Deepika R. Laddu

Public park spaces as a platform to promote healthy living: introducing a HealthPark concept

The concept of Healthy Living (HL) as a primary medical intervention continues to gain traction, and rightfully so. Being physically active, consuming a nutritious diet, not smoking and maintaining an appropriate body weight constitute the HL polypill, the foundation of HL medicine (HLM). Daily use of the HL polypill, working toward optimal dosages, portends profound health benefits, substantially reducing the risk of chronic disease [i.e., cardiovascular disease (CVD), pulmonary disease, metabolic syndromes, certain cancers, etc.] and associated adverse health consequences. To be effective and proactive, our healthcare system must rethink where its primary intervention, HLM, is delivered. Waiting for individuals to come to the traditional outpatient setting is an ineffective approach as poor lifestyle habits are typically well established by the time care is initiated. Ideally, HLM should be delivered where individuals live, work and go to school, promoting immersion in a culture of health and wellness. To this end, there is a growing interest in the use of public parks as a platform to promote the adoption of HL behaviors. The current perspectives paper provides a brief literature review on the use of public parks for HL interventions and introduces a new HealthPark model being developed in Chicago.

Associations Between Self‐Reported Physical Activity and Physical Performance Measures Over Time in Postmenopausal Women: The Women's Health Initiative

To examine prospective associations between changes in physical activity (PA) and changes in physical performance measures (PPMs) over 6 years in older women.

Assessing the Value of Moving More-The Integral Role of Qualified Health Professionals

Being physically active or, in a broader sense, simply moving more throughout each day is one of the most important components of an individuals health plan. In conjunction with regular exercise training, taking more steps in a day and sitting less are also important components of ones movement portfolio. Given this priority, health care professionals must develop enhanced skills for prescribing and guiding individualized movement programs for all their patients. An important component of a health care professionals ability to prescribe movement as medicine is competency in assessing an individuals risk for untoward events if physical exertion was increased. The ability to appropriately assess ones risk before advising an individual to move more is integral to clinical decision-making related to subsequent testing if needed, exercise prescription, and level of supervision with exercise training. At present, there is a lack of clarity pertaining to how a health care professional should go about assessing an individuals readiness to move more on a daily basis in a safe manner. Therefore, this perspectives article clarifies key issues related to prescribing movement as medicine and presents a new process for clinical assessment before prescribing an individualized movement program.

36-Item Short Form Survey (SF-36) Versus Gait Speed As Predictor of Preclinical Mobility Disability in Older Women: The Women's Health Initiative

To compare the value of clinically measured gait speed with that of the self‐reported Medical Outcomes Study 36‐item Short‐Form Survey Physical Function Index (SF‐36 PF) in predicting future preclinical mobility disability (PCMD) in older women.

Factors Associated With Cardiorespiratory Fitness at Completion of Cardiac Rehabilitation: Identification of Specific Patient Features Requiring Attention

BACKGROUND We aimed to determine and compare predictors of postcardiac rehabilitation (CR) cardiorespiratory fitness (CRF), improvements in a large cohort of subjects with varying baseline CRF levels completing CR for ischemic heart disease and to refine prediction models further by baseline CRF. METHODS The Alberta Provincial Project for Outcomes Assessment in Coronary Heart disease (APPROACH) and TotalCardiology (TotalCardiology, Inc, Calgary, Alberta, Canada) databases were used retrospectively to obtain information on 10,732 (1955 [18.2%] female; mean age 60.4, standard deviation [SD] 10.5 years) subjects who completed the 12-week comprehensive CR program between 1996 and 2016. Peak metabolic equivalents (METs) were determined at program start and completion and identified patients at baseline with low fitness (L-Fit) (< 5 METs), moderate fitness (M-Fit, 5-8 METs), or high fitness (H-Fit, > 8 METs). Multivariable linear regression models were developed to predict METs at completion of the program. RESULTS Across all fitness groups, mean baseline METs was the strongest predictor of CRF at completion of CR. Other factors-including sex, age, current smoking status, obesity, and diabetes-were highly predictive of post-CR CRF (all P < 0.05). Compared with H-fit patients, coronary artery bypass graft and chronic obstructive pulmonary disease in L-Fit patients, and cerebrovascular disease in M-Fit patients had an additional negative effect on the overall model variance in post-CR CRF. CONCLUSION Expected CRF at the end of CR is highly predictable, with several key patient factors being clear determinants of CRF. Although most identified patient factors are not modifiable, our analysis highlights populations that may require extra attention over the course of CR to attain maximal benefit.

25-Year Physical Activity Trajectories and Development of Subclinical Coronary Artery Disease as Measured by Coronary Artery Calcium: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Objective To evaluate 25‐year physical activity (PA) trajectories from young to middle age and assess associations with the prevalence of coronary artery calcification (CAC). Patients and Methods This study includes 3175 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who self‐reported PA by questionnaire at 8 follow‐up examinations over 25 years (from March 1985‐June 1986 through June 2010‐May 2011). The presence of CAC (CAC>0) at year 25 was measured using computed tomography. Group‐based trajectory modeling was used to identify PA trajectories with increasing age. Results We identified 3 distinct PA trajectories: trajectory 1, below PA guidelines (n=1813; 57.1%); trajectory 2, meeting PA guidelines (n=1094; 34.5%); and trajectory 3, 3 times PA guidelines (n=268; 8.4%). Trajectory 3 participants had higher adjusted odds of CAC>0 (adjusted odds ratio [OR], 1.27; 95% CI, 0.95‐1.70) vs those in trajectory 1. Stratification by race showed that white participants who engaged in PA 3 times the guidelines had higher odds of developing CAC>0 (OR, 1.80; 95% CI, 1.21‐2.67). Further stratification by sex showed higher odds for white males (OR, 1.86; 95% CI, 1.16‐2.98), and similar but nonsignificant trends were noted for white females (OR, 1.71; 95% CI, 0.79‐3.71). However, no such higher odds of CAC>0 for trajectory 3 were observed for black participants. Conclusion White individuals who participated in 3 times the recommended PA guidelines over 25 years had higher odds of developing coronary subclinical atherosclerosis by middle age. These findings warrant further exploration, especially by race, into possible biological mechanisms for CAC risk at very high levels of PA.

The Importance of School-based Healthy Living Initiatives: Introducing the Health and Wellness Academy Concept

Over the last 15 years, the number of school and community based health-intervention programs in the United States has grown. Many of these programs aim to prevent non-communicable chronic disease diagnoses (e.g., obesity, cardiovascular disease and type-2 diabetes). The Department of Physical Therapy in the College of Applied Health Sciences (CAHS) at the University of Illinois at Chicago (UIC) created a school-based wellness program (SBWP) that focuses on nutrition and physical activity, providing tailored experiences that motivate adolescents to make healthier lifestyle choices. The SBWP began as a camp for children in the surrounding neighborhoods and implemented healthy living practices utilizing students from Departments in the CAHS. From this camp, the Health and Wellness Academy (HWA) evolved. This paper provides a review of school-based initiatives and introduces the UIC HWA, an innovative and reproducible approach that can bring positive environmental change by improving health outcomes for children and their families.

The Association Between Trajectories of Physical Activity and All-Cause and Cause-Specific Mortality

Background The benefits of physical activity (PA) for health have primarily been evaluated during midlife. Whether patterns of change in late-life PA associate with overall and cause-specific mortality remains unclear. Methods We examined the association between PA trajectories and subsequent mortality among 3,767 men aged ≥65 years. Men self-reported PA using the Physical Activity Scale for the Elderly (PASE) at up to four time points from 2000 through 2009 (Year 7); mortality was assessed over an average of 7.1 years after the Year 7 contact. Group-based trajectory modeling identified patterns of PA change. Cox proportional hazards models described associations between patterns of change in PA, Year 7 PA, and subsequent mortality risk. Results Three discrete PA patterns were identified, all with declining PA. Compared to low-activity declining men, moderate (hazard ratio [HR] = 0.78; 95% confidence interval [CI]: 0.70, 0.88) and high-activity (HR = 0.69, 95% CI: 0.57, 0.83) declining groups were associated with lower risk of all-cause mortality. Among models with a single time point, the last time point (Year 7 PA score) was a strong predictor of mortality with HR = 0.85 (95% CI: 0.78, 0.93) per SD increase in PASE score. PA patterns were not a risk factor for mortality after adjustment for the Year 7 PA score. Conclusions Recent PA levels are a stronger indicator of subsequent mortality risk than PA patterns reported over the prior 7 years or prior PA level, suggesting that current PA rather than history of PA is the most relevant parameter in clinical settings.

Racial and Ethnic Differences in Anthropometric Measures as Risk Factors for Diabetes

OBJECTIVE The study objective was to examine the impact of race/ethnicity on associations between anthropometric measures and diabetes risk. RESEARCH DESIGN AND METHODS A total of 136,112 postmenopausal women aged 50–79 years participating in the Women’s Health Initiative without baseline cancer or diabetes were followed for 14.6 years. BMI, waist circumference (WC), and waist-to-hip ratio (WHR) were measured in all participants, and a subset of 9,695 had assessment of whole-body fat mass, whole-body percent fat, trunk fat mass, and leg fat mass by DXA. Incident diabetes was assessed via self-report. Multivariate Cox proportional hazards regression models were used to assess associations between anthropometrics and diabetes incidence. RESULTS During follow-up, 18,706 cases of incident diabetes were identified. BMI, WC, and WHR were all positively associated with diabetes risk in each racial and ethnic group. WC had the strongest association with risk of diabetes across all racial and ethnic groups. Compared with non-Hispanic whites, associations with WC were weaker in black women (P < 0.0001) and stronger in Asian women (P < 0.0001). Among women with DXA determinations, black women had a weaker association with whole-body fat (P = 0.02) but a stronger association with trunk-to-leg fat ratio (P = 0.03) compared with white women. CONCLUSIONS In postmenopausal women across all racial/ethnic groups, WC was a better predictor of diabetes risk, especially for Asian women. Better anthropometric measures that reflect trunk-to-leg fat ratio may improve diabetes risk assessment for black women.

Enhancing Participation in Cardiac Rehabilitation: A Question of Proximity and Integration of Outpatient Services

Numerous investigations have established the strong clinical utility of cardiac rehabilitation, while clinical guidelines continually call for a high level of referral and participation. Historically, medical facilities have faced challenges referring eligible patients to cardiac rehabilitation, enrolling only a small portion of those receiving referral. Consequently, less than ~10% of qualifying patients receive any amount of cardiac rehabilitation. This sobering figure has prompted many efforts to identify barriers to referral as well as enrollment and accordingly propose strategies to bolster participation rates. Although reports have highlighted improvements through focused approaches, enrollment rates still lag behind the goal of reaching 70% by 2022, proposed by the Million Hearts Cardiac Rehabilitation Collaborative. An area of inquiry that has received little to no attention in this effort has been the influence of proximity between physician-driven outpatient clinics and cardiac rehabilitation facilities. In this report we outline the development and design of a clinical faculty practice aimed to maintainclose geographical proximity between our physicianclinic and the cardiac rehabilitation area. We also propose that our impressive enrollment rates of 57% within our facility and 73% when including patients that started alternative exercise programs were likely due to establishing a close proximity between the respective practices.