention to 'joint pain,' 'joint treatment,' 'joint cartilage damage,' 'narrowing of the joint,' 'osteoarthritis,' 'intra-articular injection,' 'intra-articular PRP,' and 'joint pain supplements' has also significantly increased in the last five years.
... A sedentary lifestyle with a minimum of physical activity and overconsumption of energy-dense food have been noticed among people living in Qatar in the past 20-30 years. Prevention or reduction of obesity, particularly abdominal obesity, is a main therapeutic goal in patients with type 2 DM [15]. Multimodality approach by adapting to a healthy lifestyle through diet modification, physical activity, and possible pharmacological therapy may be followed to optimally achieve weight reduction [16]. ...
... Tobacco use, obesity, and sedentary lifestyles have long been associated with a myriad of medical and mental health complications (Avila et al., 2015;Baskaran et al., 2019;King, 2013;Kopelman, 2007;Kuper et al., 2002;Manson et al., 2004;Uhlenhopp et al., 2020;Vallance, et al., 2018). Obesity is considered a global pandemic (Blüher, 2019;Jones, 2020;Swinburn et al., 2011), yet multiple health benefits and reduced medical comorbidities are observed when elevated body weight returns to healthy levels (Haase et al., 2021). ...
Article
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Providing effective healthy behavior change interventions within primary care presents numerous challenges. Obesity, tobacco use, and sedentary lifestyle negatively impact the health quality of numerous medical patients, particularly in underserved patient populations with limited resources. Primary Care Behavioral Health (PCBH) models, which incorporate a Behavioral Health Consultant (BHC), can offer point-of-contact psychological consultation, treatment, and also provide opportunities for interdisciplinary psychologist—physician clinical partnerships to pair a BHC’s health behavior change expertise with the physician’s medical care. Such models can also enhance medical training programs by providing resident physicians with live, case-based learning opportunities when partnered with a BHC to address patient health behaviors. We will describe the development, implementation, and preliminary outcomes of a PCBH psychologist—physician interdisciplinary health behavior change clinic within a Family Medicine residency program. Patient outcomes revealed significant reductions (p < .01) in weight, BMI, and tobacco use. Implications and future directions are discussed.
... This, in turn, can increase the risk of obesity. Engaging in regular physical activity and consuming a nutritious diet can help to prevent a sedentary lifestyle and the related risk of obesity [8]. Socioeconomic factors can also contribute to the development of obesity. ...
Article
Obesity or Adiposity is a worldwide common health problem that is related with an augmented risk of a number of medical conditions, morbidity and mortality. This mini review recapitulates the epidemiology, Etiology, associated comorbidities, biomarkers and available pharmacotherapy of obesity. The epidemiology of obesity is increasing in low-, middle- and high-income countries, with sociodemographic, behavioural, and genetic factors all playing a role. Comorbidities include hypertension, diabetes mellitus, stroke, coronary artery disease, and melanoma. Biomarkers associated with obesity include anthropometric markers, biochemical markers, hormonal markers, molecular biomarkers. Obesity related Oxidative stress is also discussed in this paper as per current findings from various clinical and preclinical data available up to January 2023.Treatment approaches range from lifestyle changes to pharmacotherapy and surgery. The available pharmacotherapy is either connected with precarious ill effects or overpriced, therefore, alternative therapies for obesity attenuation are required. Article under discussion provides an insight into oxidative stress attenuation, gene therapy via biomarkers regulation for combating obesity. Prevention strategies should include multidimensional approaches tailored to each nation
... Nowadays, it refers to a specific group of activities that involves low levels of EE in the range of 1.0-1.5 Metabolic Equivalent of Task or MET (1 MET is defined as 3.5 mlO 2 /Kg/min): for example, sitting during transfers (i.e., by train or car), tasks performed while working, and for leisure or in the domestic location (2). A growing amount of evidence contended that the increased tendency to a sedentary lifestyle plays a main role in the rise of multiple chronic diseases, including cardiovascular disease, Type 2 diabetes (3), and overweight and obesity (4). Regarding the latter, despite the rising problem awareness, the obesity epidemic is constantly growing and obesity rates are increasing worldwide. ...
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From the second half of the previous century, there has been a shift toward occupations largely composed of desk-based behaviors. This, inevitably, has led to a workload reduction and a consequent lower energy expenditure. On this point, small increments of the non-exercise activity thermogenesis (NEAT) could be the rationale to reach health benefits over a prolonged period. Different published researches suggest solutions to reverse sitting time and new alternative workstations have been thought to increase total physical activity. Therefore, the purpose of this narrative review is to summarize the current state of the research regarding the “NEAT approach” to weight-gain prevention in work environments. This review analyzes the main evidence regarding new alternative workstations such as standing, walking workstations, seated pedal, and gymnastic balls to replace a standard office chair.
... 5 At least 300,000 premature deaths and $90 billion in direct healthcare costs are caused by obesity and sedentary lifestyle per year in the US alone. 6 The risk is higher among those that sit still for more than 5 hours per day. It is shown to be a risk factor on its own regardless of hard exercise and BMI. ...
Article
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Objective: This cross-sectional study was carried out among the students of Rev. Paul’s High School, Gallamari, Khulna to assess the adolescents' sedentary lifestyle and also the related factors. Methods: The sample size was 217 which were selected by systematic sampling method. Data were collected using a semi-structured questionnaire by a face-to-face interview conducted by the interviewer. Results: In this study, it was found that only 43.3% of respondents had sedentary habits (watching TV, internet browsing, playing video games and not liking to go outside for playing in the field). Comparatively majority of girls (57.8%) were associated with sedentary habits. Otherwise whose mothers are educated were not associated with sedentary habits (62.9%). In this study, it was observed that among those who like fast foods, the majority had sedentary habits (24.5%). Also, about 64.3% of respondents who have sedentary habits were unwilling to perform outdoor physical activities like playing. Conclusion: The findings of the result might help develop awareness among adolescents as well as parents and teachers regarding the sedentary lifestyle to reduce the risk of adverse health outcomes as well as to know about the associated factors. Thus, it will be helpful to minimize the factors from the daily lifestyle and become healthy citizens. Mediscope 2022;9(2): 68-74
... Importantly, fat encroachment into muscle is a major complication in DMD, starting in the lower limbs as early as the age of 5 years, (57) compromising both function and regenerative capacity. (58) Although this study was not structured to examine either the fat or muscle phenotypes per se, there is certainly evidence that inactivity is permissive to increased fat production in growing children, (59) that GC can promote adipogenesis and suppress osteoblastogenesis in DMD patients, (60,61) and that LIV suppressed regional adipogenesis. (23,46) As a more precise assessment of bone quality, QCT measures of trabecular bone density of the proximal and distal tibia showed that the placebo group remained essentially unchanged over the course of 14 months, suggesting the structural elements of the bone are not keeping pace with growth patterns in these children. ...
Article
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The ability of low intensity vibration (LIV) to combat skeletal decline in Duchenne Muscular Dystrophy (DMD) was evaluated in a randomized controlled trial. Twenty DMD boys were enrolled, all ambulant and treated with glucocorticoids (mean age 7.6, height‐adjusted Z‐scores (HAZ) of hip BMD ‐2.3). Ten DMD boys were assigned to stand for 10min/d on an Active LIV platform (0.4g @ 30Hz), while 10 stood on a Placebo device. Baseline and 14‐month BMC and BMD of spine, hip and total body were measured with DXA, and trabecular bone density (TBD) of tibia with QCT. All children tolerated the LIV intervention well, with daily compliance averaging 78%. At 14 months, TBD in the proximal and distal tibia remained unchanged in Placebo (‐1.0% & ‐0.2%), while rising 3.5% and 4.6% in Active subjects. HAZ for hip BMD and BMC in Placebo declined 22% and 13% respectively, contrasting with no change from baseline (0.9% and 1.4%) in Active. Fat mass in the leg increased 32% in Placebo, contrasting with 21% in Active subjects. Across the 14‐month study, there were four incident fractures in three placebo patients (30%), with no new fractures identified in Active subjects. Despite these encouraging results, a major limitation of the study is – despite randomized enrollment – there was a significant difference in age between the two cohorts, with the Active group being older, and thus at greater severity of disease. In sum, these data suggest that non‐invasive LIV can help protect the skeleton of DMD children against the disease progression, the consequences of diminished load bearing, and the complications of chronic steroid use. This article is protected by copyright. All rights reserved.
... V souvislosti se současným životním stylem, kde převládá sedavý způsob života (Manson et al., 2004;| 2 Jiří Mališ, Jana Vašíčková, Hana Pernicová, Veronika Kavková Park et al., 2020), může být začlenění PA do běžného režimu obtížné. Obzvláště palčivá je tato otázka v dětském věku. ...
Article
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Adolescence is an important period of life during which a positive relationship with physical activity (PA) is formed. It is very important to investigate how students approach PA, as PA is an integral part of a healthy lifestyle. In the field of health psychology, the concept of self-efficacy is often used in the context of PA. People with higher self-efficacy have higher self-esteem and are not afraid of life's challenges; this self-confidence stems from the individual's belief that he or she is in control of what is going on around them. The level of self-efficacy in relation to PA gives us valid information about how students approach PA. The priority of the study is to find out the level of general self-efficacy and self-efficacy in relation to PA in primary and secondary school students. Furthermore, we seek to determine the relationship between general self-efficacy and self-efficacy in relation to PA in this age group. We are also interested in which issues pupils will disagree with the most, i.e., have the lowest self-efficacy, and their differences depending on gender and type (second level primary/middle) of school.
... Typically, consideration of a population's health includes addressing in depth understanding of population needs in their own experience, health outcomes, patterns of health determinants including social determinants of health, and the policies and available interventions accessible to the population (47). The rapid escalation of chronic diseases, functional limitations, and disability with age in the U.S. and other aging populations (48) is associated with a high incidence of conditions such as obesity, smoking, and inactivity associated with lifestyle choices (49)(50)(51). This circumstance indicates the need to dramatically expand the attention to promoting health, not just managing disease (52). ...
Article
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By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, “just in time” communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.
... These lifestyle-related diseases are associated with modern eating habits and a sedentary lifestyle (Kopp, 2019). Nutritional-and exercise interventions should be the first in prevention-or treatment strategies because of the biological rationale, low cost and non-pharmacological approach (Manson et al., 2004). ...
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Background: Generally, food intake occurs in a three-meal per 24 h fashion with in-between meal snacking. As such, most humans spend more than ∼ 12–16 h per day in the postprandial state. It may be reasoned from an evolutionary point of view, that the human body is physiologically habituated to less frequent meals. Metabolic flexibility (i.e., reciprocal changes in carbohydrate and fatty acid oxidation) is a characteristic of metabolic health and is reduced by semi-continuous feeding. The effects of time-restricted feeding (TRF) on metabolic parameters and physical performance in humans are equivocal. Methods: To investigate the effect of TRF on metabolism and physical performance in free-living healthy lean individuals, we compared the effects of eucaloric feeding provided by a single meal (22/2) vs. three meals per day in a randomized crossover study. We included 13 participants of which 11 (5 males/6 females) completed the study: age 31.0 ± 1.7 years, BMI 24.0 ± 0.6 kg/m² and fat mass (%) 24.0 ± 0.6 (mean ± SEM). Participants consumed all the calories needed for a stable weight in either three meals (breakfast, lunch and dinner) or one meal per day between 17:00 and 19:00 for 11 days per study period. Results: Eucaloric meal reduction to a single meal per day lowered total body mass (3 meals/day –0.5 ± 0.3 vs. 1 meal/day –1.4 ± 0.3 kg, p = 0.03), fat mass (3 meals/day –0.1 ± 0.2 vs. 1 meal/day –0.7 ± 0.2, p = 0.049) and increased exercise fatty acid oxidation (p < 0.001) without impairment of aerobic capacity or strength (p > 0.05). Furthermore, we found lower plasma glucose concentrations during the second half of the day during the one meal per day intervention (p < 0.05). Conclusion: A single meal per day in the evening lowers body weight and adapts metabolic flexibility during exercise via increased fat oxidation whereas physical performance was not affected.
... The incidence in the Indian population is around 31.6% [7]. There is an increase in the prevalence of metabolic syndrome mainly due to change in lifestyle and food habits [8]. The main risk factors for the development of metabolic syndrome are obesity, increasing age, postmenopausal state, smoking, highcarbohydrate diet, physical inactivity, and family history of metabolic syndrome [9]. ...
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Background Metabolic syndrome (syndrome X) is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. Dilatation of blood vessels following stress is a function of vasodilators produced by the endothelium. Flow-mediated vasodilation assesses endothelial function. In the case of endothelial dysfunction, flow-mediated vasodilation is impaired, resulting in decreased or even absence of vasodilation following stress. The easy availability of ultrasound machines nowadays and the non-invasive nature of the test make this a practical test for assessing endothelial dysfunction and the risk of cardiovascular diseases. Various studies have confirmed the presence of impaired flow-mediated vasodilation in patients with coronary artery disease. However, the presence of impaired flow-mediated vasodilation in individuals with risk factors but no cardiovascular diseases can prove that this can be used to predict individuals at risk. This study tries to confirm the presence of endothelial dysfunction in patients with non-alcoholic fatty liver disease (NAFLD) attending a tertiary center hospital in Kochi. Objectives The study's main aim is to compare flow-mediated dilatation in patients with NAFLD and normal individuals. Materials and methods The comparative study was conducted among 50 patients attending various outpatient departments in Amrita Institute of Medical Sciences, Kochi. History and examination of cases and controls and relevant investigations were done after obtaining consent. In addition, both groups underwent measurement of flow-mediated vasodilation in the radiology department. Data were entered in Microsoft Excel and were analyzed using SPSS. Results Flow-mediated vasodilation was found to be less in patients with fatty liver (7.37 ± 2.75) when compared to individuals with normal liver (12.41 ± 3.71). In addition, flow-mediated vasodilatation was inversely proportional to BMI and age. Conclusion This study has proved that there will be endothelial dysfunction in NAFLD, as shown by the decrease in flow-mediated vasodilation when compared with normal liver.
... Interestingly, with approximately 472 million Gen Z individuals in India, they formed the largest proportion of the young population segment in the world (Hameed and Mathur, 2020). In recent years, the practice of unhealthy behaviours like consumption of junk food, improper sleep cycles, lack of regular exercise regimes and sedentary lifestyles had led to health and fitness-related problems among Gen Z individuals (Manson et al., 2004;Sousa et al., 2014). Thus, over the years, lifestyle diseases like diabetes, obesity, blood pressure and such others have affected the Gen Z Indians (Pappachan, 2011). ...
Article
Purpose The purpose of this study is to identify the major factors influencing the adoption of health-care wearables in generation Z (Gen Z) customers in India. A conceptual framework using push pull and mooring (PPM) adoption theory was developed. Design/methodology/approach Data was collected from 208 Gen Z customers based on 5 constructs related to the adoption of health-care wearables. Confirmatory factor analysis and structural equation modelling was used to analyse the responses. The mediation paths were analysed using bootstrapping method and examination of the standardized direct and indirect effects in the model. Findings The study results indicated that the antecedent factors consisted of push (real-time health information availability), pull (normative environment) and mooring (decision self-efficacy) factors. The mooring factor (MOOR) was related to the push factor but not the pull factor. The MOOR, in turn, was related to the switching intention of Gen Z customers for health wearables adoption. Research limitations/implications The research study extended the literature related to the PPM theory in the context of the adoption of health wearables among Gen Z customers in India. Practical implications The study outcome would enable managers working in health wearable organizations to understand consumer behaviour towards health wearables. Social implications The use of health wearables among Gen Z individuals would lead to future generations adopting a healthy lifestyle resulting in an effective workforce and better economy. Originality/value This was one of the few studies which have explored the PPM theory to explore the factors for the adoption of health wearables among Gen Z customers in India.
... In Arabian Gulf countries Muslim people lifestyle usually changed during Ramadan fasting, they go for very high calorie food; they sleep and work for less hours and they neither diet nor exercise [19][20][21][22][23]. Despite the large number of Muslims worldwide, there is lack of data on their food intake in Ramadan, to the best of our knowledge, we are not aware of any previous published reports on the effect of Ramadan fasting on the subject's food intake and body composition changes in this region. ...
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Background: During Ramadan, Muslims abstain from eating and drinking from sunrise to sunset. This long fasting
... 20]. Finding a link between obesity and migraine would be important because the increasing prevalence of obesity [21,22] may lead to an increase in the prevalence, frequency, and severity of migraine and may also be a potential target for prevention. Furthermore, such a link may increase the risk of comorbidities that have recently been associated with migraine, such as ischemic stroke [23] and other ischemic vascular events [24,25]. ...
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Background and Objective Many studies have evaluated the risk of migraine headache in obese persons, suggesting controversial conclusions—this systematic review and meta-analysis of the observational studies aimed to clarify the association between migraine and obesity. Methods Scopus and PubMed electronic databases were systematically searched up to February 2019 for observational studies providing data dealing with migraine disorder in obese subjects, as well as normal-weight controls. The random-effects model was applied to assess pool effect size and inter-study heterogeneity by conducting subgroup analyses. Results Among 1122 publications, 16 studies (10 cross-sectional, five cohort studies, and one case-control study) were detected and were included in the meta-analysis. The pooled data analysis illustrated an elevated risk of migraine headaches (Prevalence ratio estimate = 1.29, 95% CI, 1.15 -1.44; P = 0.000) in obese individuals than normal-weight persons. Subgroup analyses revealed that geographical distribution was an essential source of heterogeneity (p= 0.04). So that significantly greater migraine prevalence was found in European and Asian patients, but no statistically significant relationship was seen in American patients with obesity. Conclusions Based on a cumulative meta-analysis of available studies indicating an association between migraine and obesity, obesity can be appropriately considered an overall risk factor for migraine headaches. Additional high-quality original studies considering frequency, severity, and duration of headache must clarify confident evidence.
... 37 This finding is of paramount importance, as OSA is already highly prevalent in the community 38 (17% of men and 9% of women are likely to have OSA between 50 and 70 years of age), and incidence increases with age 38 and will likely become even more common because of the aging population 39 along with worsening OSA risk factors, such as obesity. 40 Despite the high current prevalence of OSA, it remains underrecognized and underdiagnosed. Based on the recent estimation, only 5.9 million adults are diagnosed with OSA, whereas 23.5 million remained undiagnosed. ...
Article
There is a strong association between obstructive sleep apnea (OSA) and cognitive dysfunction. Executive function, attention, verbal/visual long-term memory, visuospatial/constructional ability, and information processing are more likely to be affected, whereas language, psychomotor function, and short-term memory are less likely to be affected. Increased accumulation of Aß2-amyloid in the brain, episodic hypoxemia, oxidative stress, vascular inflammation, and systemic comorbidities may contribute to the pathogenesis. Patients with OSA should have cognitive screening or formal testing, and patients with cognitive decline should have testing for OSA. Treatment with continuous positive airway pressure may improve cognitive symptoms in the patient with OSA.
... In 2013, there were an estimated 17.5 million households that were food insecure with a disproportionate burden placed upon African American and Hispanic homes [1]. Further, disparate rates of obesity and obesity-related illness among minority majority communities, in comparison to majority neighborhoods, have been conclusively shown [2,3]. The primary explanation for these differences is the existence of "food deserts" within marginalized communities throughout the United States [4]. ...
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Background Prior research has demonstrated minority communities have fewer options to access healthy foods when compared to their majority counterparts. While much focus has been placed upon community-level resources, little research has been placed on the efforts that minority groups need to undergo to reach well-stocked stores to purchase healthy food options. Methods As part of the Water, Energy, Food Nexus Research Group at Texas A&M University, a nationally representative survey (n = 1612) was conducted to acquire self-reported distance, time, and motives that certain populations must travel to purchase food for themselves and their families. Results Findings suggest that minority populations consider saving money, driving less, having a better selection of foods, and have the ability to buy organic foods as an important factor when choosing where to buy foods. Further, minority populations across the nation need to drive a significantly greater (p < 0.05) amount of time to reach their destinations than white populations. Conclusion This underscores the importance, and scope of the issues, of promoting and implementing more equitably distributed opportunities to purchase healthy food options throughout the United States.
... In Arabian Gulf countries Muslim people lifestyle usually changed during Ramadan fasting, they go for very high calorie food; they sleep and work for less hours and they neither diet nor exercise [19][20][21][22][23]. Despite the large number of Muslims worldwide, there is lack of data on their food intake in Ramadan, to the best of our knowledge, we are not aware of any previous published reports on the effect of Ramadan fasting on the subject's food intake and body composition changes in this region. ...
Research
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Background: During Ramadan, Muslims abstain from eating and drinking from sunrise to sunset. This long fasting
... 4,5 In a study done at USA, it has been found that at-least 300,000 premature deaths, and $90 billion in direct healthcare costs are caused by obesity and sedentary lifestyle per year. 6 Sedentary lifestyle is shown to be a risk factor on its own, independent of hard exercise and BMI. People that sit-still more than 4 hours per day have a 40% higher risk than those who sit fewer than 4 hours per day. ...
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Background: Sedentary lifestyle is one of the important risk factors for cardiovascular diseases which is the leading cause of death globally. Workplace initiatives like promotion of staircase use are one among many simple measures to overcome the harmful effect of a sedentary workplace. Hence this study was conducted to assess effectiveness of ‘using staircase’ as a lifestyle modification among sedentary workers of a municipal corporation in improving fitness level.Methods: An interventional study was conducted over a period of 8 weeks among workers of a municipal corporation office. A semi structured questionnaire including socio demographic and morbidity details was administered. sitting-rising test (SRT) was administered before and after 8 weeks staircase use intervention to assess fitness levels among study participants.Results: The mean SRT score of 172 study population at baseline was 8.79 and 115 (67%) recorded above it. 3.5-5. Younger age was associated with higher SRT score and those with history of smoking, alcohol consumption, hypertension, diabetes, hyperlipidemia and higher BMI had lower SRT scores than their counterparts. Mean value of SRT significantly improved to 9.015 following intervention.Conclusions: Fitness level assessed using SRT score among office staff showed that people with higher age and higher BMI have low SRT score than their counterparts. This study has shown that staircase usage can be prescribed as effective method to improve fitness level at sedentary workplace.
... On the other hand, the obese and obese with cardiovascular disease (CVD) subpopulations reduced by 5 percent and 25 percent respectively after 50 months. Through these observations, we can conclude that the best way to contain the development of CVD and T2DM, and its aggravations is the lifestyle, which are adequate with the results obtained in [26,27] . The studies in [28][29][30] praising the role of healthy living (Diet, regular exercise, smoking and increasing alcohol intake above moderate levels) in alleviating the burden of cardiovascular disease (CVD), in a review of the evidence for the Canadian Physical Activity Guidelines, Warburton et al. in [16] found the relative reduction in the incidence of cardiovascular disease (CVD) averages of 33%. ...
Preprint
In this article, we study a predictive model of the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) in obese populations and investigate its impact on the evolution of their health, terms related to lifestyle and risk factors are also incorporated. This model represented mathematically by a nonlinear temporal system of ordinary differential equations. An analysis of the stability of stationary solutions is also obtained to theoretically confirm the mathematical validity. Numerical simulations presented to explain the usefulness of the developed model; they show the role of a healthy lifestyle (diet, regular exercise, smoking, and increasing alcohol consumption above moderate levels) in alleviating the burden of cardiovascular disease (CVD) and can significantly reduce the risk to develop type 2 diabetes mellitus (T2DM). On the other hand, risk factors management of obesity with complications greatly decreases the risk of developing other complications.
... WHO recommends 30 minutes of moderate exercises 5 times a week or 20 minutes of vigorous physical activity 3 times a week. Numerous studies [9,10,11,12] show that citizens of the European Union do not stick to the optimal recommended time of physical activity. It is becoming more and more perceivable in Poland. ...
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Background: This study aims at determining opinion of participants of strengthening and relaxation classes on health determinants and their influence on adoption of particular forms of physical activity. Material/Methods: Participants of the study were 113 women aged 40 to 55, among whom 70 participated in such strengthening and relaxation courses as yoga, Pilates and Tai Chi and 43 women were inactive (control group). A survey prepared by the authors of this paper was used. Results: According to the participants, the most crucial factors influencing health are proper nutrition, adoption of physical activity and keeping proper body weight. Active women are aware of beneficial effects of regular physical activity, in particular regarding improvement of their mobility. Participants of strengthening and relaxation classes proclaim that physical activity drove them to a “healthy lifestyle” and especially to healthy nutrition habits. They recognise a pro-health meaning of physical activity, particularly in order to preserve fitness in the old age. Conclusions: Participants of the classes are aware of a pro-health value of regular participation in strengthening and relaxation courses. Pro-health policy of every country should strive to raise awareness of beneficial influence of regular physical activity and proper dietary behaviours on health status.
Article
Purpose To examine factors associated with weight status underestimation and the relationship between weight status underestimation and weight loss as a weight management goal among adults living in the rural South. Methods An anonymous survey was distributed at six primary care clinics and two churches in rural, South Carolina counties. Weight status underestimation was determined based on the difference between perceived weight status using standard body mass index (BMI) categories (underweight, normal weight, overweight, and obese) and BMI category from self‐reported height and weight. Participants reported whether their weight management goal was to lose, maintain, or gain weight. Chi‐square and binary logistic regressions were used for data analysis. Findings A total of 185 respondents (76% female) at least partially completed the survey. Nearly 60% underestimated their weight status. Increasing BMI was associated with higher odds of weight status underestimation (OR: 1.10, 95%: 1.04, 1.15) and perceptions of being in fair or poor health was associated with lower odds of weight status underestimation relative to perceiving health as good or better (OR: 0.21, 95% CI: 0.06, 0.66). Among those with overweight and obesity, the association between underestimating weight status and having weight loss as a weight management goal was strong but not statistically significant (OR: 0.20, 95% CI: 0.04, 1.04). Conclusions Underestimating weight status was common among adults in the rural US South and was related to BMI and health status. Research is needed to determine if improving the accuracy of weight perceptions can promote weight management in the rural South.
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Hypothyroidism is an endocrine disorder more commonly in older adults. Simultaneously, this population has an increased incidence of cardiovascular risk factors and disease, which remains the leading cause of death worldwide. Thyroid hormones (THs) promote adequate function of the cardiovascular system as they exert their effects through receptors located in the myocardium and the vasculature. In hypothyroidism, this homeostasis is disrupted, which leads to the emergence of pathogenic pathways that accelerate the progression of cardiovascular disease and aggravate its outcomes in these individuals. This article has reviewed existing literature on the relationship between hypothyroidism and cardiovascular disease (CVD). We have explored the pathogenic mechanisms linking both conditions and highlighted the prevalence of cardiovascular risk factors as well as the increased incidence of cardiovascular events in overt and subclinical diseases. Furthermore, indications of hormone replacement therapy in subclinical disease and its efficacy in reducing CVD morbidities in a particular subset of patients have been discussed.
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The rising prevalence of obesity in Saudi Arabia is a major contributor to the nation’s high levels of cardiometabolic diseases such as type 2 diabetes. To assess the impact of obesity on the diabetic metabolic phenotype presented in young Saudi Arabian adults, participants (n = 289, aged 18–40 years) were recruited and stratified into four groups: healthy weight (BMI 18.5–24.99 kg/m2) with (n = 57) and without diabetes (n = 58) or overweight/obese (BMI > 24.99 kg/m2) with (n = 102) and without diabetes (n = 72). Distinct plasma metabolic phenotypes associated with high BMI and diabetes were identified using nuclear magnetic resonance spectroscopy and ultraperformance liquid chromatography mass spectrometry. Increased plasma glucose and dysregulated lipoproteins were characteristics of obesity in individuals with and without diabetes, but the obesity-associated lipoprotein phenotype was partially masked in individuals with diabetes. Although there was little difference between diabetics and nondiabetics in the global plasma LDL cholesterol and phospholipid concentration, the distribution of lipoprotein particles was altered in diabetics with a shift toward denser and more atherogenic LDL5 and LDL6 particles, which was amplified in the presence of obesity. Further investigation is warranted in larger Middle Eastern populations to explore the dysregulation of metabolism driven by interactions between obesity and diabetes in young adults.
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Çoğu insan gıda alımını, öğünler arasında atıştırmalıklarla birlikte 24 saatte üç öğün şeklinde gerçekleştirir (Kant, 2018; Paoli ve ark., 2019). Yemek sonrası plazma insülin konsantrasyonları yükselir ve ardından periferik dokularda glukoz alımını ve oksidasyonunu artar (Thiebaud ve ark., 1982). Ayrıca insülin, diyet yağının yağ dokusunda depolanmasını destekleyen lipoprotein lipazı aktive eder (Lafontan ve Langin, 2009). Oruç sırasında (örneğin gece boyunca) plazma insülin konsantrasyonlarının düşürülmesi, açlığın devam etmesi durumunda fizyolojik insülin direnci durumuyla sonuçlanan glikozdan yağ oksidasyonuna geçiş olan lipolize izin verir (Lafontan ve Langin, 2009; Soeters ve ark., 2012). Çeşitli postprandiyal sinyaller (örn. plazma safra asitleri, fibroblast) büyüme faktörü 19 (FGF19), lipidler), yemek alımından 4-5 saat sonra sistemik dolaşımda hala artmaktadır (Schrezenmeir ve ark., 1993; Van Nierop ve ark., 2019; Meessen ve ark., 2020). Evrimsel bir bakış açısından insan vücudunun daha düşük öğün sıklığına alıştığı düşünülebilir (Meiselman, 2000). Metabolik esneklik (yani karbonhidrat ve yağ asidi oksidasyonu) metabolik sağlığın bir özelliğidir. Öte yandan sürekli/sık gıda alımı, metabolik esnekliğin azalmasına, obeziteye ve tip 2 diyabete neden olabilir (T2DM) (Smith ve ark., 2018). Yaşam tarzıyla ilişkili bu hastalıklar, modern beslenme alışkanlıkları ve hareketsiz yaşam tarzıyla ilişkilidir (Kopp, 2019).
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The cognitivist paradigm has dominated the past 50 years of consumer research. Cognitivist theories have provided extensive insights into pre‐consumption behaviors (i.e., information gathering, attitude formation, product choice, and product purchase) and the processes that support these behaviors (i.e., attitudes, persuasion, information processing, memory, knowledge, and choice processes). Yet, the cognitivist paradigm has limitations, especially when it comes to addressing detrimental consumption, over‐consumption, and perverse incentives in consumption systems. To address these issues, we discuss how a behaviorist paradigm can be used to identify more efficient and effective interventions for societal ills. The behaviorist perspective emphasizes that an alteration of the consumption environment can influence the ease of expressing a behavior and the rewards/punishments associated with this expression. Hence, behaviorism is useful in identifying and implementing intelligent nudges.
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This article is about the metabolic health risks involved with prolonged sitting also known as sedentary lifestyle. Our bodies are designed to move, and research has shown that sedentary lifestyles increase health risks. In addition to type 2 diabetes, cancers, and cardiovascular diseases, sedentary lifestyles can lead to premature mortality. Often times a sedentary activity such as prolonged sitting is overlooked, when in fact, sitting for long periods of time has a negative effect on health. The goal of this presentation is to research and spread awareness about the health risks involved with prolonged sitting. In order to spread awareness, we have explored most of the common health risk associated with prolong sitting and as well made some crucial recommendations that are needed to elicit the right attitude to prolong sitting among individuals. This topic address sedentary lifestyles as a problem and display what a sedentary lifestyle looks like. It went further to discuss the problem of prolonged sitting and potential solutions. Although there are resources that already exist on the topic of sedentary lifestyles. We have created resources specific to the individuals in order to be more effective in spreading awareness to them. This is a widespread problem with serious consequences, yet simple fixes. This is an attempt to spread awareness to a population that includes individuals at a critical point in life who may not be informed about this issue.
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PURPOSE The purpose of this study was to analyze the level and characteristics of physical activity (sedentary, light, and MVPA) of high school students according to physical education (PE) class (DWPE: days with PE class, DNPE: days with no PE class) and sex.METHODS Data were collected on 147 students (65 male and 82 female) from four high schools in Seoul city, and physical activity was measured using a three-dimensional accelerometer. The collected physical activity data were input into SPSS 25.0, and the descriptive analysis and two-way ANOVA according to PE class and sex were performed.RESULTS The descriptive statistical analysis showed that 31% (40.7% male and 23.4% female) of participants met the recommended physical activity durations (MVPA of 60 min/day). In the two-way ANOVA, sedentary activity, light activity, and MVPA showed statistically significant main and interaction effects according to PE class and sex. According to the results of the interaction effect analysis, the gap in physical activity between DWPE and DNPE was large in male students. For male students, light activity and MVPA significantly increased on the day of the PE class, and sedentary activity significantly decreased. However, for female students, DWPE and DNPE did not differ significantly in all levels of physical activity.CONCLUSIONS In conclusion, the level of physical activity of Korean high school students was relatively low, and the effect of daily-life physical activity in the PE class was limited to male students. Accordingly, an alternative should be introduced to increase the physical activity of female high-school students through PE classes.
Chapter
The obesity and toxic behaviors in health like sedentary life style, high ingest of carbs, low exercise, high levels of stress, inadequate use of electronical devices as smart telephones, tablets,… among others, it’s causing directly and indirectly since a several years obesity and its impact and health disorders related.Obesity and overweight according to the who is defined as the abnormal or excessive accumulation of fat that can be harmful to health.The body mass index (BMI) is defined as the result of weight divided by height squared, calculating the number of kilos of weight per body surface squared, obtaining an estimate that defines normal weight, overweight and obesity being 25 upper limits for normal weight and overweight up to 30 and above 30 obesity.In 2016, more than 3.19 billion adults were overweight and more than 650 million obese and 41 million children under the age of 5 years were overweight worldwide.Overweight and obesity are the sixth risk factor for death in the world. 3.4 million die from related causes, 44% burden from type 2 diabetes, 23% from ischemic heart disease as well as another percentage from cancer is attributed to obesity.Traditional therapeutic options such as diet, exercise, and changes of habits are a cornerstone in control and management in all cases but it has been shown that current surgical management with adequate multidisciplinary preparation offers better results in the short and medium terms, with subsequent weight loss and metabolic control of related diseases such as type 2 diabetes.The surgical procedures options are several. Patient must be chosen very well, and we have to look for the most appropriate surgical procedure to their condition degree of obesity social economic environment, within these we have: the sleeve gastrectomy, Roux-en-Y gastric bypass, One-anastomosis gastric bypass, Sadi-s and the duodenal switch, among others.KeywordsObesitySedentary LifestyleComorbidities Bariatric surgeryBehaviorPhysical activity
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PURPOSE This study aimed to analyze physical activity (sedentary, light, moderate to vigorous physical activity [MVPA]) characteristics of middle school students based on region (urban and rural) and sex. METHODS Data were collected from 216 students across 6 middle schools located in medium-sized urban (3 schools) and rural areas (3 schools), and the relevant physical activity was measured using a three-dimensional accelerometer (GT3X model). The collected data were inputted into the SPSS 20.0, and descriptive analysis and two-way ANOVA based on region and gender were performed (<.05). RESULTS The descriptive statistical analysis resulted in the following achievement rate of the physical activity standard (MVPA 60 minutes/day): 9.4%. The two-way ANOVA showed that the main effect according to gender was found in sedentary activity (F=5.258), light activity (F=6.790), and MVPA (F=32.274); furthermore, the main effect according to region was found in light activity (F=10.888) and MVPA (F=7.876). Interaction effect according to region and gender was found at all intensities, and the gap between rural and urban in male students was larger compared to that of female students. CONCLUSIONS After COVID-19, the level of physical activity among adolescents has worsened; this study found the problem of “decrease in physical activity; increase in sedentary activity” to be more serious among male students in urban areas.
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Risk factors of coronary heart diseases have long been known and new risk factors are still being discovered. The control of these numerous risk factors necessitates, first of all, a classification of these factors in terms of public health; in such a way that the factors of each class would be the consequence of the previous class and trigger the following one. Thus, the priorities can be designated and the disease control activities can be carried in an organized manner. Furthermore, evaluating these factors individually with an evolutionary point of view could help all the parties concerned to better understand and manage the disease. This will allow the health profession to re-define coronary heart diseases risk factors through a two-dimensional approach.
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Introduction/Aims The ability of low intensity vibration (LIV) to combat skeletal decline in Duchenne Muscular Dystrophy (DMD) was evaluated in a randomized controlled trial. Methods Twenty DMD boys were enrolled, all ambulant and treated with glucocorticoids (mean age 7.6, height-adjusted Z-scores (HAZ) of hip BMD −2.3). Ten DMD boys were assigned to stand for 10min/d on an Active LIV platform (0.4g @ 30Hz), while 10 stood on a Placebo device. Baseline and 14-month BMC and BMD of spine, hip and total body were measured with DXA, and trabecular bone density (TBD) of tibia with QCT. Results All children tolerated the LIV intervention well, with daily compliance averaging 78%. At 14 months, TBD in the proximal and distal tibia remained unchanged in Placebo (−0.7% & −0.8%), while rising 4.1% and 4.5% in LIV. HAZ for hip BMD and BMC in Placebo declined 22% and 13% respectively, contrasting with no change from baseline (0.9% and 1.4%) in LIV. Fat mass in the leg increased 33% in Placebo, contrasting with 20% in LIV subjects. Across the 14-month study, there were four incident fractures in three placebo patients (30%), with no new fractures identified in LIV subjects. Conclusions These data suggest that non-invasive LIV can help protect the skeleton of DMD children against the disease progression, the consequences of diminished load bearing, and the complications of chronic steroid use.
Article
Introduction: Migraine is a highly prevalent condition, and prevalence of obesity is also increasing. Results of studies addressing association of body mass index (BMI) with migraine and its features are conflicting. In this cross-sectional study, we aim to assess association between BMI and various migraine features. Methods: This study was conducted in the Headache Clinic of King Fahd Hospital of University, Al Khobar, Saudi Arabia. Interviews were conducted by three consultant neurologists. Migraine was defined according to the International Headache Society and BMI was calculated as weight (kilograms)/height (m2). Results: Of total of 121 patients, 79% were female. Almost 87.6% of patients were taking prophylactic medications. Majority of patients had attack for more than 24 h (60.3%), pulsating character (81%), moderate-to-severe intensity (92.6%), associated with nausea and/or vomiting (75.2%), and photophobia/phonophobia (91.7%). About 29.8% of patients were normal weight, 28.1% were overweight, and 39.7% were obese and morbidly obese. There was insignificant association between various categories of BMI and features of migraine, that is, unilateral location (P = 0.385), pulsating character (P = 0.571), moderate-to-severe intensity (P = 0.187), nausea and/or vomiting (P = 0.582), and photophobia and/or phonophobia (P = 0.444). Conclusion: In our study, we did not find an association between BMI and various features of migraine.
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In previous work, Giuntella et al. (Proc Natl Acad Sci 118:e2016632118, 2021), we documented large disruptions to physical activity, sleep, time use and mental health among young adults at the onset of the COVID-19 pandemic in Spring 2020. This study explores the trends 1 year into COVID-19, as vaccines began to roll out, COVID-19 deaths declined, and social distancing measures eased in the United States. We combine biometric and survey data from multiple cohorts of college students spanning Spring 2019 through Spring 2021 (N = 1179). Our results show persistent impacts of the pandemic on physical activity and mental health. One year into the pandemic, daily steps averaged about 6300 per day compared to about 9800 per day prior to the pandemic, a 35% decline. Almost half of participants were at risk of clinical depression compared to a little over one-third prior to the pandemic, a 36% increase. The impacts on screen time, social interactions and sleep duration at the onset of COVID-19 largely dissipated over the course of the pandemic, though screen time remained significantly higher than pre-pandemic levels. In contrast to the sharp changes in lifestyle and mental health documented as the pandemic emerged in March 2020, we do not find evidence of behavioral changes or improvements in mental well-being over the course of Spring 2021 as the pandemic eased.
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The monograph revealed the organizational and methodical provision of the motion activity development in the extracurricular forms of physical culture of general educational establishments. Nature, standards and importance of motion activity, influence of hypokinesia and hypodynamia on the health state of pupils, ways of engaging to the systematic classes of physical exercises are described. The specific features of motion activity, physical state and motivational-valuable orientations of teenagers in general educational establishments are outlined. The model of motion activity development of teenagers in the extracurricular forms of physical culture was justified. The study is recommended for a practical use within the process of professional activity by the teachers of physical education, postgraduates, students and all motivated specialists who participate in the studies and education of pupils in general educational establishments under modern conditions.
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The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y. A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own. Both groups reported having used both diet and exercise to lose weight and nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Mean (+/-SD) current consumption reported by registry members was 5778 +/- 2200 kJ/d, with 24 +/- 9% of energy from fat, Members also appear to be highly active: they reported expending approximately 11830 kJ/wk through physical activity. Surprisingly, 42% of the sample reported that maintaining their weight loss was less difficult than losing weight. Nearly all registry members indicated that weight loss led to improvements in their level of energy, physical mobility, general mood, self-confidence, and physical health. In summary, the NWCR identified a large sample of individuals who were highly successful at maintaining weight loss. Future prospective studies will determine variables that predict continued maintenance of weight loss.
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Background Despite considerable professional consensus that modest weight losses of 5% to 10% are successful for reducing the comorbid conditions associated with obesity, obese patients often desire weight losses 2 to 3 times greater than this. Examining ways to reduce the disparities between treatment expectations and subsequent outcomes, this study evaluated the role of physical characteristics, treatment setting, and mood in patients' evaluations of treatment outcomes. Methods This study was conducted in a university outpatient weight loss clinic with a sample of 397 obese individuals seeking weight loss by a variety of modalities. Before treatment, participants' heights and weights were measured, and the Beck Depression Inventory and the Goals and Relative Weight Questionnaire were administered. Results Outcome evaluations ranged from 64.4 ± 11.1 kg (mean ± SD) for dream weight to 90.1 ± 19.1 kg for disappointed weight. Initial body weight was the strongest predictor of disappointed, acceptable, and happy weights (β = .90, .76, and .57, respectively). Sex (β = −.37) and height (β = .37) were the strongest determinants of dream weight. Heavier participants chose higher absolute weights, but the weight loss required to reach each of the outcomes was greater for heavier than for lighter patients. Conclusions These data signal a therapeutic dilemma in which the amount of weight loss produced by the best behavioral and/or pharmacologic treatments is viewed as even less than disappointing. Patients with the highest pretreatment weights are likely to have the most unrealistic expectations for success.
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Context Recent reports show that obesity and diabetes have increased in the United States in the past decade.Objective To estimate the prevalence of obesity, diabetes, and use of weight control strategies among US adults in 2000.Design, Setting, and Participants The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in all states in 2000, with 184 450 adults aged 18 years or older.Main Outcome Measures Body mass index (BMI), calculated from self-reported weight and height; self-reported diabetes; prevalence of weight loss or maintenance attempts; and weight control strategies used.Results In 2000, the prevalence of obesity (BMI ≥30 kg/m2) was 19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes (8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not engage in any physical activity, and another 28.2% were not regularly active. Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily. Among obese participants who had had a routine checkup during the past year, 42.8% had been advised by a health care professional to lose weight. Among participants trying to lose or maintain weight, 17.5% were following recommendations to eat fewer calories and increase physical activity to more than 150 min/wk.Conclusions The prevalence of obesity and diabetes continues to increase among US adults. Interventions are needed to improve physical activity and diet in communities nationwide.
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To identify and quantify the major external (nongenetic) factors that contribute to death in the United States. Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and complications of vital statistics and surveillance data were also obtained. Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity. Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates. The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations. Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.
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To compare levels of physical function, across levels of body mass index (BMI), among middle- to older-aged women. Cross-sectional study. Physical function, body weight and other covariates were measured in 1992. 56510 women aged 45-71 y, free of cardiovascular disease and cancer, participating in the Nurses' Health Study. The four physical function scores on the Medical Outcomes Study (MOS) Short Form-36 (SF36) Health Survey: physical functioning, vitality, bodily pain and role limitations. After adjusting for age, race, smoking status, menopausal status, physical activity and alcohol consumption, there was a significant dose-response gradient between increasing levels of BMI in 1992 and reduced function. For example, women with a BMI between 30-34.9 kg/m2 averaged: 9.0 point lower physical functioning score (95% Confidence interval (CI) -9.5, -8.5), 5.6 point lower vitality score (95% CI: -6.1, -5.1), and 7.0 point lower freedom from pain score (95% CI: -7.6, -6.4). These declines represent an approximate 10% loss of function compared to the reference category of women with BMIs ranging from 22.0-23.9 kg/m2. For the same BMI comparison, heavier women were at 66% increased risk of limitations in ability to work or perform other roles (RR = 1.66; 95% odds ratio (OR) CI: 1.56, 1.76). These findings were replicated when the sample was restricted to women who had maintained their BMI over a ten year period. In addition to increasing risk of chronic health conditions, greater adiposity is associated with lower every day physical functioning, such as climbing stairs or other moderate activities, as well as lower feelings of well-being and greater burden of pain.
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Excess body fat is a cause of cardiovascular diseases, several important cancers, and numerous other medical conditions1 and is a growing problem in many countries. In the United States, for example, the age-adjusted prevalence of obesity increased by approximately 30 percent from 1980 to 1994.2 In this review we consider the assessment of body fat and the definition of a healthy body weight for an adult. We also discuss how clinicians can use this information in caring for patients. Because overt obesity has undisputed adverse consequences for health, our focus is on lesser degrees of adiposity, the consequences of which . . .
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Physical activity may be an important determinant of the risk of gallstone disease in women, both independently and as a result of its role in maintaining body weight. We prospectively studied recreational physical activity (such as jogging, running, and bicycling) and sedentary behavior (such as spending hours watching television) in relation to the risk of cholecystectomy, a surrogate for symptomatic cholelithiasis, in a cohort of 60,290 women who were 40 to 65 years of age in 1986 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every two years both their activity level and whether they had undergone cholecystectomy. During a 10-year follow-up period (1986 to 1996), 3257 cases of cholecystectomy were documented. Recreational physical activity was inversely related to the risk of cholecystectomy. The multivariate relative risk for women in the highest as compared with the lowest quintile of physical activity was 0.69 (95 percent confidence interval, 0.61 to 0.78). In contrast, sedentary behavior was independently related to an increased risk of cholecystectomy. As compared with women who spent less than 6 hours per week sitting while at work or driving, women who spent 41 to 60 hours per week sitting had a multivariate relative risk of 1.42 (95 percent confidence interval, 1.06 to 1.89), and women who spent more than 60 hours per week sitting while at work or driving had a multivariate relative risk of 2.32 (95 percent confidence interval, 1.26 to 4.26). These associations persisted after we controlled for body weight and weight change. In women, recreational physical activity is associated with a decreased risk of cholecystectomy. The association is independent of other risk factors for gallstone disease, such as obesity and recent weight loss.
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This study estimated the lifetime health and economic benefits of sustained modest weight loss among obese persons. We developed a dynamic model of the relationship between body mass index (BMI) and the risks and costs of 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes, coronary heart disease (CHD), and stroke. We then calculated the lifetime health and economic benefits of a sustained 10% reduction in body weight for men and women aged 35 to 64 years with mild, moderate, and severe obesity. Depending on age, gender, and initial BMI, a sustained 10% weight loss would (1) reduce the expected number of years of life with hypertension, hypercholesterolemia, and type 2 diabetes by 1.2 to 2.9, 0.3 to 0.8, and 0.5 to 1.7, respectively; (2) reduce the expected lifetime incidence of CHD and stroke by 12 to 38 cases per 1000 and 1 to 13 cases per 1000, respectively; (3) increase life expectancy by 2 to 7 months; and (4) reduce expected lifetime medical care costs of these 5 diseases by 2200to2200 to 5300. Sustained modest weight loss among obese persons would yield substantial health and economic benefits.
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Obesity is an established risk factor for several chronic diseases. The lifetime health and economic consequences of obesity for individual patients have not been documented. To estimate the lifetime health and economic consequences of obesity. We developed a dynamic model of the relationship between body mass index and the risks and associated costs of 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes mellitus, coronary heart disease, and stroke. The model was estimated using data from the Third National Health and Nutrition Examination Survey, the Framingham Heart Study, and other secondary sources. We used this model to estimate (1) risks of hypertension, hypercholesterolemia, and type 2 diabetes mellitus at future ages; (2) lifetime risks of coronary heart disease and stroke; (3) life expectancy; and (4) expected lifetime medical care costs of these 5 diseases for men and women aged 35 to 64 years with body mass indexes of 22.5, 27.5, 32.5, and 37.5 kg/m2 (nonobese and mildly, moderately, and severely obese, respectively). Disease risks and costs increase substantially with increased body mass index. The risk of hypertension for moderately obese 45- to 54-year-old men, for example, is roughly 2-fold higher than for their nonobese peers (38.1% vs 17.7%), whereas the risk of type 2 diabetes mellitus is almost 3-fold higher (8.1% vs 3.0%). Lifetime risks of coronary heart disease and stroke are similarly elevated (41.8% vs 34.9% and 16.2% vs 13.9%, respectively), whereas life expectancy is reduced by 1 year (26.5 vs 27.5 years). Total discounted lifetime medical care costs for the treatment of these 5 diseases are estimated to differ by 10,000(10,000 (29,600 vs $19,600). Similar results were obtained for women. The lifetime health and economic consequences of obesity are substantial and suggest that efforts to prevent or reduce this problem might yield significant benefits.
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Obesity is a major health problem in the United States, but the number of obesity-attributable deaths has not been rigorously estimated. To estimate the number of deaths, annually, attributable to obesity among US adults. Data from 5 prospective cohort studies (the Alameda Community Health Study, the Framingham Heart Study, the Tecumseh Community Health Study, the American Cancer Society Cancer Prevention Study I, and the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study) and 1 published study (the Nurses' Health Study) in conjunction with 1991 national statistics on body mass index distributions, population size, and overall deaths. Adults, 18 years or older in 1991, classified by body mass index (kg/m2) as overweight (25-30), obese (30-35), and severely obese (>35). Relative hazard ratio (HR) of death for obese or overweight persons. The estimated number of annual deaths attributable to obesity varied with the cohort used to calculate the HRs, but findings were consistent overall. More than 80% of the estimated obesity-attributable deaths occurred among individuals with a body mass index of more than 30 kg/m2. When HRs were estimated for all eligible subjects from all 6 studies, the mean estimate of deaths attributable to obesity in the United States was 280184 (range, 236111-341153). Hazard ratios also were calculated from data for nonsmokers or never-smokers only. When these HRs were applied to the entire population (assuming the HR applied to all individuals), the mean estimate for obesity-attributable death was 324 940 (range, 262541-383410). The estimated number of annual deaths attributable to obesity among US adults is approximately 280000 based on HRs from all subjects and 325000 based on HRs from only nonsmokers and never-smokers.
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Overweight and obesity are increasing dramatically in the United States and most likely contribute substantially to the burden of chronic health conditions. To describe the relationship between weight status and prevalence of health conditions by severity of overweight and obesity in the US population. Nationally representative cross-sectional survey using data from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted in 2 phases from 1988 to 1994. A total of 16884 adults, 25 years and older, classified as overweight and obese (body mass index [BMI] > or =25 kg/m2) based on National Institutes of Health recommended guidelines. Prevalence of type 2 diabetes mellitus, gallbladder disease, coronary heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis. Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater. A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women. With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95% CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater in younger than in older adults. The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups. Based on these results, more than half of all US adults are considered overweight or obese. The prevalence of obesity-related comorbidities emphasizes the need for concerted efforts to prevent and treat obesity rather than just its associated comorbidities.
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Excess body weight is positively associated with sleep-disordered breathing (SDB), a prevalent condition in the US general population. No large study has been conducted of the longitudinal association between SDB and change in weight. To measure the independent longitudinal association between weight change and change in SDB severity. Population-based, prospective cohort study conducted from July 1989 to January 2000. Six hundred ninety randomly selected employed Wisconsin residents (mean age at baseline, 46 years; 56% male) who were evaluated twice at 4-year intervals for SDB. Percentage change in the apnea-hypopnea index (AHI; apnea events + hypopnea events per hour of sleep) and odds of developing moderate-to-severe SDB (defined by an AHI > or =15 events per hour of sleep), with respect to change in weight. Relative to stable weight, a 10% weight gain predicted an approximate 32% (95% confidence interval [CI], 20%-45%) increase in the AHI. A 10% weight loss predicted a 26% (95% CI, 18%-34%) decrease in the AHI. A 10% increase in weight predicted a 6-fold (95% CI, 2.2-17.0) increase in the odds of developing moderate-to-severe SDB. Our data indicate that clinical and public health programs that result in even modest weight control are likely to be effective in managing SDB and reducing new occurrence of SDB.
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BACKGROUND: Health care professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation and to determine the effect of anti-smoking advice on disease specific and all cause mortality. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register and the Cochrane Controlled Trials Register. Date of the most recent searches: October 1998. SELECTION CRITERIA: Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of followup. The main outcome measure was abstinence from smoking after at least six months follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow-up were counted as smokers. Where possible, meta-analysis was performed using a fixed effects model. MAIN RESULTS: We identified thirty-one trials, conducted between 1972 and 1997, including over 26,000 smokers. In some trials, subjects were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. Pooled data from 16 trials of brief advice versus no advice (or usual care) revealed a small but significant increase in the odds of quitting (odds ratio 1.69, 95% confidence interval 1.45 to 1.98). This equates to an absolute difference in the cessation rate of about 2.5%. There was insufficient evidence, from indirect comparisons, to establish a significant difference in the effectiveness of physician advice according to the intensity of the intervention, the amount of follow-up provided, and whether or not various aids were used at the time of the consultation in addition to providing advice. However, direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (odds ratio 1.44, 95% confidence interval 1.23 to 1.68). In one study which determined the effect of smoking advice on mortality at twenty years, there were no statistically significant differences in death rates in the group receiving advice. REVIEWER'S CONCLUSIONS: Simple advice has a small effect on cessation rates. Additional manoeuvres appear to have only a small effect, though more intensive interventions are marginally more effective than minimal interventions.
Article
Objective. —To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.Data Sources. —Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained.Study Selection. —Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.Data Extraction. —Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.Data Synthesis. —The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400000 deaths), diet and activity patterns (300 000), alcohol (100 000), microbial agents (90 000), toxic agents (60 000), firearms (35 000), sexual behavior (30 000), motor vehicles (25 000), and illicit use of drugs (20 000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.Conclusions. —Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.(JAMA. 1993;270:2207-2212)
Article
Context: The increasing prevalence of obesity is a major public health concern, since obesity is associated with several chronic diseases. Objective: To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults. Design: Cross-sectional random-digit telephone survey (Behavioral Risk Factor Surveillance System) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998. Setting: States that participated in the Behavioral Risk Factor Surveillance System. Main outcome measures: Body mass index calculated from self-reported weight and height. Results: The prevalence of obesity (defined as a body mass index > or =30 kg/m2) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status. The greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 17.8%), and those of Hispanic ethnicity (11.6% to 20.8%). The magnitude of the increased prevalence varied by region (ranging from 31.9% for mid Atlantic to 67.2% for South Atlantic, the area with the greatest increases) and by state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state with the greatest increases). Conclusions: Obesity continues to increase rapidly in the United States. To alter this trend, strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.
Article
Objectives: To review the magnitude, characteristics, and public health importance of type 2 diabetes in North American youth. Results: Among 15- to 19-year-old North American Indians, prevalence of type 2 diabetes per 1000 was 50.9 for Pima Indians, 4.5 for all US American Indians, and 2.3 for Canadian Cree and Ojibway Indians in Manitoba. From 1967-1976 to 1987-1996, prevalence increased 6-fold for Pima Indian adolescents. Among African Americans and whites aged 10 to 19 years in Ohio, type 2 diabetes accounted for 33% of all cases of diabetes. Youth with type 2 diabetes were generally 10 to 19 years old, were obese and had a family history of type 2 diabetes, had acanthosis nigricans, belonged to minority populations, and were more likely to be girls than boys. At follow-up, glucose control was often poor, and diabetic complications could occur early. Conclusions: Type 2 diabetes is an important problem among American Indian and First Nation youth. Other populations have not been well studied, but cases are now occurring in all population groups, especially in ethnic minorities. Type 2 diabetes among youth is an emerging public health problem, for which there is a great potential to improve primary and secondary prevention.
Article
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Introduction: The Activity Counseling Trial (ACT) was designed to compare the effectiveness of physician advice alone with physician advice plus behavioral counseling, provided by ACT-trained health educators, to increase levels of physical activity in healthy, sedentary patients. The objective was to determine health care providers’ adherence to the ACT protocol for delivering initial “physician” advice on physical activity and to determine providers’ satisfaction with the protocol.Methods: Fifty-four physicians or physician assistants from 11 primary care practices located in California, Texas, and Tennessee volunteered to participate as ACT-trained physicians. Providers were trained to integrate 3 to 4 minutes of initial physical activity advice into the routine office visits of sedentary patients, aged 35 to 75 years, with no acute or serious chronic conditions. This advice included assessment of current physical activities, advising the patient about an appropriate physical activity goal, and referring the patient to the health educator. Providers initialed forms to document delivery of advice, and ACT health educators recorded their advice on a computerized tracking system. A provider survey measured length of time spent advising patients about physical activity and provider satisfaction with the program.Results: Ninety-nine percent of patients received the initial physician advice about physical activity. Eighty-three percent of the providers spent less than 5 to 6 minutes, and 46% spent the recommended 3 to 4 minutes providing advice. Sixty-three percent said the advice resulted in little or no increase in the length of an office visit, and 83% said participation was an asset to their clinics.Conclusions: Providers incorporated brief physical activity advice into routine primary care visits with little disruption. Their response to the ACT advice protocol was positive and participation in the study was viewed as beneficial.
Article
Overweight in adolescence is considered an important predictor of long-term morbidity and mortality. The impact of adolescent overweight on adult overweight and related multiple cardiovascular risk factors was examined in a biracial (black-white) cohort (N = 783) who participated in two cross-sectional surveys as adolescents aged 13 to 17 years and as young adults aged 27 to 31 years. The cohort was categorized as adolescent-onset adult overweight (N = 110) or lean (N = 81) according to age-, race-, and sex-specific body mass index (BMI) greater than the 75th percentile or between the 25th and 50th percentiles on both surveys. The risk for overweight adolescents to remain overweight as young adults ranged from 52% in black males to 62% in black females. As young adults, the overweight cohort showed adverse levels of body fatness measures, systolic and diastolic blood pressure, lipoprotein cholesterol, insulin, and glucose as compared with the lean cohort (P < .01 to P < .0001). The prevalence of clinically recognized hypertension and dyslipidemia increased 8.5-fold and 3.1- to 8.3-fold, respectively, in the overweight cohort versus the lean cohort (P < .05 to P < .0001). The prevalence of parental history of diabetes mellitus and hypertension increased 2.4-fold (P < .01) and 1.3-fold (P < .05), respectively, in the overweight cohort. Clustering of adverse values (> 75th percentile) for the total cholesterol to high-density lipoprotein (HDL) cholesterol ratio, insulin level, and systolic blood pressure occurred only among the overweight cohort (P < .0001). Thus, excess weight in adolescence persists into young adulthood, and has a strong adverse impact on multiple cardiovascular risk factors, requiring primary prevention early in life.
Article
Background: The overweight population may benefit from Transtheoretical Model-based interventions focusing on regular moderate exercise. Current stages of change measures assessing regular moderate exercise specific to an overweight population (BMI > or =25) are lacking. This study examined the validity of a staging algorithm for moderate exercise for the purposes of healthy weight management. Methods: A sample of 670 healthy adults (mean age 50.9 +/- 15.0; mean BMI 30.6 +/- 5.5; 53% female; 93% Caucasian) completed a questionnaire that included demographics, self-reported levels of exercise, and constructs from the Transtheoretical Model (TTM). Analyses of variance and follow-up tests were used to assess the concurrent and construct validity of the staging algorithm. Results: The staging algorithm discriminated those in the action stages from those in the preaction stages for the moderate- and strenuous-intensity categories (P < 0.001). The constructs of pros and cons (P < 0.001) and confidence (P < 0.001) differed across the stages. Conclusions: In addition to demonstrating good concurrent and construct validity for the stages of change measure, the patterns found across the stages of change were consistent with the theoretical predictions of the TTM and replicated the patterns observed in previous studies.
Article
Recent reports show that obesity and diabetes have increased in the United States in the past decade. To estimate the prevalence of obesity, diabetes, and use of weight control strategies among US adults in 2000. The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in all states in 2000, with 184 450 adults aged 18 years or older. Body mass index (BMI), calculated from self-reported weight and height; self-reported diabetes; prevalence of weight loss or maintenance attempts; and weight control strategies used. In 2000, the prevalence of obesity (BMI >/=30 kg/m(2)) was 19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes (8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not engage in any physical activity, and another 28.2% were not regularly active. Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily. Among obese participants who had had a routine checkup during the past year, 42.8% had been advised by a health care professional to lose weight. Among participants trying to lose or maintain weight, 17.5% were following recommendations to eat fewer calories and increase physical activity to more than 150 min/wk. The prevalence of obesity and diabetes continues to increase among US adults. Interventions are needed to improve physical activity and diet in communities nationwide.
Article
To consider how physical activity interacts with diet to modify lipoprotein metabolism and comment on implications for human health. An overview of lipoprotein metabolism is followed by a summary of the main effects of physical activity on lipoprotein metabolism. Interactions with dietary practice and the disposition of dietary lipid are reviewed, with comment on links with body fatness. Literature is reviewed in relation to the risk of atherosclerotic disease. Although some data are presented on athletic groups, evidence relating to individuals with normal physical activity habits is mainly discussed. Physical inactivity is a risk factor for cardiovascular disease and one mechanism may involve changes to lipoprotein metabolism. The consensus is that aerobic activity involving an expenditure of > or = 8 MJ week(-1) results in an increase in HDL cholesterol and probably decreases in fasting triacylglycerol. These changes Occur despite the spontaneous increase in the proportion of dietary energy from carbohydrate which accompanies increased exercise. For this reason, exercise may be a means of reducing the hypertriglyceridaemic and HDL-lowering effects of low fat (high carbohydrate) diets. Decreases in total and low density lipoprotein cholesterol are sometimes, but not always, reported in sedentary individuals beginning exercise. One mechanism linking all these changes may be alterations to the dynamics of triacylglycerol-rich particles, particularly in the fed state. The expenditure of considerable amounts of energy through regular, frequent physical activity increases the turnover of lipid substrates, with effects on their transport and disposition which may reduce the progression of atherosclerosis.
Article
Approximately 34 million US adults were obese in 1980. Obesity is associated with increased risk of noninsulin-dependent diabetes mellitus (NIDDM), hypertension, cardiovascular disease, gallbladder disease and cholecystectomy, and colon and postmenopausal breast cancer. Using a prevalence-based approach to cost of illness, we estimated the economic costs in 1986 attributable to obesity for these medical conditions. Indirect costs due to morbidity and mortality were discounted at 4%. Overall, the costs attributable to obesity were 11.3billionforNIDDM,11.3 billion for NIDDM, 22.2 billion for cardiovascular disease, 2.4billionforgallbladderdisease,2.4 billion for gall bladder disease, 1.5 billion for hypertension, and 1.9billionforbreastandcoloncancer.Thusaconservativeestimateoftheeconomiccostsofobesitywas1.9 billion for breast and colon cancer. Thus a conservative estimate of the economic costs of obesity was 39.3 billion, or 5.5% of the costs of illness in 1986. Addition of costs due to musculoskeletal disorders could raise this estimate to 7.8%. The costs of treatment for severe obesity must be weighed against the improved health status and quality of life.
Article
The WHO MONICA Project was designed to measure trends and determinants in cardiovascular disease mortality and coronary heart disease and cerebrovascular disease morbidity, and to assess the extent to which these trends are related to changes in known risk factors in 39 collaborative centres in 26 countries. Results of the baseline population surveys are presented. Use of standardized methods allows cross-sectional comparisons to be made of data from the 39 collaborating centres. The proportion of smokers varied between 34-62% among men and 3-52% among women. The median systolic blood pressure (SBP) values varied from 121 mmHg to 145 mmHg in men and from 117 mmHg to 143 mmHg in women. Median diastolic blood pressure (DBP) values varied from 74 mmHg to 91 mmHg in men and from 72 mmHg to 89 mmHg in women. The prevalence of actual hypertension, defined as SBP and/or DBP greater than 159/94 mmHg, or on antihypertensive medication, varied between 8.4% and 45.3% in men and between 12.6% and 40.5% in women. Median serum total cholesterol values varied from 4.1 mmol/l to 6.4 mmol/l in men and from 4.2 mmol/l to 6.4 mmol/l in women. The results show that there is a large variability in the risk-factor patterns among the MONICA populations. They also indicate that populations with low levels of risk factors are in the minority.
Article
Lifestyle and behaviour modifications that include exercise are effective in the prevention of cardiovascular disease and stroke. The benefits are manifested largely through the role that exercise plays in the control of certain modifiable risk factors, such as control blood lipid abnormalities, diabetes and obesity. Exercise also adds an independent effect in the lowering of blood pressure in certain hypertensive groups, thus favourably modifying a major risk factor for stroke. The Honolulu Heart Program, a 22 year follow-up of 5,362 men (aged 58 to 68) revealed that physical activity was protective against "clot caused" stroke only in nonsmokers. This study also revealed that inactive and partially active men compared with those who were active had fourfold increases in intracerebral hemorrhage and threefold increases in subarachnoid hemorrhage. The Framingham study suggested a relationship between sedentary work and stroke although this was not statistically significant. In a 16-year follow-up of 3,263 cargo handlers the death rate from stroke was similar to that of more sedentary people. However, the mortality was threefold higher among those who were sedentary and had higher systolic blood pressure. The exercise employed in prevention can be mild to moderate in intensity and may be of the type experienced in occupational, recreational and leisure time activity. Clinical data reveal that aerobic exercise equal to or greater than 50% of one's maximum capacity can be "protective" in cardiovascular disease.
Article
Guy De Backer, Ettore Ambrosioni, Knut Broch-Johnsen, Carlos Brotons, Renata Cifkova, Jean Dallongeville, Shah Ebrahim, Ole Faergeman, Ian Graham, Guiseppe Mancia, Volkert Manger Cats, Kristina Orth-Gom??r, Joep Perk, Kalevi Py??r??l??, Jos?? L. Rodicio, Susana Sans, Vedat Sansoy, Udo Sechtem, Sigmund Silber, Troels Thomsen, David Wood. (2003) European guidelines on cardiovascular disease prevention in clinical practice Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts). European Journal of Cardiovascular Prevention and Rehabilitation 10, S1-S78 CrossRef David Wood, Guy De Backer, Ole Faergeman, Ian Graham, Giuseppe Mancia, Kalevi Pyörälä. (1998) Prevention of coronary heart disease in clinical practice: Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention1European Society of Cardiology, European Atherosclerosis Society, European Society of Hypertension, International Society of Behavioural Medicine, European Society of General Practice/Family Medicine, European Heart Network.1,2Published simultaneously in the European Heart Journal 1998;19:1434–1503 and the Journal of Hypertension (Summary only) 1998;16(10).2. Atherosclerosis 140, 199-270 CrossRef
Article
The per capita consumption of cigarettes has risen and fallen, depending on particular events (Figure 3) 69 . Deaths from smoking-related illnesses, however, have climbed, possibly reaching a peak or plateau in 1988 1 . Studies 70 have placed the costs of smoking for the United States as a whole at a staggering 65billionin1985intermsofhealthcareexpendituresandlostproductivity,avaluethatwouldsurelyexceed65 billion in 1985 in terms of health care expenditures and lost productivity, a value that would surely exceed 100 billion in current dollars. The estimated average lifetime medical costs for a smoker exceed those for a nonsmoker by more than $6,000 71 . This excess is a weighted average of costs incurred by all smokers, whether or not smoking-related illnesses develop. For smokers in whom such illnesses do develop, the personal financial impact is much higher 71 . The economic effect of smoking has not been overlooked by the life-insurance companies. Time magazine reported 72 that even three insurance firms owned by tobacco companies charge smokers nearly double for term life insurance, because smokers are about twice as likely as nonsmokers to die at a given age.
Article
Although sedentariness, a prevalent lifestyle, is recognized as a significant risk factor for coronary artery disease and other conditions, little is known about the effectiveness of prevention strategies in the primary care setting. This study examines the impact of brief, exercise advice-giving by family physicians. During a 2-month baseline period, patients visiting their family physician and who were age 18 or older were queried about their exercise habits and attitudes and whether their physician had discussed exercise. During the following 2-month experimental phase, the same data were gathered, and half the physicians were trained to give brief exercise advice. All patients were followed for 1 month. Changes in exercise duration and frequency were the primary outcome measures. During baseline, a sizable portion of patients were given exercise advice. This was true also of control group patients during the experimental phase, although trained physicians gave advice almost twice as often. A comparison of the patients receiving advice with those not receiving advice revealed significant increases in exercise duration, but not frequency. Patient attitudes were responsive to exercise advice. Members of primary care, adult patient population will increase their duration of physical activity in response to physician advice to exercise.
Article
A meta-analysis was done to measure the effect of physical activity on the bone mass of healthy postmenopausal women. All studies published between 1966 and 1996, in French or English, were reviewed for inclusion from Medline search, bibliographies of relevant studies, review articles and books. Studies had to be prospective intervention trials, randomized or not, evaluating the effectiveness of an exercise program of any duration, frequency and intensity, with a control group. Studies had to measure bone parameters and involve healthy postmenopausal women over 50 years of age who were free of symptomatic osteoporosis at the time of study entry. Effect sizes (ES) were calculated for each bone parameter and site measured in every eligible study according to Hedges and Olkin. DerSimonian and Laird's model was used to estimate overall effect sizes when combining studies. All analyses were bone parameter and site specific. Of 217 papers extracted from the literature, 187 did not meet eligibility criteria and 12 others were rejected. The two main reasons for rejection were that both genders were combined in the analyses and no exercise group without drug interaction was present. Eighteen studies were included for meta-analysis. Taking into account the frequency, duration, compliance rate and average age of the subjects, the programs were judged of moderate intensity and focused on walking, running, physical conditioning and aerobics. A significant effect of physical activity was detected on the bone mineral density at the L2-4 level of the lumbar column in studies published after 1991 (ES = 0.8745, p < 0.05). No effect could be seen, however, on forearm and femoral bone mass. Although applied to a small number of studies, this meta-analysis suggests that exercise programs in a population of postmenopausal women over 50 years of age are effective for preventing spinal bone mineral density loss at the L2-4 level. However, such programs do not have any effect on the forearm or femoral bone mass.
Article
To identify the features of an optimal exercise programme in terms of type of exercise, intensity and frequency that would maximise the training induced decrease in blood pressure (BP). Trials were identified by a systematic search of Medline, Embase and Science Citation Index (SCI), previous review articles and the references of relevant trials, from 1980 until 1996, including only English language studies. The inclusion criteria were limited to randomised controlled trials of aerobic or resistance exercise training conducted over a minimum of 4 weeks where systolic and diastolic BP was measured. A total of 29 studies (1533 hypertensive and normotensive participants) were included, 26 used aerobic exercise training, two trials used resistance training and one study had both resistance and aerobic training groups. Aerobic exercise training reduced systolic BP by 4.7 mm Hg (95% CI: 4.4, 5.0) and diastolic BP by 3.1 mm Hg (95% CI: 3.0, 3.3) as compared to a non-exercising control group, however, significant heterogeneity was observed between trials in the analysis. The BP reduction seen with aerobic exercise training was independent of the intensity of exercise and the number of exercise sessions per week. The evidence for the effect of resistance exercise training was inconclusive. Aerobic exercise training had a small but clinically significant effect in reducing systolic and diastolic BP. Increasing exercise intensity above 70% VO2 max or increasing exercise frequency to more than three sessions per week did not have any additional impact on reducing BP.
Article
The World Health Organization (WHO) MONICA Project is a 10-year study monitoring trends and determinants of cardiovascular disease in geographically defined populations. Data were collected from over 100,000 randomly selected participants in two risk factor surveys conducted approximately 5 years apart in 38 populations using standardized protocols. The net effects of changes in the risk factor levels were estimated using risk scores derived from longitudinal studies in the Nordic countries. The prevalence of cigarette smoking decreased among men in most populations, but the trends for women varied. The prevalence of hypertension declined in two-thirds of the populations. Changes in the prevalence of raised total cholesterol were small but highly correlated between the genders (r = 0.8). The prevalence of obesity increased in three-quarters of the populations for men and in more than half of the populations for women. In almost half of the populations there were statistically significant declines in the estimated coronary risk for both men and women, although for Beijing the risk score increased significantly for both genders. The net effect of the changes in the risk factor levels in the 1980s in most of the study populations of the WHO MONICA Project is that the rates of coronary disease are predicted to decline in the 1990s.
Article
To test the effectiveness, in the setting of primary health care, of verbal advice on exercise from a family physician (FP) combined with supporting written information. A controlled trial with subjects allocated to a control group or one of two intervention groups using a balanced design based on day of the week. Ten general practices in Perth, Western Australia. All sedentary patients consulting an FP. Verbal advice on exercise from the FP and a pamphlet on exercise mailed to the patient's home address within 2 days of his/her visit to the doctor. Level of physical activity at follow-up. 6,351 adult patients attending an FP practice completed a screening questionnaire, and 763 sedentary adults were recruited to the project. The response to follow-up, via a postal survey at 1, 6, and 12 months after the index consultation was 70%, 60%, and 57%, respectively. At 1 month a subsample of the control and intervention subjects were contacted for a telephone interview to verify self-reported levels of activity (n = 136). Treating all nonresponders as sedentary, at 1 month significantly more subjects in the combined intervention groups reported doing some physical activity (40%) compared with the control group (31%). Similarly, at 6 months, 30% of the control group and 38% of the combined intervention groups were "now active." There was very little change at follow-up at 12 months (31% control and 36% intervention groups, respectively). A simple intervention aimed at the promotion of physical activity to sedentary patients in general practice can help reduce inactivity.
Article
Although many studies suggest that physical activity may reduce risk of type 2 diabetes, the role of moderate-intensity activity such as walking is not well understood. To examine the relationship of total physical activity and incidence of type 2 diabetes in women and to compare the benefits of walking vs vigorous activity as predictors of subsequent risk of type 2 diabetes. The Nurses' Health Study, a prospective cohort study that included detailed data for physical activity from women surveyed in 11 US states in 1986, with updates in 1988 and 1992. A total of 70,102 female nurses aged 40 to 65 years who did not have diabetes, cardiovascular disease, or cancer at baseline (1986). Risk of type 2 diabetes by quintile of metabolic equivalent task (MET) score, based on time spent per week on each of 8 common physical activities, including walking. During 8 years of follow-up (534, 928 person-years), we documented 1419 incident cases of type 2 diabetes. After adjusting for age, smoking, alcohol use, history of hypertension, history of high cholesterol level, and other covariates, the relative risks (RRs) of developing type 2 diabetes across quintiles of physical activity (least to most) were 1.0, 0.77, 0.75, 0.62, and 0.54 (P for trend <.001); after adjusting for body mass index (BMI), RRs were 1.0, 0.84, 0.87, 0.77, and 0.74 (P for trend = .002). Among women who did not perform vigorous activity, multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0, 0.91,0.73, 0.69, and 0.58 (P for trend <.001). After adjusting for BMI, the trend remained statistically significant (RRs were 1.0, 0.95, 0.80, 0.81, 0.74; P for trend = .01). Faster usual walking pace was independently associated with decreased risk. Equivalent energy expenditures from walking and vigorous activity resulted in comparable magnitudes of risk reduction. Our data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes, including physical activity of moderate intensity and duration.