Matthew Wade

Programming Resistance Training Required For Positive Effects On Body Composition In Community Programmes: 1960 Board #112 June 2, 3

Purpose. Many sedentary adults possess not only a high body fat percentage (BFP), but also low lean body mass (LBM). The latter may predispose metabolic disease such as Type-2 Diabetes. The majority of public health messaging around physical activity centers on habitual (e.g., walking) or purposeful (e.g., jogging) aerobic activity. However, few positive effects on muscle mass result from such activities. Whilst resistance training (RT) is an obvious solution, its effectiveness in public health settings is not demonstrated. We report two community-based RT studies, Study 1 delivered to a sedentary population, Study 2 to overweight and pre-diabetic patients.METHODS: In Study 1 (48-weeks), participants (n=364) were allocated to either programed-exercise (PROG), un-programmed use of a community gym (FREE), or monthly physical activity counseling (PAC). A wait-list control (CONT) was employed. In Study 2 (12-weeks), overweight and pre-diabetic patients (n=141) were randomly assigned to 12 sessions of either supervised exercise (SUP), PAC, or the two combined (COMB). A wait list control was employed.RESULTS: In Study 1, ANOVA indicated significant differences between treatments. PROG performed significantly better than CONT on strength (p= .048) and LBM (p= .009). FREE performed significantly better than CONT on strength (p= .029). Paired-sample t-tests indicated that PROG improved significantly pre-post on strength (p= .001), LBM (p= .036) and BFP (p= .006), whilst improvements in strength only were observed in FREE (p= .01) and PAC (p= .014). In Study 2 ANOVA indicated no significant differences between treatments. However paired-sample t-tests indicated that SUP improved significantly pre-post on strength (p= .01) and BFP (p= .027), with a clear trend also in LBM (p= .074), whilst significantly improved strength only was observed in COMB (p= .026) and PAC (p= .016).CONCLUSIONS: In both studies, whilst statistically significant increases in strength were observed across all treatments, significant improvements in both strength and body composition were observed only in programmed and/or supervised conditions. Collectively data suggest that the programming and supervision of resistance training is beneficial in community settings when improvements in body composition are desired.

Phase Angle as an Indicator of Health and Fitness in Patients Entering an Exercise Referral Scheme

Body fat (Constant) 51.580** 58.165** 52.127** PhA 2.193* 0.187 2.649* 0.226 0.337 0.029 Age 0.076 0.099 0.111* 0.145 Sex 15.994** 0.714 Lean body mass (Constant) 21.530* 20.281 26.783* PhA 5.351** 0.366 5.438** 0.372 2.223* 0.152 Age 0.014 0.015 0.188* 0.196 Sex 17.225** 1.934 Muscular strength (Constant) 6.092 5.339 0.324 To the Editor: The loss of function as we age may be related to changes at the cellular level.1 Recently, attention has been given to measurement of the phase angle (PhA); a noninvasive simple measure using bioelectrical impedance analysis (BIA). Indeed, PhA is considered a valuable indicator of cellular health and, as it is derived purely from electrical properties of the tissue, it avoids typical concerns associated with BIA using prediction equations. PhA is calculated from the arctangent of the ratio between the resistance and reactance from BIA, and a number of studies have evidenced its associations with age and sex,2 lean body mass,3 and strength.4 Indeed, PhA has even been shown to be predictive of mortality risk.4 Physical fitness is important for health and longevity, and it has been argued that measurements should be considered routinely in clinical practice.5,6 Yet, many general practioners (GPs) have too little time to engage in discussions around physical activity or fitness, let alone their measurement.7 However, BIA is a quick and simple measure and, if PhA is predictive of such outcomes, may offer a valuable alternative for GPs and other clinical practitioners. Despite various studies in other specific clinical populations,4,8,9 there is little research considering the typical person at elevated risk of cardiometabolic disease or type 2 diabetes who might present to a GP and be referred for exercise. As such, the aim of this study was to examine the predictive value of PhA with respect to these measures in a sample of exercise referral patients. This study was a cross-sectional analysis of data collected in a wider trial of exercise referral schemes from 146 patients whowere overweight and/or obese [body mass index (BMI) 25e35], and/or at increased risk of type 2 diabetes as determined by their GP. Relationships between PhA and a range of common health measures used as risk factors including BMI, systolic blood pressure, diastolic blood pressure, and body fat were examined, in addition to lean body mass, muscular strength, and cardiorespiratory fitness. The Pearson or Spearman correlations were performed dependent upon distribution and 95% confidence intervals calculated. Hierarchical multiple linear regression was also performed by examining the predictive capacity of PhA as the independent variable upon dependent variables and adjusting for inclusion of both age and sex. An a of 0.05 was accepted as the threshold for statistical significance.

A Method by Which to Assess the Scalability of Field-Based Fitness Tests of Cardiorespiratory Fitness Among Schoolchildren.

Previous research has reported the validity and reliability of a range of field-based tests of children’s cardiorespiratory fitness. These two criteria are critical in ensuring the integrity and credibility of data derived through such tests. However, the criterion of scalability has received little attention. Scalability determines the degree to which tests developed on small samples in controlled settings might demonstrate real-world value, and is of increasing interest to policymakers and practitioners. The present paper proposes a method by which the scalability of cardiorespiratory field-based tests suitable for school-aged children might be assessed. We developed an algorithm to estimate scalability based on a six-component model; delivery, evidence of operating at scale, effectiveness, costs, resource requirements and practical implementation. We tested the algorithm on data derived through a systematic review of research that has used relevant fitness tests. A total of 229 studies that had used field based cardiorespiratory fitness tests to measure children’s fitness were identified. Initial analyses indicated that the 5-min run test did not meet accepted criteria for reliability, whilst the 6-min walk test likewise failed to meet the criteria for validity. Of the remainder, a total of 28 studies met the inclusion criteria, 22 reporting the 20-m shuttle-run and seven the 1-mile walk/run. Using the scalability algorithm we demonstrate that the 20-m shuttle run test is substantially more scalable than the 1-mile walk/run test, with tests scoring 34/48 and 25/48, respectively. A comprehensive analysis of scalability was prohibited by the widespread non-reporting of data, for example, those relating to cost-effectiveness. Of all sufficiently valid and reliable candidate tests identified, using our algorithm the 20-m shuttle run test was identified as the most scalable. We hope that the algorithm will prove useful in the examination of scalability in either new data relating to existing tests or in data pertaining to new tests.

The Feasibility, Scalability And Outcomes Of Cardiorespiratory Fitness Testing In Primary School Children: 1035 Board #351 June 1, 2: 00 PM - 3: 30 PM.

PURPOSE: The physical activity (PA) levels and fitness of schoolchildren is increasingly a public health issue. Cardiorespiratory fitness (CRF) is a validated marker of PA levels, however there is little systematic measurement of this variable in school children. Systematic measurement would allow all stakeholders, from parents and schools to activity providers and public health agencies, to monitor changes in CRF over time and to evaluate the effectiveness of interventions. The primary purpose of this investigation was to examine the CRF of children at a number of UK primary schools over one academic year. Measures were CRF and body mass index (BMI). Secondary aims were to test the feasibility of CRF testing in primary schools more generally (previous studies have been administered by research teams, and whilst providing useful data relating to validity and reliability, provide little insight into the practicality and scalability of testing).METHODS: Participants from 14 schools (n=463) aged between 8-9 (M±SD BMI 17.61±61) completed a 20 meter shuttle run test (20-mSRT) four times during a calendar year (Oct, Feb, June, Sep). This included data collection either side of the school summer break from July-Sep. CRF (VO2max ml kg-1min-1) was calculated using standardised prediction equations for children. To demonstrate both practicality and scalability of the protocol, testing sessions and data collection were conducted by appropriately trained and qualified personnel already operating in the schools and not by the research team, although the latter vetted this process.RESULTS: Paired sample t-tests indicated a significant increase in CRF during the 1st quarter of the academic year (VO2max 49.58±4.06-51.58±5.09 p 0.01).CONCLUSIONS: Significant negative changes in CRF and BMI suggest children are less active in the summer break, a finding that should be used to inform future activity provision. Data also indicate that the delivery of CRF testing in primary schools is feasible and scalable.

Combining Supervised Exercise And Physical Activity Counselling Might Increase Retention To Gp Exercise Referral Programmes.: 316 Board #153 June 1, 11

PURPOSE: Evidence for the effectiveness of GP Exercise Referral is weak (1, 2). We examined traditional supervised exercise (TRAD), physical activity counselling (PAC), combined TRAD/PAC (CMB) and wait-list controls (CON) in a community exercise referral programme in South East London, UK.METHODS: PPs (n=141) were identified by their doctors as overweight and at increased risk of Type 2 Diabetes. PPs were randomly assigned to treatment. Measures were blood pressure and body composition at baseline and 12 weeks. RESULTS: One-way ANOVA of absolute change in dependant variables between treatments indicated that body fat mass, body fat % and systolic blood pressure were reduced at 12 weeks for all groups including CONT. No statistically significant between-group effects were observed. Paired sample t-tests indicated that lean mass was significantly increased at 12 weeks for all groups including CON; diastolic blood pressure was significantly decreased for all groups at 12 weeks except PAC. Retention was highest to CMB (75%), followed by CON (68%), with PAC and TRAD both at 55%. CONCLUSIONS: Treatment groups and CON appeared to benefit from the programme, with likely measurement effects partially explaining improvement in CON. High retention to CMB is of significance to future GP Referral programmes.

Effects Of Community-based Physical Activity Counselling Among At-risk Individuals: 319 Board #156 June 1, 11: 00 AM - 12: 30 PM.

PURPOSE: Ensuring that at-risk groups are sufficiently physically active is a major public health challenge. Physical activity counselling (PAC) has shown some promise. However many programmes require multiple PAC sessions that are resource intensive and costly. We report a study of PAC – in this case the UK-based programme ‘Let’s Get Moving’ – built around just one PAC session and delivered from general medical practitioner (GP) surgeries.METHODS: Participants (n=1601, M±SD age = 41.4±21.8) were identified by their local GP surgeries as meeting one or more of the following: age 18-74, currently sedentary, BMI 28-35, and/or hypertensive, and/or first medication for hypertension in last 6 months, and/or first medication for weight management in last 6 months. Participants attended a PAC session with a local community exercise professional (CEP) who was based at the surgery. At this session participants were encouraged to increase their physical activity and to attend community exercise sessions provided by local authorities. All participants received a telephone call at 6-weeks and attended a follow-up PAC session with the CEP at 12-weeks. Measures at 0 and 12 weeks were self-reported physical activity (MET-min/week) using the International Physical activity Questionnaire short-form (IPAQ) and an additional question regarding sport participation.RESULTS: Paired sample t-tests indicated significant increases in MET-min/week in Walking (M±SD = 404.6±1622.0, p < 0.001), Moderate Activity (M±SD = 151.8±1365.2, p = 0.006), Vigorous Activity (M±SD = 193.8±1439.7, p = 0.001), Total Activity (M±SD = 659.6±2742.3, p < 0.001), and Sport Participation (M±SD = 35.5±105.5, p < 0.001). Repeated measures ANOVA revealed a significant interaction suggesting that Vigorous Activity increased significantly more for females than males (F[1,533] = 3.981, p = .047). Reasons for this are unclear and warrant further investigation.CONCLUSIONS: Whilst the absence of controls and the self-report of physical activity are limitations, data suggest that brief PAC is an effective intervention when delivered to at risk individuals, and might be especially effective in encouraging females to adopt more vigorous activity. We also speculate that PAC’s effectiveness is enhanced through being located at a GP surgery.

Effects Of Community-based Physical Activity Counselling Among At-risk Individuals: 319 Board #156 June 1, 11

PURPOSE: Ensuring that at-risk groups are sufficiently physically active is a major public health challenge. Physical activity counselling (PAC) has shown some promise. However many programmes require multiple PAC sessions that are resource intensive and costly. We report a study of PAC – in this case the UK-based programme ‘Let’s Get Moving’ – built around just one PAC session and delivered from general medical practitioner (GP) surgeries.METHODS: Participants (n=1601, M±SD age = 41.4±21.8) were identified by their local GP surgeries as meeting one or more of the following: age 18-74, currently sedentary, BMI 28-35, and/or hypertensive, and/or first medication for hypertension in last 6 months, and/or first medication for weight management in last 6 months. Participants attended a PAC session with a local community exercise professional (CEP) who was based at the surgery. At this session participants were encouraged to increase their physical activity and to attend community exercise sessions provided by local authorities. All participants received a telephone call at 6-weeks and attended a follow-up PAC session with the CEP at 12-weeks. Measures at 0 and 12 weeks were self-reported physical activity (MET-min/week) using the International Physical activity Questionnaire short-form (IPAQ) and an additional question regarding sport participation.RESULTS: Paired sample t-tests indicated significant increases in MET-min/week in Walking (M±SD = 404.6±1622.0, p < 0.001), Moderate Activity (M±SD = 151.8±1365.2, p = 0.006), Vigorous Activity (M±SD = 193.8±1439.7, p = 0.001), Total Activity (M±SD = 659.6±2742.3, p < 0.001), and Sport Participation (M±SD = 35.5±105.5, p < 0.001). Repeated measures ANOVA revealed a significant interaction suggesting that Vigorous Activity increased significantly more for females than males (F[1,533] = 3.981, p = .047). Reasons for this are unclear and warrant further investigation.CONCLUSIONS: Whilst the absence of controls and the self-report of physical activity are limitations, data suggest that brief PAC is an effective intervention when delivered to at risk individuals, and might be especially effective in encouraging females to adopt more vigorous activity. We also speculate that PAC’s effectiveness is enhanced through being located at a GP surgery.

Effects On Cardiovascular Risk Factors Of Three 48-week Community-based Exercise Interventions: 2108 Board #260 June 2, 3: 30 PM - 5: 00 PM.

A sedentary lifestyle is associated with cardiovascular disease (CVD). Blood pressure (BP) and blood lipids (cholesterols) are key mediators of CVD. A substantial body of evidence demonstrates reduced CVD risk following systematic physical activity (PA). Despite this evidence, CVD continues to rise, and public health PA initiatives often fail to demonstrate clinically relevant effects. In short, laboratory efficacy often fails to translate into real-world effectiveness.PURPOSE: We investigated the effectiveness of three physical activity interventions. We did so using a Phase-IV clinical trial model, in which all treatments were administered in uncontrolled community settings, and in which all interventions and measures were delivered by, and conducted by, community health centre staff.METHODS: Participants were sedentary individuals receiving no medication to reduce CVD risk (n=238, age 43±5 years). Participants selected a PA or exercise (EX) pathway. Those who selected PA were randomised to either fitness centre based PA counselling delivered by an exercise professional (PAC) or a wait-list control condition (CONT). Those who selected EX were randomised to either a structured exercise program (STRUC) or unstructured fitness centre use (FREE). Measures were mean arterial pressure (MAP: mmHg) estimated using the formula Diastolic Blood Pressure (BP) + (0.33 x (Systolic BP – Diastolic BP)), and total cholesterol (TC: mmol/L). Measures were taken at baseline and 48 weeks. Data were analysed using paired-sample t-tests.RESULTS: Data analysis for cholesterol indicated a small but statistically significant increase in TC in CONT (M=0.8%, SD=0.5, p = .005). TC was however approximately equivalent to baseline in PAC and FREE and reduced, although not significantly, in STRUC. Data for blood pressure indicated a statistically significant decrease in MAP in STRUC (M=2.5%, SD=8.3, P = .004). MAP was reduced, although not significantly, in all other treatments and CONT.CONCLUSIONS: Data suggest that over 48 weeks, all forms of exercise might be effective in offsetting increases in total cholesterol associated with inactivity. Furthermore, a structured exercise programme might be more effective than either unstructured exercise or physical activity counselling in reducing mean arterial blood pressure.

Effects On Cardiovascular Risk Factors Of Three 48-week Community-based Exercise Interventions: 2108 Board #260 June 2, 3

A sedentary lifestyle is associated with cardiovascular disease (CVD). Blood pressure (BP) and blood lipids (cholesterols) are key mediators of CVD. A substantial body of evidence demonstrates reduced CVD risk following systematic physical activity (PA). Despite this evidence, CVD continues to rise, and public health PA initiatives often fail to demonstrate clinically relevant effects. In short, laboratory efficacy often fails to translate into real-world effectiveness.PURPOSE: We investigated the effectiveness of three physical activity interventions. We did so using a Phase-IV clinical trial model, in which all treatments were administered in uncontrolled community settings, and in which all interventions and measures were delivered by, and conducted by, community health centre staff.METHODS: Participants were sedentary individuals receiving no medication to reduce CVD risk (n=238, age 43±5 years). Participants selected a PA or exercise (EX) pathway. Those who selected PA were randomised to either fitness centre based PA counselling delivered by an exercise professional (PAC) or a wait-list control condition (CONT). Those who selected EX were randomised to either a structured exercise program (STRUC) or unstructured fitness centre use (FREE). Measures were mean arterial pressure (MAP: mmHg) estimated using the formula Diastolic Blood Pressure (BP) + (0.33 x (Systolic BP – Diastolic BP)), and total cholesterol (TC: mmol/L). Measures were taken at baseline and 48 weeks. Data were analysed using paired-sample t-tests.RESULTS: Data analysis for cholesterol indicated a small but statistically significant increase in TC in CONT (M=0.8%, SD=0.5, p = .005). TC was however approximately equivalent to baseline in PAC and FREE and reduced, although not significantly, in STRUC. Data for blood pressure indicated a statistically significant decrease in MAP in STRUC (M=2.5%, SD=8.3, P = .004). MAP was reduced, although not significantly, in all other treatments and CONT.CONCLUSIONS: Data suggest that over 48 weeks, all forms of exercise might be effective in offsetting increases in total cholesterol associated with inactivity. Furthermore, a structured exercise programme might be more effective than either unstructured exercise or physical activity counselling in reducing mean arterial blood pressure.

Effects On Aerobic Capacity Of Three 48-week Community-based Exercise Interventions: 2115 Board #267 June 2, 3: 30 PM - 5: 00 PM.

A sedentary lifestyle is associated with cardiovascular disease (CVD). A substantial and compelling body of evidence demonstrates reduced CVD risk following systematic physical activity (PA). Despite this evidence, CVD continues to rise, and public health PA initiatives appear to be failing to demonstrate clinically relevant effects.PURPOSE: A core component of cardiovascular health is the ability to utilise oxygen, termed ‘oxygen uptake’ or VO2. We investigated the effectiveness of three physical activity interventions on oxygen uptake. We did so using a Phase-IV clinical trial model, in which all treatments were administered in uncontrolled community settings, and in which all interventions and measures were delivered by, and conducted by, community health centre staff.METHODS: Participants were sedentary individuals receiving no medication to reduce CVD risk (n=238, age 43±5 years). Participants selected a PA or exercise (EX) pathway. Those who selected PA were randomised to either fitness centre based physical activity counselling delivered by an exercise professional (PAC) or a wait-list control condition (CON). Those who selected EX were randomised to either a structured exercise program (STRUC) or unstructured fitness centre use (FREE). The dependent measure was predicted maximum oxygen uptake (VO2 max; ml/kg/min), measured using the COSMED Fitmate. Measures were taken at baseline and 48 weeks.RESULTS: Repeated measures ANOVA indicated no statistically significant difference between treatments (F [3,215] = 1.173, p = .321), and paired-sample t-tests indicated no significant pre-post effects for any treatment. When data were grouped using a quartile split by baseline VO2 max however, repeated measures ANOVA indicated significant differences between groups (F [3,215] = −6.1, p < .001), specifically that whilst in the highest two quartiles VO2 max was reduced (M = -2.7, SD = 7.0, p=.05 and M = -2.6, SD = 6.0, p=.008 respectively), and no significant change was observed in the third quartile (M = -0.1, SD = 5.0, p = .89), in the lowest quartile, VO2 max was significantly increased (M = 4.1, SD = 6.6, p < .001). CONCLUSIONS: Data suggest that in terms of VO2, treatments in the current study were more effective with the least fit participants at baseline, and actually counter-productive for the most fit.