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Boomers and Physical Fitness: An AARP Bulletin Survey

April 15, 2014 Comments off

Boomers and Physical Fitness: An AARP Bulletin Survey
Source: AARP

Aimed at exploring the U.S. Boomers’ perceptions and behavior around physical health and fitness, this survey was conducted via telephone by AARP Research, on behalf of the AARP Bulletin, in January 2014, among a national representative sample of 760 Boomers (ages 49-67 years).

Key findings include:

  • Over four-in-ten (43%) Boomers rate their physical health excellent or very good while three-in-ten (29%) rate it fair or poor.
  • Two-thirds (67%) of Boomers say physical fitness exercise is a priority for them today.
  • “It keeps me mobile, not dependent on others (48%), “I enjoy it/it’s fun” (30%), “I have always had this as a priority” (26%), “Doctor recommended it as a must” (26%), and “It makes me feel younger” (25%) are the top-five reasons why physical fitness exercise is a priority for them today.
  • While asking the reasons to those who say physical fitness exercise is not a priority for them today, the highest proportion reported “I don’t have time” (30%), followed by “I am disabled/physically impaired” (22%), “I have chronic illness/I am sick” (21%), and “I have other more important priorities” (20%).
  • About one-in-six (16%) Boomers are currently a member of a health, fitness, or exercise club. Use of personal fitness mobile apps is infrequent among Boomers – only 7% reported using them over the past five years.
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Dynamic Association of Mortality Hazard with Body Shape

March 3, 2014 Comments off

Dynamic Association of Mortality Hazard with Body Shape
Source: PLoS ONE

Background
A Body Shape Index (ABSI) had been derived from a study of the United States National Health and Nutrition Examination Survey (NHANES) 1999–2004 mortality data to quantify the risk associated with abdominal obesity (as indicated by a wide waist relative to height and body mass index). A national survey with longer follow-up, the British Health and Lifestyle Survey (HALS), provides another opportunity to assess the predictive power for mortality of ABSI. HALS also includes repeat observations, allowing estimation of the implications of changes in ABSI.

Methods and Findings
We evaluate ABSI z score relative to population normals as a predictor of all-cause mortality over 24 years of follow-up to HALS. We found that ABSI is a strong indicator of mortality hazard in this population, with death rates increasing by a factor of 1.13 (95% confidence interval, 1.09–1.16) per standard deviation increase in ABSI and a hazard ratio of 1.61 (1.40–1.86) for those with ABSI in the top 20% of the population compared to those with ABSI in the bottom 20%. Using the NHANES normals to compute ABSI z scores gave similar results to using z scores derived specifically from the HALS sample. ABSI outperformed as a predictor of mortality hazard other measures of abdominal obesity such as waist circumference, waist to height ratio, and waist to hip ratio. Moreover, it was a consistent predictor of mortality hazard over at least 20 years of follow-up. Change in ABSI between two HALS examinations 7 years apart also predicted mortality hazard: individuals with a given initial ABSI who had rising ABSI were at greater risk than those with falling ABSI.

Conclusions
ABSI is a readily computed dynamic indicator of health whose correlation with lifestyle and with other risk factors and health outcomes warrants further investigation.

Fact Sheet — Physical activity

February 27, 2014 Comments off

Physical activity
Source: World Health Organization

Key facts

  • Physical inactivity is the fourth leading risk factor for death worldwide.
  • Approximately 3.2 million people die each year due to physical inactivity.
  • Physical inactivity is a key risk factor for noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes.
  • Physical activity has significant health benefits and contributes to prevent NCDs.
  • Globally, one in three adults is not active enough.
  • Policies to address physical inactivity are operational in 56% of WHO Member States.
  • WHO Member States have agreed to reduce physical inactivity by 10% by 2025.

Active lifestyles related to excellent self-rated health and quality of life: cross sectional findings from 194,545 participants in The 45 and Up Study

January 17, 2014 Comments off

Active lifestyles related to excellent self-rated health and quality of life: cross sectional findings from 194,545 participants in The 45 and Up Study
Source: BMC Public Health

Background
Physical activity and sitting time independently contribute to chronic disease risk, though little work has focused on aspirational health outcomes. The purpose of this study was to examine associations between physical activity, sitting time, and excellent overall health (ExH) and quality of life (ExQoL) in Australian adults.

Methods
The 45 and Up Study is a large Australian prospective cohort study (n = 267,153). Present analyses are from 194,545 participants (48% male; mean age = 61.6 ± 10.7 yrs) with complete baseline questionnaire data on exposures, outcomes, and potential confounders (age, income, education, smoking, marital status, weight status, sex, residential remoteness and economic advantage, functional limitation and chronic disease). The Active Australia survey was used to assess walking, moderate, and vigorous physical activity. Sitting time was determined by asking participants to indicate number of hours per day usually spent sitting. Participants reported overall health and quality of life, using a five-point scale (excellent—poor). Binary logistic regression models were used to analyze associations, controlling for potential confounders.

Results
Approximately 16.5% of participants reported ExH, and 25.7% reported ExQoL. In fully adjusted models, physical activity was positively associated with ExH (AOR = adjusted odds ratio for most versus least active = 2.22, 95% CI = 2.20, 2.47; Ptrend < 0.001) and ExQoL (AOR for most versus least active = 2.30, 95% CI = 2.12, 2.49; Ptrend < 0.001). In fully adjusted models, sitting time was inversely associated with ExH (AOR for least versus most sitting group = 1.13, 95% CI = 1.09, 1.18; Ptrend < 0.001) and ExQoL (AOR for least versus most sitting group = 1.13, 95% CI = 1.10, 1.17; Ptrend < 0.001). In fully adjusted models, interactions between physical activity and sitting time were not significant for ExH (P = 0.118) or ExQoL (P = 0.296).

Conclusions
Physical activity and sitting time are independently associated with excellent health and quality of life in this large diverse sample of Australian middle-aged and older adults. These findings bolster evidence informing health promotion efforts to increase PA and decrease sitting time toward the achievement of better population health and the pursuit of successful aging.

Do Workplace Wellness Programs Save Employers Money?

January 13, 2014 Comments off

Do Workplace Wellness Programs Save Employers Money?
Source: RAND Corporation

Examines the return on investment (ROI) that companies realize from workplace wellness programs, focusing on the ROI provided by disease management programs versus lifestyle management programs.

Cycling, Health and Safety

December 24, 2013 Comments off

Cycling, Health and Safety
Source: Organisation for Economic Co-operation and Development

Many jurisdictions around the world are trying to retain or increase the share of cycling in urban traffic in order to benefit from the many health and transport efficiency benefits. Safety is a key concern and should be accounted for in these policies.

This report of the International Transport Forum’s Cycling Safety Working Group monitors international trends in cycling, safety and policy, and explores options that may help decision makers design safe environments for cycling. Key messages relate to strategic goal-setting for cycling policy and managing crash risks while increasing health benefits. The report also discusses how to better capture crash and bicycle usage statistics. The safety impacts of a wide range of pro-cycling measures are examined in detail.

Educating the Student Body: Taking Physical Activity and Physical Education to School

November 7, 2013 Comments off

Educating the Student Body: Taking Physical Activity and Physical Education to School
Source: Institute of Medicine

Physical inactivity is a key determinant of health across the lifespan. A lack of activity increases the risk of heart disease, colon and breast cancer, diabetes mellitus, hypertension, osteoporosis, anxiety and depression and others diseases. Emerging literature has suggested that in terms of mortality, the global population health burden of physical inactivity approaches that of cigarette smoking. The prevalence and substantial disease risk associated with physical inactivity has been described as a pandemic.

The prevalence, health impact, and evidence of changeability all have resulted in calls for action to increase physical activity across the lifespan. In response to the need to find ways to make physical activity a health priority for youth, the Institute of Medicine’s Committee on Physical Activity and Physical Education in the School Environment was formed. Its purpose was to review the current status of physical activity and physical education in the school environment, including before, during, and after school, and examine the influences of physical activity and physical education on the short and long term physical, cognitive and brain, and psychosocial health and development of children and adolescents.

Educating the Student Body makes recommendations about approaches for strengthening and improving programs and policies for physical activity and physical education in the school environment. This report lays out a set of guiding principles to guide its work on these tasks. These included: recognizing the benefits of instilling life-long physical activity habits in children; the value of using systems thinking in improving physical activity and physical education in the school environment; the recognition of current disparities in opportunities and the need to achieve equity in physical activity and physical education; the importance of considering all types of school environments; the need to take into consideration the diversity of students as recommendations are developed.

This report will be of interest to local and national policymakers, school officials, teachers, and the education community, researchers, professional organizations, and parents interested in physical activity, physical education, and health for school-aged children and adolescents.

Does doing housework keep you healthy? The contribution of domestic physical activity to meeting current recommendations for health

October 22, 2013 Comments off

Does doing housework keep you healthy? The contribution of domestic physical activity to meeting current recommendations for health
Source: BMC Public Health

Background
Recent lifestyle approaches to physical activity have included the promotion of domestic physical activities such as do-it-yourself or home maintenance, gardening and housework. Although it is acknowledged that any activity is better than none, there is a danger that those undertaking domestic ‘chores’ may assume that this activity is moderate intensity and therefore counts towards this 150 minute per week target The purpose of this paper was to report the contribution domestic physical activity makes to total weekly physical activity and the relationship between domestic physical activity and leanness in the Northern Ireland population.

Methods
4563 adults participated in this cross-sectional survey of physical activity behaviour. Data were collected through face-to-face interviews using computer assisted personal interviewing. were not normally distributed, Gender and age group differences in domestic MVPA activity and the ratio of domestic to total MVPA were explored using non-parametric Kruskal-Wallis tests. Self-reported volume and intensity of physical activity (in bouts of 10 minutes or more) in the home and self-reported height and weight were used to determine the association between domestic physical activity and leanness using an ANCOVA having controlled for age, gender, socio-economic and smoking status.

Results
42.7% of the population report levels of physical activity which meet or exceed the current United Kingdom recommendations. Domestic physical activity accounts for 35.6% of the reported moderate to vigorous physical activity (MVPA). For women, if domestic physical activity was excluded from total MVPA, only 20.4% would be deemed to meet current recommendations. Time spent in domestic physical activity at moderate or vigorous intensity was found to be negatively associated with leanness (P = 0.024), [R Squared = .132 (Adjusted R Squared = .125)].

Conclusions
Domestic physical activity accounts for a significant proportion of self-reported daily MVPA particularly among females and older adults however such activity is negatively associated with leanness suggesting that such activity may not be sufficient to provide all of the benefits normally associated with meeting the physical activity guidelines.

CDC releases 2012 School Health Policies and Practices Study results

August 30, 2013 Comments off

CDC releases 2012 School Health Policies and Practices Study results
Source: Centers for Disease Control and Prevention

School districts nationwide are showing improvements in measures related to nutritional policies, physical education and tobacco policies, according to the 2012 School Health Policies and Practices Study (SHPPS). SHPPS is the largest and most comprehensive survey to assess school health policies.

Key findings include:
Nutrition:

  • The percentage of school districts that allowed soft drink companies to advertise soft drinks on school grounds decreased from 46.6 percent in 2006 to 33.5 percent in 2012.
  • Between 2006 and 2012, the percentage of districts that required schools to prohibit offering junk food in vending machines increased from 29.8 percent to 43.4 percent.
  • Between 2006 and 2012, the percentage of districts with food procurement contracts that addressed nutritional standards for foods that can be purchased separately from the school breakfast or lunch increased from 55.1 percent to 73.5 percent.
  • Between 2000 and 2012, the percentage of districts that made information available to families on the nutrition and caloric content of foods available to students increased from 35.3 percent to 52.7 percent.

Physical education/physical activity:

  • The percentage of school districts that required elementary schools to teach physical education increased from 82.6 percent in 2000 to 93.6 percent in 2012.
  • More than half of school districts (61.6 percent) had a formal agreement, such as a memorandum of agreement or understanding, between the school district and another public or private entity for shared use of school or community property. Among those districts, more than half had agreements with a local youth organization (e.g., the YMCA, Boys or Girls Clubs, or the Boy Scouts or Girl Scouts) or a local parks or recreation department.

Tobacco:

  • The percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.

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Factors Predicting Physical Activity Among Children With Special Needs

August 28, 2013 Comments off

Factors Predicting Physical Activity Among Children With Special Needs
Source: Preventing Chronic Disease

Introduction
Obesity is especially prevalent among children with special needs. Both lack of physical activity and unhealthful eating are major contributing factors. The objective of our study was to investigate barriers to physical activity among these children.

Methods
We surveyed parents of the 171 children attending Vista Del Mar School in Los Angeles, a nonprofit school serving a socioeconomically diverse group of children with special needs from kindergarten through 12th grade. Parents were asked about their child’s and their own physical activity habits, barriers to their child’s exercise, and demographics. The response rate was 67%. Multivariate logistic regression was used to examine predictors of children being physically active at least 3 hours per week.

Results
Parents reported that 45% of the children were diagnosed with attention deficit hyperactivity disorder, 38% with autism, and 34% with learning disabilities; 47% of children and 56% of parents were physically active less than 3 hours per week. The top barriers to physical activity were reported as child’s lack of interest (43%), lack of developmentally appropriate programs (33%), too many behavioral problems (32%), and parents’ lack of time (29%). However, child’s lack of interest was the only parent-reported barrier independently associated with children’s physical activity. Meanwhile, children whose parents were physically active at least 3 hours per week were 4.2 times as likely to be physically active as children whose parents were less physically active (P = .01).

Conclusion
In this group of students with special needs, children’s physical activity was strongly associated with parental physical activity; parent-reported barriers may have had less direct effect. Further studies should examine the importance of parental physical activity among children with special needs.

Daily time use among men and women in 2012

July 31, 2013 Comments off

Daily time use among men and women in 2012
Source: Bureau of Labor Statistics

On an average day in 2012, people age 15 and over spent 8.7 hours each day sleeping. Men spent 8.6 hours per day sleeping, while women spent 8.9 hours, on average. Nearly everyone age 15 and over engaged in some sort of leisure activity on average day, such as watching TV, socializing, or exercising. Overall, people spent 5.4 hours each day on leisure activities, on average; men spent more time in these activities (5.8 hours) than did women (5.0 hours).

Prevalence of physical activity and obesity in US counties, 2001-2011: a road map for action

July 19, 2013 Comments off

Prevalence of physical activity and obesity in US counties, 2001-2011: a road map for action
Source: Institute for Health Metrics and Evaluation

Research objective
Obesity and lack of physical activity are associated with several chronic conditions, such as heart disease and diabetes, increased health care costs, and premature death. Since different local governments have pursued different approaches to address both risks, levels of obesity and physical activity are likely to vary substantially across counties. To understand local trends in physical activity and obesity that would help identify successful and less successful strategies, researchers examined county-level changes in physical activity and obesity between 2001 and 2011.

Analytical approach
The researchers used data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit telephone survey that covers the majority of United States counties, and the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US civilian noninstitutionalized population. They calculated body mass index (BMI) from self-reported weight and height in BRFSS, adjusting for self-reporting bias using NHANES, and calculated self-reported physical activity—both any physical activity and physical activity meeting recommended levels—from self-reported data in BRFSS. To generate estimates of obesity and physical activity prevalence for each county annually for 2001 to 2011, they used validated small area estimation methods.

Findings
Results showed that physical activity in US counties is increasing. Levels were generally higher in men than in women, but increases were greater in women than men, and counties in California, Florida, Georgia, and Kentucky reported the largest gains. However, this increase in level of activity was matched by an increase in obesity in almost all counties during the same time period. Increases in physical activity in counties were not shown to be strongly related to decreases in obesity – from 2001 to 2009, for every 1 percentage point increase in physical activity prevalence, obesity prevalence was 0.11 percentage points lower, controlling for changes in poverty, unemployment, number of doctors per 100,000 population, percent rural, and baseline levels of obesity.

Conclusions
While the increases in physical activity seen at the county level will have a positive impact on the health of Americans, these increases have a small impact on the prevalence of obesity. This means that other strategies are likely needed. Coordinated actions involving the health care and public health systems, non-governmental organizations, and food labeling, taxation, and incentive programs should be considered to curb the obesity epidemic and its burden.

The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study

July 10, 2013 Comments off

The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study
Source: Institute for Health Metrics and Evaluation

The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study presents key findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for the US and documents trends in nearly 300 different diseases and injuries that are killing people prematurely and disabling them. The report sheds light on the substantial health threat posed by potentially modifiable risk factors such as poor diet, high body mass index, and lack of physical activity. It also provides an in-depth look at life expectancy, obesity, and physical activity in US counties.

In the US, males and females are living longer than ever before, but their progress lagged behind that of their peers in other wealthy countries. As the US population grows older, the number of years Americans can expect to live with disability from causes such as depression and low back and neck pain has increased. The study reveals that thousands of lives could be saved by implementing policies that improve Americans’ diets and levels of physical activity and reduce smoking, high body mass index, and high blood pressure.

At the local level, this report reveals the massive and growing disparities in life expectancy across US counties. Females in almost half of US counties made no significant progress in improving life expectancy between 1985 and 2010, compared to only 5% in males. It is also important to note that more Americans are getting recommended levels of exercise than ever before, which is likely to have positive effects on health. These increases in sufficient physical activity, however, have done little to mitigate rising obesity rates around the country.

Trends in Health-Related Quality of Life Among Adolescents in the United States, 2001–2010

July 3, 2013 Comments off

Trends in Health-Related Quality of Life Among Adolescents in the United States, 2001–2010
Source: Preventing Chronic Disease (CDC)

Health-related quality of life (HRQOL) measures are often used to track changes in population health, mostly among adults. Prompted by the recent US recession, we assessed trends in adolescent HRQOL by using cross-sectional data from the 2001–2010 National Health and Nutrition Examination Survey. Adolescents’ self-rated health and reported mental health declined significantly, especially among those in low-income families, but their physical health and activity limitation did not change. Because these HRQOL declines occurred at the end of the decade and especially among adolescents from low-income families, we conclude that these declines are consistent with recession effects and warrant further study.

Educating the Student Body: Taking Physical Activity and Physical Education to School

May 28, 2013 Comments off

Educating the Student Body: Taking Physical Activity and Physical Education to School

Source: Institute of Medicine

Physical inactivity is a key determinant of health across the lifespan. A lack of activity increases the risk of heart disease, colon and breast cancer, diabetes mellitus, hypertension, osteoporosis, anxiety and depression and others diseases. Emerging literature has suggested that in terms of mortality, the global population health burden of physical inactivity approaches that of cigarette smoking. The prevalence and substantial disease risk associated with physical inactivity has been described as a pandemic.

The prevalence, health impact, and evidence of changeability all have resulted in calls for action to increase physical activity across the lifespan. In response to the need to find ways to make physical activity a health priority for youth, the Institute of Medicine’s Committee on Physical Activity and Physical Education in the School Environment was formed. Its purpose was to review the current status of physical activity and physical education in the school environment, including before, during, and after school, and examine the influences of physical activity and physical education on the short and long term physical, cognitive and brain, and psychosocial health and development of children and adolescents.

Educating the Student Body makes recommendations about approaches for strengthening and improving programs and policies for physical activity and physical education in the school environment. This report lays out a set of guiding principles to guide its work on these tasks. These included: recognizing the benefits of instilling life-long physical activity habits in children; the value of using systems thinking in improving physical activity and physical education in the school environment; the recognition of current disparities in opportunities and the need to achieve equity in physical activity and physical education; the importance of considering all types of school environments; the need to take into consideration the diversity of students as recommendations are developed.

This report will be of interest to local and national policymakers, school officials, teachers, and the education community, researchers, professional organizations, and parents interested in physical activity, physical education, and health for school-aged children and adolescents.

High-Intensity Circuit Training Using Body Weight: Maximum Results With Minimal Investment

May 22, 2013 Comments off

High-Intensity Circuit Training Using Body Weight: Maximum Results With Minimal Investment

Source: Health & Fitness Journal (American College of Sports Medicine)

To address the limitations of traditional exercise protocols and provide an effective and efficient program for our clients, one of the exercise strategies we use is high-intensity circuit training (HICT) using body weight as resistance. Our approach combines aerobic and resistance training into a single exercise bout lasting approximately 7 minutes. Participants can repeat the 7-minute bout 2 to 3 times, depending on the amount of time they have. As body weight provides the only form of resistance, the program can be done anywhere.

HICT is not a new concept, but it is growing in popularity because of its efficiency and practicality for a time-constrained society. The combination of aerobic and resistance training in a high-intensity, limited-rest design can deliver numerous health benefits in much less time than traditional programs (5, 9, 10, 16, 18). When body weight is used as resistance, it eliminates the limiting factors of access to equipment and facilities.

As this programming modality is applied to a growing number of populations, it is important to understand the benefits, methodologies, and supporting research with regard to HICT.

Categories: exercise and fitness

Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study

April 22, 2013 Comments off

Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study
Source: British Medical Journal

Objectives To prevent pain inhibiting their performance, many athletes ingest over-the-counter (OTC) analgesics before competing. We aimed at defining the use of analgesics and the relation between OTC analgesic use/dose and adverse events (AEs) during and after the race, a relation that has not been investigated to date.

Design Prospective (non-interventional) cohort study, using an online questionnaire.

Setting The Bonn marathon 2010.

Participants 3913 of 7048 participants in the Bonn marathon 2010 returned their questionnaires.

Primary and secondary outcomes Intensity of analgesic consumption before sports; incidence of AEs in the cohort of analgesic users as compared to non-users.

Results There was no significant difference between the premature race withdrawal rate in the analgesics cohort and the cohort who did not take analgesics (‘controls’). However, race withdrawal because of gastrointestinal AEs was significantly more frequent in the analgesics cohort than in the control. Conversely, withdrawal because of muscle cramps was rare, but it was significantly more frequent in controls. The analgesics cohort had an almost 5 times higher incidence of AEs (overall risk difference of 13%). This incidence increased significantly with increasing analgesic dose. Nine respondents reported temporary hospital admittance: three for temporary kidney failure (post-ibuprofen ingestion), four with bleeds (post-aspirin ingestion) and two cardiac infarctions (post-aspirin ingestion). None of the control reported hospital admittance.

Conclusions The use of analgesics before participating in endurance sports may cause many potentially serious, unwanted AEs that increase with increasing analgesic dose. Analgesic use before endurance sports appears to pose an unrecognised medical problem as yet. If verifiable in other endurance sports, it requires the attention of physicians and regulatory authorities.

See: Painkillers Taken Before Marathons Linked to Potentially Serious Side Effects

A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness

April 17, 2013 Comments off

A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness
Source: New England Journal of Medicine

Background
Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness.

Methods
We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months.

Results
Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was −3.2 kg (−7.0 lb, P=0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P=0.009). There were no significant between-group differences in adverse events.

Conclusions
A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials.gov number, NCT00902694.)

Strategies To Prevent Weight Gain Among Adults

March 28, 2013 Comments off

Strategies To Prevent Weight Gain Among Adults (PDF)

Source: Agency for Healthcare Research and Quality

Objectives.

Adults tend to gain weight progressively through middle age. Although the average weight gain is 0.5 to 1 kg per year, this modest accumulation of weight can lead to obesity over time. We aimed to compare the effectiveness, safety, and impact on quality of life of strategies to prevent weight gain among adults. Self-management, dietary, physical activity, orlistat and combinations of these strategies were considered.

Data sources.

We searched MEDLINE ® , Embase ® , theCochrane Central Register of Controlled Trials, CINAHL® , and PsycINFO® through June 2012 for published articles that were potentially eligible for this review.

Review methods.

Two reviewers independently reviewed titles, abstracts, and articles, and included English-language articles that reported on maintenance of weight or prevention of weight gain among adults. Studies targeting a combination of weight loss with weight maintenance or weight loss exclusively were considered to be outside of the scope of this review. Trials of interventions and observational studies of approaches with at least 1 year of followup with a weight outcome were included. Data were abstracted on measures of weight, adherence, obesity-related outcomes, safety, and quality of life. The timepoints of interest for weight outcomes were: 1 year, 2 years, 5 years, and the last reported timepoint after 5 years. For the other outcomes, we abstracted data only from the last reported timepoint on or after 1 year. We selected a meaningful difference threshold in addition to a statistically significant threshold (p<0.05) for the outcomes. A meaningful between group difference was defined as 0.5 kg of weight, 0.2 units of BMI (based on a 0.5-kg change for an individual with a BMI of 27), or 1 cm of waist circumference per year of followup. We considered an intervention or approach effective if the difference between groups met the meaningful between group difference threshold and was statistically significant. We qualitatively synthesized the studies by population, intervention, and outcome.

Results.

We included 58 publications (describing 51 studies) involving 555,783 patients. Two interventions may be effective compared with no intervention at preventing weight gain with moderate strengths of evidence: workplace interventions having individual and environmental components and exercise performed at home by women with cancer. Potentially effective interventions with low strength of evidence include a clinic-based program to teach heart rate monitoring, a combination intervention for mothers of young children, small group sessions to educate college women, and physical activity among individuals at risk of cardiovascular disease and diabetes. Potentially effective approaches described in observational studies having low strength of evidence include eating meals prepared at home among college graduates and less television viewing among individuals with colorectal cancer. When reported, adherence to interventions tended to be below 80 percent. There were no adverse events among the few trials that reported on adverse events. Trial study quality tended to be poor due to knowledge of the intervention by the study personnel who measured the weight of the participants or lack of reporting on this item. This lack of blinding of the outcome assessor along with inclusion of studies that were not designed to prevent weight gain resulted in a low strength of evidence for the majority of comparisons.

Conclusions.

The literature provides some, although limited, evidence about interventions and approaches that may prevent weight gain. Although there is not strong evidence to promote a particular weight gain prevention strategy, there is no evidence that not adopting a strategy to prevent weight gain is preferable.

State Variations of Chronic Disease Risk Factors in Older Americans

December 28, 2012 Comments off

State Variations of Chronic Disease Risk Factors in Older Americans

Source: Preventing Chronic Disease

Abstract

The objective of this study was to examine and compare 3 key health behaviors associated with chronic disease (ie, risky drinking, smoking, and sedentary lifestyle). We used data from the National Health Interview Survey from 1997 through 2010 to calculate the prevalence of these behaviors among older Americans and rank each state, and we analyzed overall trends in prevalence for each behavior over the 14 years. Older adults residing in Arkansas and Montana had the worst chronic disease risk profile compared with other states. These findings indicate the need for improved or increased targeted interventions in these states.

Objective

Risky drinking, smoking, and sedentary lifestyle are key health behaviors associated with chronic disease and increased illness and death in older adults (1). Excessive drinking is associated with cancers of the liver, head and neck, colorectum, pancreas, and breast, as well as cardiovascular disease and diabetes (2). Smoking is associated with cancer and poor cardiovascular outcomes (1). Cardiovascular disease and cancer risk are increased by sedentary behavior (1). The objective of this study was to examine the prevalence and trends of these 3 health behaviors among older Americans and rank them at the state level to determine the best allocation of public health resources.

Methods

Data were obtained from the National Health Interview Survey (NHIS), an annual, cross-sectional, multistage probability household survey of the noninstitutionalized civilian US population, from 1997 through 2010. Eligibility criteria were adults aged 65 or older (N = 79,973; representing 34,632,575 people). NHIS questions regarding the 3 variables are available online (3). Smoker was defined as “current smoker” (4). Risky drinking was defined as current drinkers having 10 or more drinks per week in men and 7 or more drinks per week in women, or having 5 or more drinks on 1 occasion, 1 or more times per year for men and women (4). Physical activity level was defined as compliance with the Healthy People 2010 goal of moderate physical activity for at least 30 minutes per day on 5 or more days per week or vigorous physical activity for at least 20 minutes per day on 3 or more days per week (5).

NHIS data were pooled and analyses were conducted using SAS version 9.2 (SAS Institute Inc, Cary, North Carolina), adjusting for sample weights and design effects (3). We calculated prevalence, standard errors (SEs), and 95% confidence intervals (CIs) and ranked states according to the prevalence of each risk factor indicator. We analyzed trends by using weighted linear regression of prevalence on year. Weight was generated with the inverse of the variance of prevalence. Some states were missing values because they did not meet the criteria for stable estimate analysis in all study years (6).

Because state-level data are not released to the public, all analyses were performed remotely at the National Center for Health Statistics Research Data Center. The study was approved by the University of Miami’s institutional review board.

Results

The prevalence of smoking among US adults aged 65 years or older was 9.6% (Table 1). States with the highest smoking prevalence were Nevada (17.9%) and Kentucky (15.0%). States with the lowest rates of smoking were Utah (5.4%) and South Dakota (6.2%). Overall, 22% of older Americans reported risky drinking patterns; Arizona and New Hampshire had the highest prevalence, both at 29.0%, and the lowest prevalences were found in Kansas (14.4%) and Oklahoma (16.4%) (Table 2). Twenty-two percent of older Americans reported meeting physical activity recommendations; the highest prevalence was reported in Colorado (30.8%), Hawaii (34.8%), and Maine (40.1%), and the lowest prevalence was reported in Louisiana (13.4%), Mississippi (13.4%), and South Dakota (14.6%) (Table 3). Older Americans residing in Arkansas and Montana were in the top 10 worst rankings for all 3 behaviors.

A downward trend in smoking was observed during the 14 years for California (slope, −0.32; SE, 0.09; P = .004) and South Carolina (slope, −0.54; SE, 0.21; P = .046), and an increased trend for risky drinking was observed in Massachusetts (slope, 1.07; SE, 0.39; P = .026). In North Carolina (slope, 0.82; SE, 0.25; P = .007) and Texas (slope, 0.57; SE, 0.16; P = .004), an upward trend in exercise compliance was observed. Trend analysis was not conducted for 7 states and the District of Columbia due to insufficient sample sizes.

Discussion

The average age of Americans is expected to increase substantially in the coming years (7). Modifying key health behaviors and creating cost-effective interventions may contribute to decreasing illness and death in this growing population demographic (8).

Lifestyle changes that occur with aging can affect chronic disease risk. Older adults who exercise regularly have a reduced mortality risk (9), but those who drink alcohol excessively are more prone to oxidative stress, which further increases the incidence of chronic disease (10). A twofold higher mortality rate was shown for older male smokers than nonsmokers (11). Risky drinking with aging has been positively associated with vigorous physical activity and negatively associated with current smoking, possibly reflecting better health among adults who engage in risky drinking as they age (12). Nevertheless, excessive alcohol consumption is associated with risk of falls (1) and adverse medication interactions in older Americans (10).

Limitations of this study included an inability to use estimates from all states due to small sample sizes or unstable estimates in some states (ie, a relative SE of ≥30%). We were unable to conduct complete trend analyses for all states given sample size limitations. The strength of this study was the access to a large set of sample data at the state level for prevalence comparisons in older Americans.

Public health resources should focus on specific interventions to affect behaviors in states with residents at high risk for developing chronic disease. These resources can include a purposeful combination of the following: 1) increasing tobacco excise taxes, proven to be the most effective means to decrease smoking (1), 2) using online and telephone substance abuse treatment facility locators and media campaigns to disseminate information on alcohol abuse (1), and 3) enhancing access to recreational and physical activity facilities in communities specific to older Americans, pursuant to the Healthy People 2010 guidelines (5). Emphasis on geographic aggregation of risk factors should be considered so that integrated and tailored prevention activities can be developed and customized to each state’s profile and funds be made appropriately available. States with the highest prevalence of 2 or 3 risky behaviors should review resource allocation to promote health more effectively.

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