A multi-level approach to reduce exploding type 2 diabetes in Pakistan

Pakistan has the third-highest rate of type 2 diabetes globally, following China and India, making this a significant public health crisis. Despite the severity of the issue, efforts from health and policy practitioners to address it remain limited. With millions already diagnosed as pre-diabetic, the rising incidence of diabetes is rapidly becoming a public health emergency that demands immediate attention. This policy brief provides an accessible overview of diabetes, focusing on its types, mechanisms, and preventive measures. It also identifies key contributing factors, such as dietary habits, obesity, physical inactivity, and the influence of modern dietary trends, while proposing strategies for individuals, communities, and policymakers to combat this growing epidemic in Pakistan. The brief emphasizes the need for a multi-level approach that includes public awareness, education, behavioral and dietary changes, and policy interventions to reverse the trend. Strategies discussed include promoting healthy eating, increasing physical activity, managing obesity, and enhancing access to affordable, healthy food. Additionally, the brief highlights the importance of community and government support, such as public health campaigns, infrastructure improvements, and legislative efforts. By adopting this comprehensive approach, Pakistan can take meaningful steps to address the diabetes epidemic and improve public health outcomes.

Virtual reality assessment of walking in a modifiable urban environment: a feasibility and acceptability study

Physical activity is known to be one of the most health-beneficial behaviors, and salutogenic design modifications to the built environment can facilitate increased physical activity. Unfortunately, it is not often clear in advance which environmental and urban design implementations will generate increases in activities such as walking, and which will have little impact or even reduce walking. The present study tested the feasibility and acceptability of a virtual reality (VR) model for pre-testing urban designs for their impact on walking. Using a wearable VR head-mounted display/computer, young adults (n = 40) walked freely through a large indoor gymnasium, simultaneously walking through a virtual model of an urban streetscape that was designed to be modifiable and allow for testing impacts on walking of various changes to the urban environment. The majority of participants found the experience to be acceptable: pleasant and nonaversive, and they walked freely through the VR model for approximately 20 min, on average. Using modifiable VR models to pre-test built-environment changes for their impacts on walking behavior appears to be a feasible and acceptable approach and worthy of continued research investigation.

Veterinary-Prescribed Physical Activity: Feasibility and Acceptability among Veterinary Staff and Dog Owners

Physical inactivity remains a global epidemic leading to an estimated 5 million preventable deaths per year. Although there exist numerous public-health campaigns aimed at increasing physical activity (PA), a potentially fruitful but underexplored avenue to promote both human and animal health is veterinary-prescribed PA programs. The aim of this study was to determine the feasibility and acceptability of incorporating veterinary-prescribed PA programming into a diverse array of clinic settings. Participants (n = 722 veterinary-clinic staff (VS); n = 1028 dog owners (DOs)) completed an online survey assessing: (a) the perceived importance of PA for promoting health and preventing disease, (b) willingness to participate in a veterinary-prescribed PA program, and (c) potential benefits and barriers of such a program. Both groups of participants indicated that PA is important for both human and animal health (97% and 98% of VS and 92% and 93% of DOs said PA is very or extremely important for animal and human health, respectively). Additionally, most participants in both groups expressed an interest in participating in a veterinary-prescribed PA program in the future, with only 11% of DOs and 10% of VS saying they were not interested. Benefits and barriers of this type of intervention for both practitioners and patients were also identified. Incorporating veterinary-prescribed PA programming into veterinary clinics seems to be acceptable to both DOs and VS. Additionally, many VS believe such programming would be feasible at their clinics; thus, pursuing such programs appears to be a promising avenue for promoting human and animal health.

Increasing physical activity by four legs rather than two: systematic review of dog-facilitated physical activity interventions

OBJECTIVES

Regular walking is a critical target of physical activity (PA) promotion, and dog walking is a feasible PA intervention for a large segment of the population. The purpose of this paper was to review PA interventions that have involved canine interactions and to evaluate their effectiveness. A secondary aim of this review was to highlight the populations, settings, designs and intervention components that have been applied so as to inform future research.

DESIGN

Systematic review.

DATA SOURCES

We carried out literature searches to August 2019 using six common databases.

ELIGIBILITY CRITERIA

Studies included published papers in peer-reviewed journals and grey literature (theses and dissertations) in the English language that included any PA behaviour change design (ie, randomised controlled trial, quasi-experimental) that focused on canine-related intervention. We grouped findings by population, setting, medium, research design and quality, theory and behaviour change techniques applied.

RESULTS

The initial search yielded 25 010 publications which were reduced to 13 independent studies of medium and high risks of bias after screening for eligibility criteria. The approaches to intervene on PA were varied and included loaner dogs, new dog owners and the promotion of walking among established dog owners. Findings were consistent in showing that canine-assisted interventions do increase PA (82% of the studies had changes favouring the canine-facilitated intervention). Exploratory subanalyses showed that specific study characteristics and methods may have moderated the effects. Compared with studies with longer follow-up periods, studies with shorter follow-up favoured behaviour changes of the canine intervention over the control condition.

CONCLUSION

Canine-based PA interventions appear effective, but future research should move beyond feasibility and proof of concept studies to increase rigour, quality and generalisability of findings.

Built environment and cardio-metabolic health: systematic review and meta-analysis of longitudinal studies

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.

Cardiorespiratory, enzymatic and hormonal responses during and after walking while fasting

The aim of the present study was to observe whether performing a low intensity endurance exercise following an overnight fasted (FAST) or fed (FED) condition promotes different cardiorespiratory, enzymatic and hormonal responses. Nine male physical active subjects, (age 21.89 ± 2.52 years old, height 175.89 ± 5.16 cm, weight 72.10 ± 4.31 kg, estimated body fat 7.25 ± 2.11%), randomly performed two sessions of 45 minutes' low intensity exercise (individual ventilator threshold) interspersed by seven days, differentiated only in whether they were provided with a standardized meal or not. The oxygen consumption (VO2) and heart rate (HR) were measured continuously at the 30-min rest, the 45-min during and the 30-min post-exercise. The testosterone (T) and cortisol (C) hormones were measured at rest, immediately post-exercise and 15-min post-exercise. The Glucose (GLU), Free fatty acids (FFA) and enzyme lipase activity (ELP) were measured at rest, 15-min and 30-min exercise, immediately, 15-min and 30-min post-exercise. Significantly lower values were observed in FED compared to FAST with: C (nmol/L) from pre (428.87 ± 120.41; 454.62 ± 148.33, respectively) to immediately post-exercise (285.10 ± 85.86; 465.66 ± 137.70, respectively) and 15-min post-exercise (248.00 ± 87.88; 454.31 ± 112.72, respectively) (p<0.05); and GLU at all times, with an exception at 15-min post-exercise. The testosterone/cortisol ratio (T/C) was significantly higher in the FED compared with FAST from pre (0.05 ± 0.02, 0.05 ± 0.01, respectively) to 15-min post-exercise (0.08 ± 0.03, 0.05 ± 0.02, respectively). No other significant differences were observed between conditions. We conclude that fasting prior to low intensity endurance exercise does not seem be advantageous, when it comes to fat loss, compared with the same exercise performed after a meal.

The mysterious case of the public health guideline that is (almost) entirely ignored: call for a research agenda on the causes of the extreme avoidance of physical activity in obesity

Physical activity and exercise guidelines for weight management call for at least 60 min of daily activity. However, these documents fail to acknowledge that almost no obese adults meet this target and that non-adherence and dropout are even higher among obese individuals than the general population. The reasons for this level of activity avoidance among obese individuals remain poorly understood, and there are no evidence-based methods for addressing the problem. Opinions among exercise scientists are polarized. Some advocate moderate intensity and long duration, whereas others call for high intensity and shorter duration. The latter approach attributes the inactivity and high dropout to limited discretionary time and the slow accrual of visible benefits. However, higher intensity has been associated with non-adherence and dropout, whereas longer duration has not. A conceptual model is then proposed, according to which obesity interacts with intensity, causing physical activity and exercise to be associated with reduced pleasure among obese individuals. We theorize that, in turn, repeated experiences of reduced pleasure lead to avoidance. On this basis, we call for a research agenda aimed at identifying the causes of activity-associated and exercise-associated displeasure in obesity and, by extension, the causes of the extreme physical inactivity among obese individuals.

Effect of aerobic exercise on risk factors of cardiovascular disease and the apolipoprotein B / apolipoprotein a-1 ratio in obese woman

[Purpose] The objective of this study was to confirm whether consistent aerobic exercise has an effect on the apolipoprotein B/apolipoprotein A-1 ratio or reduces the risk of cardiovascular disease in obese women. [Subjects and Methods] The participants included 32 obese women between the ages of 40 and 49. Subjects were randomly divided into two groups (n = 16 in each group): the control group and the exercise group. The exercise program in this study corresponded to an intensity of 50 to 60% of the maximum volume of minute oxygen consumption and was performed three times per week over 12 weeks. Physical measurements, measurement of cardiorespiratory fitness and blood pressure, and blood collection were done before and after the 12 weeks of exercise at the same time and under the same conditions. [Results] Based on the results of this study, there were significant interaction effects in both time and group weight, for body mass index, percent body fat, maximum volume of minute oxygen consumption, high-density lipoprotein cholesterol, and the apolipoprotein B/apolipoprotein A-1 ratio. Moreover, waist circumference, total cholesterol, and the atherogenic index decreased significantly after 12 weeks of aerobic exercise. [Conclusion] Regular aerobic exercise effectively improved cardiovascular risk factors and decreased the obesity index in obese women.

Estimativa do equivalente metabólico (MET) de um protocolo de exercícios físicos baseada na calorimetria indireta

OBJETIVO: O objetivo do estudo foi determinar o gasto energético (GE) em termos de gasto calórico e equivalente metabólico (MET) de duas sessões de um protocolo de exercício. MÉTODOS: Quinze indivíduos adultos (51,0 ± 5,5 anos) realizaram as sessões de exercício (80min), compostas por (aquecimento, caminhada e flexibilidade; Sessão A) e (aquecimento, caminhada e resistência muscular local; Sessão B). A frequência cardíaca (FC) foi medida durante cada parte da sessão. Em laboratório, foram medidos, em dias diferentes, o consumo máximo de oxigênio (VO2max), durante repouso e exercício (usando a FC média obtida nas aulas), por calorimetria indireta. O MET dos exercícios foi obtido dividindo VO2 em exercício (mL.kg-¹. min-¹) pelo VO2 em repouso (mL.kg-¹.min-¹). O GE dos exercícios foi calculado por: MET x Peso (kg) x Tempo (min)/60. RESULTADOS: Os resultados foram analisados por ANOVA com teste post hoc de Tukey (p < 0,05). Resultados: Um MET para este grupo foi de 2,7 ± 0.1mL.kg ¹. min-¹. O valor médio de MET nos exercícios foi de 4,7 ± 0,8 (aquecimento), 5,8 ± 0,9 (caminhada) e 3,6 ± 0,7 (flexibilidade) na sessão A, e 4,6 ± 1,2 (aquecimento), 5,6 ± 1,0 (caminhada) e 4,8 ± 1,0 (resistência muscular localizada) na sessão B. O custo de energia foi similar entre as sessões (A: 398 ± 86,7 kcal e B: 404 ± 45 kcal; p > 0,05). Nenhuma atividade foi classificada como vigorosa (> 7 METs). Não houve diferença no VO2 entre caminhada (15,6 ± 2,8 ou 15,4 ± 2,6 mL.kg-¹.min-¹) e resistência muscular localizada (13,2 ± 2,9 mL.kg-¹.min-¹) embora ambos tenham sido superiores (p > 0,05) aos exercícios de flexibilidade (10,1 ± 2,2 mL.kg-¹. min-¹). CONCLUSÃO: O protocolo proposto atinge a atividade física necessária para adultos saudáveis, para melhorar e manter a saúde, por sua estrutura, intensidade moderada, duração, frequência e gasto calórico.

Physical activity in obesity and metabolic syndrome

Biological aging is typically associated with a progressive increase in body fat mass and a loss of lean body mass. Owing to the metabolic consequences of reduced muscle mass, it is understood that normal aging and/or decreased physical activity may lead to a higher prevalence of metabolic disorders. Lifestyle modification, specifically changes in diet, physical activity, and exercise, is considered the cornerstone of obesity management. However, for most overweight people it is difficult to lose weight permanently through diet or exercise. Thus, prevention of weight gain is thought to be more effective than weight loss in reducing obesity rates. A key question is whether physical activity can extenuate age-related weight gain and promote metabolic health in adults. Current guidelines suggest that adults should accumulate about 60 minutes of moderate-intensity physical activity daily to prevent unhealthy weight gain. Because evidence suggests that resistance training may promote a negative energy balance and may change body fat distribution, it is possible that an increase in muscle mass after resistance training may be a key mediator leading to better metabolic control.

The Worksite Heart Health Improvement Project (WHHIP): feasibility and efficacy

OBJECTIVE

Test the feasibility and efficacy of the Worksite Heart Health Improvement Project (WHHIP).

DESIGN

The WHHIP was a quasi-experimental 6-month pilot performed in 2 long-term care facilities.

SAMPLE

Thirty-nine female minority nursing assistants participated in this study with a mean age of 42.39 (SD = 12.79) years.

MEASUREMENTS

Measures were collected at baseline, 3, and 6 months and included blood pressure, lipid panel, body mass index, physical activity levels, diet behaviors, depressive symptoms, and self-efficacy outcomes.

INTERVENTION

The 3-month WHHIP intervention included 3 components: environmental and policy assessment; education; and on-going motivation. The control site received education only.

RESULTS

Subject participation averaged 47% and 58% in exercise and diet related activities, respectively. Generalized estimating equations showed the treatment group showed significant improvements in depressive symptoms (p = .012), systolic blood pressure (p = .028), total cholesterol (p = .002) and triglycerides (p = .011) over time. The treatment group also showed trends for improvement in diet behaviors (p = .069) and diastolic blood pressure (p = .073).

CONCLUSIONS

This study provided feasibility evidence for the WHHIP and preliminary evidence that the WHHIP can improve heart healthy behaviors and subsequent outcomes among nursing assistants in long-term care settings.

The Association between Objectively Measured Neighborhood Features and Walking in Middle-Aged Adults

Purpose.

Explore the role of the neighborhood environment in supporting walking.

Design.

Cross-sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate).

Setting.

Brisbane City Local Government Area, Australia, 2007.

Subjects.

Brisbane residents aged 40 to 65 years.

Measures.

Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and streetlights within a 1-km circular buffer from each resident's home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes walked in the previous week: <30 minutes, ≥30 to <90 minutes, ≥90 to <150 minutes, ≥150 to <300 minutes, and ≥300 minutes.

Analysis.

The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression, and the model parameters were estimated using Markov chain Monte Carlo simulation.

Results.

After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (odds ratio [OR] = 1.93; 99% confidence intervals [CI], 1.32–2.80), greatest residential density (OR = 1.47; 99% CI, 1.02–2.12), least tree coverage (OR = 1.69; 99% CI, 1.13–2.51), most bikeways (OR = 1.60; 99% CI, 1.16–2.21), and most streetlights (OR = 1.50; 99% CI, 1.07–2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR = 2.06; 99% CI, 1.41–3.02).

Conclusion.

The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more streetlights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease. (Am J Health Promot 2011;25[4]:e12–e21.)

PSYCHOSOCIAL CORRELATES OF BODY MASS INDEX IN FOUR GROUPS OF QUEBEC ADULTS

The objective of the present analysis was to study the associations between body weight psychosocial correlates and body mass index (BMI) among four groups of adults in the Quebec population. Data were taken from the Social Lifestyles and Health 1998 Survey performed by the Institut de la Statistique du Québec (ISQ). The suggested guidelines of the ISQ were used to estimate the population's proportions and for statistical analysis. The groups studied were 25- to 44- and the 45- to 64-year-old men and women. In all groups, currently trying to lose weight increased the odds of reporting an excess weight. Better perceived eating habits was associated with lower BMI in most groups except in the 25- to 44-year-old women, where the trend was not significant. Higher number of physical activities related to transport and cigarette smoking were associated with lower BMI in both men groups. In both women groups, more frequent consumption of alcoholic beverages decreased significantly the odds of reporting excess body weight. A university degree was associated with a lower BMI only in the 25- to 44-year-old men. Regular practise of leisure time physical activity was associated with a lower BMI only in 45- to 64-year-old women. Opposite associations were observed between perceived health and BMI. In the 45- to 64-year-old men, better perceived health increased the odds of reporting an excess weight. Conversely, the odds of reporting excess weight decreased with better health in 25- to 44-year-old women. Many correlates differ between age group and sex. The identification of these factors illustrates the need to adapt obesity-related programmes toward specific sub-groups within the general population.

Fat loss depends on energy deficit only, independently of the method for weight loss

BACKGROUND

This study was designed to compare the effects of 2 different but isocaloric fat reduction programs with the same amount of energy deficit - diet alone or diet combined with aerobic training - on body composition, lipid profile and cardiorespiratory fitness in non- or moderately obese women.

METHODS

Twenty non- or moderately obese (BMI 24.32 +/- 3.11) females (27.3 +/- 6.6 years) were tested at the beginning and after an 8-week period of a mild hypocaloric diet for the following parameters: (1) body mass and body fat; (2) total cholesterol, HDL-C, LDL-C and triglycerides; (3) lactate (millimol/liter) during submaximal exertion (100 W); (4) heart rate during submaximal exertion (100 W), and (5) maximum exercise performance (watt). Subjects were randomly divided into either a diet alone (D, -2,095 +/- 659 kJ/day) or a diet (-1,420 +/- 1,084 kJ/day) plus exercise (DE, three 60-min sessions per week at 60% of VO(2)max or -5,866 kJ/week) group.

RESULTS

Body mass and body fat decreased significantly in D (-1.95 +/- 1.13 kg or -1.47 +/- 0.87%; p < 0.05) and DE (-2.23 +/- 1.28 kg or -1.59 +/- 0.87%; p < 0.05), but there was no significant difference observed between the groups. Statistical analysis revealed no significant changes of total cholesterol, HDL-C, LDL-C, triglycerides and heart rate during submaximal exertion (100 W). Lactic acid accumulation during submaximal exertion (100 W) decreased significantly (-0.8 +/- 1.4 mmol/l, p < 0.05) in DE and increased significantly (+0.4 +/- 0.5 mmol/l, p < 0.05) in D. Maximum exercise performance improved significantly (+12.2 +/- 8.8 W, p < 0.05) in DE and did not change significantly in D.

CONCLUSIONS

This study showed that independently of the method for weight loss, the negative energy balance alone is responsible for weight reduction.