Michael R. Kushnick

Can Lifestyle Interventions Do More Than Reduce Diabetes Risk? Treating Depression in Adults With Type 2 Diabetes With Exercise and Cognitive Behavioral Therapy

The epidemic of metabolic syndrome, prediabetes, and type 2 diabetes is global in scope and comprehensive in its impact on individuals, health care systems, and societies. One in four patients with diabetes will experience depression in their lifetime. Comorbid depression is associated with poorer outcomes, greater functional disability, and early mortality. Prior studies have demonstrated beneficial effects of exercise as an efficacious form of treatment for depression in the general population. Few studies have evaluated this strategy in patients with prediabetes or type 2 diabetes. Program ACTIVE (Appalachians Coming Together to Increase Vital Exercise) was designed to treat depression among adults with type 2 diabetes by pairing aerobic activity with individual cognitive behavioral therapy. This combination treatment approach has been shown to be feasible to implement in a rural environment and promising in terms of depression, diabetes, and cardiovascular outcomes. Data from this study suggest that exercise can be used to achieve multiple benefits for adults with type 2 diabetes. Future work to compare this approach to singular treatment strategies for adults at risk for type 2 diabetes is needed.

Depression Among Adults With Diabetes: Prevalence, Impact, and Treatment Options.

In Brief Patients with type 1 or type 2 diabetes are two times more likely to experience depression than their peers without diabetes. Comorbid depression results in deleterious effects on glycemic control, worsened diabetes complications, functional disability, and premature mortality. Once identified, depression can be effectively treated with antidepressant medications, psychotherapy, or a combination of both. Patients and providers should monitor depressive symptoms to identify their recurrence and work collaboratively to address barriers to care that exist in both urban and rural areas.

Comparison of early phase adaptations for traditional strength and endurance, and low velocity resistance training programs in college-aged women

The purpose of this study was to investigate the effects of a six-week (16-17 training sessions) low velocity resistance training program (LV) on various performance measures as compared to a traditional strength (TS) and a traditional muscular endurance (TE) resistance training program. Thirty-four healthy adult females (21.1 ± 2.7 y) were randomly divided into 4 groups: control (C), TS, TE, and LV. Workouts consisted of 3 exercises: leg press (LP), back squat (SQ), and knee extension (KE). Each subject was pre- and posttested for 1 repetition maximum (1RM), muscular endurance, maximal oxygen consumption (VO2max), muscular power, and body composition. After the pretesting, TS, TE, and LV groups attended a minimum of 16 out of 17 training sessions in which the LP, SQ, and KE were performed to fatigue for each of 3 sets. For each training session, TS trained at 6-10 RM and TE trained at 20-30 RM both with 1-2 second concentric/1-2 second eccentric; and LV trained at 6-10 RM, with 10 second concentric/4 s eccentric. Statistical significance was determined at an alpha level of 0.05. LV increased relative LP and KE 1 RM, but the percent increase was smaller than TS, and not different from C in the SQ. For muscular endurance, LV improved similarly to TE for LP and less than TS and TE for KE. Body composition improved for all groups including C (significant main effect). In conclusion, muscular strength improved with LV training however, TS showed a larger improvement. Muscular endurance improved with LV training, but not above what TE or TS demonstrated. For all other variables, there were no significant improvements for LV beyond what C demonstrated.

Starch-Entrapped Biopolymer Microspheres as a Novel Approach to Vary Blood Glucose Profiles

Background: With emerging knowledge of the impact of the metabolic quality of glycemic carbohydrates on human health, there is a need for novel carbohydrate ingredients that can be custom-made to deliver controlled amounts of glucose to the body and to test hypotheses on the postprandial metabolic consequences of carbohydrates. Objective: The goal of the present study was to demonstrate the applicability and action of starch-entrapped biopolymer microspheres as customized, novel, slowly digestible carbohydrates to obtain desired glycemic responses. Methods: Starch-entrapped microspheres were developed; and starch digestion and glucose release, subsequent to their cooking (100°C, 20 min) in water, were initially monitored by measuring the rapidly digestible, slowly digestible, and resistant starch fractions using the in vitro Englyst assay. Glycemic and insulinemic responses after consumption of glucose and two different slowly digestible starch microsphere diets were compared using a crossover study in 10 healthy individuals. The mechanism of starch digestion in the microspheres was elucidated from scanning electron microscopic images of the in vitro digested microspheres. Results: Factors such as biopolymer type and concentration, microsphere size, and starch type were manipulated to obtain starch materials with defined amounts of slowly digestible starch based on in vitro studies. Scanning electron microscopy showed that cooked starch entrapped in the dense biopolymer matrix is digested layer by layer from the outside to the inside of the microsphere. Glycemic and insulinemic responses to microsphere test diets were moderate as compared to a glucose diet, but more important, they showed extended glucose release. Conclusions: Starch-entrapped microspheres provide a useful tool to study the postprandial metabolic consequences of slowly digestible carbohydrates.

Using a practical approach for determining the most effective stretching strategy in female college division I volleyball players.

Abstract Kruse, NT, Barr, MW, Gilders, RM, Kushnick, MR, and Rana SR. Using a practical approach for determining the most effective stretching strategy in female college division I volleyball players. J Strength Cond Res 27(11): 3060–3067, 2013—The purpose of this investigation was to quantify the effects that a practical bout of static stretching (SS) and dynamic stretching (DS) has on maximal countermovement jump (CMJ) height across a time spectrum of 25 minutes in National Collegiate Athletic Association Division I varsity volleyball players. Eleven female varsity volleyball players (mean ± SD; age 20.00 ± 1.55 years; height 1.78 ± 0.08 m; mass 74.55 ± 12.18 kg) volunteered for this investigation. Three days of randomized experimental testing (SS, DS, control) were completed. The SS protocol consisted of stretching 7 muscle groups. The DS protocol consisted of the volleyball teams actual DS routine of equal duration (30 seconds) to SS. Poststretch performance measures of CMJ were determined at 1, 5, 15, and 25 minutes poststretch. Countermovement jump had an acute significant trial-by-time interaction, indicating that DS was found to produce significantly higher scores than the SS and control session at 1 and 5 minutes poststretch, but not at 15 and 25 minutes poststretch. Additionally, there was a timing interaction within trials where SS scores were significantly lower at 1minute poststretch compared with 5 and 25 minutes poststretch, and DS scores were significantly higher at 1 and 5 minutes poststretch compared with 15 and 25 minutes poststretch. Athletes engaging in competitive power sports should continue to utilize their DS routine but may need to do so within 5 minutes before activity.

Continuous and intermittent walking alters HDL2-C and LCATa

PURPOSE The purpose of this study was to determine if exercise, whether continuous (CE: completed all in one session) or intermittent (completed in either two (IE 2) or three (IE 3) exercise sessions) expending the same number of calories alters reverse cholesterol transport or low density lipoprotein (LDL) particle size. METHODS Sixteen healthy (22±2.1 year old) men (VO(2) max=37.0±3.3mL/kg/min) randomly completed three exercise trials, CE, IE 2 and IE 3, expending 450 calories. Blood samples were drawn immediately post-exercise (IPE) and 24 and 48h following exercise and analyzed for total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) and subfractions (HDL(2)-C, HDL(3)-C). Samples were also analyzed to determine LDL-C particle size, lecithin cholesterol acyl transferase activity (LCATa) and cholesterol ester transfer protein activity (CETPa). RESULTS HDL(2)-C increased significantly 48h post-exercise in the CE and IE 2 groups. Additionally, the IE 3 group had significant increases in HDL(2)-C at 24 (39%) and 48h post-exercise by 66%. This change in HDL(2)-C was significantly and positively correlated (r=0.62; p<0.05) to the changes in LCATa which increased compared to baseline at 48h post-exercise in the CE and IE 3 groups. No significant changes in LDL particle size or alterations in CETPa were seen. CONCLUSIONS The results of this study indicate that whether the exercise is continuous or intermittent, keeping calorie expenditure the same, causes significant changes in the HDL(2)-C subfraction, which was augmented by an increase in LCATa.

A Model of Community-Based Behavioral Intervention for Depression in Diabetes: Program ACTIVE

In Brief Depression affects one in four people with diabetes and significantly affects diabetes health. Earlier studies of the treatment of depression have documented that cognitive behavioral therapy (CBT) and exercise have each been found to be effective in treating depression in people with and without diabetes in the context of medical settings. Individuals in rural areas lack regular access to medical centers and require treatment options that may be adapted for local communities. To date, no studies have combined CBT and exercise for people with diabetes. This article presents a translational behavioral depression intervention study designed for individuals with type 2 diabetes in a rural Appalachian region as a model of an interdisciplinary approach to the treatment of depression in diabetes.