Ann Blair Kennedy

Fitness or Fatness: Which Is More Important?

Three decades ago, the relative importance of the detrimental effects of obesity on health was called into question by a longitudinal study1 that included 10 224 men and 3120 women who were followed up for more than 8 years. The findings showed that better cardiorespiratory fitness (CRF), as measured by a maximal treadmill exercise test, was associated with decreased all-cause mortality in both sexes. Based on the maximal treadmill tests, participants were stratified into quintiles of fitness categories, with 1 equaling the lowest level of fitness and 5 being the highest level of fitness. Analysis of lifestyle behaviors and clinical measures, such as blood pressure, hyperlipidemia, smoking, and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), found that for both men and women, all variables, except BMI and familial coronary heart disease (CHD) only for women, were associated with a statistically significantly higher risk of mortality across fitness categories. For example, individuals who were current smokers and were in higher fitness categories had lower relative risk of death compared with current smokers who were in lower fitness categories. These findings combined with similar results from other studies raised questions about the relative contributions of obesity (or fatness) or CRF (or fitness) to all-cause mortality and to cardiovascular disease

Motivating People to Exercise

Physical inactivity is a worldwide public health problem. Primary care physicians are in an excellent position to prescribe exercise and physical activity to their patients. This article discusses theories and methods of behavior change to help physicians motivate their patients to become more physically active. Calls to action for physicians are discussed.

Process evaluation of a preschool physical activity intervention using web-based delivery☆

BACKGROUND AND PURPOSE Preschool/childcare settings offer a practical target for physical activity interventions. Online learning programs have the potential for greater public health reach and impact. The SHAPES-Dissemination (SHAPES-D) project adapted the original SHAPES in-person intervention for online delivery to teachers. The purpose of this paper is to describe the implementation monitoring and process evaluation for the SHAPES-D project. METHODS Nine preschools with 26 classrooms participated. A total of 41 teachers were trained via online learning to implement the SHAPES-D program in their classrooms. The dose received, completeness, and fidelity of implementation were assessed through website metrics, teacher surveys and interviews, and classroom observations. RESULTS Dose received was adequate (73%). Observed completeness and physical activity enjoyment fidelity were high (100%), although moderate-to-vigorous physical activity fidelity and social environment fidelity were low (25% each). Overall implementation was high (91%). DISCUSSION Results indicate that the online method of delivery is viable for dissemination. The online delivery system provides an easy method of monitoring dose received. This may be the first structural intervention to monitor dose received through web metrics. CONCLUSION The adaptation of an in-person intervention to an online delivery system increases the potential for dissemination of a successful program to increase physical activity in preschool settings.

Mindfulness and Physical Activity

Mindfulness and mindful activity can have a profound effect on physical and mental health. When considering mindfulness and physical activity, it is important to differentiate between physical activities, which are geared toward mindfulness and have mindful components, for example, yoga, platies, and tai chi, from other mindfulness interventions that are then geared toward greater awareness and mindfulness, which may then lead to healthful behavior change such as increasing physical activity. Prescribing mindfulness interventions may be another resource to help physicians when interacting with their patients, considering motivating patients to exercise and become more physically active can be challenging. Engaging in mindfulness can elicit change over time. Integrating mindfulness to interventions with exercise is one way to initiate exercise adherence as well as improve self-efficacy. When practicing mindful-based exercise programs, the benefits can also be seen with improved breathing rate and depth, heart rate, and parasympathetic activity. Promoting mindfulness-based training for physical activity has positive effects both psychologically and physiologically.

Using Lifestyle Medicine in U.s. Health Care to Treat Obesity: Too Many Bariatric Surgeries?

More than one-third of Americans are classified as obese. Many clinicians perform bariatric surgery (BSx) when it is said that lifestyle intervention failed. However, BSx is medically complex, with extremely variable success, certain failures, major complications, and sometimes death. Although many studies declare BSx as more effective for producing weight loss than nonsurgical lifestyle management, these conclusions are flawed when lifestyle management between cohorts are not identical. Lifestyle behavior change is essential to success for both surgical and nonsurgical weight loss, as over 50% of BSx patients regain weight without lifestyle modification. Indeed, programs that include self-reward and reinforcement are extremely effective. It is therefore possible that successful BSx is simply an intrinsic reward for an intensive change in lifestyle behavior. Accounting for the costs and risks associated with BSx, providing state and federal resources for lifestyle behavior change programs could provide a key opportunity for the war against obesity.

Advancing health promotion through massage therapy practice: A cross-sectional survey study

The human resources needed to provide health promotion services to improve health behaviors in populations are currently limited. Health promotion and education is included in the definition of massage therapy, and many within the massage therapy profession understand that health promotion and education are a part of massage therapy practice. However, the amounts and types of health promotion activities in massage therapy practice have not been thoroughly explored. The objective of this study was to investigate the current attitudes, practices, and barriers toward providing health promotion in a national sample of practicing massage therapists. A descriptive cross-sectional survey disseminated May to August 2016 to practicing massage therapists in the United States. The majority (90.2%) of the 182 participants agree or strongly agree that it is important for massage therapists to provide health promotion. Therapists with less favorable attitudes about providing health promotion reported more barriers to providing the messages to their patients. Barriers to providing health promotion included a lack of guidelines, knowledge, and skills. Training and guidelines for massage therapists regarding health promotion would be a reasonable next step for future research development. Utilizing massage therapists as health promoters may provide opportunities to deliver more prevention messages to patients which may impact public health.

‘Recover quicker, train harder, and increase flexibility’: massage therapy for elite paracyclists, a mixed-methods study

Objectives Massage therapy (MT) enhances recovery by reducing pain and fatigue in able-bodied endurance athletes. In athletes with disabilities, no studies have examined similar MT outcomes, yet participation in sport has increased by >1000 athletes from 1996 to 2016 Olympic games. We examined the effect of MT on pain, sleep, stress, function and performance goals on the bike, as well as quality of life off the bike, in elite paracycling athletes. Methods This is a quasi-experimental, convergent, parallel, mixed-methods design study of one team, with nine paracycling participants, in years 2015 and 2016. One-hour MT sessions were scheduled one time per week for 4 weeks, and then every other week for the duration of the time the athlete was on the team and/or in the study. Closed and open-ended survey questions investigating athlete goals, stress, sleep, pain and muscle tightness were gathered pre and post each MT session, and every 6 months for health-related quality of life. Quantitative analysis timepoints include baseline, 4–6 months of intervention and final visit. Additional qualitative data were derived from therapists’ treatment notes, exit surveys, and follow-up emails from the athletes and therapists. Results Significant improvement was found for sleep and muscle tightness; quantitative results were reinforced by athlete comments indicating MT assisted in their recovery while in training. There were no improvements in dimensions measuring quality of life; qualitative comments from athletes suggest reasons for lack of improvement. Conclusion This real-world study provides new information to support MT for recovery in elite paracyclists.