1
|
Jhamb M, Devaraj SM, Alemairi M, Lavenburg LM, Shiva S, Yabes JG, Forman DE, Hergenroeder AL. A Comprehensive Exercise (COMEX) Intervention to Optimize Exercise Participation for Improving Patient-Centered Outcomes and Physical Functioning in Patients Receiving Hemodialysis: Development and Pilot Testing. Kidney Med 2023; 5:100720. [PMID: 37928754 PMCID: PMC10623365 DOI: 10.1016/j.xkme.2023.100720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Rationale & Objective To address the need for an intradialytic exercise program that is easily delivered in clinical setting, engaging and scalable, we developed a novel COMprehensive EXercise (COMEX) program based on input from patients receiving hemodialysis (HD), dialysis staff members and nephrologists. The objective of this study was to determine the feasibility, safety, and acceptance of COMEX during HD. Study Design Single-arm prospective pilot feasibility study. Setting & Participants Seventeen patients receiving in-center HD. Intervention Three-month participation in the COMEX program, which included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Outcomes Data on recruitment, adherence, safety and acceptability were collected. Additional assessments were performed to evaluate changes in physical functioning, patient-reported symptoms, and objectively measured sleep and physical activity. We also examined the feasibility of obtaining skeletal muscle biopsies and blood samples to explore molecular mechanisms of muscle atrophy and to assess platelet mitochondrial function and adaptation to exercise during HD. Results Thirteen of the 17 (76%) participants completed the 3-month intervention. The mean participant age was 63.6 ± 15.1 years. In total, 46% of participants were males, and 55% were White. The mean body mass index was 38.7 ± 11.6 kg/m2. There were no reported adverse effects, and the adherence rate to exercise sessions was high with 88% of the sessions completed. Patient satisfaction was high, as 100% of the patients would recommend the program to other dialysis patients. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Limitations Small sample size, lack of an onsite exercise professional, and technological issues with telemedicine behavioral motivation. Conclusions The COMEX intradialytic exercise intervention is safe and acceptable to patients, and outcome measures were feasible to obtain. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol. Funding Source This work is supported by pilot award from P30 DK079307 (PI, Jhamb). Trial Registration ClinicalTrials.gov, NCT03055299. Plain-Language Summary We tested a new COMprehensive EXercise (COMEX) program to deliver exercise during dialysis. This 3-month program included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Our study shows COMEX was feasible, had high satisfaction and adherence, and was safe. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol.
Collapse
Affiliation(s)
- Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Susan M. Devaraj
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Maryam Alemairi
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Kuwait University, Kuwait City, Kuwait
| | - Linda-Marie Lavenburg
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Sruti Shiva
- Vascular Medicine Institute, Department of Medicine and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan G. Yabes
- Center for Research on Health Care Data Center, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Daniel E. Forman
- Department of Medicine (Divisions of Geriatrics and Cardiology), University of Pittsburgh, and Pittsburgh Geriatrics, Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | |
Collapse
|
2
|
Hergenroeder AL, Willey B, Vendetti M, Dabbs AD. Exercise Progression Protocol for Lung Transplant GO: A Multicomponent Telerehab Exercise Intervention for Patients After Lung Transplantation. Cardiopulm Phys Ther J 2023; 34:2-12. [PMID: 36644217 PMCID: PMC9838685 DOI: 10.1097/cpt.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lung transplantation is one of the fastest growing solid organ transplant procedures in the United States. After transplantation, lung function typically returns to near normal levels; however, reduced physical function and an inactive lifestyle compromise this benefit. To promote rehabilitation goals, lung transplant recipients (LTRs) are advised to participate in pulmonary rehab, but participation is low due to barriers related to scheduling, travel requirements, lack of insurance coverage, and the concern about exposure to infection. Telerehabilitation offers a flexible alternative with the potential to promote self-management of exercise in LTRs. The purpose of this report was to describe the exercise progression protocol for the Lung Transplant GO multicomponent telerehab exercise intervention for patients after lung transplantation. The progression protocol is an evidence-informed exercise protocol designed to improve physical function and physical activity in LTRs safely and effectively in a remote environment. The protocol standardizes the prescription of exercise while permitting adaptation of the program to meet the needs of the individual. Using this model, the decisions about program progression are systematic, transparent, and replicable to other LTRs.
Collapse
|
3
|
Barone Gibbs B, Sternfeld B, Whitaker KM, Brach JS, Hergenroeder AL, Jacobs DR, Reis JP, Sidney S, White D, Pettee Gabriel K. Bidirectional associations of accelerometer-derived physical activity and stationary behavior with self-reported mental and physical health during midlife. Int J Behav Nutr Phys Act 2021; 18:74. [PMID: 34090471 PMCID: PMC8180096 DOI: 10.1186/s12966-021-01145-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background Moderate-to-vigorous intensity physical activity (MVPA) is associated with favorable self-rated mental and physical health. Conversely, poor self-rated health in these domains could precede unfavorable shifts in activity. We evaluated bidirectional associations of accelerometer-estimated time spent in stationary behavior (SB), light intensity physical activity (LPA), and MVPA with self-rated health over 10 years in in the CARDIA longitudinal cohort study. Methods Participants (n = 894, age: 45.1 ± 3.5; 63% female; 38% black) with valid accelerometry wear and self-rated health at baseline (2005–6) and 10-year follow-up (2015–6) were included. Accelerometry data were harmonized between exams and measured mean total activity and duration (min/day) in SB, LPA, and MVPA; duration (min/day) in long-bout and short-bout SB (≥30 min vs. < 30 min) and MVPA (≥10 min vs. < 10 min) were also quantified. The Short-Form 12 Questionnaire measured both a mental component score (MCS) and physical component score (PCS) of self-rated health (points). Multivariable linear regression associated baseline accelerometry variables with 10-year changes in MCS and PCS. Similar models associated baseline MCS and PCS with 10-year changes in accelerometry measures. Results Over 10-years, average (SD) MCS increased 1.05 (9.07) points, PCS decreased by 1.54 (7.30) points, and activity shifted toward greater SB and less mean total activity, LPA, and MVPA (all p < 0.001). Only baseline short-bout MVPA was associated with greater 10-year increases in MCS (+ 0.92 points, p = 0.021), while baseline mean total activity, MVPA, and long-bout MVPA were associated with greater 10-year changes in PCS (+ 0.53 to + 1.47 points, all p < 0.005). In the reverse direction, higher baseline MCS and PCS were associated with favorable 10-year changes in mean total activity (+ 9.75 cpm, p = 0.040, and + 15.66 cpm, p < 0.001, respectively) and other accelerometry measures; for example, higher baseline MCS was associated with − 13.57 min/day of long-bout SB (p < 0.001) and higher baseline PCS was associated with + 2.83 min/day of MVPA (p < 0.001) in fully adjusted models. Conclusions The presence of bidirectional associations between SB and activity with self-rated health suggests that individuals with low overall activity levels and poor self-rated health are at high risk for further declines and supports intervention programming that aims to dually increase activity levels and improve self-rated health. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01145-4.
Collapse
Affiliation(s)
- Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Room 220, Pittsburgh, PA, 15216, USA.
| | | | | | - Jennifer S Brach
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Room 220, Pittsburgh, PA, 15216, USA
| | - Andrea L Hergenroeder
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Room 220, Pittsburgh, PA, 15216, USA
| | | | - Jared P Reis
- National Heart Lung and Blood Institute, Bethesda, USA
| | | | | | | |
Collapse
|
4
|
Moon SJE, Dabbs AD, Hergenroeder AL, Vendetti ML, Jones KB, Willey BM, Morrell MR, Imes CC. Considerations for assessing physical function and physical activity in clinical trials during the COVID-19 pandemic. Contemp Clin Trials 2021; 105:106407. [PMID: 33887443 PMCID: PMC8055496 DOI: 10.1016/j.cct.2021.106407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 01/12/2023]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has changed the conduct of clinical trials. For studies with physical function and physical activity outcomes that require in-person participation, thoughtful approaches in transitioning to the remote research environment are critical. Here, we share our experiences in transitioning from in-person to remote assessments of physical function and activity during the pandemic and highlight key considerations for success. Details on the development of the remote assessment protocol, integration of a two-way video platform, and implementation of remote assessments are addressed. In particular, procedural challenges and considerations in transitioning and conducting remote assessments will be discussed in terms of efforts to maintain participant safety, maximize study efficiency, and sustain trial integrity. Plans for triangulation and analysis are also discussed. Although the role of telehealth platforms and research activities in remote settings are still growing, our experiences suggest that adopting remote assessment strategies are useful and convenient in assessing study outcomes during, and possibly even beyond, the current pandemic. Trial register and number: ClinicalTrials.gov [NCT03728257].
Collapse
Affiliation(s)
- Seol Ju E Moon
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States.
| | | | - Andrea L Hergenroeder
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Melissa L Vendetti
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kristen B Jones
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bryan M Willey
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthew R Morrell
- Pulmonary Transplant Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Imes
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
5
|
Abstract
BACKGROUND Breaking up sedentary behavior with standing or walking can decrease discomfort, fatigue, and sleepiness. However, less is known about acceptability and impact of resistance exercise breaks on these outcomes. Therefore, we evaluated the acceptability of resistance exercise breaks and their influence on discomfort, physical and mental fatigue, and sleepiness during occupational sitting. METHODS Workers completed two 4-hour conditions in random order: prolonged sitting (SIT) and sitting with hourly resistance exercise breaks (REX). All outcomes were measured at baseline and every hour thereafter with five total breaks. Linear mixed models evaluated overall condition effects and differences at each hour. Cohen's d estimated magnitudes of effect. Acceptability was assessed via questionnaire after the REX condition and reported as percentages. FINDINGS Fourteen adults (age: 53.4 ± 9.5 years, body mass index [BMI]: 30.9 ± 4.8 kg/m2) were enrolled. Although ratings of discomfort, fatigue, and sleepiness were typically lower during REX as compared with SIT, overall outcomes were not significantly different between conditions (p > .05). However, a significant reduction in mental fatigue at hour 4 in favor of the REX condition (β = -0.48 log-points, p < .05, d = 0.37) was observed. Program acceptability questions revealed the majority (>50%) of participants reported a "4" or "5" on a 5-point Likert-type scale for all questions, indicating high acceptability for implementation. CONCLUSIONS/APPLICATION TO PRACTICE Resistance exercise breaks had high acceptability and provided preliminary evidence of improving ratings of mental fatigue. More research is needed to better understand the role of resistance training to reduce sedentary behavior.
Collapse
|
6
|
Kotlarczyk MP, Hergenroeder AL, Gibbs BB, Cameron FDA, Hamm ME, Brach JS. Personal and Environmental Contributors to Sedentary Behavior of Older Adults in Independent and Assisted Living Facilities. Int J Environ Res Public Health 2020; 17:ijerph17176415. [PMID: 32899196 PMCID: PMC7504320 DOI: 10.3390/ijerph17176415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
Sedentary behavior is associated with negative health outcomes and unhealthy aging. Older adults are the most sedentary age group, and decreasing sitting time represents an intervention target for improving health. Determinants of sedentary behavior have been examined in older adults living in their own homes, yet less is known about sedentary behavior of older adults in residential care facilities. The purpose of this study was to explore factors contributing to sedentary behavior among residents of independent and assisted living facilities. We conducted eight focus groups with residents (n = 44) and semi-structured interviews with staff (n = 6) across four living facilities. Audio recordings were transcribed and analyzed using an iterative, inductive approach. Three salient themes were identified. Residents and staff both viewed sedentary behavior negatively unless it was in the context of social engagement. Additionally, fear of falling was discussed as a significant contributor to sedentary behavior. Finally, residents felt the community living environment contributed to their sedentary behavior while staff did not. Our findings provide valuable insight for designing targeted interventions for older adults in residential facilities and suggest thinking beyond the individual and considering environmental influences on sedentary behavior in the residential care setting.
Collapse
Affiliation(s)
- Mary P. Kotlarczyk
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Correspondence:
| | - Andrea L. Hergenroeder
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.L.H.); (J.S.B.)
| | - Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Flor de Abril Cameron
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; (F.d.A.C.); (M.E.H.)
| | - Megan E. Hamm
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; (F.d.A.C.); (M.E.H.)
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.L.H.); (J.S.B.)
| |
Collapse
|
7
|
Kowalsky RJ, Jakicic JM, Hergenroeder AL, Rogers RJ, Gibbs BB. The Use Of Resistance Exercises To Interrupt Sitting: Acceptability And Impact On Sleepiness, Discomfort, And Fatigue. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561939.14142.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Hergenroeder AL, Barone Gibbs B, Kotlarczyk MP, Kowalsky RJ, Perera S, Brach JS. Accuracy of Objective Physical Activity Monitors in Measuring Steps in Older Adults. Gerontol Geriatr Med 2018; 4:2333721418781126. [PMID: 29977979 PMCID: PMC6024488 DOI: 10.1177/2333721418781126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of this study is to evaluate accuracy of research activity monitors in measuring steps in older adults with a range of walking abilities. Method: Participants completed an initial assessment of gait speed. The accuracy of each monitor to record 100 steps was assessed across two walking trials. Results: In all, 43 older adults (age 87 ± 5.7 years, 81.4% female) participated. Overall, the StepWatch had the highest accuracy (99.0% ± 1.5%), followed by the ActivPAL (93.7% ± 11.1%) and the Actigraph (51.4% ± 35.7%). The accuracy of the Actigraph and ActivPAL varied according to assistive device use, and the accuracy of all three monitors differed by gait speed category (all p < .05). StepWatch was highly accurate (⩾97.7) across all conditions. Discussion: The StepWatch and ActivPAL monitor were reasonably accurate in measuring steps in older adults who walk slowly and use an assistive device. The Actigraph significantly undercounted steps in those who walk slow or use an assistive device. Researchers should consider gait speed and the use of assistive devices when selecting an activity monitor.
Collapse
|
9
|
Kowalsky RJ, Jakicic JM, Hergenroeder AL, Rogers RJ, Gibbs BB. Cardiometabolic Effects of Interrupting Sitting with Resistance Exercise Breaks. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535526.60029.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med 2018; 75:321-327. [PMID: 29330230 PMCID: PMC8283944 DOI: 10.1136/oemed-2017-104732] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/13/2017] [Accepted: 12/22/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Stand Back study evaluated the feasibility and effects of a multicomponent intervention targeting reduced prolonged sitting and pain self-management in desk workers with chronic low back pain (LBP). METHODS This randomised controlled trial recruited 27 individuals with chronic LBP, Oswestry Disability Index (ODI) >10% and desk jobs (sitting ≥20 hours/week). Participants were randomised within strata of ODI (>10%-<20%, ≥20%) to receive bimonthly behavioural counselling (in-person and telephone), a sit-stand desk attachment, a wrist-worn activity-prompting device and cognitive behavioural therapy for LBP self-management or control. Self-reported work sitting time, visual analogue scales (VAS) for LBP and the ODI were assessed by monthly, online questionnaires and compared across intervention groups using linear mixed models. RESULTS Baseline mean (SD) age was 52 (11) years, 78% were women, and ODI was 24.1 (10.5)%. Across the 6-month follow-up in models adjusted for baseline value, work sitting time was 1.5 hour/day (P<0.001) lower comparing intervention to controls. Also across follow-up, ODI was on average 8 points lower in intervention versus control (P=0.001). At 6 months, the relative decrease in ODI from baseline was 50% in intervention and 14% in control (P=0.042). LBP from VAS was not significantly reduced in intervention versus control, though small-to-moderate effect sizes favouring the intervention were observed (Cohen's d ranged from 0.22 to 0.42). CONCLUSION An intervention coupling behavioural counselling targeting reduced sedentary behaviour and pain self-management is a translatable treatment strategy that shows promise for treating chronic LBP in desk-bound employees. TRIAL REGISTRATION NUMBER NCT0224687; Pre-results.
Collapse
Affiliation(s)
- Bethany Barone Gibbs
- Department of Health and Physical Activity, School of Education; University of Pittsburgh
| | - Andrea L. Hergenroeder
- Department of Physical Therapy, School of Health and Rehabilitation Sciences; University of Pittsburgh
| | - Sophy J. Perdomo
- Department of Health and Physical Activity, School of Education; University of Pittsburgh
| | - Robert J. Kowalsky
- Department of Health and Physical Activity, School of Education; University of Pittsburgh
- Department of Health & Kinesiology, Texas A&M University of Kingsville
| | - Anthony Delitto
- Department of Physical Therapy, School of Health and Rehabilitation Sciences; University of Pittsburgh
| | - John M. Jakicic
- Department of Health and Physical Activity, School of Education; University of Pittsburgh
| |
Collapse
|
11
|
Quinn TD, Hergenroeder AL, Perdomo SJ, Jakicic JM, Delitto A, Gibbs BB. Energy, Health, and Productivity Following a Sedentary Behavior Intervention in Workers with Low Back Pain. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536775.74739.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Gregg EW, Lin J, Bardenheier B, Chen H, Rejeski WJ, Zhuo X, Hergenroeder AL, Kritchevsky SB, Peters AL, Wagenknecht LE, Ip EH, Espeland MA. Impact of Intensive Lifestyle Intervention on Disability-Free Life Expectancy: The Look AHEAD Study. Diabetes Care 2018; 41:1040-1048. [PMID: 29545462 PMCID: PMC5911793 DOI: 10.2337/dc17-2110] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 02/09/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The impact of weight loss intervention on disability-free life expectancy in adults with diabetes is unknown. We examined the impact of a long-term weight loss intervention on years spent with and without physical disability. RESEARCH DESIGN AND METHODS Overweight or obese adults with type 2 diabetes age 45-76 years (n = 5,145) were randomly assigned to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Physical function was assessed annually for 12 years using the 36-Item Short Form Health Survey. Annual incidence of physical disability, mortality, and disability remission were incorporated into a Markov model to quantify years of life spent active and physically disabled. RESULTS Physical disability incidence was lower in the ILI group (6.0% per year) than in the DSE group (6.8% per year) (incidence rate ratio 0.88 [95% CI 0.81-0.96]), whereas rates of disability remission and mortality did not differ between groups. ILI participants had a significant delay in moderate or severe disability onset and an increase in number of nondisabled years (P < 0.05) compared with DSE participants. For a 60-year-old, this effect translates to 0.9 more disability-free years (12.0 years [95% CI 11.5-12.4] vs. 11.1 years [95% CI 10.6-11.7]) but no difference in total years of life. In stratified analyses, ILI increased disability-free years of life in women and participants without cardiovascular disease (CVD) but not in men or participants with CVD. CONCLUSIONS Long-term lifestyle interventions among overweight or obese adults with type 2 diabetes may reduce long-term disability, leading to an effect on disability-free life expectancy but not on total life expectancy.
Collapse
Affiliation(s)
- Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ji Lin
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Barbara Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Haiying Chen
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | | | | | | | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward H Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | | |
Collapse
|
13
|
Hayden KM, Baker LD, Bray G, Carvajal R, Demos-McDermott K, Hergenroeder AL, Hill JO, Horton E, Jakicic JM, Johnson KC, Neiberg RH, Rapp SR, Wadden TA, Miller ME. Long-term impact of intensive lifestyle intervention on cognitive function assessed with the National Institutes of Health Toolbox: The Look AHEAD study. Alzheimers Dement (Amst) 2017; 10:41-48. [PMID: 29159267 PMCID: PMC5675717 DOI: 10.1016/j.dadm.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction This study sought to determine whether 10 years of assignment to intensive lifestyle intervention (ILI) relative to diabetes support and education leads to better cognition. We examine intervention effects overall and among clinical subgroups, and report correlations between computer-administered and interviewer-administered cognitive batteries. Methods The Action for Health in Diabetes (Look AHEAD) was a 16-site randomized controlled trial with overweight/obese individuals (aged 45-76) who had type 2 diabetes. The NIH Toolbox Cognition Battery tests developed to measure cognition across the lifespan were used to evaluate cognition. Results were compared with standard paper-and-pencil tests. The Toolbox and paper-and-pencil tests were administered an average of 10.9 years after randomization to 1002 participants. Results Toolbox measures significantly correlated with interviewer-administered measures, with the strongest correlations between the Toolbox Fluid Cognition Composite and Trails B (r = -0.64, P < .0001) and Digit Symbol Coding (r = 0.63, P < .0001), and between the Toolbox Dimensional Change Card Sort (r = 0.55, P < .0001) and the Digit Symbol Coding test. Overall, ILI and diabetes support and education groups had similar adjusted mean cognitive outcomes (P > .05 for all). Subgroup analyses identified different intervention effects within baseline body mass index groups for Picture Sequence Memory (P = .01), within baseline cardiovascular disease groups for Picture Vocabulary (P = .01) and Fluid Cognition Composite (P = .02) measures, and within baseline age groups for Picture Vocabulary (P = .02). Discussion Correlations between Toolbox and interviewer-administered outcomes provide a measure of internal validity. Findings suggest no overall effect of the intervention on cognition and that an ILI resulting in weight loss may have negative implications for cognition in individuals aged ≥60, with previous history of cardiovascular disease, and those with body mass index ≥40.
Collapse
Affiliation(s)
- Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura D Baker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - George Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Raymond Carvajal
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Andrea L Hergenroeder
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - James O Hill
- Anschultz Health and Wellness Center, Aurora, CO, USA
| | | | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca H Neiberg
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
14
|
Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Delitto A, Jakicic JM. Reducing Sedentary Behavior to Decrease Low Back Pain. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518341.84525.ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Kline CE, Perdomo SJ, Hergenroeder AL, Barone Gibbs B. 1041 THE EFFECT OF REDUCING SEDENTARY BEHAVIOR ON SLEEP QUALITY AMONG ADULTS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROLLED PILOT STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
16
|
Choi J, Hergenroeder AL, Burke L, Dabbs AD, Morrell M, Saptono A, Parmanto B. Delivering an in-Home Exercise Program via Telerehabilitation: A Pilot Study of Lung Transplant Go (LTGO). Int J Telerehabil 2016; 8:15-26. [PMID: 28775798 PMCID: PMC5536726 DOI: 10.5195/ijt.2016.6201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We evaluated the feasibility, safety, system usability, and intervention acceptability of Lung Transplant Go (LTGO), an 8-week in-home exercise intervention for lung transplant recipients using a telerehabilitation platform, and described changes in physical function and physical activity from baseline to post-intervention. The intervention was delivered to lung transplant recipients in their home via the Versatile and Integrated System for TeleRehabilitation (VISYTER). The intervention focused on aerobic and strengthening exercises tailored to baseline physical function. Participants improved walk distance (6-minute walk distance), balance (Berg Balance Scale), lower body strength (30-second chair stand test) and steps walked (SenseWear Armband®). No adverse events were reported. Participants rated the program highly positively in regard to the technology and intervention. The telerehabilitation exercise program was feasible, safe, and acceptable. Our findings provide preliminary support for the LTGO intervention to improve physical function and promote physical activity in lung transplant recipients.
Collapse
Affiliation(s)
- Jiyeon Choi
- DEPARTMENT OF ACUTE & TERTIARY CARE, SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Andrea L Hergenroeder
- DEPARTMENT OF PHYSICAL THERAPY, SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Lora Burke
- DEPARTMENT OF HEALTH & COMMUNITY SYSTEMS, SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Annette Devito Dabbs
- DEPARTMENT OF ACUTE & TERTIARY CARE, SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Matthew Morrell
- DIVISION OF PULMONARY ALLERGY AND CRITICAL CARE MEDICINE, DEPARTMENT OF MEDICINE, UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE & SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Andi Saptono
- DEPARTMENT OF HEALTH INFORMATION MANAGEMENT, SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Bambang Parmanto
- DEPARTMENT OF HEALTH INFORMATION MANAGEMENT, SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| |
Collapse
|
17
|
Beavers KM, Leng I, Rapp SR, Miller ME, Houston DK, Marsh AP, Hire DG, Baker LD, Bray GA, Blackburn GL, Hergenroeder AL, Jakicic JM, Johnson KC, Korytkowski MT, Dorsten BV, Kritchevsky SB. Effects of Longitudinal Glucose Exposure on Cognitive and Physical Function: Results from the Action for Health in Diabetes Movement and Memory Study. J Am Geriatr Soc 2016; 65:137-145. [PMID: 27676466 DOI: 10.1111/jgs.14478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To test whether average long-term glucose exposure is associated with cognitive and physical function in middle-aged and younger-old adults with type 2 diabetes mellitus. DESIGN Prospective cohort study. SETTING Data obtained as part of the Action for Health in Diabetes (Look AHEAD) trial (NCT00017953) and Look AHEAD Movement and Memory ancillary study (NCT01410097). PARTICIPANTS Overweight and obese individuals with type 2 diabetes mellitus aged 45 to 76 at baseline (N = 879). MEASUREMENTS Glycosylated hemoglobin (HbA1c) was measured at regular intervals over 7 years, and objective measures of cognitive function (Trail-Making Test, Modified Stroop Color-Word Test, Digit Symbol-Coding, Rey Auditory Verbal Learning Test, Modified Mini-Mental State Examination) and physical function (Short Physical Performance Battery, expanded Physical Performance Battery, 400-m and 20-m gait speed) and strength (grip and knee extensor strength) were assessed at the Year 8 or 9 follow-up examination. RESULTS Average HbA1c exposure was 7.0 ± 1.1% (53 ± 11.6 mmol/mol), with 57% of participants classified as having HbA1c levels of less than 7% (<53 mmol/mol), 27% having levels of 7% to 8% (53-64 mmol/mol), and 16% having levels of greater than 8% (>64 mmol/mol). After adjustment for age, sex, race, education, smoking status, alcohol intake, knee pain, physical fitness, body mass index, diabetes mellitus medication and statin use, ancillary year visit, and study arm and site, higher HbA1c was associated with worse physical but not cognitive function. Further adjustment for prevalent diabetes mellitus-related comorbidities made all associations nonsignificant. Results did not differ when stratified according to participant baseline age (<60 vs ≥ 60). CONCLUSION Results presented here suggest that, in the absence of diabetes mellitus-related complications, longitudinal glucose exposure is not associated with future cognitive and physical function. Optimal management of diabetes mellitus-related comorbidities may prevent or reduce the burden of disability associated with type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Iris Leng
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Denise K Houston
- Department of Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Don G Hire
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Laura D Baker
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - George L Blackburn
- Division of Nutrition, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen C Johnson
- Department of Preventive Medicine, Health Science Center, University of Tennessee, Memphis, Tennessee
| | - Mary T Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brent Van Dorsten
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Stephen B Kritchevsky
- Department of Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | |
Collapse
|
18
|
Abstract
PURPOSE AND METHODS Although evidence is accumulating that sedentary behavior (SB), independent of moderate-to-vigorous intensity physical activity (MVPA), is associated with cardiometabolic and aging outcomes in adults, several gaps present opportunities for future research. This article reports on the "Research Evidence on Sedentary Behavior" session of the Sedentary Behavior: Identifying Research Priorities workshop, sponsored by the National Heart, Lung, and Blood Institute and the National Institute on Aging, which aimed to identify priorities in SB research. RESULTS AND CONCLUSIONS A consensus definition of SB has not yet been established, although agreement exists that SB is not simply all behaviors other than MVPA. The two most common definitions are as follows: one based solely on intensity (<1.5 metabolic equivalents [METs]) and another which combines low intensity (≤1.5 METs) with a seated or reclining posture. Thus, for the definition of SB, evaluation of whether or not to include a postural component is a research priority. SB assessment methodologies include self-report and objective measurement, each offering distinct information. Therefore, evaluation, standardization, and comparison across self-report and objective assessment methods are needed. Specific priorities include the development and validation of novel devices capable of assessing posture and standardization of research practices for SB assessment by accelerometry. The prospective evidence that SB relates to health outcomes is limited in that SB is almost exclusively measured by self-report. The lack of longitudinal studies with objectively measured SB was recognized as a major research gap, making examination of the association between objectively measured SB and adverse health outcomes in longitudinal studies a research priority. Specifically, studies with repeated measures of SB, evaluating dose-response relationships, with inclusion of more diverse populations are needed.
Collapse
|
19
|
Houston DK, Leng X, Bray GA, Hergenroeder AL, Hill JO, Jakicic JM, Johnson KC, Neiberg RH, Marsh AP, Rejeski WJ, Kritchevsky SB. A long-term intensive lifestyle intervention and physical function: the look AHEAD Movement and Memory Study. Obesity (Silver Spring) 2015; 23:77-84. [PMID: 25452229 PMCID: PMC4276480 DOI: 10.1002/oby.20944] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/29/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the long-term effects of an intensive lifestyle intervention on physical function using a randomized post-test design in the Look AHEAD trial. METHODS Overweight and obese (BMI ≥ 25 kg m(-2)) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes (n = 964) at four clinics in Look AHEAD, a trial evaluating an intensive lifestyle intervention (ILI) designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including an expanded short physical performance battery (SPPBexp ), 20-m and 400-m walk, and grip and knee extensor strength 8 years post-randomization, during the trial's weight maintenance phase. RESULTS Eight years post-randomization, individuals randomized to ILI had better SPPBexp scores [adjusted mean (SE) difference: 0.055 (0.022), P = 0.01] and faster 20-m and 400-m walk speeds [0.032 (0.012) m s(-1) , P = 0.01, and 0.025 (0.011) m s(-1) , P = 0.02, respectively] compared to those randomized to DSE. Achieved weight loss greatly attenuated the group differences in physical function, and the intervention effect was no longer significant. CONCLUSIONS An intensive lifestyle intervention has long-term benefits for mobility function in overweight and obese middle-aged and older individuals with type 2 diabetes.
Collapse
Affiliation(s)
- Denise K. Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Winston-Salem, NC 27157
| | - Xiaoyan Leng
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - George A. Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, 70808
| | | | - James O. Hill
- University of Colorado Denver School of Medicine, Aurora, CO 80010
| | - John M. Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA 15203
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38105
| | - Rebecca H. Neiberg
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Anthony P. Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Winston-Salem, NC 27157
| | | |
Collapse
|
20
|
Espeland MA, Rapp SR, Bray GA, Houston DK, Johnson KC, Kitabchi AE, Hergenroeder AL, Williamson J, Jakicic JM, van Dorsten B, Kritchevsky SB. Long-term impact of behavioral weight loss intervention on cognitive function. J Gerontol A Biol Sci Med Sci 2014; 69:1101-8. [PMID: 24619151 PMCID: PMC4158413 DOI: 10.1093/gerona/glu031] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/04/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is unknown whether intentional weight loss provides long-term benefits for cognitive function. METHODS An ancillary study to a randomized controlled clinical trial was conducted in overweight and obese individuals (N = 978), aged 45-76 years at enrollment, with type 2 diabetes. An intensive behavioral intervention designed to promote and maintain weight loss through caloric restriction and increased physical activity was compared with diabetes support and education. Standardized assessments of cognitive function were collected an average of 8.1 years after trial enrollment. RESULTS Participants assigned to intensive lifestyle intervention lost a mean (SE) 11.1% (0.4%) and 7.2% (0.5%) of weight at Years 1 and 8, respectively, compared with 1.0% (0.2%) and 3.3% (0.5%) in the control group (p < .001). Covariate-adjusted mean composite cognitive function test scores were similar for the two groups (p = .69), and no significant differences were found for any individual cognitive test. There was some evidence of a differential effect (nominal interaction p = .008) for a prespecified comparison: Intensive lifestyle intervention was associated with a relative mean benefit for composite cognitive function of 0.276 (95% confidence interval: 0.033, 0.520) SDs among individuals with body mass index less than 30 kg/m(2) at baseline compared with a relative mean deficit of 0.086 (-0.021, 0.194) SDs among individuals with body mass more than or equal to 30 kg/m(2). CONCLUSIONS Eight years of intensive lifestyle intervention did not alter cognitive function in obese adults with type 2 diabetes; however, there was evidence for benefit among overweight but not obese individuals. Changes in cognition were not assessed in this cross-sectional study.
Collapse
Affiliation(s)
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge
| | - Denise K Houston
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Abbas E Kitabchi
- Department of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Jeff Williamson
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Kulynych Center for Memory and Cognition Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pennsylvania
| | | | - Stephen B Kritchevsky
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
21
|
Hergenroeder AL, Brach JS, Otto AD, Sparto PJ, Jakicic JM. The Influence of Body Mass Index on Self-report and Performance-based Measures of Physical Function in Adult Women. Cardiopulm Phys Ther J 2011; 22:11-20. [PMID: 21886476 PMCID: PMC3163413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Little is known about limitations in physical function across BMI categories in middle aged women using both self-report and performance-based measures. Furthermore, the impact of BMI on the measurement of function has not been explored. The purpose of this study was to assess physical function in adult women across BMI categories using self-report and performance-based measures and determine the influence of BMI on the relationship between the measures. METHODS Fifty sedentary females (10 in each BMI category: normal weight, overweight, obese class I, II, and III) aged 51.2 ± 5.4 years participated. Assessments included demographics, past medical history, physical activity level, BMI, and self-report (Late Life Function and Disability Instrument) and performance-based measures of physical function (6-Minute Walk Test, timed chair rise, gait speed). Physical function was compared between BMI categories using analysis of variance. The influence of BMI on the relationship of self-report and performance-based measures was analyzed using linear regression. RESULTS Compared to those that were normal weight or overweight, individuals with obesity scored lower on the self-report measure of physical function (LLFDI) for capability in participating in life tasks and ability to perform discrete functional activities. On the performance-based measures, the individuals with obesity had slower gait speed compared to the normal and overweight weight groups. For the 6-Minute Walk Test and timed chair stands, individuals with obesity had poorer performance compared to those who were normal weight. Linear regression analyses revealed that BMI attenuated the relationship between the self-report and performance-based measures by approximately 50%. CONCLUSIONS While those with severe obesity were most impaired, adult women with less severe obesity also demonstrated significant decrements in physical function.
Collapse
Affiliation(s)
- Andrea L Hergenroeder
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | | |
Collapse
|
22
|
Hergenroeder AL, Wert DM, Hile ES, Studenski SA, Brach JS. Association of body mass index with self-report and performance-based measures of balance and mobility. Phys Ther 2011; 91:1223-34. [PMID: 21680770 PMCID: PMC3145897 DOI: 10.2522/ptj.20100214] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 04/17/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND The incidence of obesity is increasing in older adults, with associated worsening in the burden of disability. Little is known about the impact of body mass index (BMI) on self-report and performance-based balance and mobility measures in older adults. OBJECTIVE The purposes of this study were (1) to examine the association of BMI with measures of balance and mobility and (2) to explore potential explanatory factors. DESIGN This was a cross-sectional, observational study. METHODS Older adults (mean age=77.6 years) who participated in an ongoing observational study (N=120) were classified as normal weight (BMI=18.5-24.9 kg/m(2)), overweight (BMI=25.0-29.9 kg/m(2)), moderately obese (BMI=30.0-34.9 kg/m(2)), or severely obese (BMI ≥ 35 kg/m(2)). Body mass index data were missing for one individual; thus, data for 119 participants were included in the analysis. Mobility and balance were assessed using self-report and performance-based measures and were compared among weight groups using analysis of variance and chi-square analysis for categorical data. Multiple linear regression analysis was used to examine the association among BMI, mobility, and balance after controlling for potential confounding variables. RESULTS Compared with participants who were of normal weight or overweight, those with moderate or severe obesity were less likely to report their mobility as very good or excellent (52%, 55%, 39%, and 6%, respectively); however, there was no difference in self-report of balance among weight groups. Participants with severe obesity (n=17) had the lowest levels of mobility on the performance-based measures, followed by those who were moderately obese (n=31), overweight (n=42), and of normal weight (n=29). There were no differences on performance-based balance measures among weight groups. After controlling for age, sex, minority status, physical activity level, education level, and comorbid conditions, BMI still significantly contributed to mobility (β=-.02, adjusted R(2)=.41). CONCLUSIONS Although older adults with severe obesity were most impaired, those with less severe obesity also demonstrated significant decrements in mobility.
Collapse
Affiliation(s)
- Andrea L Hergenroeder
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA.
| | | | | | | | | |
Collapse
|
23
|
Sathe G, Hergenroeder AL, Josbeno D, Niyonkuru C, Sowa GA. Poster 101: Barriers to Exercise in Chronic Lower Back Pain. PM R 2010. [DOI: 10.1016/j.pmrj.2010.07.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
McCrory JL, Roy SJ, Hergenroeder AL, Jakicic JM. The Relationship Between Body Mass Index And Physical Function. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000354205.30354.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
25
|
Josbeno D, Eid GM, Jakicic JM, Hergenroeder AL. PL-25: Physical activity and physical function changes in obese individuals following gastric bypass surgery. Surg Obes Relat Dis 2008. [DOI: 10.1016/j.soard.2008.03.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|