John Duperly

Physical activity habits of doctors and medical students influence their counselling practices

Doctors are well positioned to provide physical activity (PA) counselling to patients. They are a respected source of health-related information and can provide continuing preventive counselling feedback and follow-up; they may have ethical obligations to prescribe PA. Several barriers to PA counselling exist, including insufficient training and motivation of doctors and improvable, personal PA habits. Rates of exercise counselling by doctors remain low; only 34% of US adults report exercise counselling at their last medical visit. In view of this gap, one of the US health objectives for 2010 is increasing the proportion of patients appropriately counselled about health behaviours, including exercise/PA. Research shows that clinical providers who themselves act on the advice they give provide better counselling and motivation of their patients to adopt such health advice. In summary, there is compelling evidence that the health of doctors matters and that doctors’ own PA practices influence their clinical attitudes towards PA. Medical schools need to increase the proportion of students adopting and maintaining regular PA habits to increase the rates and quality of future PA counselling delivered by doctors.

Nivel de actividad física global en la población adulta de Bogotá (Colombia). Prevalencia y factores asociados

Objetivo: Determinar la prevalencia de los grados de actividad fisica global en las personas de 18 a 65 anos de la ciudad de Bogota (Colombia) e identificar los factores asociados con la regularidad en la actividad. Metodos: Se realizo una encuesta poblacional, aplicada a 3.000 adultos residentes en la ciudad de Bogota durante el ano 2003, seleccionados en una muestra probabilistica multietapica. Los niveles de actividad fisica fueron determinados por medio de la version abreviada del IPAQ. La aplicacion de un modelo de regresion logistico permitio identificar los factores asociados con la regularidad en la actividad. Resultados: La prevalencia ajustada de personas regularmente activas fue del 36,8%. Despues del ajuste de las potenciales variables de confusion, las posibilidades de ser regularmente activo fueron mayores en los varones (odds ratio [OR] = 1,62; intervalo de confianza [IC] del 95%,1,31-2,01) y en personas con una autopercepcion del estado de salud buena o muy buena (OR = 1,87; IC del 95%, 1,41-2,49). Las posibilidades fueron menores en las personas de los grupos de edad de 30-49 y 50-65 anos (OR = 0,78; IC del 95%, 0,63-0,96 y OR = 0,60; IC del 95%, 0,43-0,82, respectivamente) y en aquellas cuya principal actividad en los ultimos 30 dias era buscar trabajo (OR = 0,71; IC del 95%, 0,51-0,97) o realizar labores del hogar (OR = 0,72; IC del 95%, 0,54-0,96). En las mujeres, a diferencia de los varones, los grupos de edad no tuvieron asociacion con la regularidad en la actividad. Conclusion: En este estudio se ponen de manifiesto diferencias entre los sexos en las prevalencias de los niveles de actividad fisica global y en sus factores asociados. En futuros trabajos se debera establecer, en el contexto de ciudades latinoamericanas, si es pertinente determinar, ademas de los grados de actividad fisica global, los indicadores especificos en cada dominio

Low muscle strength is associated with metabolic risk factors in Colombian children: the ACFIES study.

Purpose In youth, poor cardiorespiratory and muscular strength are associated with elevated metabolic risk factors. However, studies examining associations between strength and risk factors have been done exclusively in high income countries, and largely in Caucasian cohorts. The aim of this study was to assess these interactions in schoolchildren in Colombia, a middle income Latin American country. Methods We measured body mass index, body composition, handgrip strength (HG), cardiorespiratory fitness (CRF) and metabolic risk factors in 669 low-middle socioeconomic status Colombian schoolchildren (mean age 11.52±1.13, 47% female). Associations between HG, CRF and metabolic risk factors were evaluated. Results HG and CRF were inversely associated with blood pressure, HOMA index and a composite metabolic risk score (p<0.001 for all) and HG was also inversely associated with triglycerides and C-reactive protein (CRP) (both p<0.05). Associations between HG and risk factors were marginally weakened after adjusting for CRF, while associations between CRF and these factors were substantially weakened after adjusting for HG. Linear regression analyses showed inverse associations between HG and systolic BP (β = −0.101; p = 0.047), diastolic BP (β = −0.241; p> = 0.001), HOMA (β = −0.164; p = 0.005), triglycerides (β = −0.583; p = 0.026) and CRP (β = −0.183; p = 0.037) but not glucose (p = 0.698) or HDL cholesterol (p = 0.132). The odds ratios for having clustered risk in the weakest quartile compared with the strongest quartile were 3.0 (95% confidence interval: 1.81–4.95). Conclusions In Colombian schoolchildren both poorer handgrip strength/kg body mass and cardiorespiratory fitness were associated with a worse metabolic risk profile. Associations were stronger and more consistent between handgrip and risk factors than between cardiorespiratory fitness and these risk factors. Our findings indicate the addition of handgrip dynamometry to non-invasive youth health surveillance programs would improve the accuracy of the assessment of cardio-metabolic health.

Carga de Mortalidad Asociada a la Inactividad Física en Bogotá

UNLABELLED Estimates of the burden of mortality associated to physical inactivity (PI) have not been quantified for large urban centers located in developing countries. OBJECTIVES To estimate the burden of mortality due to six chronic diseases (CDZ) associated to PI and the number of potentially preventable deaths associated to reductions in the prevalence of PI. METHODS PI exposure prevalence obtained via population surveys was linked to mortality data registered during 2002 among adult (> 45 y) Bogotá residents. The strength of association between PI and disease-specific mortality was obtained from the literature. Population attributable risk (PAR) was used to calculate the CDZ mortality attributable to PI and to estimate the number of potentially preventable deaths associated to a 30 % reduction in the prevalence of PI. RESULTS A 53,2 % PI exposure prevalence was associated to a PAR of 19,3 % for coronary artery disease, 24,2 % for stroke, 13,8 % for arterial hypertension, 21 % for Diabetes Mellitus, 17,9 % for colon cancer and 14,2 % for breast cancer. An estimated 7,6 % of all-cause mortality and 20,1 % of CDZ mortality could be attributed to PI. An estimated 5% of the CDZ mortality could be prevented if PI prevalence is reduced by 30 %. CONCLUSION Conservative estimates indicate that a considerable proportion of deaths due to highly prevalent CDZ could be attributed to PI. Strategies to reduce the prevalence of PI in Bogotá could lead to progressive reductions in the burden of CDZ mortality.

Higher Household Income and the Availability of Electronic Devices and Transport at Home Are Associated with Higher Waist Circumference in Colombian Children: The ACFIES Study

Background: The current “epidemic” of childhood obesity is described as being driven by modern lifestyles with associated socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Objective: To evaluate the association between household income and the availability of electronic devices and transport at home, and the values of waist circumference (WC), as an indicator of abdominal obesity, in children and adolescents from Bucaramanga, Colombia. Methods: Cross-sectional study of public elementary and high school population, of low-middle socioeconomic status. Results: A total of 668 schoolchildren were recruited. After adjusting for potential confounders, significant positive associations between waist circumference and higher household income (p = 0.011), and waist circumference and the availability of electronic devices and transport at home (p = 0.026) were found. Conclusions: In low-middle socioeconomic status schoolchildren in a developing country, those from relatively more affluent families had greater waist circumference, an association that is opposite to that observed in developed countries. This finding could be related to higher income family’s ability to purchase electronic devices and motorized transport which discourage physical activity and for their children to buy desirable and more costly western fast food.

Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association

Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association’s My Life Check - Life’s Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association’s 2020 Impact Goals.

One-day workshop-based training improves physical activity prescription knowledge in Latin American physicians: a pre-test post-test study

BackgroundThe physical inactivity pandemic and related non-communicable diseases have made it imperative for medical doctors (MDs) to effectively provide lifestyle counseling as part of prevention and treatment plans for patients. A one-day certification workshop was designed to improve MDs PA prescription knowledge, as part of the Exercise is Medicine® (EIM®) global health initiative. The objective was to determine knowledge gain of MDs participating in a standardized, one-day PA prescription workshop performed throughout Latin America (LA).MethodsA 20-question multiple-choice test on PA topics, based on international guidelines, was completed before and after the workshop. Pre and post-test analyses, without a control group, were performed on 1044 MDs after the 8-h workshop that was delivered 41 times across 12 LA countries, from January 2014 to January 2015. Knowledge improvement was determined using the class-average normalized gain and individual relative gain. T-tests with 95% confidence interval levels were conducted to analyze differences between MD specialties.ResultsTest scores improved on average from 67 to 82% after the workshop (p <0.001). The average total individual relative gain was 29% [CI: 26 to 32%]. Relative gain by country ranged from 9.3% [CI: 2 to 16%; Nicaragua] to 73% [CI: 47 to 98%; Dominican Republic]. The mean of the 41 workshops’ class-average normalized gain was 46% [CI: 42 to 51%]. The largest groups of participants were general practitioners (GPs) (33%; n = 348), internal medicine (19%; n = 194), and family medicine (9%n = 92) specialists. Relative gain for GPs was not different than for all grouped primary care specialties (30% vs. 27%, p =0.48). The knowledge gain was higher for the workshop modules on screening/risk stratification and prescription (43% [CI: 39–48%] and 38% [CI: 34–42%], than for the module on PA benefits and risks (26% [CI: 23–28%]).ConclusionThis one-day workshop had a positive impact on the knowledge gain of MD’s on the topic of PA prescription. Although all groups of specialties increased knowledge, GPs and family medicine MDs benefited the most. This short course is an effective continuing education strategy for teaching PA assessment, counseling and prescription to MDs in Latin America, a topic rarely included in the training of MD’s in the region and the world. Further follow-up is needed to ascertain impact on PA counseling practices.