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Lifestyle intervention improves cardiovascular disease risk factors in young overweight women
Friday 2 November Papers / Journal of Science and Medicine in Sport 15 (2012) S188–S264
hourly to calculate the incremental area under the curve (iAUC) and high sensitivity C-reactive protein (hsCRP) was assessed at baseline and 7 hours. Seated brachial artery blood pressure was also measured every hour as a single measurement, 5 mins prior to each activity bout, with an automated oscillometric blood pressure monitor (Philips SureSigns VS3 Monitor). GEE models were adjusted for sex, age, BMI, fasting blood pressure and treatment order. Results: Systolic blood pressure decreased similarly and significantly during the light and moderate-intensity activity conditions [light: 120 ± 4 mmHg (hourly mean ± SEM), p = 0.002; moderate: 120 ± 3 mmHg, p = 0.02] compared to uninterrupted sitting (125 ± 4 mmHg). Diastolic blood pressure was also significantly reduced with both activity conditions (light: 78 ± 3 mmHg, p = 0.006; moderate: 78 ± 3 mmHg, p = 0.03) compared to uninterrupted sitting (79 ± 3 mmHg). No significant group differences were observed in triglyceride iAUC, hsCRP and the hourly measurement of heart rate. Discussion: These findings indicate that breaking up prolonged sitting with frequent short breaks of either light or moderateintensity physical activity may have favourable effects on seated blood pressure. Further studies are needed to evaluate the chronic effects of breaking up sedentary time on cardiovascular disease risk factors and the feasibility of such strategies in the general community. http://dx.doi.org/10.1016/j.jsams.2012.11.565 563 Is incidence of a health condition associated with physical activity change in adults over two years? A. Khan 1,∗ , W. Brown 2 , N. Burton 2 1
School of Health and Rehabilitation Sciences, The University of Queensland 2 School of Human Movement Studies, The University of Queensland Introduction: Physical activity is a recommended component of self management of many health conditions. The aim of this study was to examine if health status change or incidence of any of arthritis, diabetes, cardiovascular disease, or hypertension was associated with a change in physical activity level over a two year period. Methods: Data were from a mail survey conducted in Brisbane in 2007 and 2009 (n = 6427). Participants were mid aged adults aged 40–65 years at baseline. At each time point, respondents indicated whether or not they had each of arthritis, diabetes, cardiovascular disease, or hypertension. Incidence was defined as a change from “no” to “yes” for any of the four health conditions. A measure of physical activity during the previous week was derived (MET.mins) and categorized as inactive, very low, low, recommended, high, or very high level. Change in physical activity level was categorized as increase, decrease, or no change. Respondents indicated overall health status using a five point likert scale (strongly agree to strongly disagree) and change in health status was categorized as improve, decline, or no change. Data were analyzed using multilevel multinomial logistic regression with the reference category being no change in physical activity level. Results: Over the two years, 21% of adults developed at least one of the four health conditions, and 18% had improved and 23% had declined in health status. Approximately 34% increased their physical activity level and 30% decreased. About 19% of adults who had recommended to very high levels of physical activity in 2007 were below the recommended level of physical activity in 2009. After adjusting for the effects of sex, age, education, body mass
S233
index, and wellbeing, incidence of a health condition was not significantly associated with either an increase (OR = 1.18, 0.96–1.44) or decrease (OR = 1.14,0.92–1.41) in physical activity level over two years. However, those with an improved health status had higher odds for an increase in physical activity level (OR = 1.32, 1.07–1.63), and those with a decline in health status had higher odds for a decrease in physical activity level (OR = 1.45, 1.20–1.76). Discussion: This study offers no evidence of association between incidence of the four health conditions and a change (either increase or decrease) in physical activity. Subjective heath status could be a more useful means by which to understand changes in physical activity. However, further research is needed to examine the temporality of this association. http://dx.doi.org/10.1016/j.jsams.2012.11.566 564 Lifestyle intervention improves cardiovascular disease risk factors in young overweight women B. Share 1,∗ , J. Kemp 1 , G. Naughton 1 , P. Obert 2 , E. Aumand 1 1
Centre of Physical Activity Across the Lifespan, Australian Catholic University 2 Laboratory of Physiology and Physiopathology of Cardiovascular Adaptations to Exercise, University of Avgnon, France
Introduction: Heart disease claims the lives of 31 women every day in Australia. Despite this, heart health programs only target older women. A number of modifiable risk factors for cardiovascular disease (CVD) such as inactivity and abdominal obesity (elevated waist circumference) already exist in young women (aged 18 to 30 years) in Australia. Reductions to risk factors following a multidisciplinary lifestyle intervention are yet to be explored in young women, already at risk of CVD. The overall aim of this study was to test the effectiveness of a 12-wk multi-disciplinary lifestyle intervention (exercise, nutrition and cognitive behavioral therapy [CBT]) on CVD risk factors, specifically abdominal obesity (defined as a waist circumference ≥80 cm) and cardiovascular fitness in inactive young women, as an early detection and primary prevention program. Methods: Nineteen Caucasian women (age 22.3 ± 3.3 y, body mass 87.1 ± 19.9 kg), with abdominal obesity (waist circumference 90.7 ± 9.4 cm) and poor aerobic fitness (predicted VO2 max 28.3 ± 7.2 ml kg−1 min−1 ) participated in the intervention comprising weekly: i) two supervised (aerobic and resistance training circuit) and one unsupervised (brisk walk or jog) exercise sessions; ii) nutrition education about healthy lifestyle choices provided by a dietician; iii) one-hour group CBT session which offered psychosocial support and developed skills to overcome personal barriers. Paired-sample t-tests compared means of pre and post CVD risk factors and lifestyle-related changes Results: Waist circumference (87.3 ± 9.8 cm, P < 0.01, d = 0.3) and cardiovascular fitness [predicted VO2 max] (32.8 ± 6.6 ml kg−1 min−1 , P < 0.05, d = 0.6) were improved in association with the lifestyle intervention. Preliminary analysis also showed positive dietary changes over the 12-week program with a reduction in total energy consumption and fat intake compared to baseline data Discussion: The intervention in this study was effective in reducing waist circumference. Waist circumference is a strong indicator of single and multiple risk factors in CVD. Therefore, a lifestyle intervention incorporating physical activity, nutrition education and CBT may be effective as a primary prevention program for reducing cardiovascular risk factors, as well as enhancing cardio-
S234
Friday 2 November Papers / Journal of Science and Medicine in Sport 15 (2012) S188–S264
vascular fitness, in young overweight women. The sustainability of positive health changes requires exploration to ascertain the continued effectiveness of such programs. http://dx.doi.org/10.1016/j.jsams.2012.11.567 565 Sport participation and metablic health in adolescents: Is more always better? S. Brouwer 1,∗ , R. Stolk 2 , E. Liem 3 , K. Lemmink 1 , E. Corpeleijn 2 1
Hanze University Groningen Institute for Sportstudies University Medical Centre Groningen, Department Epidemiology 3 University Medical Centre Groningen, Department Pediatrics 2
Introduction: High levels of physical activity and sports participation are associated with more advantageous metabolic outcomes. The aim of this study was to examine the effect of the level of competition in sports and its effects on metabolic risk. Methods: Participants from the ‘Tracking Adolescents’ Individuals Lives Survey’ (TRAILS) with measures for sport participation and with fasting blood samples were included in this analysis (n = 1188). Data on sport participation (type, frequency and duration) were collected at age 16 (September 2005–Dec 2007) by questionnaire. Level of competition (not active in sports, active in sports but not in competition, local, regional, national or international competition) were filled in. A clustered metabolic risk score was calculated as the mean of the Z-scores of waist circumference, triglycerides, HDL-cholesterol and mean arterial pressure. Insulin resistance (IR) was assessed as HOMA-IR. Cardiorespiratory fitness (CRF) was estimated using the Shuttle Run Test in a subsample (n = 565). Results: With the increasing level of competition, this study observed increasing time spent in sports (p < 0.001), more training sessions (p < 0.001) and higher VO2 max (p < 0.001). Also HOMAIR (p = 0.003) and fasting insulin concentrations (p < 0.001) were different. Not engaging in sports or competition at the highest level showed increased insulin concentrations and HOMA-IR. Interestingly, being active at a regional level showed lowest insulin concentrations and HOMA-IR. No effects on the clustered metabolic risk score were found. Discussions: This study showed a U-shaped association curve between level of sport competition and insulin and HOMA-IR with lowest levels for regional competitors. Therefore engaging in (inter)national competition level and thus participating in sports more often is not always healthier.
Stage of Change behaviour change model to a one-year organisational intervention to promote physical activity and reduce sedentary behaviours in employees. Method: Ten worksites were recruited and allocated to a staged intervention, standard intervention or control intervention group. Intervention information was delivered to participants, which was dependent on their intervention group allocation and their readiness to change physical activity behaviours. Health assessments were conducted onsite to collect physiological measures (height, weight, Body Mass Index (BMI), body composition, blood pressure and resting heart rate) and psychological measures (lifestyle and physical activity information, sitting time data, work ability, self reported general health and job attitudes). Results from baseline and mid-intervention data-points are presented. Results: A total of 1120 participants signed up to participate in the intervention programme. In terms of the demographic profile, 54% were male and the average BMI score was 26.7 (range = 16.8–49.6, SD = 4.8) kg/m2 . At the mid-intervention assessment, 86.5% of participants reported using a pedometer compared to 24.2% at baseline. The mean time spent walking on a particular day of activity for the sample at the mid-intervention point was 129 (SD = 97.3) minutes compared to 53.8 (SD = 71.4) minutes at baseline. There was a statistically significant difference in BMI scores for the groups during mid-intervention: F (2, 368) = 3.43, p = .03. Posthoc tests indicated that mean BMI scores for the staged intervention group (M = 25.7 kg/m≤, SD = 4.9 kg/m≤) was significantly different from the standard (M = 27.2 kg/m2 , SD = 4.4 kg/m2 ) and control (M 27.2 kg/m2 , SD = 4.9 kg/m2 ) intervention groups Discussion: The results provide an insight into how physical activity interventions can be modified to deliver tailored information based on an individual’s readiness to change their physical activity behaviours. Participants in the yearlong intervention are now being followed up for a further twelve months. This research has developed tried and tested physical activity interventions that could be usefully adopted by organisations to maintain and promote the health of workers across the life course. http://dx.doi.org/10.1016/j.jsams.2012.11.569 567 The interpersonal and ecological factors influencing employee health status in South African worksites T. Kolbe-Alexander 1,∗ , M. Greyling 2 , K. Milner 2 , R. da Silva 2 , M. Beckowski 3 , D. Patel 4 , L. Wyper 4 , R. Goetzel 3,5 1
University Cape Town University of Witwatersrand 3 Emory University 4 Discovery Health 5 Thomson Reuters Consulting and Applied Research 2
http://dx.doi.org/10.1016/j.jsams.2012.11.568 566 Physical activity interventions to promote employee health and wellbeing: A Stage of Change approach A. Kazi 1,∗ , C. Haslam 1 , M. Duncan 1 , S. Clemes 1 , L. Kerr 1 , R. Twumasi 1 1
Loughborough University
Introduction: Sitting time and sedentary activity is developing into a major public health priority. Research suggests time spent in sedentary behaviours represent a unique aspect of human behaviour, independent of physical activity. A challenge for any physical activity intervention programme is to create sustained change in behaviour. This research applied the health psychology
Introduction: The workplace has been identified as an opportune setting for health promotion programs and can include environmental approaches to increasing access to healthy choices. The aim of this research study is to investigate the relationship between the availability of wellness facilities with employee health status and lifestyle behaviors (physical activity (PA), nutrition) in South African worksites. Methods: Employers (n = 71) and employees (n = 11472) volunteered to participate in a national Healthy Company Index survey. The Human Resource Manger completed the Employer Questionnaire that assessed current health promotion initiatives, on-site facilities, company health-related policy and leadership support. The Employee questionnaire included self reported clinical meas-
hourly to calculate the incremental area under the curve (iAUC) and high sensitivity C-reactive protein (hsCRP) was assessed at baseline and 7 hours. Seated brachial artery blood pressure was also measured every hour as a single measurement, 5 mins prior to each activity bout, with an automated oscillometric blood pressure monitor (Philips SureSigns VS3 Monitor). GEE models were adjusted for sex, age, BMI, fasting blood pressure and treatment order. Results: Systolic blood pressure decreased similarly and significantly during the light and moderate-intensity activity conditions [light: 120 ± 4 mmHg (hourly mean ± SEM), p = 0.002; moderate: 120 ± 3 mmHg, p = 0.02] compared to uninterrupted sitting (125 ± 4 mmHg). Diastolic blood pressure was also significantly reduced with both activity conditions (light: 78 ± 3 mmHg, p = 0.006; moderate: 78 ± 3 mmHg, p = 0.03) compared to uninterrupted sitting (79 ± 3 mmHg). No significant group differences were observed in triglyceride iAUC, hsCRP and the hourly measurement of heart rate. Discussion: These findings indicate that breaking up prolonged sitting with frequent short breaks of either light or moderateintensity physical activity may have favourable effects on seated blood pressure. Further studies are needed to evaluate the chronic effects of breaking up sedentary time on cardiovascular disease risk factors and the feasibility of such strategies in the general community. http://dx.doi.org/10.1016/j.jsams.2012.11.565 563 Is incidence of a health condition associated with physical activity change in adults over two years? A. Khan 1,∗ , W. Brown 2 , N. Burton 2 1
School of Health and Rehabilitation Sciences, The University of Queensland 2 School of Human Movement Studies, The University of Queensland Introduction: Physical activity is a recommended component of self management of many health conditions. The aim of this study was to examine if health status change or incidence of any of arthritis, diabetes, cardiovascular disease, or hypertension was associated with a change in physical activity level over a two year period. Methods: Data were from a mail survey conducted in Brisbane in 2007 and 2009 (n = 6427). Participants were mid aged adults aged 40–65 years at baseline. At each time point, respondents indicated whether or not they had each of arthritis, diabetes, cardiovascular disease, or hypertension. Incidence was defined as a change from “no” to “yes” for any of the four health conditions. A measure of physical activity during the previous week was derived (MET.mins) and categorized as inactive, very low, low, recommended, high, or very high level. Change in physical activity level was categorized as increase, decrease, or no change. Respondents indicated overall health status using a five point likert scale (strongly agree to strongly disagree) and change in health status was categorized as improve, decline, or no change. Data were analyzed using multilevel multinomial logistic regression with the reference category being no change in physical activity level. Results: Over the two years, 21% of adults developed at least one of the four health conditions, and 18% had improved and 23% had declined in health status. Approximately 34% increased their physical activity level and 30% decreased. About 19% of adults who had recommended to very high levels of physical activity in 2007 were below the recommended level of physical activity in 2009. After adjusting for the effects of sex, age, education, body mass
S233
index, and wellbeing, incidence of a health condition was not significantly associated with either an increase (OR = 1.18, 0.96–1.44) or decrease (OR = 1.14,0.92–1.41) in physical activity level over two years. However, those with an improved health status had higher odds for an increase in physical activity level (OR = 1.32, 1.07–1.63), and those with a decline in health status had higher odds for a decrease in physical activity level (OR = 1.45, 1.20–1.76). Discussion: This study offers no evidence of association between incidence of the four health conditions and a change (either increase or decrease) in physical activity. Subjective heath status could be a more useful means by which to understand changes in physical activity. However, further research is needed to examine the temporality of this association. http://dx.doi.org/10.1016/j.jsams.2012.11.566 564 Lifestyle intervention improves cardiovascular disease risk factors in young overweight women B. Share 1,∗ , J. Kemp 1 , G. Naughton 1 , P. Obert 2 , E. Aumand 1 1
Centre of Physical Activity Across the Lifespan, Australian Catholic University 2 Laboratory of Physiology and Physiopathology of Cardiovascular Adaptations to Exercise, University of Avgnon, France
Introduction: Heart disease claims the lives of 31 women every day in Australia. Despite this, heart health programs only target older women. A number of modifiable risk factors for cardiovascular disease (CVD) such as inactivity and abdominal obesity (elevated waist circumference) already exist in young women (aged 18 to 30 years) in Australia. Reductions to risk factors following a multidisciplinary lifestyle intervention are yet to be explored in young women, already at risk of CVD. The overall aim of this study was to test the effectiveness of a 12-wk multi-disciplinary lifestyle intervention (exercise, nutrition and cognitive behavioral therapy [CBT]) on CVD risk factors, specifically abdominal obesity (defined as a waist circumference ≥80 cm) and cardiovascular fitness in inactive young women, as an early detection and primary prevention program. Methods: Nineteen Caucasian women (age 22.3 ± 3.3 y, body mass 87.1 ± 19.9 kg), with abdominal obesity (waist circumference 90.7 ± 9.4 cm) and poor aerobic fitness (predicted VO2 max 28.3 ± 7.2 ml kg−1 min−1 ) participated in the intervention comprising weekly: i) two supervised (aerobic and resistance training circuit) and one unsupervised (brisk walk or jog) exercise sessions; ii) nutrition education about healthy lifestyle choices provided by a dietician; iii) one-hour group CBT session which offered psychosocial support and developed skills to overcome personal barriers. Paired-sample t-tests compared means of pre and post CVD risk factors and lifestyle-related changes Results: Waist circumference (87.3 ± 9.8 cm, P < 0.01, d = 0.3) and cardiovascular fitness [predicted VO2 max] (32.8 ± 6.6 ml kg−1 min−1 , P < 0.05, d = 0.6) were improved in association with the lifestyle intervention. Preliminary analysis also showed positive dietary changes over the 12-week program with a reduction in total energy consumption and fat intake compared to baseline data Discussion: The intervention in this study was effective in reducing waist circumference. Waist circumference is a strong indicator of single and multiple risk factors in CVD. Therefore, a lifestyle intervention incorporating physical activity, nutrition education and CBT may be effective as a primary prevention program for reducing cardiovascular risk factors, as well as enhancing cardio-
S234
Friday 2 November Papers / Journal of Science and Medicine in Sport 15 (2012) S188–S264
vascular fitness, in young overweight women. The sustainability of positive health changes requires exploration to ascertain the continued effectiveness of such programs. http://dx.doi.org/10.1016/j.jsams.2012.11.567 565 Sport participation and metablic health in adolescents: Is more always better? S. Brouwer 1,∗ , R. Stolk 2 , E. Liem 3 , K. Lemmink 1 , E. Corpeleijn 2 1
Hanze University Groningen Institute for Sportstudies University Medical Centre Groningen, Department Epidemiology 3 University Medical Centre Groningen, Department Pediatrics 2
Introduction: High levels of physical activity and sports participation are associated with more advantageous metabolic outcomes. The aim of this study was to examine the effect of the level of competition in sports and its effects on metabolic risk. Methods: Participants from the ‘Tracking Adolescents’ Individuals Lives Survey’ (TRAILS) with measures for sport participation and with fasting blood samples were included in this analysis (n = 1188). Data on sport participation (type, frequency and duration) were collected at age 16 (September 2005–Dec 2007) by questionnaire. Level of competition (not active in sports, active in sports but not in competition, local, regional, national or international competition) were filled in. A clustered metabolic risk score was calculated as the mean of the Z-scores of waist circumference, triglycerides, HDL-cholesterol and mean arterial pressure. Insulin resistance (IR) was assessed as HOMA-IR. Cardiorespiratory fitness (CRF) was estimated using the Shuttle Run Test in a subsample (n = 565). Results: With the increasing level of competition, this study observed increasing time spent in sports (p < 0.001), more training sessions (p < 0.001) and higher VO2 max (p < 0.001). Also HOMAIR (p = 0.003) and fasting insulin concentrations (p < 0.001) were different. Not engaging in sports or competition at the highest level showed increased insulin concentrations and HOMA-IR. Interestingly, being active at a regional level showed lowest insulin concentrations and HOMA-IR. No effects on the clustered metabolic risk score were found. Discussions: This study showed a U-shaped association curve between level of sport competition and insulin and HOMA-IR with lowest levels for regional competitors. Therefore engaging in (inter)national competition level and thus participating in sports more often is not always healthier.
Stage of Change behaviour change model to a one-year organisational intervention to promote physical activity and reduce sedentary behaviours in employees. Method: Ten worksites were recruited and allocated to a staged intervention, standard intervention or control intervention group. Intervention information was delivered to participants, which was dependent on their intervention group allocation and their readiness to change physical activity behaviours. Health assessments were conducted onsite to collect physiological measures (height, weight, Body Mass Index (BMI), body composition, blood pressure and resting heart rate) and psychological measures (lifestyle and physical activity information, sitting time data, work ability, self reported general health and job attitudes). Results from baseline and mid-intervention data-points are presented. Results: A total of 1120 participants signed up to participate in the intervention programme. In terms of the demographic profile, 54% were male and the average BMI score was 26.7 (range = 16.8–49.6, SD = 4.8) kg/m2 . At the mid-intervention assessment, 86.5% of participants reported using a pedometer compared to 24.2% at baseline. The mean time spent walking on a particular day of activity for the sample at the mid-intervention point was 129 (SD = 97.3) minutes compared to 53.8 (SD = 71.4) minutes at baseline. There was a statistically significant difference in BMI scores for the groups during mid-intervention: F (2, 368) = 3.43, p = .03. Posthoc tests indicated that mean BMI scores for the staged intervention group (M = 25.7 kg/m≤, SD = 4.9 kg/m≤) was significantly different from the standard (M = 27.2 kg/m2 , SD = 4.4 kg/m2 ) and control (M 27.2 kg/m2 , SD = 4.9 kg/m2 ) intervention groups Discussion: The results provide an insight into how physical activity interventions can be modified to deliver tailored information based on an individual’s readiness to change their physical activity behaviours. Participants in the yearlong intervention are now being followed up for a further twelve months. This research has developed tried and tested physical activity interventions that could be usefully adopted by organisations to maintain and promote the health of workers across the life course. http://dx.doi.org/10.1016/j.jsams.2012.11.569 567 The interpersonal and ecological factors influencing employee health status in South African worksites T. Kolbe-Alexander 1,∗ , M. Greyling 2 , K. Milner 2 , R. da Silva 2 , M. Beckowski 3 , D. Patel 4 , L. Wyper 4 , R. Goetzel 3,5 1
University Cape Town University of Witwatersrand 3 Emory University 4 Discovery Health 5 Thomson Reuters Consulting and Applied Research 2
http://dx.doi.org/10.1016/j.jsams.2012.11.568 566 Physical activity interventions to promote employee health and wellbeing: A Stage of Change approach A. Kazi 1,∗ , C. Haslam 1 , M. Duncan 1 , S. Clemes 1 , L. Kerr 1 , R. Twumasi 1 1
Loughborough University
Introduction: Sitting time and sedentary activity is developing into a major public health priority. Research suggests time spent in sedentary behaviours represent a unique aspect of human behaviour, independent of physical activity. A challenge for any physical activity intervention programme is to create sustained change in behaviour. This research applied the health psychology
Introduction: The workplace has been identified as an opportune setting for health promotion programs and can include environmental approaches to increasing access to healthy choices. The aim of this research study is to investigate the relationship between the availability of wellness facilities with employee health status and lifestyle behaviors (physical activity (PA), nutrition) in South African worksites. Methods: Employers (n = 71) and employees (n = 11472) volunteered to participate in a national Healthy Company Index survey. The Human Resource Manger completed the Employer Questionnaire that assessed current health promotion initiatives, on-site facilities, company health-related policy and leadership support. The Employee questionnaire included self reported clinical meas-