Katherine B. Gunter

Impact Exercise Increases BMC During Growth: An 8‐Year Longitudinal Study

Our aim was to assess BMC of the hip over 8 yr in prepubertal children who participated in a 7‐mo jumping intervention compared with controls who participated in a stretching program of equal duration. We hypothesized that jumpers would gain more BMC than control subjects. The data reported come from two cohorts of children who participated in separate, but identical, randomized, controlled, school‐based impact exercise interventions and reflect those subjects who agreed to long‐term follow‐up (N = 57; jumpers = 33, controls = 24; 47% of the original participants). BMC was assessed by DXA at baseline, 7 and 19 mo after intervention, and annually thereafter for 5 yr (eight visits over 8 yr). Multilevel random effects models were constructed and used to predict change in BMC from baseline at each measurement occasion. After 7 mo, those children that completed high‐impact jumping exercises had 3.6% more BMC at the hip than control subjects whom completed nonimpact stretching activities (p < 0.05) and 1.4% more BMC at the hip after nearly 8 yr (BMC adjusted for change in age, height, weight, and physical activity; p < 0.05). This provides the first evidence of a sustained effect on total hip BMC from short‐term high‐impact exercise undertaken in early childhood. If the benefits are sustained into young adulthood, effectively increasing peak bone mass, fracture risk in the later years could be reduced.

Physical Activity in Childhood May Be the Key to Optimizing Lifespan Skeletal Health

Physical activities undertaken in childhood, particularly activities, which apply large forces quickly convey optimal benefits to bone mass, size, and structure. Evidence is accumulating that benefits persist well beyond activity cessation. This review examines the potential for early childhood activity to improve bone mineralization and structure and explores childhood activity as prevention for osteoporosis in later life.

Jump starting skeletal health: A 4-year longitudinal study assessing the effects of jumping on skeletal development in pre and circum pubertal children ☆

INTRODUCTION Evidence suggests bone mineral increases attributable to exercise training prior to puberty may confer a significant advantage into adulthood. However, there is a dearth of supportive prospective longitudinal data. The purpose of this study was to assess bone mineral content (BMC) of the whole body (WB), total hip (TH), femoral neck (FN) and lumbar spine (LS) over four years in pre-pubertal boys and girls following a 7-month jumping intervention. METHODS The study population included 107 girls and 98 boys aged 8.6+/-0.88 years at baseline. Participating schools were randomly assigned as either intervention or control school. Children at the intervention school (n=101) participated in a jumping intervention embedded within the standard PE curriculum. The control school children (n=104) had similar exposure to PE without the jumping intervention. BMC was assessed by DXA at baseline, at 7-month post intervention, and annually thereafter for three years totaling 5 measurement opportunities. Multi-level random effects models were constructed and used to predict change from study entry in BMC parameters at each measurement occasion. RESULTS A significant intervention effect was found at all bone sites. The effect was greatest immediately following the intervention (at 7 months) but still significant three years after the intervention. At 7 months, intervention participants had BMC values that were 7.9%, 8.4%, 7.7% and 7.3% greater than the controls at the LS, TH, FN and WB, respectively (p<0.05), when the confounders of age, maturity and tissue mass were controlled. Three years after the intervention had concluded the intervention group had 2.3%, 3.2%, 4.4% and 2.9% greater BMC than controls at the LS, TH, FN and WB respectively (p<0.05), when the confounders of age, maturity and tissue mass were controlled. CONCLUSIONS This provides evidence that short-term high impact exercise in pre-puberty has a persistent effect over and above the effects of normal growth and development. If the benefits are sustained until BMC plateaus in early adulthood, this could have substantial effects on fracture risk.

Factors associated with physical activity in children attending family child care homes.

OBJECTIVE To determine the relationship between family child care home (FCCH) practices and characteristics, and objectively measured physical activity (PA) among children attending FCCHs. METHODS FCCH practices and characteristics were assessed in 45 FCCHs in Oregon (USA) in 2010-2011 using the Nutrition and Physical Activity Self-Assessment for Child Care Instrument. Within the 45 FCCHs, 136 children between ages 2 and 5 years wore an accelerometer during child care attendance over a one-week period. Time spent in light, moderate, and vigorous PA per hour was calculated using intensity-related cut-points (Pate et al., 2006). RESULTS FCCH characteristics and practices associated with higher levels of PA (min/h; p<0.05) included provision of sufficient outdoor active play [32.2 (1.0) vs. 28.6 (1.3)], active play using portable play equipment [31.7 (1.0) vs. 29.3 (1.4)], the presence of a variety of fixed play equipment [32.2 (1.0) vs. 28.9 (1.3)], and suitable indoor play space [32.2 (1.0) vs. 28.6 (1.3)], engaging in active play with children [32.1 (1.1) vs. 29.6 (1.2)], and receiving activity-related training [33.1 (1.2) vs. 30.3 (1.1)]. CONCLUSIONS This is the first study to identify practices and characteristics of FCCHs that influence childrens PA. These data should be considered when developing programs and policies to promote PA in FCCHs.

Stride width discriminates gait of side-fallers compared to other-directed fallers during overground walking

Purpose: The purpose was to identify differences in gait characteristics between older fallers with a tendency to fall sideways compared to those who do not fall to the side. Method: The authors conducted a prospective, case control study of ambulatory adults older than 70 residing in retirement communities. Measurements included spatial and temporal gait parameters and prospective fall surveillance. Results: In all, 29 participants fell to the side, and 64 fell in other directions (forward, backward, straight down); 46 participants experienced no falls. Side-fallers exhibited narrower stride widths compared to other-directed fallers, and stepwise and discriminant analysis correctly classified 67% of side-fallers and other-directed fallers using only stride width. Discussion: This study suggests that side-fallers, who have narrower stride widths compared to those who fall in other directions, may not be adapting their gait to compensate for lateral instability. More research is needed to determine whether narrow gait contributes to unstable walking patterns.

The influence of participation in Better Bones and Balance™ on skeletal health: evaluation of a community-based exercise program to reduce fall and fracture risk.

SummaryOlder women participating in Better Bones and Balance™ (BBB) had similar bone mass at the hip compared to a sample of low active/sedentary controls. However, both groups had higher than expected hip BMD, despite higher risk for osteoporosis among BBB participants.IntroductionBBB is a community-based fall and fracture risk reduction program shown to reduce bone loss at the hip in older women under controlled laboratory conditions. Whether bone benefits are derived from BBB as delivered in the community setting is unknown. The purpose of this study is to evaluate the relationship between community-based BBB participation and parameters of skeletal health in postmenopausal women.MethodsWomen were recruited from BBB classes (n=69) and compared to low active/sedentary controls (n=46); total sample aged 69 + 7.7 years. Bone mineral density (BMD) of the hip and spine was measured using DXA; hip bone structure [cross-sectional area, cross-sectional moment of inertia] at the narrow neck and intertrochanter were derived using hip structural analysis software. Diet, physical activity, and health history were assessed by questionnaires. Group differences in bone outcomes were determined using ANCOVA controlling for age and body mass.ResultsWhile controls were heavier and exhibited greater total body BMD compared to BBB participants (p<0.05), there were no differences between groups in hip or spine BMD or bone structural outcomes (p>0.05) despite BBB participants reporting more frequent prior diagnoses of or risk factors for osteoporosis compared to controls. Both controls and BBB participants had higher than average T-scores at the hip (p<0.05) when compared to an age-matched cohort from NHANES.ConclusionsThese data suggest that participation in BBB may not result in direct benefits to bone. However long-term participation may be associated with other positive outcomes.

Food insecurity and physical activity insecurity among rural Oregon families

Among rural families, rates of both child obesity and household food insecurity (FI) are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA) behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n = 144) were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC), a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%), more were non-white (77.8% vs. 22.2%; p = 0.036) and had lower adult education (30.4% vs. 11.8% with > high school degree; p = 0.015) compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p = 0.002). These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families.

The Family-Home Nutrition Environment and Dietary Intake in Rural Children.

Obesity and food insecurity rates are higher among rural compared to non-rural populations. Little is known, however, about how family-home environments influence childhood obesity-related behaviors, particularly in rural settings. This study examined associations between the family-home nutrition (FN) environment, food insecurity, and dietary intake (fruits, vegetables, whole grains, dairy, protein foods, and added sugars) in rural elementary school-age children (grades K-5/6; n = 102). Parents/caregivers completed surveys on FN, food insecurity, and the Block Kids Food Screener (BKFS). Body mass index (BMI, kg/m2) was calculated from measured height and weight. Approximately 33% of children were classified as overweight/obese and 28% of families were at-risk for food insecurity. Multivariable linear regression analyses examined associations between dietary intakes with FN and food insecurity. More favorable FN scores were associated with lower added sugar intake (B = −1.38, p = 0.04) and higher vegetable (B = 0.15, p < 0.001), fruit (B = 0.71, p = 0.01), and dairy (B = 0.31, p < 0.001) intakes. No significant associations were found between food insecurity and dietary intake. Given the association between higher FN scores and more favorable dietary intake, promoting healthy FN environments among rural children is warranted.

Physical activity levels and obesity status of Oregon Rural Elementary School children

Objective To evaluate the relationship between physical activity (PA, min/school-day) at school and body mass index (BMI, kg/m2) among rural elementary-aged children. Methods Height (cm), weight (kg), and PA were measured for 1767 children (5–12 years) enrolled in six rural Oregon elementary schools in fall, 2013. PA at school was measured over four days using Walk4Life pedometers. Children with ≥ 3 valid monitoring days (n = 1482) were included in analyses. Means (min/d) were calculated for wear time, total PA (TPA: combined light, moderate, vigorous PA), and moderate to vigorous PA (MVPA: step count > 120/min). BMI z-scores were calculated and regression models were run to examine the relationship between PA and BMI z-scores, adjusting for wear time, sex, and grade. Results Overweight (38.1%: BMI ≥ 85th percentile for age and sex) and obesity (19.4%: BMI ≥ 95th percentile) prevalence was similar for boys (n = 782) and girls (n = 700). More MVPA was associated with lower BMI (P < 0.001), independent of sex, wear time or grade. Mean MVPA was 18.9 +/− 8 min/d, versus 15.2 +/− 6.7 min/d for healthy-weight and obese children, respectively. Conclusions Children are not meeting minimum MVPA recommendations (60 min/d) during school hours. Efforts to promote PA for obesity prevention in rural elementary schools should focus on increasing opportunities for MVPA.

engAGE in Community: Using Mixed Methods to Mobilize Older People to Elucidate the Age-Friendly Attributes of Urban and Rural Places.

The growing numbers of older adults in the United States will have a significant impact on community resources, which will affect the ability of residents to live and thrive in their local community regardless of age. For this study, we applied explanatory sequential mixed methods and community-based participatory research (CBPR) to discover how attributes of the physical, social, and service environments determine residents’ perceptions of community age-friendliness and conditions for aging-in-place. A population survey measuring county residents’ (n = 387) perceptions and importance of community resources that support community livability are explained by thematic results of the CBPR, that is, emergent proximal and distal age-friendly factors. Our qualitative approach engaged local people (n = 237) in participatory processes to study and share perceptions of environmental attributes in six communities in one Oregon county. Findings are integrated to explain similarities and differences in older residents’ lived experience of rural and urban settings with regard to age-friendly foci.