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Homeless youth in Toronto are nutritionally vulnerable.

This study was undertaken to characterize nutritional vulnerability among a sample of homeless youth in downtown Toronto. Interviews were conducted with 261 homeless youth (149 male, 112 female), recruited from drop-in centers and outdoor locations. Information about current living circumstances, nutrition and health-related behaviors, and 24-h dietary intake recalls were collected, and height, weight, triceps skinfold thickness, and mid-upper arm circumference were measured. A second 24-h dietary intake recall was conducted with 195 youth. Youth's energy intakes approximated the requirements for a very sedentary lifestyle; 7% were underweight and 22% were overweight or obese. Over half of the youth had inadequate intakes of folate, vitamin A, vitamin C, magnesium, and zinc; in addition, more than half of females had inadequate vitamin B-12 and iron intakes. Most youth got food from more than one source in the course of a day: 74% of males and 75% of females purchased food; 48% of males and 51% of females obtained food from charitable meal programs; 47% of males and 75% of females received food from strangers or acquaintances; and 10% of males and 6% of females stole food or took it from the garbage. Compared to a sample of 114 domiciled youth from the 1997-1998 Ontario Food Survey, males had lower energy and nutrient intakes and females had lower intakes of most nutrients.

Adolescent↗

Adolescent screen-viewing behaviour is associated with consumption of sugar-sweetened beverages: the role of habit strength and perceived parental norms.

The association between adolescent screen-viewing behaviour (i.e., television viewing and computer use) and the consumption of sugar-sweetened beverages was studied in a Dutch sample of adolescents (N=383) using self-administered questionnaires. In particular, the previously understudied role of habit and perceived parental norms in the execution of these behaviours was investigated. Results showed that screen-viewing behaviour was associated with consumption of sugar-sweetened beverages (r=.32). Habit strength of both behaviours correlated with a large effect size (r=.50). The interaction between both behaviours was underlined by the finding that consumption of sugar-sweetened beverages was explained by perceived parental norms regarding screen-viewing behaviour (beta=.12; adjusted for the behaviour and perceived parental norm regarding sugar-sweetened beverage consumption). Consequences of the identified role of habit and parental norms in the interplay between sedentary behaviour and consumption of sugar-sweetened beverages among adolescents are discussed.

Adolescent↗

Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy.

OBJECTIVE: Achilles tendinopathy is prevalent in athletes, but can also affect sedentary patients. We studied the effects of eccentric exercises in sedentary non-athletic patients with Achilles tendinopathy. METHODS: Thirty-four sedentary patients (18 males, average age 44 years, range 23-67; 16 females, average age 51 years, range 20-76; average BMI: 28.6+/-4.7, range 22.1-35.4) with a clinical diagnosis of unilateral tendinopathy of the main body of the Achilles tendon completed the VISA-A questionnaire at first attendance (39+/-S.D. 22.8) and at their subsequent visits. The patients underwent a graded progressive eccentric calf strengthening exercises programme for 12 weeks. RESULTS: Fifteen patients (44%) did not improve with eccentric exercise regimen. Three patients improved after perintendinous injections aprotinin and local anaesthetic. Surgery was performed in seven patients as 6 months of conservative management failed to produce improvements. The overall average VISA-A scores at latest follow up was 50 (S.D. 26.5). CONCLUSIONS: Eccentric exercises, though effective in nearly 60% of our patients, may not benefit sedentary patients to the same extent reported in athletes.

Achilles Tendon↗

[Physical activity and leisure time in children. II: Relationship with dietary habits].

OBJECTIVE: To investigate the relationship between physical activity, leisure time activities and dietary habits in adolescents. PATIENTS AND METHODS: We have studied 541 girls and 537 boys from 24 schools. Physical activity, leisure time activities and dietary habits were assessed by 3 different questionnaires, taking into account one week of normal activity and diet. RESULTS: Foods such as milk, fish, meat, egg, fruits, vegetables, pasta and snacks were consumed more frequently in children who spent more time doing sport, but difference were not statistically significant. Boys who spent more time watching T.V. ate greater amounts of almost all foods (p < 0.05). In girls, we have observed the same results, but differences were not statistically significant. CONCLUSIONS: Sports and T.V. watching are both related to a greater amount of food intake From our results we can deduce that in order to prevent obesity, and other cardiovascular risk factors, we must improve food intake related with sedentary habits.

Adolescent↗

Effects of a computer-based, telephone-counseling system on physical activity.

BACKGROUND: There is increasing interest in developing interventions to promote physical activity (PA) that do not involve face-to-face contact with health professionals. We developed a fully automated PA counseling system (telephone-linked communication, TLC-PA) that was delivered via telephone. DESIGN: A randomized, controlled trial with 298 adult, sedentary members (mean age, 45.9 years; 72% women; 45% white; and 45% African American) of a multi-site medical practice. The comparison group (TLC-Eat) received an automated intervention promoting healthy eating, which was also delivered via telephone. INTERVENTION: The TLC-PA promoted moderate-intensity PA (MI-PA) based on the transtheoretical model of behavior change and social cognitive theory. The system was available to participants for 6 months. MAIN OUTCOMES: Energy expenditure in MI-PA, proportion of participants who met recommendations for MI-PA, and motivational readiness for PA. MEASURES: Self-reports of PA behavior and motivational readiness at baseline, 3 months, and 6 months. RESULTS: At 3 months, intention-to-treat analyses showed that the TLC-PA group was more likely to meet recommendations for MI- or vigorous-intensity PA (VI-PA) compared to the TLC-Eat group (TLC-PA=26% vs TLC-Eat=19.6%, p=0.04). Among study completers, TLC-PA subjects reported significantly higher daily kilocalorie energy expenditure in MI-PA (2.3 kcal/kg/d vs 2.0 kcal/kg/d, p=0.02); a larger proportion met recommendations for MI- or VI-PA (31.2% vs 21.3%, p=0.02) and were in more advanced stages of motivational readiness than TLC-Eat subjects (TLC-PA=52.5% vs TLC-Eat=42.2%, p=0.04). Results were not maintained at 6 months. The proportion of TLC-PA users decreased significantly over the intervention period. CONCLUSIONS: A fully automated counseling system had positive short-term effects on PA among sedentary adults. Lack of maintenance of effects may be due to a decrease in the number of participants who continued to use the system.

Chi-Square Distribution↗

An experiential perspective on the motivational features of exercise and lifestyle.

The purpose of this study was to describe the cognitive, emotional and behavioral concomitants of direction, intensity and persistence for exercise in individuals displaying different levels of exercise involvement. In order to attain this goal, 78 one-hour interviews were conducted with individuals who were either autonomous exercisers, fitness program enrollees, fitness program dropouts or sedentary individuals. Subjects were asked to describe their thoughts, feelings and behaviours, before, during and after a workout, and trained interviewers used probes to further tease out aspects of direction, intensity and persistence. Findings were content-analyzed to detect significant trends. Results revealed that autonomous exercisers differed from individuals with less active lifestyles in several ways: participation motives were geared mainly toward fitness-health; the aspect they enjoyed the most about their participation was the task itself; they did not need to do any planning to ensure that they regularly attended their workouts; they expended a moderately high amount of effort and intensity in pursuing their exercise; they conceded that sometimes they missed workouts simply out of fatigue and that they felt that something was missing in their life when they did not exercise. By contrast, other types of exercisers displayed different profiles. These findings replicate and extend data available in the literature and thus support the viability of qualitatively conceptualizing and assessing motivation in exercise settings.

Adolescent↗

A pilot study of group exercise training (GET) for women with primary breast cancer: feasibility and health benefits.

Evidence is accumulating for physical activity as an effective, well-tolerated, highly rewarding complementary behavioral intervention for enhancing quality of life (QOL) as well as fitness among individuals with chronic and even terminal illnesses. However, relatively few studies have examined the feasibility and potential health benefits of supervised, structured exercise programs for sedentary women with primary breast cancer. Forty women over the age of 45 with primary breast cancer participated in a course of group exercise training (GET) delivered in a structured format three times per week for 16 weeks. GET emphasizes physical activities that promote aerobic fitness, strength, and flexibility. Assessments of fitness/vigor and QOL were conducted prior to, during, and upon completion of the program. Results demonstrated that GET was feasible, safe, and well-tolerated. Moreover, the participants experienced significant health benefits over the course of the intervention in multiple dimensions of fitness/vigor (aerobic capacity, strength, flexibility) as well as QOL (increased positive affect, decreased distress, enhanced well-being, and improved functioning). Discussion highlights the need for inclusion of physical activity programs in comprehensive, complementary treatment regimes for breast cancer patients.

Adaptation, Psychological↗

Test-retest reliability of four physical activity measures used in population surveys.

Accurate monitoring of prevalence and trends in population levels of physical activity (PA) is a fundamental public health need. Test-retest reliability (repeatability) was assessed in population samples for four self-report PA measures: the Active Australia survey (AA, N=356), the short International Physical Activity Questionnaire (IPAQ, N=104), the physical activity items in the Behavioral Risk Factor Surveillance System (BRFSS, N=127) and in the Australian National Health Survey (NHS, N=122). Percent agreement and Kappa statistics were used to assess reliability of classification of activity status as 'active', 'insufficiently active' or 'sedentary'. Intraclass correlations (ICCs) were used to assess agreement on minutes of activity reported for each item of each survey and for total minutes. Percent agreement scores for activity status were very good on all four instruments, ranging from 60% for the NHS to 79% for the IPAQ. Corresponding Kappa statistics ranged from 0.40 (NHS) to 0.52 (AA). For individual items, ICCs were highest for walking (0.45 to 0.78) and vigorous activity (0.22 to 0.64) and lowest for the moderate questions (0.16 to 0.44). All four measures provide acceptable levels of test-retest reliability for assessing both activity status and sedentariness, and moderate reliability for assessing total minutes of activity.

Adolescent↗

Behavioral and physiological indices related to BMI in a cohort of primary schoolchildren in Greece.

The purpose of this study was to investigate the differences between normal weight and overweight primary schoolchildren in terms of certain cardiovascular disease (CVD) risk factors and furthermore to identify behavioral correlates significantly affecting their body mass index (BMI). The sample consisted of 198 children with a mean age of 11.5 +/- 0.4 years (106 females and 92 males). Data was obtained on children anthropometry, plasma lipids, plasma glucose, dietary intake, cardiorespiratory fitness, and physical activity. Significant gender differences were observed for most of these parameters, with boys being more active and fit but also spending more time on sedentary activities and exhibiting higher intake of energy and fat compared to girls. Using the International Obesity Task Force's (IOTF) BMI cut-off points, the prevalence of overweight and obesity was estimated to be 35.6% and 6.7% among boys and 25.7% and 6.7% among girls, respectively. Overweight and obese children had higher levels of plasma triglycerides (TG) and total cholesterol to HDL-cholesterol (TC/HDL-C) ratio and lower levels of HDL-C and physical fitness compared to their normal-weight peers. Among the behavioral variables tested, only participation in organized sports, cardiorespiratory fitness, and TV watching were significantly correlated with BMI, while energy and fat intake were found to have no significant effect. The current study suggests that even in childhood, overweight and obesity are indicative of an unfavorable lipidemic profile. Among the behavioral parameters known to affect BMI, those found to exert a significant effect were organized physical activities, cardiorespiratory fitness, and TV watching, but not energy or fat intake.

Behavioral Research↗

Alterations in fear conditioning and amygdalar activation following chronic wheel running in rats.

Several convergent lines of evidence point to the amygdala as a key site of plasticity underlying most forms of fear conditioning. Studies have shown that chronic physical activity, such as wheel running, can alter learning in a variety of contexts, including aversive conditioning. The ability of chronic wheel running (WR) to alter both behavioral correlates of fear conditioning and indices of amygdalar activation, however, has not been simultaneously assessed. Here, rats were given constant access to either free-turning or--as a control--locked (LC) running wheels in their home cages. After 8 weeks of housing under these conditions, animals were exposed to a series of shocks in a separate testing chamber. Twenty-four hours later, the animals were returned to the shock chamber and freezing behavior was measured as an indicator of contextual fear conditioning. The animals were then sacrificed and their brains processed for immunohistochemical detection of Fos to assess patterns of putative neuronal activation. WR rats spent significantly more time freezing than their LC counterparts upon return to the shock-paired context. The enhanced conditioned freezing response was most pronounced in animals showing high levels of nightly wheel running activity. WR animals also had significantly higher levels of neuronal activation, as indicated by Fos expression in the central nucleus of the amygdala, but less activation in the basolateral nucleus, compared to sedentary controls. These data demonstrate the ability of chronic physical activity to alter contextual fear conditioning and implicate the amygdala as a potential site of plasticity underlying this phenomenon.

Amygdala↗

Groningen Active Living Model (GALM): stimulating physical activity in sedentary older adults.

BACKGROUND: A significant number of Dutch older adults can be considered sedentary when it comes to regular participation in leisure-time physical activity. Sedentariness is considered a potential public health burden-all the more reason to develop a strategy for stimulating older adults toward becoming more involved in leisure-time physical activity. The Groningen Active Living Model (GALM) is a behavioral change strategy for stimulating participation in leisure-time physical activity. METHODS: The GALM strategy is based on a process model of behavioral change in which behavioral change is seen as a multidimensional and dynamic process. The strategy has three phases: recruitment, introduction, and follow-up, and lasts 18 months. RESULTS: Preliminary results indicate that, up until the summer of 1998, about 4000 older adults were participating in 76 local GALM projects. Further research will be done to assess the validity of the model and its effects on the leisure-time physical activity pattern, ADL performance, and health in newly active older adults. CONCLUSIONS: The GALM strategy is a feasible strategy for stimulating leisure-time physical activity participation on a large-scale basis. The strategy is being implemented in The Netherlands on a nationwide basis.

Activities of Daily Living↗

Nature of the breakdown in the Stokes-Einstein relationship in a hard sphere fluid.

Molecular dynamics simulations of high density hard sphere fluids clearly show a breakdown of the Stokes-Einstein equation (SE). This result has been conjectured to be due to the presence of mobile particles, i.e., ones which have the propensity to "hop" distances that are integer multiples of the interparticle distance. We conclusively show that the sedentary particles, i.e., ones complementary to the "hoppers," obey the SE relationship to a good approximation, even though the fluid as a whole violates the SE equation at high densities. These results support the notion that the unusual diffusive behavior of supercooled liquids is dominated by the hopping particles.

Journal Article↗

Automated physical activity monitoring: validation and comparison with physiological and self-report measures.

Physical activity can be assessed via self-report, via physiological measures such as heart rate and oxygen uptake, or via automated monitor. An electronic accelerometer-based physical activity device (Actigraph) has been reported as an improvement over other activity measurement techniques in terms of utility and accuracy. Four studies provide systematic validation and reliability testing for this device and comparisons with other techniques for assessing daily activities. In the first study, the sensitivity of the Actigraph was determined for differentiating physical activities (walking, running, stair climbing, knee bends) versus sedentary activities (reading, typing, playing video games, and performing a mental arithmetic task). Fifteen healthy adults wore the Actigraph on their wrist during activities; oxygen uptake and heart rate were simultaneously recorded. Results revealed that the Actigraph significantly differentiated between the physical activities (p < .0001) and the sedentary activities (p < .0001). Actigraph counts also correlated significantly with oxygen uptake (r = .73) and heart rate (r = .71) during physical activities (r = .46) and sedentary activities (r = .35), respectively. Test-retest reliability was very high for 12 activities (r = .98). The high level of activity differentiation and strong relationship to oxygen uptake and heart rate suggest the usefulness of this device for behavioral and biomedical studies. However, these studies also indicate that the wrist may not always be the most adequate placement for indexing rate and intensity of daily activities and that further studies are needed to determine the optimal site of monitor attachment. Advantages and disadvantages of self-report, physiological, and automated measures of activity are discussed.

Adult↗

Community heart health programs: components, rationale, and strategies for effective interventions.

Large, well-funded, community heart health programs (CHHPs) have successfully focused on improving the cardiovascular health status of entire communities. CHHPs attempt to reduce the prevalence of risk factors associated with high rates of coronary heart disease mortality: high blood pressure, elevated serum cholesterol, smoking, overweight, and sedentary lifestyle. Program components include community organization, needs assessment, priority and evaluation, and program maintenance. Organizing the community, assessing needs and resources, and setting priorities generally occur concurrently, followed by implementing interventions. CHHP activities include social marketing, direct behavior-change efforts (including skills training, health education, and contingency management), screening (including counseling and referral), and policy and environmental change. Because State-sponsored efforts will seldom have the resources of federally-funded demonstration projects, they must pay particular attention to the "3 As" of community interventions: affordability, acceptability, and adequacy. Attention to these principles and the critical program components outlined in this paper facilitate the planning, development, implementation and evaluation of the next generation of CHHPs.

Cardiovascular Diseases↗

A controlled trial of physician counseling to promote the adoption of physical activity.

BACKGROUND: In accordance with one of the Year 2000 Health Objectives, the current study tests the efficacy of brief physician-based counseling to increase physical activity in sedentary patients in a nonrandomized controlled trial. METHODS: Control and intervention physicians were matched on medical practice variables. Two hundred fifty-five apparently healthy, sedentary, adult patients were recruited from 17 physician offices (mean age = 39 years, 84% female, 28% ethnic minority). Intervention physicians delivered 3 to 5 min of structured physical activity counseling during a well visit or follow-up for a chronic condition. A health educator made a brief booster phone call to patients 2 weeks after receiving physician counseling. Self-reported physical activity and stage of change (i.e., behavioral readiness to adopt or maintain activity) were collected at baseline and at 4- to 6-week follow-up. Objective activity monitoring was conducted on a subsample. RESULTS: Intervention patients reported increased walking more than control patients (+37 min/week vs. +7 min/week). There was a significant intervention effect on the activity monitor. Intervention participants also demonstrated a greater increase in readiness to adopt activity than control subjects. CONCLUSIONS: Physician-based counseling for physical activity is efficacious in producing short-term increases in moderate physical activity among previously sedentary patients.

Adult↗

[Practitioners confronted with the four main health behavioral risk factors].

Four behavioural risk factors are common in primary care and are often clustered in individuals. Smoking is present from I cigarette per day, excessive alcohol use is defined either by drinking regularly more than 2-3 standard glasses per day or by occasional heavy drinking of more than 4-5 glasses at a time. Patients who don't have regular moderate physical activity of at least 30 minutes during 5 days of a week or intensive physical activity of at least 20 minutes 3 times a week are sedentary. A Body Mass Index of over 30 defines obesity. We propose a "generic" counselling tool in 5 steps, the 5 As, that can be used for any of the four behavioural risk factors during routine consultations. With this counselling guide, practitioners can help patients change behaviour in a motivational style that allows shared decision-making.

Health Behavior↗

Ambulatory blood pressure, sympathetic activity, and left ventricular structure and function in middle-aged normotensive men with exaggerated blood pressure response to exercise.

BACKGROUND: It is claimed that exaggerated blood pressure (BP) reactivity to behavioral stress may play a role in hypertension. This study aimed to clarify whether exaggerated BP reactivity during physical exercise is associated with any other abnormalities in ambulatory BP, autonomic nervous control, and target organ damage among middle-aged normotensive men. MATERIAL/METHODS: A total of 54 sedentary men (39+/-4 years old) with normal BP were enrolled in this study. Twenty-seven with exaggerated BP reactivity to exercise (ER) were compared with 27 age-matched controls with normal BP reactivity (NR). The subjects underwent 24-hour ambulatory BP monitoring, short-term Finapres recordings, a bicycle ergometry test, and M-mode and pulsed-Doppler echocardiography. RESULTS: The ambulatory BP measurements were significantly higher in the ER group than in the NR group averaged over a 24-hour period, during daytime and nighttime. Power spectral analysis from continuous Finapres data revealed increased systolic BP variability in the low frequency band in the ER group. During graded exercise, the ER group showed remarkable elevations in systolic and diastolic BP compared to the NR group without a difference in heart rate increments. Although the plasma epinephrine showed similar levels, yet the exercise-induced increase in plasma norepinephrine in the ER group was significantly greater than in the NR group. In echocardiographic dimensions, left ventricular internal diameter and mass index were not different, whereas the ER group presented significantly greater posterior wall thickness. Doppler functional data showed significant increase in the late to early flow velocity ratio in the ER group. CONCLUSIONS: Even in the absence of hypertension, exaggerated BP reactivity to physical exercise suggests greater BP elevation during daily activity as well as enhanced sympathetic nervous tonus, which may be considered a risk factor promoting hypertension, and these hemodynamic and neurohumoral behaviors are associated with a tendency to develop target organ abnormalities in the heart.

Adult↗

Ultrasonic myocardial texture in hypertensive mild-to-moderate left ventricular hypertrophy: a videodensitometric study.

Myocardial texture analysis of two-dimensional echocardiographic gray level distribution is abnormal in hypertensive patients with severe increase of left ventricular mass. The aim of this study was to investigate the behavior of this parameter in hypertensive patients with absent-to-moderate left ventricular hypertrophy, more representative of the overall hypertensive population. We compared male essential hypertensive patients, with absent or mild-to-moderate left ventricular hypertrophy, with normotensive sedentary healthy subjects as controls. The groups (n = 18 each) were age- (+/- 2 years) and sex-matched. All subjects performed ambulatory blood pressure measurements for the evaluation of 24 h mean systolic and diastolic blood pressure. Quantitative analysis of echocardiographic digitized imaging was performed through a calibrated 256 gray level digitization system to calculate midseptum and midposterior end-diastolic and end-systolic first and second order textural analysis. In particular were observed the mean gray level cyclic variations to deriving the cyclic variation index (CVI). The hypertensives showed a significantly lower CVI compared with controls both for septum (P < .001) and for posterior wall (P < .0001). No significant relationships were found between CVI and relative diastolic thickness both of septum and posterior wall. Conversely, a significant inverse relationship was found between systolic arterial pressure values and CVI both of septum and posterior wall. Abnormalities of two dimensional echocardiographic gray level distribution are present also in hypertensive patients with absent or with mild-to-moderate levels of left ventricular hypertrophy, but seem unrelated to the degree of echocardiographic hypertrophy as such. Changes in collagen network distribution or microcirculatory alterations, secondary to pressure-volume overload per se or to other complex humoral factors, could explain these abnormalities. Further work is needed to establish the clinical, therapeutic, and prognostic implications of these findings.

Adult↗