Deborah Rohm Young

A comparison of the Yale Physical Activity Survey with other physical activity measures

PURPOSE The purpose of this study was to determine associations of the Yale Physical Activity Survey (YPAS) with the Stanford 7-d physical activity recall (PAR) and several physiologic measures, both cross-sectionally and longitudinally. METHODS Participants were 59 individuals (45% African-American, 79% women) between the ages of 60 and 80 yr who were enrolled in a clinical trial. From the YPAS, total time in activity, estimated weekly energy expenditure, and indices of vigorous activity, leisurely walking, moving, standing, sitting, and an overall summary index were determined. From the PAR, daily energy expenditure, and hours spent in light, moderate, and hard/very hard activities were estimated. Physiologic measurements included estimated VO2max, resting pulse rate, and body mass index (BMI). RESULTS Weekly energy expenditure, total time in activity, and the summary index correlated with daily energy expenditure at baseline (Spearman correlations = 0.37, 0.30, 0.33, respectively, Ps < 0.01) and time in moderate activity (r = 0.37, 0.29, 0.39, Ps < 0.01). The vigorous index was also significantly correlated with daily energy expenditure and time in light, moderate, and hard/very hard activity. The summary, moving, and standing indices correlated with VO2max (Ps < 0.05) and BMI (Ps < 0.05). Change in physical activity determined from the PAR correlated with change in most YPAS dimensions, although few correlations were statistically significant. CONCLUSIONS The global activities and the vigorous activity index determined from the YPAS correlated with corresponding measures of the PAR. The validity of the YPAS for light-intensity activities is less clear, although optimal validation measures for light-intensity activity are yet to be defined. The ability of the YPAS to detect change in physical activity shows some promise, but data from this study are insufficient to be conclusive.

Physical activity patterns of urban African Americans.

This study assessed physical activity patterns in a sample of urban African Americans, whose participation in physical activity has not previously been well-described. From questions administered by interviewers during health fair screenings in 19 churches in East Baltimore, information regarding participation in regular, leisure-time activity (defined as 30 minutes of activity, 5 days per week), time spent walking on the job, and distance walked to and from work was assessed from 365 adults (69% women). Regular, leisure-time activity participation was 18% for men and 16% for women. When the definition of physical activity participation was broadened to include: (1) spending over half the day walking at work; (2) walking at least 10 blocks to and from work; as well as (3) regular, leisure-time activity, 41% of men and 38% of women were active. These data suggest that, while a small percentage of African Americans participate in regular physical activity, a substantial percentage are regularly active when non-leisure-time activity is assessed. To accurately characterize overall participation, physical activity derived from a variety of sources, including transportation and work-related activity, should be assessed.

Physical activity levels of persons with mental illness attending psychiatric rehabilitation programs

This study objectively measured physical activity levels in overweight and obese adults with severe mental illness and examined relationships among psychiatric symptoms, cognitive functioning and physical activity. A diverse sample (50% female, 50% African American) of overweight and obese adults (n=55) with mental illness were asked to wear accelerometers for 4 days. Study participants averaged 120 min/week of moderate to vigorous physical activity (MVPA); 35% had >or=150 min/week of MVPA. Only 4% accumulated >or=150 min/week of MVPA in bouts >or=10 min as per public health recommendations. Depressive symptoms, psychological distress and cognitive functioning were not associated with physical activity (p>.05). Although participants appeared to have substantial minutes of MVPA, increased physical activity bouts, or sessions, may be necessary for increased health and weight management benefits for persons with severe mental illness. Efforts are needed to increase physical activity sessions in this vulnerable population.

Reliability of RT3 accelerometers among overweight and obese adults.

PURPOSE Accurate and reliable measurement of physical activity plays an important role in assessing effective lifestyle interventions for obesity. This study examined reliability of accelerometer-based estimates of physical activity levels of overweight and obese adults before and after a lifestyle weight loss program. METHODS Participants were overweight and obese (body mass index = 25-45 kg x m) members (n = 1592; 67% female, 42% African American) of the multicenter weight loss maintenance trial. They wore RT3 accelerometers during waking hours for 7 d at baseline and after a 6-month weight loss intervention that included diet and physical activity recommendations. Moderate-to-vigorous physical activity (MVPA) and MVPA occurring in bouts >or=10 min (bout MVPA) were assessed. RESULTS At baseline, wear time minimums of 10 and 6 h.d resulted in similar average minutes per day of MVPA (18.3 and 18.0 min) and MVPA bout minutes per day (6.9 and 6.7 min). Similar wear times occurred after the weight loss intervention for MVPA (27.0 and 26.8 min) and bout MVPA (15.1 and 15.0 min). Reliability measurements by intraclass correlation (ICC) were larger for 4 versus 2 d x wk minimum wear time for both MVPA and bout MVPA (4-d ICC = 0.27-0.44 and 2-d ICC = 0.19-0.38), but there was little increase in ICC comparing 4 (ICC = 0.27-0.44) and 7 d x wk (ICC = 0.30-0.46). CONCLUSIONS Longer wear time requirements did not result in significant increases in reliability. Using 4 d of data with >or=6 h x d of wear time optimized the balance between ICC and participant burden in overweight and obese adults before and after a weight loss intervention. Future investigations using accelerometers to estimate MVPA in overweight and obese samples can consider requiring less monitor wear time.

Associations Between Family Support, Family Intimacy, and Neighborhood Violence and Physical Activity in Urban Adolescent Girls

We examined the association between various dimensions of the family environment, including family intimacy and involvement in activities, family support for physical activity, and neighborhood violence (perceived and objective) and physical activity among urban, predominantly African American, ninth-grade girls in Baltimore, Md. Greater family intimacy (P = .05) and support (P = .01), but not neighborhood violence, was associated with physical activity. Family factors, including family intimacy and support, are potential targets in physical activity interventions for urban high-school girls.

Can individuals meet multiple physical activity and dietary behavior goals

OBJECTIVES To examine whether participants with the most behavioral goals to achieve were more likely to meet more goals than those given fewer goals. METHODS Eight hundred ten participants were randomly assigned to advice-only, established guidelines for blood pressure control (reduced sodium, increased physical activity), or established guidelines plus the DASH diet (increased fruits, vegetables, low-fat dairy, reduced fat). RESULTS At 6 months, 11.7% of Advice-Only, 19.3% of Established, and 44.6% of Established plus DASH met at least 3 goals (P<0.0001). At 18 months, 33.5% of Established plus DASH met at least 3 goals. CONCLUSIONS Those with the most goals to achieve reached the most goals.

Associations Between Physical Activity and Cardiometabolic Risk Factors Assessed in a Southern California Health Care System, 2010–2012

Introduction Risk factors associated with many chronic diseases can be improved through regular physical activity. This study investigated whether cross-sectional associations between physical activity, assessed by the Exercise Vital Sign (EVS), and cardiometabolic risk factors can be detected in clinical settings. Methods We used electronic records from Kaiser Permanente Southern California members (N = 622,897) to examine the association of EVS category with blood pressure, fasting glucose, random glucose, and glycosylated hemoglobin. Adults aged 18 years or older with at least 3 EVS measures between April 2010 and December 2012, without comorbid conditions, and not taking antihypertension or glucose-lowering medications were included. We compared consistently inactive (EVS = 0 min/wk for every measure) with consistently active (EVS ≥150 min/wk) and irregularly active (EVS 1–149 min/wk or not meeting the consistently active or inactive criteria) patients. Separate linear regression analyses were conducted controlling for age, sex, race/ethnicity, body mass index, and smoking status. Results Consistently active women had lower systolic (−4.60 mm Hg; 95% confidence interval [CI], −4.70 to −4.44) and diastolic (−3.28 mm Hg; 95% CI, −3.40 to −3.17) blood pressure than inactive women. Active men had lower diastolic blood pressure than inactive men. Consistently active patients (women, −5.27 mg/dL [95% CI, −5.56 to −4.97]; men, −1.45 mg/dL [95% CI, −1.75 to −1.16] and irregularly active patients (women, −4.57 mg/dL [95% CI, −4.80 to −4.34]; men, −0.42 mg/dL [95% CI, −0.66 to −0.19]) had lower fasting glucose than consistently inactive patients. Consistently active and irregularly active men and women also had favorable random glucose and HbA1c compared with consistently inactive patients. Conclusion Routine clinical physical activity assessment may give health care providers additional information about their patients’ cardiometabolic risk factors.

Cardiometabolic Risk Factors Among 1.3 Million Adults With Overweight or Obesity, but Not Diabetes, in 10 Geographically Diverse Regions of the United States, 2012–2013

Introduction Various phenotypes of overweight and obesity pose various health risks. The objective of this study was to determine the prevalence of 4 commonly measured cardiometabolic risk factors (CRFs) among adults with overweight or obesity, but not diabetes, at the time of the study. Methods We analyzed data for 1,294,174 adults (aged ≥20 y) who were members of one of 4 integrated health systems. Each cohort member had a body mass index in 2012 or 2013 that indicated overweight or obesity. We determined the presence of 4 CRFs within 1 year of the first BMI measurement: elevated blood pressure (systolic ≥130 mm Hg or diastolic >85 mm Hg or ICD-9-CM [International Classification of Diseases, Ninth Revision, Clinical Modification] diagnosis code 401.0–405.9); elevated triglycerides (≥150 mg/dL or ICD-9-CM 272.1); low high-density lipoprotein cholesterol (<40 mg/dL for men or <50 mg/dL for women or ICD-9-CM 272.5); and prediabetes (fasting glucose 100–125 mg/dL or HbA1c 5.7%–6.4% or ICD-9-CM 790.2x). We tested the risk of having 1 or more CRFs after adjusting for obesity class and demographic characteristics with multivariable logistic regression. Results Among participants with overweight (52.5% of the sample), 18.6% had none of the 4 CRFs. Among the 47.5% of participants with obesity, 9.6% had none; among participants with morbid obesity, 5.8% had none. Age was strongly associated with CRFs in multivariable analysis. Conclusion Almost 10% of participants with obesity had no CRFs. Overweight or obesity increases cardiometabolic risk, but the number and type of CRFs varied substantially by age, even among participants with morbid obesity.

Re-recruiting young adult women into a second follow-up study

Background Recruitment among young adults presents a unique set of challenges as they are difficult to reach through conventional methods. Purpose To describe our experience using both traditional and nontraditional methods in the re-recruitment of young adult women into the second follow-up study of the Trial of Activity for Adolescent Girls (TAAG). Methods 589 adolescent girls were re-recruited as 11th graders into TAAG 2. Re-recruitment efforts were conducted when they were between 22 and 23 years of age (TAAG 3). Facebook, email, postal mail, and telephone (call and text) were used. Descriptive statistics were used to summarize cohort characteristics. Discrete categorical variables were compared using Pearson chi-square or Fishers exact test, while Wilcoxon rank sum or t-tests were calculated for continuous variables. Pearsons chi square test, analysis of variance, and the Kruskal-Wallis test were also used. Logistic regression was used to calculate adjusted models. Results All 589 cohort members were located and 479 (81.3%) were re-recruited. Participants who reported living in a two parent household or with their mothers only, and who did not perceive a lot of crime in their neighborhood were more likely to consent to participate in TAAG 3 (p = 0.047 and p = 0.008, respectively). Perceived neighborhood crime remained significant in the adjusted model (OR 0.48, 95% CI 0.25–0.90, p = 0.02). Early and late consenters differed by race/ethnicity (p = 0.015), household type (p = 0.001), and socioeconomic status (p = 0.005). In the adjusted model, Black participants were more likely to consent later than White participants (OR 1.83, 95% CI 1.07–3.13, p = 0.03). Conclusions A number of recruitment strategies and outreach attempts were needed to recruit young adult women into a follow-up study. Persistent efforts may be needed to recruit participants with race/ethnic diversity and lower socioeconomic status.

Associations of overweight/obesity and socioeconomic status with hypertension prevalence across racial and ethnic groups

Racial/ethnic disparities in the prevalence of diagnosed hypertension are persistent but may be partially explained by racial/ethnic differences in weight category and neighborhood socioeconomic status. The authors compared hypertension prevalence rates among 4 060 585 adults with overweight or obesity across 10 healthcare systems by weight category and neighborhood education level in geographically and racially diverse individuals. Data were obtained from electronic health records. Hypertension was defined as at least two outpatient visits or one inpatient hospitalization with a coded diagnosis. Logistic regression, adjusted for age, sex, and site, with two‐way interactions between race/ethnicity and weight category or neighborhood education, was used to examine the association between hypertension and race/ethnicity, with whites as the reference. Results documented that odds ratios for hypertension prevalence were greater for blacks, American Indians/Alaskan Natives, Asians, and Native Hawaiians/other Pacific Islanders compared with whites and lower for Hispanics in similar weight categories and neighborhood education levels. Although two‐way interactions were statistically significant, the magnitude of the odds of hypertension compared with whites did not substantially vary across weight or neighborhood education. Hypertension odds were almost double relative to whites for blacks and Native Hawaiians/other Pacific Islanders across most weight categories and all neighborhood education levels. Odds of hypertension were about 50% greater for Asians relative to whites across weight categories. Results suggest that other factors might be associated with racial/ethnic disparities in hypertension. More research is needed to understand the many factors that may contribute to variation in diagnosed hypertension across racial/ethnic groups with overweight or obesity.