An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women

BACKGROUND: Rates of physical inactivity and poor nutrition, which are 2 of the most important modifiable risk factors for cardiovascular disease in women, are substantial. Even so, studies of interventions designed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas. OBJECTIVE: To evaluate the effect of Choose to Move on increasing women's physical activity, improving their knowledge of heart disease and stroke, and improving their nutrition. PARTICIPANTS AND METHODS: A prospective, nonrandomized, 12-week educational intervention designed by the American Heart Association for women across the United States. Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change. Women (N = 23 171) aged 25 years or older were recruited by direct mail, the media, health care providers, and other means. Follow-up evaluations were returned from 6389 women at 2 weeks, 5338 at 4 weeks, 4209 at 8 weeks, 3916 at 10 weeks, and 3775 at 12 weeks. Participants self-reported their physical activity, diet, and knowledge about heart disease, stroke, and related symptoms. RESULTS: Ninety percent of the participants were white and 56% were aged between 35 and 54 years. Among the participants who completed the week 12 follow-up evaluation, the percentage who reported being active (at least moderate exercise > or =5 times per week or >2(1/2) hours per week for the past 1 to 6 months) increased from 32% at baseline to 67% at the program's end (P =.001). Participants currently limiting excess calories or fat increased from 72% to 91% at week 10 follow-up evaluation (P =.001). The proportion correctly identifying heart disease as the leading cause of death increased from 84% to 91% at week 10 follow-up evaluation (P<.001). CONCLUSIONS: Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity, reduced their consumption of high-fat foods, and increased their knowledge and awareness of cardiovascular disease risk and its symptoms. This program provides an important model for public health, voluntary, and other health organizations of population-based, targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and cardiovascular health.     

Response of oxidative stress biomarkers to a 16-week aerobic physical activity program,and to acute physical activity,in healthy young men and women

Physical activity (PA) is associated with a reduced risk of coronary heart disease, and may favorably modify the antioxidant-prooxidant balance. This study assessed the effects of aerobic PA training on antioxidant enzyme activity, oxidized LDL concentration, and LDL resistance to oxidation, as well as the effect of acute PA on antioxidant enzyme activity before and after the training period. Seventeen sedentary healthy young men and women were recruited for 16 weeks of training. The activity of superoxide dismutase in erythrocytes (E-SOD), glutathione peroxidase in whole blood (GSH-Px), and glutathione reductase in plasma (P-GR), and the oxidized LDL concentration and LDL composition, diameter, and resistance to oxidation were determined before and after training. Shortly before and after this training period they also performed a bout of aerobic PA for 30 min. The antioxidant enzyme activity was also determined at 0 min, 30 min, 60 min, 120 min, and 24 h after both bouts of PA. Training induces an increase in GSH-Px (27.7%), P-GR (17.6%), and LDL resistance to oxidation, and a decrease in oxidized LDL (-15.9%). After the bout of PA, an increase in E-SOD and GSH-Px was observed at 0 min, with a posterior decrease in enzyme activity until 30-60 min, and a tendency to recover the basal values at 120 min and 24 h. Training did not modify this global response pattern. Regular PA increases endogenous antioxidant activity and LDL resistance to oxidation, and decreases oxidized LDL concentration; 30 min of aerobic PA decreases P-GR and B-GSH-Px activity in the first 30-60 min with a posterior recovery.     

A diabetes intervention program of physical activity carried out at primary care settings in Mexico

OBJECTIVE: The aim of this study was to document physical activity (PA) of migrant Mexican women with type 2 diabetes who have participated in diabetes intervention programs at a primary care level. METHODS: One hundred out of 133 women of seven diabetes education groups from different Mexican institutions located in the city of Tijuana were invited to participate in the study. A PA history questionnaire was completed weekly. Metabolic Equivalents (METs) were used to calculate physical activity level (PAL). RESULTS: Forty percent were classified as overweight and 31% as obese. Six percent of the women performed more than 150 min of moderate/vigorous weekly PA, while more than 80 min of weekly PA was reported by 73% of the population. There was no difference in frequency and intensity of PA between the participants from both institutions. The main indoor activities were cooking, dish washing, clothes washing and cleaning, and the main outdoor activities were walking, semi-active exercise and running. CONCLUSIONS: The majority of these migrant women who participated in the diabetes intervention program seem to engage in the minimum recommended levels of PA. In a country like Mexico, where its public health care system is facing huge economic constraints, PA counseling done in a primary health care practice may be a cost-effective approach.     

A pilot structured behavioural intervention trial to increase physical activity among women with recent gestational diabetes

Forty-three women were recruited into a 1-year randomised controlled trial to test the feasibility of a structured behavioural intervention to increase physical activity after gestational diabetes. Increases in achievement of physical activity targets were not attained. Recruitment and subject retention were identified as major challenges.     

Sexual activity satisfaction in symptomatic hip osteoarthritis patients: A cross-sectional,national web-based study

Aim

Despite high-interest rates in sex in people with hip osteoarthritis (OA), clinicians tend not to address sexual issues, especially in older adults. The objective of this study is to evaluate sexual activity and factors associated with sexual activity satisfaction in people with symptomatic hip OA.

Methods

A cross-sectional study was conducted among 252 participants with symptomatic hip OA in Australia. Quality of sex life was assessed using the online composite of sexual activities and positions questionnaires. A Poisson model with robust variance was used to calculate the prevalence ratio (PR). Factors that showed a univariate association with sexual satisfaction were then included in a multivariable model. PR with corresponding 95% confidence intervals (CI) are reported.

Results

Among the 282 participants registered on the study website, 252 met the inclusion criteria, and 60.3% (152/252) completed the sexual activity questionnaires. Hip OA interfered with sexual activity in 70.0% of the participants. High confidence in completing sexual activity (PR: 0.53, 95% CI: 0.36 to 0.77) was associated with an increased prevalence ratio of sexual satisfaction. High anxiety, depression or stress during sexual activity (PR: 1.33, 95% CI: 1.10 to 1.60) was associated with an increased prevalence ratio of sexual dissatisfaction after adjusting for hip pain level and perceived partner's orgasm.

Conclusion

Although a large proportion of people with hip OA remain sexually active, a substantial proportion of persons are dissatisfied with their sexual activity. Hip OA interfered with sexual activity in most participants. Psychological factors were found to be associated with sexual activity satisfaction.     

Exercise heart rate variability of older women in relation to level of physical activity

The purpose of this study was to determine the effect of the level of physical activity in older women on heart rate (HR) response to its neural control at rest and during exercise by using heart rate variability (HRV) analysis. Electrocardiogram (ECG) was recorded in 3 (low, moderately, and highly) active groups of older women at rest and during submaximal exercise. Spectral HRV indexes were obtained from the ECG signal. At rest, highly active subjects have low HR without any alteration of HRV. During incremental submaximal exercise, parasympathetic modulations of HR decreased only in the highly active subjects (p <.01) without any alteration of HR, compared with the other groups. In older women, the effects of the level of physical activity on HR and HRV are dissociated. Quite a high level of physical training induces a higher sensitivity of sinus node response to the autonomic nervous system during exercise.     

Psychosocial and perceived environmental correlates of physical activity in rural and older african american and white women

African American and rural older women are among the least active segments of the population. This study, guided by social cognitive theory, examined the correlates of physical activity (PA) in 102 rural older women (41% African American; 70.6 +/- 9.2 years). In bivariate associations, education, marital status, self-efficacy, greater pros than cons, perceived stress, social support, and perceived neighborhood safety were positively associated with PA; age, depressive symptoms, perceived sidewalks, health care provider discussion of PA, and perceived traffic were negatively associated with PA. In a hierarchical regression analysis, the sociodemographic (R(2) = 23%), psychological (IR(2) = 9%), social (IR(2) = 6%), and perceived physical environmental (IR(2) = 9%) sets of variables were significant (p <.05) predictors of PA (model R(2) = 47%). In response to open-ended questions, most women cited individual and social factors as PA barriers and motivators; falls, injuries, and heart attacks were identified most often as risks. These findings support the importance of multilevel influences on PA in older rural women and are useful for informing PA interventions.     

Response of oxidative stress markers and antioxidant parameters to an 8-week aerobic physical activity program in healthy, postmenopausal women

The aim of the study was to assess the influence of an 8-week aerobic physical activity program on oxidative stress markers, antioxidant parameters, and selected metabolic parameters in healthy, postmenopausal women. The study was carried out in a group of 41 healthy women (mean age 65 years) participating in an 8-week cycle ergometer physical workout of moderate intensity. Before and after completing the training program, the following parameters were assessed: total antioxidant status (TAS) and concentrations of thiobarbituric acid reactive substances (TBARS) in plasma, serum levels of antibodies against oxidatively modified low-density lipoproteins (LDL) (oLAB), serum concentrations of glucose, high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), insulin, and reduced glutathione (GSH) concentrations in red blood cells (RBC). Atherogenic index of plasma (AIP) and insulin resistance index (HOMA(IR)) were calculated. The 8-week aerobic physical activity program resulted in significant decrease (p<0.01) in serum glucose and LDL-cholesterol (LDL-C) levels, plasma TBARS concentrations (p<0.05), and in significant decrease of HOMA(IR) (p<0.01). TAS of plasma and GSH concentrations in RBC increased significantly (p<0.01) over the study period. The results show that an 8-week aerobic training enhanced insulin sensitivity, and improved the balance between oxidants and antioxidants in healthy, postmenopausal women.     

A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects

OBJECTIVE: To investigate the effects of a specific program to implement physical activity (fitness program) on weight loss maintenance, activity level and resting energy expenditure (REE). DESIGN: Observational study of subjects completing a behavioral program. SUBJECTS: In total, 200 overweight/obese subjects (36 males, aged 20-66 years; average BMI, 35.2 kg/m2).Program and measurements:The fitness program consisted of 12 bimonthly sessions, chaired by doctors and dietitians, involving groups of 8-12 subjects. Patients entered the program approximately 9 months after the end of behavioral treatment, during a weight loss maintenance period. The goal was set at a light-to-moderate daily physical activity (brisk walking), quantitatively measured by a pedometer; REE was measured before and after the fitness program by indirect calorimetry in a subset of patients. RESULTS: The fitness program restarted the process of weight loss in over 60% of subjects. At the end of the study, 84% of patients walked at least 5000 steps per day, compared with 24% at the beginning of the study. The probability of losing from 5 to 10% of initial body weight increased by 20% for any 1000 steps/day (OR, 1.20; 95% CI (confidence interval), 1.07-1.35), and that of losing more than 10% by over 30% (OR, 1.33; 95% CI, 1.19-1.49). REE increased significantly by 100 kcal/day (+7.5%), in spite of further weight loss (-1.8%). CONCLUSION: A specific fitness program in the weight maintenance phase after a behavioral program may significantly improve the long-term control of obesity.     

A questionnaire-based assessment of daily physical activity in heart failure

Type and dose of daily energy expenditure (DEE) play a major role in modulations of health status and an increased knowledge of these dimensions of physical activity in congestive heart failure (CHF) patients would be valuable for clinical and epidemiological aims. We propose a new self-administered DEE questionnaire adapted to CHF patients and tested its validity. One hundred and five stable CHF participants, NYHA class I-IV, LVEF=33.2+/-6.1% performed an incremental symptom-limited Vo(2) (peak) test and filled in the questionnaire for DEE calculation. Reproducibility (n=24), sensitivity (n=21) of the questionnaire and inter-observer variability (n=105) were tested. Intensity levels were identified from DEE and their relationships to Vo(2)(peak), ventilatory and anthropometric characteristics were assessed by simple and multiple regression models. Reproducibility and sensitivity were high (r=0.98 and 0.88, respectively, P<0.0001) and inter-observer error reached 1.37%. DEE was highly correlated to physical activity energy expenditure (r=0.96, P<0.0001). Relationships between DEE, Vo(2)(peak), V(E)/Vo(2) and anthropometric characteristics were significant. An activity level above 3 MET was the best intensity criteria related to Vo(2)(peak) (r=0.62, P<0.0001) and DEE (r=0.80, P<0.0001). The questionnaire seems reproducible, sensible and valid for DEE estimation. Vo(2)(peak) appears related to DEE and especially to activities above 3 MET in CHF.     

The metabolic syndrome: prevalence and association to leisure-time and work-related physical activity in 60-year-old men and women

Background and aimThis study examined the prevalence of the metabolic syndrome and its association to lifestyle factors in 60-year-old men and women, with special emphasis on physical activity (PA).Methods and resultsEvery third 60-year-old man and woman in the Stockholm County, Sweden, was invited to a survey of cardiovascular risk factors. Seventy-seven percent of the sample, 4228 individuals, agreed to participate (2036 men and 2192 women). Participants underwent physical examination and laboratory tests, and completed a questionnaire. After excluding 364 subjects suffering from cardiovascular disease and/or cancer, the prevalence of the metabolic syndrome was 24% and 19% in men and women, respectively. The adjusted odds ratio for having the metabolic syndrome in the high leisure-time PA group was 0.33 (95% confidence interval: 0.22–0.51) using the low leisure-time PA group as reference. However, no such inverse association was noted for work-related PA.ConclusionsThis cross-sectional survey of 60-year-old men and women demonstrates a high prevalence of the metabolic syndrome. The robust inverse dose–response relationship between leisure-time PA and the metabolic syndrome emphasises the role of PA in the prevention and treatment of the metabolic syndrome.     

A propensity-matched study of the association of physical function and outcomes in geriatric heart failure

Most heart failure (HF) patients are older adults. However, the association of functional status and outcomes in ambulatory older adults with chronic HF has not been well studied. Of the 7788 Digitalis Investigation Group (DIG) trial participants, 4036 were > or =65 years. Of these, 1369 (34%) had New York Heart Association (NYHA) class III-IV symptoms. We calculated propensity scores for NYHA III-IV symptoms for all 4036 patients using a non-parsimonious logistic regression model. We used propensity scores to match 1010 (74% of 1369) NYHA III-IV patients with 1010 of NYHA I-II patients. Kaplan-Meier and matched Cox proportion hazard analyses were used to estimate associations of NYHA class III-IV with mortality and hospitalizations. Patients had a mean age of 73 years, 31% were female, and 11% were nonwhites. All-cause mortality occurred in 394 (rate, 1385/10000 person-years) NYHA I-II and 452 (rate, 1654/10000 person-years) NYHA III-IV patients, respectively, during 2967 and 2733 years of follow up (hazard ratio: {HR}, 1.28; 95% confidence interval {CI}, 1.09-1.50; p=0.002). NYHA III-IV class was associated with increased cardiovascular (HR, 1.25; 95% CI, 1.04-1.49; p=0.016) and HF mortality (HR, 1.51; 95% CI, 1.16-1.97; p=0.002). NYHA III-IV class was not significantly associated with hospitalizations due to all causes (HR, 1.10; 95% CI, 0.96-1.25; p=0.165), cardiovascular causes (HR, 1.11; 95% CI, 0.96-1.29; p=0.150), or worsening HF (HR, 1.09, 95% CI, 0.92-1.30; p=0.330). Baseline NYHA functional class was associated with mortality but not with hospitalization in ambulatory older adults with chronic HF.     

A statement of the american heart association nutrition committee on dietary protein and weight reduction: a rigorous rebuttal

Results of several recent studies show that high-protein, low-carbohydrate weight loss diets indeed have their benefits. However, there are always some concerns about high-protein diets. According to the American Heart Association (AHA) Nutrition Committee, highprotein diets may possess significant health risks. The purpose of this review is to evaluate the scientific validity of AHA Nutrition CommitteeA s statement on dietary protein and weight reduction (St. Jeor ST et al. Circulation 2001;104:1869-1874). Simply stated, there is little if any scientific evidence supporting above mentioned statement. Certainly, such public warnings should be based on a thorough analysis of the scientific literature, not unsubstantiated fears and misrepresentations. For individuals with normal renal function, the risks are minimal and must be balanced against the real and established risk of continued obesity.