Meghan Baruth

Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis

The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.

The Faith, Activity, and Nutrition (FAN) Program: Design of a participatory research intervention to increase physical activity and improve dietary habits in African American churches

BACKGROUND African Americans are at increased risk for cardiovascular disease and cancer morbidity and mortality. Physical activity and healthy dietary practices can reduce this risk. The church is a promising setting to address health disparities, and community-based participatory research is a preferred approach. OBJECTIVES Using a community-based participatory approach and the social ecologic model, the FAN trial aims to increase self-reported moderate-intensity physical activity and fruit and vegetable consumption and reduce blood pressure in African American church members. Secondary aims are to increase objectively measured moderate-intensity physical activity and fiber/whole grain consumption and reduce fat consumption. DESIGN FAN is a group randomized trial (GRT) with two levels of clustering: participants (N=1279; n=316 accelerometer subgroup) within church and church within church cluster. In the first wave, seven clusters including 23 churches were randomized to an immediate intervention or delayed intervention. In subsequent waves, 51 churches were randomized to an immediate or delayed intervention. METHODS Church committee members, pastors, and cooks participate in full-day trainings to learn how to implement physical activity and dietary changes in the church. Monthly mailings and technical assistance calls are delivered over the 15-month intervention. Members complete measurements at baseline and 15 months. A detailed process evaluation is included. SUMMARY FAN focuses on modifying the social, cultural, and policy environment in a faith-based setting. The use of a community-based participatory research approach, engagement of church leaders, inclusion of a detailed process evaluation, and a formal plan for sustainability and dissemination make FAN unique.

The Faith, Activity, and Nutrition Program: A Randomized Controlled Trial in African-American Churches

BACKGROUND Faith-based interventions hold promise for promoting health in ethnic minority populations. To date, however, few of these interventions have used a community-based participatory research (CBPR) approach, have targeted both physical activity and healthy eating, and have focused on structural changes in the church. PURPOSE To report the results of a group randomized CBPR intervention targeting physical activity and healthy eating in African-American churches. DESIGN Group RCT. Data were collected from 2007 to 2011. Statistical analyses were conducted in 2012. SETTING/PARTICIPANTS Seventy-four African Methodist Episcopal (AME) churches in South Carolina and 1257 members within them participated in the study. INTERVENTION Churches were randomized to an immediate (intervention) or delayed (control) 15-month intervention that targeted organizational and environmental changes consistent with the structural ecologic model. A CBPR approach guided intervention development. Intervention churches attended a full-day committee training and a full-day cook training. They also received a stipend and 15 months of mailings and technical assistance calls to support intervention implementation. MAIN OUTCOME MEASURES Primary outcomes were self-reported moderate- to vigorous-intensity physical activity (MVPA), self-reported fruit and vegetable consumption, and measured blood pressure. Secondary outcomes were self-reported fat- and fiber-related behaviors. Measurements were taken at baseline and 15 months. Intent-to-treat repeated measures ANOVA tested group X time interactions, controlling for church clustering, wave, and size, and participant age, gender, and education. Post hoc ANCOVAs were conducted with measurement completers. RESULTS There was a significant effect favoring the intervention group in self-reported leisure-time MVPA (d=0.18, p=0.02), but no effect for other outcomes. ANCOVA analyses showed an intervention effect for self-reported leisure-time MVPA (d=0.17, p=0.03) and self-reported fruit and vegetable consumption (d=0.17, p=0.03). Trainings were evaluated very positively (training evaluation item means of 4.2-4.8 on a 5-point scale). CONCLUSIONS This faith-based structural intervention using a CBPR framework showed small but significant increases in self-reported leisure-time MVPA. This program has potential for broad-based dissemination and reach. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00379925.

The Energy Balance Study: The Design and Baseline Results for a Longitudinal Study of Energy Balance

Purpose: The Energy Balance Study (EBS) was a comprehensive study designed to determine over a period of 12 months the associations of caloric intake and energy expenditure on changes in body weight and composition in a population of healthy men and women. Method: EBS recruited men and women aged 21 to 35 years with a body mass index between 20 and 35 kg/m2. Measurements of energy intake and multiple objective measures of energy expenditure, as well as other physiological, anthropomorphic and psychosocial measurements, were made quarterly. Resting metabolic rate and blood chemistry were measured at baseline, 6 and 12 months. Results: Four hundred and thirty (218 women and 212 men) completed all baseline measurements. There were statistically significant differences by sex uncovered for most anthropomorphic, physiological and behavioral variables. Only percent of kcals from fat and alcohol intake, as well as energy expenditure in light activity and very vigorous activity were not different. Self-reported weight change (mean ± SD) over the previous year were 0.92 ± 5.24 kg for women and − 1.32 ± 6.1 kg for men. Resting metabolic rate averages by sex were 2.88 ± 0.35 ml/kg/min for women and 3.05 ± 0.33 ml/kg/min for men. Conclusion: Results from EBS will inform our understanding of the impact of energy balance components as they relate to changes in body weight and composition. Initial findings suggest a satisfactory distribution of weight change to allow for robust statistical analyses. Resting metabolic rates well below the standard estimate suggest that the evaluation of the components of total energy expenditure will be impactful for our understanding of the roles of energy intake and expenditure on changes in energy utilization and storage.

Association between Leisure Time Physical Activity and Depressive Symptoms in Men

PURPOSE We examined the association between depressive symptoms and physical activity (PA) in a sample of men from the Aerobics Center Longitudinal Study. Secondary analysis included stratification by age and body mass index (BMI). METHODS Our cross-sectional analysis included 9580 men, age 20-87 yr, who completed the 10-item Center for Epidemiological Studies Depression Scale during 1996-2006. A score of 10 or higher defined depressive symptoms. Four PA categories based on the 2008 PA guidelines were created from a self-report leisure time PA questionnaire: inactive (0 MET·min·wk(-1)), low (1-499 MET·min·wk(-1)), medium (500-999 MET·min·wk(-1)), and high (≥1000 MET·min·wk(-1)). RESULTS There were 727 men with depressive symptoms. Cross-sectional analyses showed a significant inverse relationship between PA categories and depressive symptoms (P for trend < 0.0001). This reduction in odds was shown across all types of measured leisure time activities (odds ratios = 0.36-0.58). Compared with the inactive group, the light, medium, and high PA categories were 24%, 51%, and 51% less likely to exhibit depressive symptoms, respectively. The inverse relationship was maintained for age and BMI groups except for those 60 yr or older, who exhibited fewer depressive symptoms than other ages. Men with a BMI of 30 kg·m(-2) or higher lowered their odds of depressive symptoms for all PA categories, whereas those with a BMI less than 30 kg·m(-2) needed at least 500 MET·min·wk(-1) to show a similar association. CONCLUSIONS Overall, our analyses found an inverse association between PA and depressive symptoms. Most of this benefit was seen in the medium PA category, which seemed to plateau around 500 MET·min·wk(-1). This indicates that men meeting the 2008 PA Guidelines may not only experience physical health benefits but also reduce the likelihood of depressive symptoms.

Emotional Outlook on Life Predicts Increases in Physical Activity Among Initially Inactive Men

This study examined the relationship between emotional outlook on life and change in physical activity among inactive adults in the Aerobics Center Longitudinal Study. A total of 2,132 sedentary adults completed a baseline medical examination and returned for a follow-up examination at least 6 months later. Participants self-reported physical activity level and emotional outlook on life. Emotional outlook on life was significantly and positively related to physical activity participation at the follow-up visit in men but not women. Men who were usually very happy and optimistic at baseline had significantly greater increases in physical activity compared to men who were not happy. Men with a more positive outlook on life (e.g., happier) may be more likely to increase physical activity levels. Physical activity interventions targeting men may be more successful if they first increase happiness.

Perceived Barriers to Exercise and Healthy Eating Among Women from Disadvantaged Neighborhoods: Results from a Focus Groups Assessment

This study explored perceptions and experiences with barriers to exercise and healthy eating among women from predominately African American, disadvantaged neighborhoods. Four focus groups (n = 28) were conducted between April and May 2008 with overweight or obese women (93% African American; 34.3 ± 8.9 years; body mass index [BMI] 40.4 ± 8.5). Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size (e.g., from children or people at the gym), and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise. Lack of support and pressure from family, friends, and co-workers were barriers to healthy eating; participants experienced pressure from family and friends to eat more and were told they did not need to lose weight. Participants discussed the importance of not losing their curves; this concern needs to be considered when developing weight control programs for African American women. The findings of this qualitative study guided the development of a weight loss intervention for women from disadvantaged neighborhoods.

Perceived Environmental Church Support Is Associated with Dietary Practices among African-American Adults

A unique strength of the African-American community is the importance of church and faith. Interventions promoting health might want to build on these strengths by developing faith-based interventions that encourage churches to create an environment that supports behavior change. The objective of the study was to examine the relationship between perceived environmental church support for healthy eating and intake of fruit and vegetables and fat- and fiber-related behaviors, and to examine whether these relationships differ by sex. The design was a cross-sectional study in which participants completed self-report dietary and perceived church support measures before initiation of an intervention. Relationships between fruit and vegetable consumption, fat- and fiber-related behaviors, and perceived church support (eg, total, written informational, spoken informational, instrumental [fruit and vegetable consumption only]), along with Support×Sex interactions were examined. Participants were 1,136 African-American church members from four geographically defined districts in South Carolina. Statistical analyses included regression models controlling for sex, age, years of education, health rating, and body mass index using SAS PROC MIXED. A separate model was conducted for each measure of perceived church support and each type of healthy eating index. Perceived total church support and perceived written and spoken informational church support were associated with considerably higher fruit and vegetable intake and more favorable fiber-related behaviors, whereas only perceived total and perceived written informational support were associated with more low-fat dietary behaviors. Perceived instrumental church support was not associated with fruit and vegetable consumption. No sex differences were found. The social and physical church environment can be an important factor influencing the dietary habits of its members. Future faith-based interventions should further explore the role of the church environment in improving the dietary practices of its members.

A Prospective Study of Ideal Cardiovascular Health and Depressive Symptoms

BACKGROUND Ideal cardiovascular health is a new construct defined by the American Heart Association as part of its 2020 Impact Goal. OBJECTIVE The purpose of this study was to examine whether the simultaneous presence of ideal cardiovascular health behaviors and factors could reduce the odds of developing depressive symptoms. METHODS Participants from the Aerobics Center Longitudinal Study, who did not have any mental disorder/condition at baseline, were examined between 1987 and 1998, and they were followed up for a mean period of 6.1 years. Ideal cardiovascular health behaviors (never smoking, body mass index <25kg/m(2), physical activity at goal, and appropriate diet consistent with guideline recommendations) and factors (total cholesterol <200mg/dL, blood pressure <120/80mm Hg, and fasting blood glucose <100mg/dL) were measured at baseline. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale in 1990, 1995, or 1999. RESULTS Of the 5110 participants, 641 reported depressive symptoms. Participants meeting 3-4 or 5-7 ideal cardiovascular health components had 28% (odds ratio = 0.72; 95% confidence interval 0.59-0.87) and 36% (odds ratio = 0.64; confidence interval 0.50-0.82) decreased odds of depressive symptoms, respectively, when compared with those meeting 0-2 ideal components. Ideal behaviors were associated with lower odds of depressive symptoms in participants meeting 2 or 3-4 ideal behaviors, compared with those meeting 0-1 (odds ratio = 0.81; confidence interval 0.67-0.98 and odds ratio = 0.72; confidence interval 0.57-0.91). Ideal factors were not associated with depressive symptoms. CONCLUSION Ideal cardiovascular health components, especially health behaviors, present an inverse relationship with depressive symptoms.

Psychological well-being, cardiorespiratory fitness, and long-term survival.

BACKGROUND Psychological well-being is associated with mortality/survival. Although cardiorespiratory fitness (CRF) is one of the strongest predictors of mortality, studies examining the relationship between well-being and survival seldom account for the possible effects of CRF. PURPOSE This study examined the independent associations of psychological well-being components (low level of negative emotion and high level of positive emotion) and CRF, as well as their combined effects, with survival. METHODS Participants (N=4888) were examined in 1988-1997 and followed up for a median period of ∼15 years (212 deaths, 4.3%). CRF was assessed by a maximal exercise test on a treadmill. Low-level negative emotion was defined as the minimum score of the negative emotion subscale of the CES-D scale and high-level positive emotion as the maximum score of the positive emotion subscale. Results are presented as hazard ratios (95% CIs). Data were analyzed in 2009. RESULTS After adjustment for a set of established risk factors, men and women with low levels of negative emotion had lower risk of death than those with higher levels of negative emotion, 0.66 (95% CI=0.50, 0.87). The association persisted after additional adjustment for CRF and positive emotion. High level of positive emotion was not associated with survival. A high level of CRF independently predicted lower risk of death, 0.54 (95% CI=0.37, 0.79), compared to a low level of CRF. The risk of death in participants with both a low level of negative emotion and a high level of CRF was 0.37 (95% CI=0.22, 0.63), compared to their peers with higher levels of negative emotion/low levels of CRF. CONCLUSIONS Low levels of negative emotion and high levels of CRF are independent predictors of long-term survival in men and women. A strong combined effect was observed, as individuals with both a low level of negative emotion and a high level of CRF had a 63% lower risk of premature death than those with higher levels of negative emotion and a low level of CRF.