Publications by authors named "Xuemei Sui"

223 Publications

The association of fitness and fatness with intermediate hyperglycemia incidence in women: A cohort study.

Prev Med 2021 Apr 20;148:106552. Epub 2021 Apr 20.

University of South Carolina, Columbia, SC, USA.

The purpose of this study was to examine the associations of cardiorespiratory fitness, general adiposity, and central adiposity with incident intermediate hyperglycemia (IH) in women. We conducted a prospective cohort study of 1534 women aged 20-79 years old who had an annual health check-up with no history of major chronic diseases. At baseline, fitness was assessed by a Balke graded exercise test, and the estimated metabolic equivalents were used to create quartile groups. Women were also grouped based on their body mass index (<25 kg/m, 25-29.9 kg/m, and ≥ 30 kg/m) and waist-to-height ratio (≥0.50 or < 0.50). Cox proportional hazards models were conducted to assess the association of fitness and fatness variables with incident IH defined as fasting glucose of 5.6-6.9 mmol/L. Overall, 18.1% (n = 277) of the women developed IH during an average follow-up of 5.06 years. Fitness, body mass index, and waist-to-height ratio at baseline were the independent predictors of the IH incidence in separate age-adjusted models; yet when all three variables were included in the same model along with confounding variables, only fitness remained significant and demonstrated a clear inverse association with incident IH (P-for-trend <0.001). Health promotion efforts should focus on improving fitness for the prevention of IH in women.
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http://dx.doi.org/10.1016/j.ypmed.2021.106552DOI Listing
April 2021

Changes in Compliance With Physical Activity Guidelines and Cardiovascular Disease Mortality.

J Phys Act Health 2021 Apr 9:1-6. Epub 2021 Apr 9.

Background: The effects of compliance with the US Physical Activity (PA) Guidelines and changes in compliance over time on cardiovascular disease (CVD) mortality are unknown.

Methods: Male participants in the Aerobics Center Longitudinal Study (n = 15,411; 18-100 y) reported leisure-time PA between 1970 and 2002. The frequency of and time spent in PA were converted into metabolic equivalent minutes per week. The participants were classified into remained inactive, became active, became inactive, or remained active groups according to their achievement of the PA guidelines along the follow-up, equivalent here to at least 500 metabolic equivalent minutes of PA per week. Cox regression adjusted for different models was used for the analyses, using age, body mass index, smoking and drinking status, hypertension, diabetes, hypercholesterolemia, and parental history of CVD.

Results: Over a mean follow-up of 6.2 years, 439 CVD deaths occurred. Consistently meeting the PA guidelines, compared with not meeting, was associated with a 54% (95% confidence interval, 0.32-0.67) decreased risk of CVD mortality. After controlling for all potential confounders, the risk reduction was 47% (95% confidence interval, 0.36-0.77).

Conclusions: Maintaining adherence to the PA guidelines produces substantial reductions in the risk of CVD deaths in men. Furthermore, discontinuing compliance with the guidelines may offset the beneficial effects on longevity.
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http://dx.doi.org/10.1123/jpah.2020-0740DOI Listing
April 2021

Muscle strength cut-points for metabolic syndrome detection among adults and the elderly from Brazil.

Appl Physiol Nutr Metab 2021 Apr;46(4):379-388

Research Center in Kinanthropometry and Human Performance. Federal University of Santa Catarina. Florianópolis, SC 88040900, Brazil.

We aimed to determine cut-points for muscle strength based on metabolic syndrome diagnosis. This cross-sectional analysis comprised data from 2 cohorts in Brazil (EpiFloripa Adult, = 626, 44.0 ± 11.1 years; EpiFloripa Aging, = 365, 71.6 ± 6.1 years). Metabolic syndrome was assessed by relative handgrip strength (kgf/kg). Metabolic syndrome was defined as including ≥3 of the 5 metabolic abnormalities according to the Joint Interim Statement. Optimal cut-points from Receiver Operating Characteristic (ROC) curves were determined. Adjusted logistic regression was used to test the association between metabolic syndrome and the cut-points created. The cut-point identified for muscle strength was 1.07 kgf/kg (Youden index = 0.310; area under the curve (AUC)) = 0.693, 95% CI 0.614-0.764) for men and 0.73 kgf/kg (Youden index = 0.481; AUC = 0.768, 95% confidence interval (CI) = 0.709-0.821) for women (age group 25 to < 50 years). The best cut-points for men and women aged 50+ years were 0.99 kgf/kg (Youden index = 0.312; AUC = 0.651; 95% CI = 0.583-0.714) and 0.58 kgf/kg (Youden index = 0.378; AUC = 0.743; 95% CI = 0.696-0.786), respectively. Cut-points derived from ROC analysis have good discriminatory power for metabolic syndrome among adults aged 25 to <50 years but not for adults aged 50+ years. First-line management recommendation for metabolic syndrome is lifestyle modification, including improvement of muscle strength. Cut-points for muscle strength levels according to sex and age range based on metabolic syndrome were created. Cut-points for muscle strength can assist in the identification of adults at risk for cardiometabolic disease.
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http://dx.doi.org/10.1139/apnm-2020-0758DOI Listing
April 2021

Resting Heart Rate and Risk of Cancer Mortality.

Cancer Epidemiol Biomarkers Prev 2021 Apr 7. Epub 2021 Apr 7.

Arnold School of Public Health, University of South Carolina.

Background: Increased resting heart rate (RHR) is a predictor of mortality. RHR is influenced by cardiorespiratory fitness (CRF). Little is known about the combined associations of RHR and CRF on cancer mortality.

Methods: 50,108 men and women (mean age 43.8 years) were examined between 1974 and 2002 at the Cooper Clinic in Dallas, Texas. RHR was measured by electrocardiogram and categorized as <60, 60-69, 70-79, or >=80 beats/min. CRF was quantified by maximal treadmill test and dichotomized as unfit and fit corresponding to the lower 20% and the upper 80%, respectively, of the age- and sex-specific distribution of treadmill exercise duration. The National Death Index was used to ascertain vital status. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer mortality across RHR categories.

Results: During a mean follow-up of 15.0 (8.6) years, 1,090 cancer deaths occurred. Compared with RHR <60 beats/min, individuals with RHR >=80 beats/min had 35% increased risk of overall cancer mortality (HR, 1.35; CI, 1.06-1.71) after adjusting for confounders, including CRF. Compared with "fit and RHR <80 beats/min", HRs (95% CIs) for cancer mortality were 1.41 (1.20-1.66), 1.51 (1.11-2.04), and 1.78 (1.30-2.43) in "unfit and RHR<80", "fit and RHR >=80", and "unfit and RHR >=80 beats/min", respectively.

Conclusions: RHR >=80 is associated with an increased risk of overall cancer mortality. High CRF may help lower the risk of cancer mortality among those with high RHR.

Impact: RHR along with CRF may provide informative data about an individual's cancer mortality risk.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-1731DOI Listing
April 2021

The independent and joint associations among muscle strength, abdominal obesity and cardiometabolic variables among adults.

Eur J Sport Sci 2021 Apr 2:1-10. Epub 2021 Apr 2.

Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil.

The aim of the present study was to investigate the independent and joint associations among muscle strength (MS) and obesity with blood pressure, atherosclerosis, and laboratory markers. This was a cross-sectional study comprising a representative sample of 642 adults (men: 44.9%, 39.9 ± 11.2 years; women: 55.1%, 39.3 ± 11.1 years) from Florianópolis, Brazil. MS was assessed by handgrip strength. Obesity was defined as a Body Mass Index (BMI) ≥30.0 kg/m² and a waist circumference ≥80.0 cm in women and ≥90.0 cm in men. Clinical variables included systolic (SBP) and diastolic blood pressure (DBP), C-reactive protein (CRP), lipids, glucose metabolism markers and carotid intima-media thickness (IMT). Linear regression models stratified by sex and adjusted for confounders were used. Higher MS levels were related to lower CRP (up to 0.59 times lower), triglycerides (up to 0.33 times lower), HOMA-IR (up to 0.35 times lower), and higher HDL cholesterol (up to 5.2 mg/dL) levels among men. Among women, higher MS levels were related to lower SBP and DBP (up to -10.2 mmHg), CRP (up to 0.56 times lower), HOMA-IR (up to 0.27 times lower) and IMT (up to -4.8 × 10 mm). In addition, MS was inversely related to triglycerides and HOMA-IR among obese men, inversely related to CRP among obese men and women, and inversely associated to DBP only among obese women. This population-based study corroborates findings from clinical studies suggesting that even among individuals with obesity, higher MS might help adults to reduce cardiometabolic risk. HighlightsMuscle strength levels were directly associated with better prognosis in relation to cardiometabolic variables in individuals with or without abdominal obesity.Among men with abdominal obesity, to have higher values of muscle strength were associated with lower values of diastolic blood pressure, C-reactive protein, triglycerides, cholesterol and HOMA-IR.Higher muscle strength levels were inversely associated with C-reactive protein among women with abdominal obesity; Higher muscle strength might help adults to reduce cardiometabolic risk.
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http://dx.doi.org/10.1080/17461391.2021.1902571DOI Listing
April 2021

Temporal changes in personal activity intelligence and mortality: Data from the aerobics center longitudinal study.

Prog Cardiovasc Dis 2021 Jan-Feb;64:127-134. Epub 2020 Dec 25.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; School of Human Movement & Nutrition Sciences, University of Queensland, Australia.

Background: Personal activity intelligence (PAI) is a metric developed to simplify a physically active lifestyle for the participants. Regardless of following today's advice for physical activity, a PAI score ≥100 per week at baseline, an increase in PAI score, and a sustained high PAI score over time were found to delay premature cardiovascular disease (CVD) and all-cause mortality in a large population of Norwegians. However, the association between long-term temporal change in PAI and mortality in other populations have not been investigated.

Objective: To test whether temporal change in PAI is associated with CVD and all-cause mortality in a large population from the United States.

Methods: We studied 17,613 relatively healthy participants who received at least two medical examinations in the Aerobics Center Longitudinal Study between 1974 and 2002. The participant's weekly PAI scores were estimated twice, and adjusted hazard ratios (AHR) and 95% confidence intervals (CI) for CVD and all-cause mortality related to changes in PAI between baseline and last examination were assessed using Cox proportional hazard regression analyses.

Results: During a median follow-up time of 9.3 years [interquartile range, 2.6-16.6; 181,765 person-years], there were 1144 deaths, including 400 CVD deaths. We observed an inverse linear association between change in PAI and risk of CVD mortality (P=0.007 for linear trend, and P=0.35 for quadratic trend). Compared to participants with zero PAI at both examinations, multivariable-adjusted analyses demonstrated that participants who maintained high PAI scores (≥100 PAI at both examinations) had a 51% reduced risk of CVD mortality [AHR, 0.49: 95% CI, 0.26-0.95)], and 42% reduced risk of all-cause mortality [AHR, 0.58: 95% CI, 0.41-0.83)]. For participants who increased their PAI scores over time (PAI score of zero at first examination and ≥100 at last examination), the AHRs were 0.75 (95% CI, 0.55-1.02) for CVD mortality, and 0.82 (95% CI, 0.69-0.99) for all-cause mortality. Participants who maintained high PAI score had 4.8 (95% CI, 3.3-6.4) years of life gained. For those who increased their PAI score over time, the corresponding years gained were 1.8 years (95% CI, 0.1-3.5).

Conclusion: Among relatively healthy participants, an increase in PAI and maintaining a high PAI score over time was associated with reduced risk of CVD and all-cause mortality.

Condensed Abstract: Our objective was to investigate the association between temporal changes in PAI and mortality in a large population from the United States. In this prospective cohort study of 17,613 relatively healthy participants at baseline, maintaining a high PAI score and an increase in PAI score over an average period of 6.3 years was associated with a significant reduction in CVD and all-cause mortality. Based on our results, clinicians can easily recommend that patients obtain at least 100 PAI for most favourable protection against CVD- and all-cause mortality, but can also mention that significant benefits also occur at maintaining low-to-moderate PAI levels.
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http://dx.doi.org/10.1016/j.pcad.2020.12.001DOI Listing
December 2020

Association between type 2 diabetes and non-exercise estimated cardiorespiratory fitness among adults: evidences from a middle-income country.

Public Health 2020 Dec 16;189:110-114. Epub 2020 Nov 16.

University of South Carolina, Department of Exercise Science, Division of Health Aspects of Physical Activity, Columbia, USA.

Objective: The objective of this study is to assess the association between type 2 diabetes (T2D) and cardiorespiratory fitness (CRF) estimated through a non-exercise model in a large representative group of Brazilian adults.

Study Design: The study design of this study is a cross-sectional population-based study.

Methods: The presence of T2D was assessed through self-report in 42,631 individuals aged 20-59 years. The CRF was predicted from a non-exercise equation containing the following data: sex, age, body mass index, and physical activity level. The corresponding metabolic equivalent (MET) value was used to classify participants into the following four groups based on the cutpoints: <6, 6-9, 10-11, and ≥12 METs. Crude and multivariable-adjusted logistic regressions were carried out to determine the association between CRF and the presence of diabetes.

Results: Significant linear trends were observed in diabetes across different categories of CRF in men. In women, however, linear trends were not observed in T2D across '10-11' and '≥12' categories. A 1-MET increase in estimated CRF was associated with 29% lower odds of diabetes in men and 14% in women after adjusting all the potential confounders (P < 0.001).

Conclusions: The presence of T2D was inversely associated with every CRF level in men and with 6-9 METs when comparing with <6 METs in women, through a non-exercise model in Brazilian adults. This finding suggests that a practical, viable, and low-cost measurement of CRF could be applied in lower income countries to assess the relationship between CRF and T2D. However, new non-exercise models are needed to better detect T2D in women.
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http://dx.doi.org/10.1016/j.puhe.2020.09.020DOI Listing
December 2020

Waist circumference does not improve established cardiovascular disease risk prediction modeling.

PLoS One 2020 2;15(10):e0240214. Epub 2020 Oct 2.

School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.

Despite considerable evidence demonstrating that waist circumference (WC) is independently associated with cardiovascular disease (CVD) and/or all-cause mortality, whether the addition of WC improves risk prediction models is unclear. The objective was to evaluate the improvement in risk prediction with the addition of WC, alone or in combination with BMI, to the Framingham Risk Score (FRS) and a population specific model. 34,377 men and 9,477 women aged 20 to 79 years who completed a baseline examination at the Cooper Clinic (Dallas, TX) during 1977-2003 and enrolled in the Aerobics Center Longitudinal Study (ACLS). WC was measured at the level of the umbilicus and expressed as a continuous variable. Deaths among participants were identified using the National Center for Health Statistics National Death Index. A total of 728 fatal cardiovascular disease (CVD) events occurred over a mean follow-up period of 13.1 ± 7.5 years. WC was significantly higher in CVD decedents (P = .002). The FRS C-statistic for fatal CVD in men was 0.836 (0.816-0.855) and 0.883 (0.851-0.915) in women. The addition of WC did not improve the C-statistic in men (0.831 (0.809-0.853)) or women (0.883 (0.850-0.916)). Similar findings were observed for non-fatal CVD and all-cause mortality, and when WC was added to a population specific model. Upon adding WC, the net-reclassification index was 0.024 with an integrated discrimination improvement of -0.0004. The addition of WC, alone or in combination with BMI, did not substantively improve risk prediction for CVD or all-cause mortality compared to the Framingham Risk Score or a population specific model.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240214PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531816PMC
December 2020

Semiparametric regression of the illness-death model with interval censored disease incidence time: An application to the ACLS data.

Stat Methods Med Res 2020 Dec 8;29(12):3707-3720. Epub 2020 Jul 8.

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.

To investigate the effect of fitness on cardiovascular disease and all-cause mortality using the Aerobics Center Longitudinal Study, we develop a semiparametric illness-death model account for intermittent observations of the cardiovascular disease incidence time and the right censored data of all-cause mortality. The main challenge in estimation is to handle the intermittent observations (interval censoring) of cardiovascular disease incidence time and we develop a semiparametric estimation method based on the expectation-maximization algorithm for a Markov illness-death regression model. The variance of the parameters is estimated using profile likelihood methods. The proposed method is evaluated using extensive simulation studies and illustrated with an application to the Aerobics Center Longitudinal Study data.
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http://dx.doi.org/10.1177/0962280220939123DOI Listing
December 2020

Association between change in maternal physical activity during pregnancy and infant size, in a sample overweight or obese women.

Women Health 2020 09 26;60(8):929-938. Epub 2020 Jun 26.

University of South Carolina , Columbia, SC, USA.

Physical activity (PA) naturally declines during pregnancy and its effects on infant size are unclear, especially in overweight or obese pregnancies, a low-active subpopulation that tends deliver heavier infants. The objective of this study was to evaluate changes in prenatal PA and infant birthweight in a group of overweight or obese pregnant women. We employed a prospective analysis using data from a randomized controlled exercise trial (2001 to 2006) in sedentary, overweight or obese pregnant women in Michigan. Women with complete data on peak oxygen consumption, daily PA (via pedometers) and birthweight were included in the analyses. Change in PA was estimated via repeated measures analyses, and then its influence on infant birthweight was assessed via linear regression. Eighty-nine pregnant women were included and considered low-active (6,579.91 ± 2379.17 steps/day). PA declined from months 4 to 8 (-399.73 ± 371.38 steps∙day∙month). Analyses showed that the decline in PA (β = -0.28 g, 95%CI: -0.70, 0.25 g, = .35) was not associated with birthweight. The findings of this study demonstrated that the decline in maternal PA during mid- to late-pregnancy, in overweight or obese women, was unrelated to infant birthweight. Future investigations should employ rigorous measurements of PA and infant anthropometry in this subpopulation.
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http://dx.doi.org/10.1080/03630242.2020.1779904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415545PMC
September 2020

Personal activity intelligence and mortality - Data from the Aerobics Center Longitudinal Study.

Prog Cardiovasc Dis 2021 Jan-Feb;64:121-126. Epub 2020 Jun 16.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; School of Human Movement & Nutrition Sciences, University of Queensland, Australia.

Importance: Personal activity intelligence (PAI) is a novel activity metric that can be integrated into self-assessment heart rate devices, and translates heart rate variations during exercise into a weekly score. Previous studies relating to PAI have been conducted in the same populations from Norway where the PAI metric has been derived, limiting generalizability of the results.

Objective: To test whether PAI is associated with total and cause-specific mortality in a large cohort from the United States.

Design: Aerobics Center Longitudinal Study (ACLS) - a prospective cohort between January 1974 and December 2002 with a mean follow-up of 14.5 years.

Setting: Population-based.

Participants: 56,175 relatively healthy participants (26.5% women) who underwent extensive preventive medical examinations at Cooper Clinic (Dallas, TX).

Exposure: Personal activity intelligence (PAI) score per week was estimated and divided into 4 groups (PAI scores of 0, ≤50, 51-99, and ≥100).

Main Outcomes And Measures: Total and cause-specific mortality.

Results: During a median follow-up time of 14.9 (interquartile range, 6.7-21.4) years, there were 3434 total deaths including 1258 cardiovascular (CVD) deaths. Compared with the inactive (0 PAI) group, participants with a baseline weekly ≥100 PAI had lower risk of mortality: adjusted hazard ratio (AHR), 0.79: 95% CI, 0.71-0.87 for all-cause mortality, and AHR, 0.72: 95% CI, 0.60-0.87 for CVD mortality among men; AHR, 0.85: 95% CI, 0.64-1.12 for all-cause mortality, and AHR, 0.48: 95% CI, 0.26-0.91 for CVD mortality among women. For deaths from ischemic heart disease (IHD), PAI score ≥100 was associated with lower risk in both men and women (AHR, 0.70: 95% CI, 0.55-0.88). Obtaining ≥100 weekly PAI was also associated with significantly lower risk of CVD mortality in pre-specified age groups, and in participants with known CVD risk factors. Participants with ≥100 weekly PAI gained 4.2 (95% CI, 3.5-4.6) years of life when compared with those who were inactive at baseline.

Conclusions And Relevance: PAI is associated with long-term all-cause, CVD, and IHD, mortality. Clinicians and the general population can incorporate PAI recommendations and thresholds in their physical activity prescriptions and weekly physical activity assessments, respectively, to maximize health outcomes.

Key Points: Question: What is the association between personal activity intelligence (PAI), a novel activity metric, and mortality in a large cohort from the United States?

Findings: In this prospective study of 56,175 healthy participants at baseline, followed-up for a mean of 14.5 years, ≥100 PAI score/week was associated with significant 21% lower risk of all-cause and 30% lower risk of CVD mortality in comparison with inactive people. Participants with ≥100 PAI/week lived on average 4.2 years longer compared with inactive. Meaning: PAI is associated with long-term all-cause and CVD mortality. Clinicians and general population may incorporate PAI recommendations into weekly physical activity assessments to maximize CVD prevention.
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http://dx.doi.org/10.1016/j.pcad.2020.05.005DOI Listing
June 2020

Differential relationships between waist circumference and cardiorespiratory fitness among people with and without type 2 diabetes.

Prev Med Rep 2020 Jun 1;18:101083. Epub 2020 Apr 1.

Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

Adults with type 2 diabetes mellitus tend to exhibit an increased level of central adiposity, augmenting their risk of further non-communicable diseases (NCDs). Importantly, consistent evidence demonstrates a significant, negative association between cardiorespiratory fitness (CRF) and waist circumference (WC). However, no previous studies have investigated differences in these CRF-related reductions in WC between adults with and without diabetes. This study used data from the Aerobic Center for Longitudinal Studies, conducted between 1970 and 2006 among predominately Non-Hispanic White, middle-to-upper class adults in Texas. Quantile regression models were used to estimate CRF-related differences in WC between persons with and without diabetes. Age, height, smoking status and birth cohort served as covariates. The analytic sample included 45901 adults. Significantly larger reductions in WC were observed among adults with diabetes as compared to without diabetes across all WC percentiles. Among males, high CRF levels were associated with significant reductions, as compared to their low-fit counterparts, in WC as large as 21.9 cm for adults without diabetes and as large as 27 cm for adults with diabetes. Among females, high CRF levels were associated with significant reductions, as compared to their low-fit counterparts, in WC as large as 22.3 and 30.0 cm for adults without and with diabetes, respectively. This study demonstrated that higher CRF is associated with significant reductions in WC, with greater magnitudes found among adults with diabetes, especially among the most centrally obese, highlighting the necessity of exercise prescription in this clinical population potentially leading to lower risks of future NCDs.
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http://dx.doi.org/10.1016/j.pmedr.2020.101083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7155224PMC
June 2020

Weight Status and Sedentary Behavior of Alzheimer's Disease Caregivers.

Am J Health Behav 2020 01;44(1):3-12

Professor, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC;, Email:

In this study, we sought to characterize the weight status, sedentary behavior, and physical activity of caregivers of individuals with Alzheimer's disease. In 2014, we surveyed caregivers of individuals with Alzheimer's disease from the South Carolina Alzheimer's Disease Registry (N = 47) about their personal health behaviors. Additionally, a subset of individuals (N = 14) wore an accelerometer for 7 days. Caregivers (N = 47) were mostly overweight or obese (85%) and self-reported a daily average sedentary time of 246.5 ± 203.0 minutes and 455.8 ± 291.4 minutes, as measured by 2 questionnaires. Objective measures indicated that persons spent an average of 769.4 ± 167.6 minutes per day (77.8% of their waking day) engaged in sedentary behavior. Given the negative health outcomes associated with both obesity and sedentary behavior, this is a vulnerable population that likely would benefit from interventions focused on weight management and reducing sedentary behavior.
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http://dx.doi.org/10.5993/AJHB.44.1.1DOI Listing
January 2020

Area-level Socioeconomic Environment and Cardiorespiratory Fitness in Youth.

Med Sci Sports Exerc 2019 12;51(12):2474-2481

Department of Exercise Science, University of South Carolina, Columbia, SC.

Introduction: Cardiorespiratory fitness is one of the most important markers of cardiometabolic health and is a strong predictor of cardiovascular disease and all-cause mortality across the lifespan. However, little is known regarding the relationship of area-level socioeconomic environment on cardiorespiratory fitness during childhood and adolescence.

Purpose: To examine the relationship between area-level socioeconomic environment and cardiorespiratory fitness in a diverse sample of school-age youth; and to determine the extent to which grade level, sex, race/ethnicity, and student poverty status moderate this relationship.

Methods: South Carolina FitnessGram data for school year 2015 to 2016 were obtained for 44,078 youth. Cardiorespiratory fitness was determined using Progressive Aerobic Cardiovascular Endurance Run or 1-mile run/walk test. Area-level socioeconomic environment was expressed as a composite index score at the census tract level using data from the American Community Survey. Multilevel logistic regression analyses were conducted, controlling for individual-level characteristics and nesting within schools and districts. Interaction terms were then introduced to the model to examine their effect of multiple sociodemographic moderators.

Results: Approximately half of the sample had inadequate cardiorespiratory fitness for health. The odds of achieving the Healthy Fitness Zone for cardiorespiratory fitness decreased by approximately 25% to 34% with increasing deprivation of the area-level socioeconomic environment, after controlling for covariates. The association between area-level socioeconomic environment and cardiorespiratory fitness also varied significantly by sex, grade level, and race/ethnicity subgroups.

Conclusions: Cardiorespiratory fitness was positively associated with area-level socioeconomic environment; however, the relationship varied by demographic characteristics. These results highlight the importance of examining the influence of area-level socioeconomic environment on health across the life span. Additional research is needed to explore how area-level socioeconomic environment may impact evidence-based efforts to improve youth cardiorespiratory fitness levels.
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http://dx.doi.org/10.1249/MSS.0000000000002066DOI Listing
December 2019

Impact of fitness and changes in fitness on lipids and survival.

Prog Cardiovasc Dis 2019 Sep - Oct;62(5):431-435. Epub 2019 Nov 9.

Department of Exercise Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.

In the past five decades, cardiorespiratory fitness (CRF) has become fairly established as an important risk factor or marker for cardiovascular disease (CVD), as well as CVD - and all-cause mortality. Substantial evidence supports a strong inverse association between baseline levels of CRF and the risk of developing CVD risk factors, including dyslipidemia. Additionally, accumulating evidence also supports that maintaining or improving a certain level of CRF over time leads to a lower rate of developing CVD risk factors, such as dyslipidemia, and also improves survival. Recent evidence also supports the role of resistance exercise and muscular strength to reduce the development of metabolic syndrome and hypercholesterolemia and potentially reduce development of diabetes as well, in addition to improving survival. Therefore, great efforts are needed to increase both CRF and muscle strength with aerobic exercise and resistance exercise in the primary and secondary prevention of CVD.
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http://dx.doi.org/10.1016/j.pcad.2019.11.007DOI Listing
January 2020

The Association of Cardiorespiratory Fitness and Ideal Cardiovascular Health in the Aerobics Center Longitudinal Study.

J Phys Act Health 2019 11 24;16(11):968-975. Epub 2019 Sep 24.

Background: This study examined the cross-sectional and longitudinal associations of cardiorespiratory fitness (CRF) and ideal cardiovascular health (CVH).

Methods: CRF and the 7 CVH components were measured in 11,590 (8865 males; 2725 females) adults at baseline and in 2532 (2160 males; 372 females) adults with at least one follow-up examination from the Aerobics Center Longitudinal Study. Ideal CVH score was calculated as a composite of 7 measures, each scored 0 to 2. CVH groups were based on participant point score: ≤7 (poor), 8 to 11 (intermediate), and 12 to 14 (ideal). Analyses included general linear, logistic regression, and linear mixed models.

Results: At baseline, participants in the high CRF category had 21% and 45% higher mean CVH scores than those in the moderate and poor CRF categories (P < .001). The adjusted odds (95% confidence interval) of being in the poor CVH group at baseline were 4.9 (4.4-5.4) and 16.9 (14.3-19.9) times greater for individuals with moderate and low CRF, respectively, compared with those with high CRF (P < .001). Longitudinal analysis found that for every 1-minute increase in treadmill time, CVH score increased by 0.23 units (P < .001) independent of age, sex, exam number, and exam year.

Conclusions: Higher CRF is associated with better CVH profiles, and improving CRF over time is independently associated with greater improvements in CVH.
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http://dx.doi.org/10.1123/jpah.2018-0220DOI Listing
November 2019

Parents' Lifestyle, Sedentary Behavior, and Physical Activity in Their Children: A Cross-Sectional Study in Brazil.

J Phys Act Health 2019 08 1;16(8):631-636. Epub 2019 Aug 1.

Background: This study investigated associations between different types of sedentary behavior (SB) and physical activity (PA) in parent and their child, including the moderating effects of parent and child sex.

Methods: In total, 1231 adolescents, 1202 mothers, and 871 fathers were evaluated. The SB (TV viewing + computer + video game); different types of PA (leisure-time PA, occupational PA, and total PA); and the socioeconomic level were evaluated by questionnaire. The relationship between adolescents' SB and PA with parental characteristics was estimated by linear regression.

Results: The SB of male adolescents was correlated to the father's SB (β = 0.26; 95% confidence interval [CI], 0.13-0.39) and mother's SB (β = 0.18; 95% CI, 0.06-0.31). A similar relationship was observed between SB of female adolescents and the father's SB (β = 0.31; 95% CI, 0.19-0.42) and mother's SB (β = 0.29; 95% CI, 0.20-0.38]). The SB of girls was inversely related to mother's occupational PA (β = -2.62; 95% CI, -3.66 to -0.53]). The PA of the boys and girls was correlated with their fathers and mothers PA. All the results were adjusted for age and parent's socioeconomic level.

Conclusions: SB and PA of parents were associated with SB and PA of their children, regardless of gender. Strategies for health promotion should consider the family environment to increase PA and reduce SB.
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http://dx.doi.org/10.1123/jpah.2018-0173DOI Listing
August 2019

Age- and sex- specific all-cause mortality risk greatest in metabolic syndrome combinations with elevated blood pressure from 7 U.S. cohorts.

PLoS One 2019 13;14(6):e0218307. Epub 2019 Jun 13.

School of Kinesiology and Health Science, York University, Toronto, Canada.

Background: The association between metabolic syndrome (MetS) and all-cause mortality is well established but it is unclear if there are differences in mortality risk among the 32 possible MetS combinations. Hence, the purpose of this study is to evaluate the associations between different MetS combinations and its individual components with all-cause mortality, and to examine differences in the association by age and sex.

Methods: A merged sample of 82,717 adults from 7 U.S. cohorts was used.

Results: In our sample, MetS was present in 32% of men, 34% of women, 28% of younger adults (18-65 years) and 62% of older adults (>65 years) with 14,989 deaths over 14.6 ± 7.4 years of follow-up. Risk of all-cause mortality was higher in younger individuals with a greater number of MetS factors present, but in older adults having all 5 MetS factors was the only combination significantly associated with mortality. Regardless of age or sex, elevated blood pressure was the MetS factor most consistently present in MetS combinations that were significantly and most strongly associated with mortality. In fact, elevated blood pressure in the absence of other risk factors was significantly associated with mortality in men (HR, 95% CI = 1.56, 1.33-1.84), women (HR = 1.62, 1.44-1.81) and younger adults (HR = 1.61, 1.45-1.79). Conversely, waist circumference, glucose and triglycerides in isolation were not associated with mortality (p>0.05).

Conclusion: In a large U.S. population, different combinations of MetS components vary substantially in their associations with all-cause mortality. Men, women and younger individuals with MetS combinations including elevated blood pressure had stronger associations with greater mortality risk, with minimal associations between MetS and mortality risk in older adults. Thus, we suggest that future algorithms may wish to consider differential weighting of these common metabolic risk factors, particularly in younger populations.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218307PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564014PMC
March 2020

Structure of Physical Activity Opportunities Contribution to Children's Physical Activity Levels in After-School Programs.

J Phys Act Health 2019 06;16(7):512-517

Background: The primary purpose of this study was to determine which physical activity (PA) opportunity elicits the most moderate to vigorous PA (MVPA) in after-school programs. This study used a 3-group cross-over design in which participants were exposed to 3 variations of activity structures: free play, organized, or a mixture.

Methods: PA was measured using ActiGraph GT3X+ accelerometers. All data were transformed into percentage of time spent sedentary or in MVPA. Repeated-measures mixed-effects models were used to examine differences in MVPA and sedentary among the 3 activity sessions. Participants included 197 unique children, aged 5-12 years, and were 53% male and 55% white.

Results: Statistically significant differences were observed in the percentage of time boys spent in MVPA during free play and mixed compared with organized only sessions (35.8% and 34.8% vs 29.4%). No significant difference was observed in the percentage of time girls spent in MVPA during free play compared with organized or mixed (27.2% and 26.1% vs 26.1%). Both boys and girls experienced ∼10% less time sedentary during free play compared with the others.

Conclusion: Offering free play during PA opportunities can help children attain as much if not more MVPA compared with only offering organized, adult-led games.
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http://dx.doi.org/10.1123/jpah.2018-0288DOI Listing
June 2019

Adiposity does not modify the effect of the dietary inflammatory potential on type 2 diabetes incidence among a prospective cohort of men.

J Nutr Intermed Metab 2019 Jun 1;16. Epub 2019 Mar 1.

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.

Purpose: Inflammatory contributions from diet and adiposity may interact with respect to the development of type 2 diabetes mellitus (T2DM). We investigated the degree to which adiposity modified the association between dietary inflammatory potential and incident T2DM.

Methods: Data from 6,016 US men in the Aerobics Center Longitudinal Study who completed a 3-day diet record were used. The inflammatory potential of diet was characterized by the Dietary Inflammatory Index (DII®), and adiposity was assessed with body mass index, waist circumference, body fat percentage (BF) and waist-to-height ratio. Inverse probability weights were used in modified Poisson regression models to examine whether adiposity modifies the relationship between the DII and T2DM, while accounting for selection bias from participants who were lost to follow-up.

Results: There were 336 incident cases of T2DM after a mean follow-up of 6.5 years. DII scores were not significantly associated with T2DM incidence in multivariable models, but point estimates were consistently elevated across increasing DII quartiles compared to the most anti-inflammatory DII quartile. In the model that evaluated BF, the term for overall effect modification was significant (p = 0.02), but there was no evidence of effect modification on the multiplicative and additive scales when examined further. Effect modification was not present for any other adiposity measures.

Conclusions: We did not observe evidence that a pro-inflammatory diet, as measured by the DII, is associated with incidence of T2DM, nor evidence that adiposity modifies a potential relationship. Further investigation is needed in larger cohorts with longer follow-up.
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http://dx.doi.org/10.1016/j.jnim.2019.100095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440686PMC
June 2019

A varying-coefficient generalized odds rate model with time-varying exposure: An application to fitness and cardiovascular disease mortality.

Biometrics 2019 09 17;75(3):853-863. Epub 2019 Jun 17.

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina.

Varying-coefficient models have become a common tool to determine whether and how the association between an exposure and an outcome changes over a continuous measure. These models are complicated when the exposure itself is time-varying and subjected to measurement error. For example, it is well known that longitudinal physical fitness has an impact on cardiovascular disease (CVD) mortality. It is not known, however, how the effect of longitudinal physical fitness on CVD mortality varies with age. In this paper, we propose a varying-coefficient generalized odds rate model that allows flexible estimation of age-modified effects of longitudinal physical fitness on CVD mortality. In our model, the longitudinal physical fitness is measured with error and modeled using a mixed-effects model, and its associated age-varying coefficient function is represented by cubic B-splines. An expectation-maximization algorithm is developed to estimate the parameters in the joint models of longitudinal physical fitness and CVD mortality. A modified pseudoadaptive Gaussian-Hermite quadrature method is adopted to compute the integrals with respect to random effects involved in the E-step. The performance of the proposed method is evaluated through extensive simulation studies and is further illustrated with an application to cohort data from the Aerobic Center Longitudinal Study.
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http://dx.doi.org/10.1111/biom.13057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736699PMC
September 2019

Leisure-Time Running Reduces the Risk of Incident Type 2 Diabetes.

Am J Med 2019 10 17;132(10):1225-1232. Epub 2019 May 17.

Department of Exercise Science, University of South Carolina, Columbia, SC.

Objectives: We examined the overall association as well as the dose-response relationship between leisure-time running and incident type 2 diabetes.

Methods: Participants were 19,347 adults aged 18-100 years who were free of cardiovascular disease, cancer, and diabetes at baseline, and who received at least 2 extensive preventive medical examinations between 1974 and 2006. Running and other types of aerobic physical activity were assessed by self-reported leisure-time activities. Type 2 diabetes was defined as fasting glucose ≥126 mg/dL (7.0 mmol/L), physician diagnosis, or insulin use.

Results: During an average follow-up of 6.5 years, 1015 adults developed type 2 diabetes. Approximately 29.5% of adults participated in leisure-time running at baseline. Runners had a 28% (hazard ratio [HR] 0.72; 95% confidence interval [CI], 0.62-0.84) lower risk of developing type 2 diabetes compared with nonrunners during follow-up. The HRs (95% CIs) of type 2 diabetes were 0.98 (0.75-1.28), 0.69 (0.51-0.92), 0.62 (0.45-0.85), 0.78 (0.59-1.04), and 0.57 (0.42-0.79) across quintiles of running time (minutes/week) compared with nonrunners after adjusting for potential confounders, including levels of nonrunning aerobic physical activity. Similar dose-response relationships between running distance (miles/week), frequency (times/week), total amount (MET-minutes/week), and speed (mph) were also observed.

Conclusions: Participating in leisure-time running is associated with a lower risk of developing type 2 diabetes in adults. Consistent linear dose-response relationships were observed between various running parameters and incident type 2 diabetes, supporting the prescription of running to prevent type 2 diabetes.
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http://dx.doi.org/10.1016/j.amjmed.2019.04.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832784PMC
October 2019

Lifetime predictors of stroke in subjects without a diagnosis of hypertension: the aerobics center longitudinal study.

Neuropsychiatr Dis Treat 2019 8;15:849-856. Epub 2019 Apr 8.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain,

Background And Purpose: Although several studies have assessed the importance of traditional risk factors in predicting stroke, none have concurrently addressed the stroke-predicting ability of these risk factors across the lifespan of subjects without a hypertension (HTN) diagnosis. Thus, this study aimed to assess the importance of blood-pressure-related risk indicators, cardiorespiratory fitness (CRF), weight status, diabetes mellitus (DM), and lifestyle factors as predictors of stroke in different stages of life among non-hypertensive subjects.

Materials And Methods: This study was a long-term follow-up study including 33,254 men and 10,598 women from the Aerobics Center Longitudinal Study (ACLS) who were 18-100 years old and did not have a HTN diagnosis at baseline. Logistic regression models were constructed using forward selection procedures for each age category, with stroke occurrence as the dependent variable, and pulse pressure (PP), mean arterial pressure (MAP), systolic blood pressure (SBP), smoking status, CRF, drinking behavior, DM status, and weight status as potential predictors.

Results: In total, 507 subjects had a stroke during an average follow-up period of 17 years (range=1-34 years). Logistic regression models showed that MAP values (=0.043) in those aged 19-39 years; SBP (<0.001), CRF (=0.001), weight status (=0.005), and alcohol consumption (=0.001) in those 40-60 years old; and CRF (=0.002), weight status (=0.005), and DM status (=0.037) in those over 60 years old were predictors of stroke.

Conclusion: These findings suggest that, among individuals without a baseline HTN diagnosis, classic modifiable risk factors for stroke change across different stages of life.
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http://dx.doi.org/10.2147/NDT.S193842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459140PMC
April 2019

Cardiorespiratory Fitness and the Risk of First Acute Myocardial Infarction: The HUNT Study.

J Am Heart Assoc 2019 05;8(9):e010293

1 Department of Public Health and Nursing Faculty of Medicine and Health Sciences Norwegian University of Science and Technology (NTNU) Trondheim Norway.

Background The majority of studies evaluating cardiorespiratory fitness ( CRF ) as a cardiovascular risk factor use cardiovascular mortality and not cardiovascular disease events as the primary end point, and generally do not include women. The aim of this study was to investigate the association of estimated CRF ( eCRF ) with the risk of first acute myocardial infarction ( AMI ). Methods and Results We included 26 163 participants (51.5% women) from the HUNT study (Nord-Trøndelag Health Study), with a mean age of 55.7 years, without cardiovascular disease at baseline. Baseline eCRF was grouped into tertiles. AMI was derived from hospital records and deaths from the Norwegian Cause of Death Registry. We used Fine and Gray regression modeling to estimate subdistribution hazards ratio ( SHR ) of AMI , accounting for competing risk of death. During a mean (range) follow-up of 13 (0.02-15.40) years (347 462 person-years), 1566 AMI events were recorded. In fully adjusted models men in the 2 highest eCRF had 4% ( SHR : 0.96, 95% CI : 0.83-1.11) and 10% ( SHR : 0.90, 95% CI : 0.77-1.05) lower SHR of AMI , respectively, when compared with men in the lowest tertile. The corresponding numbers in women were 12% ( SHR : 0.88, 95% CI : 0.72-1.08) and 25% ( SHR : 0.75, 95% CI : 0.60-0.95). Conclusions eCRF was inversely associated with risk of AMI event among women but not in men. Our data suggest that high eCRF may have substantial benefit in reducing the risk of AMI . Therefore, our data suggest that an increased focus on eCRF as a cardiovascular disease risk marker in middle-aged and older adults is warranted.
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http://dx.doi.org/10.1161/JAHA.118.010293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6512140PMC
May 2019

Cross-sectional and longitudinal association of non-exercise estimated cardiorespiratory fitness with depression and anxiety in the general population: The HUNT study.

J Affect Disord 2019 06 8;252:122-129. Epub 2019 Apr 8.

Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Background: Cardiorespiratory fitness may help to prevent depression and anxiety. A paucity of literature has considered the relationship between cardiorespiratory fitness (CRF) and the incidence of depression and anxiety. The objective of this study was to investigate cross-sectional and longitudinal associations of estimated cardiorespiratory fitness (CRF) with depression and anxiety.

Methods: This study included middle-aged and older participants from the second (HUNT 2, 1995-1997) and third (HUNT3, 2006-2008) survery of the Nord-Trøndelag Health Study (HUNT). Baseline non-exercise estimated CRF (eCRF) was determined using standardized algorithms. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale. Logistic regression models were used to evaluate the cross-sectional and longitudinal associations between eCRF and depression and anxiety.

Results: In cross-sectional adjusted analysis including those who participated in HUNT2 (n = 26,615 mean age 55.7 years), those with medium and high level of eCRF had 21% (OR, 0.79; 95% CI, 0.71-0.89) and 26% (OR, 0.74; 95% CI, 0.66-0.83) lower odds of depression compared to those with low eCRF level, respectively. Longitudinal analysis including those who participated in both HUNT2 and HUNT3 (n = 14,020 mean age 52.2 years) found that medium and level of eCRF was associated with 22% (OR, 0.78; 95% CI, 0.64-0.96) and 19% (OR, 0.81; 95% CI, 0.66-0.99) lower odds of depression compared to those with low eCRF level, respectively. CRF was not associated with anxiety, either cross-sectionally or longitudinally.

Conclusion: Our data suggest that a medium and high level of eCRF during late middle age is cross-sectionally and prospectively associated with lower odds of depression. However, our data do not support that eCRF is associated with anxiety. Further studies are warranted to conclude a causal relationship between eCRF and depression.
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http://dx.doi.org/10.1016/j.jad.2019.04.016DOI Listing
June 2019

Association of Muscular Strength and Incidence of Type 2 Diabetes.

Mayo Clin Proc 2019 04 11;94(4):643-651. Epub 2019 Mar 11.

Department of Exercise Science, University of South Carolina, Columbia, SC.

Objective: To examine the association between muscular strength and incident type 2 diabetes, independent of cardiorespiratory fitness (CRF).

Patients And Methods: A total of 4681 adults aged 20 to 100 years who had no type 2 diabetes at baseline were included in the current prospective cohort study. Participants underwent muscular strength tests and maximal treadmill exercise tests between January 1, 1981, and December 31, 2006. Muscular strength was measured by leg and bench press and categorized as age group- and sex-specific thirds (lower, middle, and upper) of the combined strength score. Type 2 diabetes was defined on the basis of fasting plasma glucose levels, insulin therapy, or physician diagnoses.

Results: During a mean follow-up of 8.3 years, 229 of the 4681 patients (4.9%) had development of type 2 diabetes. Participants with the middle level of muscular strength had a 32% lower risk of development of type 2 diabetes (hazard ratio, 0.68; 95% confidence interval, 0.49-0.94; P=.02) compared with those with the lower level of muscular strength after adjusting for potential confounders, including estimated CRF. However, no significant association between the upper level of muscular strength and incident type 2 diabetes was observed.

Conclusion: A moderate level of muscular strength is associated with a lower risk of type 2 diabetes, independent of estimated CRF. More studies on the dose-response relationship between muscular strength and type 2 diabetes are needed.
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http://dx.doi.org/10.1016/j.mayocp.2018.08.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450733PMC
April 2019

Cardiorespiratory Fitness and Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality in Men With Musculoskeletal Conditions.

J Phys Act Health 2019 02 11;16(2):134-140. Epub 2019 Jan 11.

Background: To investigate the association between cardiorespiratory fitness and risk of cardiovascular disease, cancer, and all-cause mortality in men with musculoskeletal conditions.

Methods: Participants were 12,728 men (mean age 47.0 [9.3] y) with a history of musculoskeletal conditions (including joint pain, low back pain, stiff joints, arthritis, osteoporosis, or gout) and were followed for all-cause mortality to December 31, 2003. Fitness was quantified by maximal treadmill exercise test and was categorized for analysis as low, moderate, and high performance. Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals.

Results: Overall, the multivariable-adjusted hazard ratios and 95% confidence intervals for mortality across incremental fitness categories were 1.00 (reference), 0.45 (0.30-0.68) and 0.35 (0.22-0.53), linear trend P < .01 for all-cause, 0.50 (0.23-1.10) and 0.29 (0.12-0.71), linear trend P = .02 for cardiovascular disease, and 0.38 (0.20-0.74) and 0.40 (0.20-0.80), linear trend P = .01 for cancer mortality.

Conclusion: Among men with musculoskeletal conditions, higher fitness is associated with lower risk of death by cardiovascular disease, cancer, or any cause, independent of other risk factors.
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http://dx.doi.org/10.1123/jpah.2017-0644DOI Listing
February 2019

Physical Activity, Depression, and Antiretroviral Therapy Adherence Among People Living With HIV: A Mediation Analysis.

J Assoc Nurses AIDS Care 2019 Sep-Oct;30(5):556-562

The aim of our study was to explore the relationships between physical activity, depression, and antiretroviral therapy (ART) adherence. Data were obtained from a randomized controlled trial of people living with HIV (N = 658) in China. Ordinal regression and logistic regression analyses were performed to examine associations between ART adherence, depression, and physical activity. A better ART adherence was associated with higher levels of physical activity (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI] = 1.02-1.80) and lower levels of depression (aOR = 0.95, 95% CI = 0.92-0.99). Higher levels of physical activity were also associated with lower levels of depression (aOR = 0.50, 95% CI = 0.32-0.76). Sobel Z test indicated the mediating effect of depression between physical activity and ART adherence (Sobel Z = 1.96, p < .05). This study suggests the benefit of appropriate levels of physical activity to promote both psychological health and ART adherence in people living with HIV.
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http://dx.doi.org/10.1097/JNC.0000000000000045DOI Listing
September 2020

Impact of sports participation on mortality rates among Brazilian adults.

J Sports Sci 2019 Jul 9;37(13):1443-1448. Epub 2019 Jan 9.

a Faculty of Sciences and Technology , São Paulo State University (UNESP) , Presidente Prudente , Brazil.

: To analyze the possible dose-response association between components of sports participation (intensity, volume and previous engagement) and 4-year mortality rates among Brazilian adults. : 679 males and females (mean age among men = 66.7 ± 9.3 years old and mean age among women = 64.8 ± 8.9 years old) composed the study sample. Sports participation was assessed using Baecke's questionnaire, which considers intensity, duration and previous engagement. Medical records were used to identify the cause of the death. Cox regression analysis was performed to determine the independent associations of exercise components and mortality. : Participants that reported exercising at moderate-vigorous intensity (Moderate/vigorous: 4.1% versus None/light: 10.3% [p-value = 0.012]; HR = 0.42 [0.1 to 0.94)] and for more than four months (≥4 months: 5.3% versus <4 months: 10.2% [p-value = 0.038]; HR = 0.47 [0.24 to 0.94]) had lower mortality risk. The percentage of survival according to all-cause mortality was significantly higher for participants engaged in sports at moderate-vigorous intensity (p-value = 0.014), as well as for those engaged in sports for periods superior than four months (p-value = 0.036). : We found higher percentage of survival among adults engaged in sports at moderate-vigorous intensity and with at least four months of previous engagement.
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http://dx.doi.org/10.1080/02640414.2019.1565109DOI Listing
July 2019

The Effect of Structured Exercise on Sleep During the Corresponding Night Among Older Women in an Exercise Program.

J Aging Phys Act 2019 08 1;27(4):482-488. Epub 2019 Aug 1.

This study investigated the acute effect of exercise on sleep outcomes among healthy older women by comparing days with structured exercise versus days without structured exercise during 4 months of exercise training. Participants (n = 51) in this study had wrist-worn actigraphic sleep data available following at least 3 days with structured exercise and 3 days without structured exercise at mid-intervention and at the end of intervention. The exercise intervention was treadmill walking. Multilevel models were used to examine whether structured exercise impacted sleep outcomes during the corresponding night. Overall, 1,362 nights of data were included in the analyses. In unadjusted and adjusted models, bedtimes were significantly earlier on evenings following an acute bout of structured exercise than on evenings without structured exercise. No other sleep parameters differed between exercise and nonexercise days. Understanding the effects of exercise on sleep in this understudied population may help to improve their overall sleep quality.
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http://dx.doi.org/10.1123/japa.2018-0194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775633PMC
August 2019