Joseph E. Donnelly’s research while affiliated with Kansas City University and other places

Introduction Obesity is associated with increased morbidity in patients with advanced liver disease, but it is particularly challenging for these patients to preserve skeletal muscle mass during weight loss and accelerating sarcopenia is a concern. Alternate‐day modified fasting (ADMF) may be particularly effective for weight loss in patients with concomitant cirrhosis and obesity due to preservation of fat‐free mass (FFM). Methods A weight loss program featuring either ADMF or a continuous low‐calorie diet (LCD) was evaluated in a 24‐week randomized clinical trial in 20 adult patients with Child‐Pugh Class A cirrhosis and obesity. Participants were randomized to either ADMF (n = 11) or LCD (n = 9). Both groups received a remotely delivered exercise program. Body composition, sarcopenia measures, and functional outcomes were assessed pre‐post. Results Thirteen participants completed the intervention (Age = 57 ± 10; BMI = 37.7 ± 5.8 kg/m²). The median body weight lost in ADMF was 13.7 ± 4.8 kg (13.9% of initial body weight), while LCD lost 9.9 ± 6.9 kg (10.7% of initial body weight). Total body fat percentage decreased in both groups (ADMF: −4.1 ± 4.0%; LCD = −2.8 ± 1.4%). Fat‐free mass accounted for 34 ± 20% of total weight loss in ADMF and 38 ± 10% in LCD. Functional measures, such as timed chair stands, improved in both groups. Conclusion This pilot study demonstrates the feasibility of the ADMF and LCD interventions to produce significant weight loss while improving body composition in patients with cirrhosis and obesity. Further research is needed to validate these findings in larger cohorts and to assess changes in muscle quality and visceral fat. Trial Registration ClinicalTrials.gov Identifier: NCT05367596.

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk ⁻¹ of moderate-intensity physical activity, and these benefits occur in a dose–response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk ⁻¹ of moderate-intensity physical activity, and these benefits occur in a dose–response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

Introduction Limited information exists on the descriptive epidemiology of physical activity (PA) in individuals with intellectual disabilities (ID). The purpose of this study was to report device-measured PA and sedentary time for individuals with ID (age 10–70 yr) eligible to participate in PA promotion (i.e., self-reported PA <60–90 min·wk ⁻¹ ) and weight loss (i.e., body mass index ≥25 kg·m ⁻² ) clinical trials. We aimed to examine patterns of PA by diagnosis within a day and across days and US meteorological seasons. Methods This cross-sectional study used baseline accelerometer data from individuals with ID participating in clinical trials. The Troiano adult and Freedson child cut-points were used to classify sedentary time and PA, and Wilcoxon rank sum or Kruskal–Wallis tests assessed differences by age, diagnosis, weekday versus weekend, time of day, and season. Mixed effects linear regressions explored the effect of time of day, weekend, and season on PA and sedentary time. Results There were 330 individuals (57% female) who had valid wear time with an average of 14 ± 18 min·d ⁻¹ of moderate-to-vigorous PA (age 10–17 yr: 13 ± 16 min·d ⁻¹ ; age 18–24 yr: 18 ± 23 min·d ⁻¹ ; age ≥25 yr: 12 ± 13 min·d ⁻¹ ). Fewer minutes of moderate-to-vigorous PA were observed on the weekends ( β = −0.10, P < 0.001) and in the morning (before 0900 h, β = −0.23, P < 0.001) and evening (after 1900 h, β = −0.32, P < 0.001) compared to weekdays and late afternoon (1500–1659h). Conclusion The promotion of PA to individuals with ID is needed, particularly during times when these individuals are not in school or at work (i.e., mornings, evenings, and weekends). Future research should explore PA patterns in adolescents and adults with ID who are normal weight and regularly participating in PA, sport, and fitness programs.

Introduction Moderate-to-vigorous physical activity (MVPA) is inadequate in adolescents with intellectual and developmental disabilities (IDD). This report describes the results of an 18-mo. clinical trial in adolescents with IDD which compared changes in accelerometer assessed daily MVPA, gross motor quotient and leg press strength between participants randomized to an exercise intervention delivered to adolescents only (AO) or to the adolescent and a parent (A + P). Methods The 18-mo. trial included a 6-mo. active intervention, 6-mo. maintenance interventions, and a 6-mo. no-contact follow-up. Adolescents in both arms were asked to attend 40 min. remotely delivered group video exercise sessions (0-6 mos. =3 sessions·wk ⁻¹ ., 7-12 mos. =1 session·wk ⁻¹ ). In the A + P arm, one parent/guardian was asked to attend all group remote video exercise sessions and a monthly remotely delivered 30-min. educations/support session with their adolescent across the 12-mo. intervention. Results Adolescents ( n = 116) with IDD (age ~ 16 yrs., 52% female) were randomized to the AO ( n = 59) or A + P ( n = 57) arms. Mixed modeling, controlling for baseline MVPA and season, indicated minimal but statistically significant changes in MVPA across 6 ( p = 0.006), 12 ( p < 0.001), and 18 mos. ( p < 0.001). However, the change in MVPA in the two intervention arms did not differ significantly at any time point (all p > 0.05). Similarly, gross motor quotient and leg press strength improved significantly over time ( p < 0.001) and these changes did not differ between intervention arms (all p > 0.05). Conclusions Parental involvement had no impact on changes in daily MVPA, gross motor quotient or leg press strength in response to a remotely delivered exercise intervention in adolescents with IDD.

Aim To assess the feasibility of the flipped classroom pedagogy in a clinical weight loss program and its impact on 6-month weight change. Methods Adults with overweight/obesity enrolled in a 6-month program with a structured diet (portion-controlled meals and fruits/vegetables) and exercise plan (≥150mins/week), plus weekly, 1-h group education sessions. Sessions used a flipped classroom approach: educational content was delivered beforehand via podcast/video and book readings and session time involved application-based activities (e.g., case studies, games). Satisfaction surveys were completed at 3 months. Weight change was assessed using paired t-tests (SAS 9.4, significance 0.05). Results Eighteen participants completed 6 months (retention 94%). Participants maintained diet adherence and exercise at 3 months (∼84% diet adherence, ∼153mins exercise/week) and 6 months (∼83% diet adherence, ∼158mins exercise/week), as well as attendance to behavioral sessions (3 months: 77%; 6mo: 71%). Satisfaction surveys showed high program enjoyment (∼8.1/10). Mean weight change at 3 and 6 months was −6.5 ± 4.2% and − 9.3 ± 5.0% (both p < 0.01), respectively. Conclusion The flipped classroom pedagogy was feasible for delivery in a clinical weight loss program and supported significant 6-month weight loss. Innovation This is the first evaluation of the flipped classroom in a clinical setting and supports the investigation of this pedagogy in weight management.

Introduction Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non‐physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6‐month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team. Methods Rural living adults with overweight/obesity ( n = 187, age ∼ 50 years 82% female, body mass index ∼35 kg/m ² ) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly ∼ 45 min sessions with 7–14 participants ( n = 71), IP, which included weekly ∼ 15 min individual sessions ( n = 80), or EUC, which included one‐45 min in‐person session at baseline. Results Weight loss at 6 months was clinically relevant, that is, ≥5% in the GP (−11.4 kg, 11.7%) and the IP arms (−9.1 kg, 9.2%) but not in the EUC arm (−2.6%, −2.5% kg). Specifically, 6 month weight loss was significantly greater in the IP versus EUC arms (−6.5 kg. p ≤ 0.025) but did not differ between the GP and IP arms (−2.4 kg, p > 0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and$60 for the IP and GP arms, respectively. Conclusions Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6 months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost‐effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).

Introduction: Physical activity (PA) may elicit important health benefits when coupled with contemporary anti-obesity medications (AOM). However, currently there is little known about perceptions of PA and associated PA engagement of patients receiving these AOM therapies. Hypothesis: We assessed the hypothesis that PA would differ by perceptions of confidence to engage in PA, current and future importance of PA, and PA amount in patients receiving AOM treatment within the context of a medical weight loss clinic. Methods: An electronic survey was distributed to patients in a clinical research registry who were receiving treatment with an AOM at a university medical center-based weight loss clinic. The survey included questions about their perceived confidence to do structured PA or exercise regularly (PA-CONFIDENCE) and perceived importance of structured PA or exercise for management of their body weight currently (PA-IMPORTANCE) or in the future (PA-FUTURE). Participants also reported their current level of PA. Results: Survey responses were received from 96 patients. For these analyses, data were examined for patients currently prescribed a GLP-1 AOM (83 patients). High PA-CONFIDENCE was reported by 44.6% of participants, with 34.9% and 20.5% reporting moderate and low PA-CONFIDENCE, respectively. PA was 154±117 min/wk, 107±105 min/wk, and 76±77 min/wk for high, moderate, and low PA-CONFIDENCE (p=0.033). Participating in ≥150 min/wk of PA was reported by 54.1% with high, 20.7% with moderate, and 11.8% with low PA-CONFIDENCE (p=0.002). Ratings of PA-IMPORTANCE were 63.9% for high, 28.9% for moderate, and 7.2% for low. Participating in ≥150 min/wk of PA was reported by 48.2% with high, 12.5% with moderate, and 0% with low PA-IMPORTANCE (p=0.002). Ratings of PA-FUTURE were 79.5% for high, 18.1% for moderate, and 2.4% for low. Current participation in ≥150 min/wk of PA was reported by 33.7% with high, 12.5% with moderate, and 0% with low PA-FUTURE (p=0.002). Conclusions: Less than one-half of patients prescribed an AOM report confidence to engage in regular structured PA, and of those with high confidence only approximately one-half achieve current public health recommendations for PA. While more than one-half of patients report that PA is important, less than one-half engage in the recommended amount of PA. Strategies are needed to increase perceived confidence to perform and importance of PA in AOM treated patients, and to increase PA participation.