Britta A. Larsen

Associations of physical activity and sedentary behavior with regional fat deposition.

INTRODUCTION Increased sedentary behavior predicts greater cardiovascular morbidity and mortality and does so independently of physical activity (PA). This association is only partially explained by body mass index (BMI) and overall body fat, suggesting mechanisms besides general increased adiposity. The purpose of this study was to explore associations of self-reported leisure PA and sitting time with regional fat depositions and abdominal muscle among community-dwelling older adults. METHODS Participants were 539 diverse adults (mean age = 65 yr) who completed a study visit in 2001-2002. Areas of pericardial, intrathoracic, subcutaneous, visceral, and intermuscular fat, as well as abdominal muscle, were measured using computed tomography. Leisure PA and sitting hours were entered simultaneously into multivariate regression models to determine associations with muscle and fat areas. RESULTS After adjusting for demographics, smoking, diabetes, hypertension, triglycerides, and cholesterol, greater PA was associated with less intrathoracic, visceral, subcutaneous, and intermuscular fat (for all P < 0.05), while greater sedentary time was associated with greater pericardial and intrathoracic fat (for both P < 0.05). After further adjusting for BMI, each hour of weekly PA was associated with 1.85 cm less visceral fat (P < 0.01) but was not associated with other fat depositions. Conversely, each hour of daily sitting was associated with 2.39 cm more pericardial fat (P < 0.05) but was not associated with any other fat depositions. There were no associations with abdominal muscle area. Adjusting for common inflammatory markers had little effect. Associations between fat and PA were stronger for men. CONCLUSIONS Sitting and PA have distinct associations with regional fat deposition in older adults. The association between sitting and pericardial fat could partially explain the link between sitting and coronary heart disease.

The Seamos Saludables study: A randomized controlled physical activity trial of Latinas.

BACKGROUND Latinas in the U.S. are less physically active than non-Latino white women and also report higher levels of diabetes, obesity, and other conditions related to inactivity. Interventions are needed to address disparities in this high-risk group. PURPOSE To evaluate the efficacy of a culturally adapted, Spanish-language, individually tailored, computer expert system-driven physical activity print-based intervention for adult Latinas. DESIGN RCT. SETTING/PARTICIPANTS Participants were 266 inactive adult Latinas who participated between 2009 and 2012. INTERVENTION Participants were randomized to one of two treatment arms: a 6-month tailored physical activity intervention condition or wellness contact control. For both conditions, print materials were delivered by mail. MAIN OUTCOME MEASURES The main outcome measure was change in weekly moderate-to-vigorous physical activity (MVPA) measured by the 7-Day Physical Activity Recall interview, which was administered at baseline and post-intervention (6 months). Participants also wore accelerometers for a week at baseline and follow-up. Analyses were conducted in 2013. RESULTS Increases in minutes/week of MVPA measured by the 7-Day PAR were significantly greater in the intervention group compared to the control group (mean difference=41.36, SE=7.93, p<0.01). This difference was corroborated by accelerometer readings (rho=0.44, p<0.01). Further, results indicate that intervention participants had greater increases in self-efficacy, cognitive processes, and behavioral processes at 3 months compared to control paricipants (ps<0.05). CONCLUSIONS The tailored Spanish-language intervention was effective in increasing MVPA among predominantly low-income, less-acculturated Latinas. Such print-based interventions are poised for widespread dissemination, and thus may help address health disparities.

Cardiovascular Disease and Psychiatric Comorbidity: The Potential Role of Perseverative Cognition

The high comorbidity between psychiatric disorders and cardiovascular disease has received increasing attention, yet little is known about the processes linking the two. One plausible contributing mechanism is the tendency of those with psychiatric disorders to ruminate on stressful events. This phenomenon, sometimes called perseverative cognition, can extend the psychological and physiological effects of stress, which could contribute to cardiovascular disease etiology. In this paper, we discuss the potential role of perseverative cognition in mediating the relationship between psychiatric illness and cardiovascular disease. Rumination can delay physiological recovery from acute stress, which in turn has been found to predict future cardiovascular health. This delayed recovery could act as a mechanism in the longitudinal link between worry and cardiovascular health. The cognitive inflexibility that characterizes mood and anxiety disorders may then contribute to disease not by producing greater reactivity, but instead through extending activation, increasing the risks for cardiovascular damage.

Cognitive distancing, cognitive restructuring, and cardiovascular recovery from stress

Research suggests that phasic changes in cardiovascular reactivity can increase the risk of heart disease, yet much of this research has focused on the magnitude rather than the duration of reactivity. In recent years, studies have confirmed that recovery time is also a significant predictor of future heart cardiovascular disorders. Here we review these studies, as well as the cognitions and behaviors that have been found to influence recovery. We suggest that a useful distinction is that some utilize cognitive distancing while others seem to be based on cognitive restructuring. These different approaches have implications for the immediacy and permanence of the recovery effects. Finally, we outline the questions that have yet to be answered about recovery and how it could influence long-term health.

Physical Activity in Latino Men and Women Facilitators, Barriers, and Interventions

Latinos report less leisure time physical activity (PA) than non–Latino Whites and suffer disproportionately from diseases related to sedentary lifestyle, yet remain underserved and understudied. Gaining a better understanding of PA behavior in Latinos is critical to intervene on this significant public health issue. This article discusses the growing literature on the facilitators and barriers of PA in Latino men and women and reviews recent interventions to promote activity. Apart from acculturation influences, facilitators of PA in Latinos are similar to those of non–Latino Whites, with most research focusing on self-efficacy and social support. Barriers for Latinas, however, are more culturally distinct, such as a focus on caregiving and cultural standards for body shape. Barriers unique to Latino men largely have not been studied. Researchers have adopted a variety of approaches to increase PA, including using promotores and incorporating culturally appropriate activities, and have had mixed success. However, the community and randomized controlled trials almost exclusively included only women. Studies reviewed here suggest that interventions should target culturally specific barriers beyond language to successfully increase PA in Latinos and highlight a need for formative research and design of interventions for Latino men.

Association of Muscle Mass, Area, and Strength With Incident Diabetes in Older Adults: The Health ABC Study

CONTEXT Skeletal muscle plays a key role in glucose regulation, yet the association between muscle quantity or quality and the risk of developing type 2 diabetes has not been explored. OBJECTIVE The objective of the study was to assess the association between muscle quantity and strength and incident diabetes and to explore whether this association differs by body mass index (BMI) category. DESIGN AND SETTING Participants were 2166 older adults in the Health, Aging, and Body Composition Study who were free of diabetes at baseline (1997–1998). Computed tomography and dual-energy x-ray absorptiometry were used to measure abdominal and thigh muscle area and total body lean mass, respectively. Strength was quantified by grip and knee extensions. MAIN OUTCOME MEASURE Incident diabetes, defined as fasting glucose of 126 mg/dL or greater, a physicians diagnosis, and/or the use of hypoglycemic medication were measured. RESULTS After a median 11.3 years of follow-up, there were 265 incident diabetes cases (12.2%). In fully adjusted models, no association was found between muscle or strength measures and incident diabetes (for all, P > .05). For women, there was a significant interaction with BMI category for both abdominal and thigh muscle, such that greater muscle predicted lower risk of incident diabetes for normal-weight women (hazard ratio 0.37 [0.17–0.83] and 0.58 [0.27–1.27] per SD, respectively) and a greater risk for overweight and obese women (hazard ratio 1.23 [0.98–1.54] and 1.28 [1.00–1.64], respectively). No significant interactions by BMI category existed for strength measures or any measures for men (for all, P > .05). CONCLUSIONS Greater muscle area is associated with a lower risk of incident diabetes for older normal-weight women but not for men or overweight women.

Twelve-month physical activity outcomes in Latinas in the Seamos Saludables trial.

BACKGROUND Physical activity interventions designed for Latinas have shown short-term behavior change, but longer-term change and maintenance is rarely measured. PURPOSE To assess physical activity change at 12 months, following 6-month tapered completion of an RCT of a physical activity intervention for Latinas. METHODS Two hundred sixty-six underactive (<60 minutes/week physical activity) Latinas were randomized to an individually tailored, culturally and linguistically adapted physical activity intervention, or a wellness contact control. Participants received the materials through the mail for 6 months, then received booster doses at 8, 10, and 12 months. Minutes per week of moderate to vigorous physical activity were measured by the 7-Day Physical Activity Recall interview at baseline and 6 and 12 months. Data were collected at Brown University between 2009 and 2013, and analyses were conducted in 2013. RESULTS At 12 months, increases in moderate to vigorous physical activity were significantly greater in the intervention than in the wellness group (mean difference=52 minutes/week, SE=9.38, p<0.01), with both groups showing slight increases in moderate to vigorous physical activity from 6 to 12 months. Intervention participants were also more likely to meet national moderate to vigorous physical activity guidelines (OR=3.14, p=0.01). CONCLUSIONS The intervention was more effective than the wellness control at 12 months, and physical activity increases from baseline to 6 months were maintained, suggesting the intervention may lead to sustainable behavior change. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov NCT01583140.

Using interactive Internet technology to promote physical activity in Latinas: Rationale, design, and baseline findings of Pasos Hacia La Salud

Internet-based interventions show promise as an effective channel for promoting physical activity. However, a paucity of research has been conducted among underserved groups despite recent increases in Internet access and physical activity-related health disparities in these communities. Thus, the current randomized controlled trial will test the efficacy of an individually tailored, Internet-based physical activity intervention for Latinas. This program was culturally and linguistically adapted for the target population through extensive formative research. Two hundred eighteen sedentary Latinas were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. The Physical Activity Internet Intervention, based on Social Cognitive Theory and the Transtheoretical Model, utilizes a website with features including self-monitoring, goal setting, discussion forum, links to online resources, individually tailored and motivation-matched physical activity feedback reports, and exercise tip sheets. Participants receive regular emails over the first 6months with a tapered dose during the second 6months (maintenance phase) to alert them to new content on the website. The main outcome is differences in minutes/week of moderate to vigorous physical activity at six months as measured by the 7-Day Physical Activity Recall and accelerometer data. High reach, low cost, culturally relevant Internet-based interventions that encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.

The Immediate and Delayed Cardiovascular Benefits of Forgiving

Background The putative health benefits of forgiveness may include long-term buffering against cardiovascular reactivity associated with rumination. Although studies show short-term benefits of adopting a forgiving perspective, it is uncertain whether this perspective protects against repeated future rumination on offenses, which may be necessary for long-term health benefits. Also unclear is whether forgiveness offers unique benefits beyond simple distraction. Methods Cardiovascular parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], and heart rate) were measured while 202 participants thought about a previous offense from an angry or forgiving perspective or were distracted. All participants were then distracted for 5 minutes, after which they freely ruminated on the offense. Results Angry rumination initially yielded the greatest increase in blood pressure from baseline (mean [M] [standard deviation {SD}]: SBP = 9.24 [11.16]; M [SD]: DBP = 4.69 [7.48]) compared with forgiveness (M [SD]: SBP = 3.30 [6.48]; M [SD]: DBP = 1.51 [4.94]) and distraction (M [SD]: SBP = 4.81 [6.28]; M [SD]: DBP = 1.75 [3.80]), which did not differ from each other (p > .30). During free rumination, however, those who had previously focused on forgiveness showed less reactivity (M [SD]: SBP = 7.33 [9.61]; M [SD]: DBP = 4.73 [7.33]) than those who had been distracted (M [SD]: SBP = 10.50 [7.77]; M [SD]: DBP = 7.71 [6.83]) and those who previously focused on angry rumination (M [SD]: SBP = 12.04 [11.74]; M [SD]: DBP = 8.64 [12.63]). There were no differences for heart rate. Conclusions Forgiveness seems to lower reactivity both during the initial cognitive process and, more importantly, during mental recreations of an offense soon thereafter, potentially offering sustained protection, whereas effects of distraction appear transient.

The Association Between Abdominal Muscle and Type II Diabetes Across Weight Categories in Diverse Post-Menopausal Women

CONTEXT Despite the key role of muscle in glucose regulation, little is known about the association between muscle area and prevalence of metabolic disorders, or the role low muscle may play in normal weight metabolic obesity. OBJECTIVE The objective was to assess the independent associations between both abdominal muscle and fat depositions (measured by computed tomography) and the prevalence of type II diabetes, and to explore the modifying role of weight category. DESIGN We conducted a cross-sectional analysis of the 2001-2002 visit for the Rancho Bernardo Study, Filipino Womens Health Study, and Health Assessment Study of African American Women. SETTING AND PARTICIPANTS Participants were 392 community-dwelling older women (mean age = 64) free of clinical cardiovascular disease. MAIN OUTCOME MEASURE The main outcome was prevalence of type II diabetes, defined as use of anti-diabetes medication, fasting plasma glucose ≥ 126 mg/dL, and/or OGTT ≥ 200 mg/dL. RESULTS Adjusting for demographics, hypertension, estrogen use, lipids, smoking, physical activity, visceral fat area, and height, a greater muscle-to-total abdominal area ratio (MAR) was associated with lower odds of diabetes [OR = 0.63 per standard deviation, 95% CI (0.43-0.92), p = .02]. Higher visceral fat was associated with greater odds of diabetes in fully adjusted models including total muscle area [OR = 1.48, 95% CI (1.09, 2.01), p = .01]. Associations between MAR and diabetes were stronger for normal weight (BMI 18.5-24.9; OR = 0.32) than overweight/obese women (BMI ≥ 25, OR = 0.71, p-for-interaction = 0.046). Associations with visceral fat did not differ by BMI (p-for-interaction = 0.71). CONCLUSIONS In older women, abdominal muscle area is inversely associated with type II diabetes independent of visceral adiposity, particularly for normal weight women.