Karen J. Coleman

Comparison of activity monitors to estimate energy cost of treadmill exercise.

PURPOSE To evaluate the validity of five physical activity monitors available for research: the CSA, the TriTrac-R3D, the RT3, the SenseWear Armband, and the BioTrainer-Pro. METHODS A total of 10 healthy men and 11 healthy women performed 10 min of treadmill walking at 54, 80, and 107 mxmin and treadmill running at 134, 161, 188, and 214 mxmin. The CSA, TriTrac-R3D, RT3, and BioTrainer-Pro accelerometers were placed side by side bilaterally at the waist in the axillary position, and the SenseWear Armband monitors were placed bilaterally on the posterior portion of each arm in the mid-humeral position. Simultaneous measurements of body motion and indirect calorimetry were continuously recorded during all exercise. Data were analyzed with repeated measures ANOVA and pairwise Bonferroni-adjusted estimated marginal means. RESULTS : There was no significant difference in the mean energy expenditure (EE) recorded bilaterally by any of the monitors (P < 0.05) at any treadmill speed. The SenseWear Armband, the TriTrac-R3D, and the RT3 had significant increases in mean EE across all walking and running speeds (P < 0.05). Below 161 mxmin, the mean EE recorded by the BioTrainer-Pro and the CSA increased significantly (P < 0.001); however, there was no significant difference (P > 0.10) in mean EE recorded by either monitor for speeds above 161 mxmin. In general, all monitors overestimated EE at most treadmill speeds when compared with indirect calorimetry (P < 0.001), except for the CSA which underestimated EE at the lowest and highest speeds. CONCLUSION The CSA was the best estimate of total EE at walking and jogging speeds, the TriTrac-R3D was the best estimate of total EE at running speeds, and the SenseWear Armband was the best estimate of total EE at most speeds.

Pre‐ and Postsurgery Behavioral Compliance, Patient Health, and Postbariatric Surgical Weight Loss

This study investigated the relationship between weight loss from gastric bypass surgery, patient characteristics, and compliance with physician instructions before and after surgery. A chart review of psychiatric and medical files was conducted for an initial cohort of 172 patients in a postsurgical management program. A total of 112 patients (primarily women (85%), white (79%), and well educated) from this cohort had presurgical data. Of these 112 subjects, 67 (60%) had postsurgical compliance information and BMI at 24 months postsurgery. The relationships between weight loss and a number of demographic, psychiatric, comorbid, and behavioral compliance factors were examined for these 67 patients. Missed appointments and noncompliance with exercise and weight loss plan instructions were high before and after surgery (65% vs. 72% for missed appointments, 39% vs. 51% for exercise, 42% vs. 57% for weight loss instructions). Although poor food choices were not frequently a problem before surgery (11%), they increased significantly after surgery: 37%, χ2(1) = 25.00, P < 0.001. Participants who lost the least weight at 2 years postsurgery were more likely to be nonwhite (r = 0.27, P = 0.039), have a lower socioeconomic status (SES) (r = 0.285, P = 0.02), and have a diagnosis of binge eating before surgery (r = 0.25, P = 0.039). Having more contact with patients and requiring adherence to behavioral changes, especially with respect to exercise and dietary restrictions, may improve the long‐term outcomes for bariatric procedures. In addition, those patients who are depressed and suffer from binge eating may need special attention from physicians during long‐term postoperative follow‐up.

Determinants of physical activity in obese children assessed by accelerometer and self-report

Previous research has shown that predictors of activity in adults depend upon the method of measurement. This study is designed to assess the predictors of activity in a sample of 59 obese children. Activity was measured using self-reported and TriTrac accelerometer METs. Self-report and TriTrac accelerometer measures were moderately correlated, r = 0.46, with the self-reported activity (2.3 METs) significantly greater than TriTrac (1.6 METs). Hierarchical regression analysis examined the influence of socioeconomic level, body composition, fitness, hedonics of child and adult activity behaviors, and decisional balance on self-reported and accelerometer-measured activity, controlling for child and parent psychopathology. Child and parent psychological symptoms accounted for 8.3% and 3.4% of the variance in accelerometer and self-reported METs, respectively. The model for accelerometer-measured activity showed socioeconomic level and parent self-report of activity accounted for 14.8% of the incremental variance in child activity. The model for self-report of child activity found that child fitness accounted for 23.5% of the incremental variance in child activity. These results suggest that the predictors of activity level are different based upon the method of measurement, consistent with research in adults.

Differences in salivation to repeated food cues in obese and nonobese women.

In a series of studies we have shown that salivation, a cephalic phase preingestive response, habituates to repeated presentations of olfactory or gustatory cues in nonobese subjects.Previous research has studied the differences in anticipatory response to food cues in obese vs. nonobese subjects. This study was designed to assess if obese and nonobese females differed in their patterns of salivary response to repeated presentation of palatable food cues. The salivary response to 10 gustatory presentations of lemon yogurt was studied in 10 obese and 10 nonobese nonrestrained women. Results showed significant differences in the pattern of salivary responding, with obese subjects showing a significantly slower decline in salivation than nonobese subjects. These results are consistent with the hypothesis that obese women differ from nonobese women in their pattern of response to repeated food cues. The results are discussed in relationship to models of intake that focus on differences in satiety or differences in the reinforcing value of food between obese and nonobese subjects.

Prevalence of Extreme Obesity in a Multiethnic Cohort of Children and Adolescents

OBJECTIVE To estimate the prevalence of extreme obesity in a large, multiethnic contemporary cohort of children and adolescents. STUDY DESIGN In a cross-sectional study, measured weight and height were extracted from electronic medical records of 710,949 patients aged 2 to 19 years (87.8% of eligible patients) who were enrolled in an integrated prepaid health plan in 2007 and 2008. Prevalence of extreme obesity was defined as body mass index (BMI)-for-age>or=1.2 times 95th percentile or BMI>or=35 kg/m2. RESULTS Extreme obesity was observed in 7.3% of boys and 5.5% of girls. The prevalence peaked at 10 years of age in boys and at 12 years of age with a bimodal distribution in girls (second peak at 18 years; P value for sex x age interaction=.036). The prevalence of extreme obesity varied in ethnic/racial and age groups, with the highest prevalence in Hispanic boys (as high as 11.2%) and African-American girls (as high as 11.9%). CONCLUSION Extreme obesity in Southern California youth is frequently observed at relatively young ages. The shift toward extreme body weights is likely to cause an enormous burden of adverse health outcomes once these children and adolescents grow older.

Validation of the telephone and in-person interview versions of the 7-day PAR.

PURPOSE To validate the 7-d Physical Activity Recall (PAR) telephone interview version and its activity intensity categories. METHODS Seventy-four adults (47 women, 27 men), ranging in age (18-67) and activity levels, were interviewed by phone and in-person using the same PAR protocol. Each participant wore a TriTrac-R3D accelerometer for 10 d. Validity was assessed by comparing the phone and in-person PAR interviews with the TriTrac-R3D data. RESULTS Sixty-nine adults (44 women, 25 men) were used for all statistical analyses. Intraclass correlations between the two PAR interviews for total minutes per week of activity were r = 0.96, and r = 0.94 for moderate, r = 0.97 for hard, and r = 0.97 for very hard intensity activities. Pearson product moment correlations between the phone PAR and TriTrac-R3D for total minutes per week of physical activity were r = 0.43, and r = 0.31 for moderate, r = 0.39 for hard, and r = 0.78 for very hard intensity activities. Pearson correlations between the in-person PAR and TriTrac-R3D for total minutes per week of physical activity were r = 0.41, and r = 0.33 for moderate, r = 0.43 for hard, and r = 0.74 for very hard intensity activities. Participants overestimated the amount of physical activity in both interviews as compared with the TriTrac-R3D. CONCLUSION The phone and in-person versions of the PAR are equivalent measures for self-reported physical activity. Regardless of age, body mass index, or physical activity level both interview methods had similar estimates for total minutes per week of moderate, hard, and very hard activity. Correlations between each interview method and the TriTrac-R3D were lower for moderate and hard activities as compared with very hard activities.

Initial validation of an exercise "vital sign" in electronic medical records.

PURPOSE The objective of this study is to describe the face and discriminant validity of an exercise vital sign (EVS) for use in an outpatient electronic medical record. METHODS Eligible patients were 1,793,385 adults 18 yr and older who were members of a large health care system in Southern California. To determine face validity, median total self-reported minutes per week of exercise as measured by the EVS were compared with findings from national population-based surveys. To determine discriminant validity, multivariate Poisson regression models with robust variance estimation were used to examine the ability of the EVS to discriminate between groups of patients with differing physical activity (PA) levels on the basis of demographics and health status. RESULTS After 1.5 yr of implementation, 86% (1,537,798) of all eligible patients had an EVS in their electronic medical record. Overall, 36.3% of patients were completely inactive (0 min of exercise per week), 33.3% were insufficiently active (more than 0 but less than 150 min·wk), and 30.4% were sufficiently active (150 min or more per week). As compared with national population-based surveys, patient reports of PA were lower but followed similar patterns. As hypothesized, patients who were older, obese, of a racial/ethnic minority, and had higher disease burdens were more likely to be inactive, suggesting that the EVS has discriminant validity. CONCLUSIONS We found that the EVS has good face and discriminant validity and may provide more conservative estimates of PA behavior when compared with national surveys. The EVS has the potential to provide information about the relationship between exercise and health care use, cost, and chronic disease that has not been previously available at the population level.

Exercise in treating obesity in children and adolescents

This paper reviews the use of exercise programs with obese children and adolescents. Studies included for review met two criteria: 1) children or adolescents were defined as obese using objective criteria for obesity, and 2) obese children or adolescents were provided either different types of exercise programs or an exercise program compared with a no-exercise control condition. Thirteen controlled outcome studies were identified. Experimental design, methods, and outcomes are presented and evaluated for each study. Factors that should be considered in research testing exercise interventions are discussed, including adherence, diet, age, gender, and type of exercise. In addition, the potential for exercise programs in the prevention of obesity in childhood and adolescence is discussed. The results support the continued use of exercise in combination with diet for child and adolescent obesity treatment, but the limited number of controlled studies indicates the need for more research in the area. The potential for exercise programs in the prevention of obesity in childhood and adolescence is discussed.

Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study

Objective To investigate if the widely publicized warnings in 2003 from the US Food and Drug Administration about a possible increased risk of suicidality with antidepressant use in young people were associated with changes in antidepressant use, suicide attempts, and completed suicides among young people. Design Quasi-experimental study assessing changes in outcomes after the warnings, controlling for pre-existing trends. Setting Automated healthcare claims data (2000-10) derived from the virtual data warehouse of 11 health plans in the US Mental Health Research Network. Participants Study cohorts included adolescents (around 1.1 million), young adults (around 1.4 million), and adults (around 5 million). Main outcome measures Rates of antidepressant dispensings, psychotropic drug poisonings (a validated proxy for suicide attempts), and completed suicides. Results Trends in antidepressant use and poisonings changed abruptly after the warnings. In the second year after the warnings, relative changes in antidepressant use were −31.0% (95% confidence interval −33.0% to −29.0%) among adolescents, −24.3% (−25.4% to −23.2%) among young adults, and −14.5% (−16.0% to −12.9%) among adults. These reflected absolute reductions of 696, 1216, and 1621 dispensings per 100 000 people among adolescents, young adults, and adults, respectively. Simultaneously, there were significant, relative increases in psychotropic drug poisonings in adolescents (21.7%, 95% confidence interval 4.9% to 38.5%) and young adults (33.7%, 26.9% to 40.4%) but not among adults (5.2%, −6.5% to 16.9%). These reflected absolute increases of 2 and 4 poisonings per 100 000 people among adolescents and young adults, respectively (approximately 77 additional poisonings in our cohort of 2.5 million young people). Completed suicides did not change for any age group. Conclusions Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting.

Physical Activity and Healthy Eating in the After-School Environment.

BACKGROUND No research to date has extensively described moderate and vigorous physical activity (MVPA) and healthful eating (HE) opportunities in the after-school environment. The current study described the quality of the after-school environment for its impact on childrens MVPA and HE. METHODS An alliance of 7 elementary schools and Boys and Girls Clubs who worked with the Cooperative Extension Service in Lawrence, KS, was selected to participate in a larger intervention study. After-school settings were observed for information regarding session type, session context, leader behavior, physical activity, and snack quality using validated instruments such as the System for Observing Fitness Instruction Time. Data presented are baseline measures for all sites. RESULTS Participating children (n = 144) were primarily non-Hispanic white (60%) and in fourth grade (69%). After-school sites offered 4 different sessions per day (active recreation, academic time, nonactive recreation, and enrichment activities). Children were provided with a daily snack. On 36% of the days observed, this snack included fruit, fruit juice, or vegetables. There was significantly more time spent in MVPA during free play sessions (69%) compared to organized adult-led sessions (51%). There was also significantly more discouragement of physical activity during organized adult-led sessions (29%) as compared to the free play sessions (6%). CONCLUSIONS The quality of after-school programs can be improved by providing fruits and vegetables as snacks; offering more free play activities; training the after-school staff in simple, structured games for use in a variety of indoor and outdoor settings; and training after-school staff to promote and model MVPA and HE in and out of the after-school setting.