Renee J. Rogers

Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial

Importance Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss. Objective To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss. Design, Setting, Participants Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014. Interventions Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self-monitoring of diet and physical activity using a website, and those randomized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity. Main Outcomes and Measures The primary outcome of weight was measured over 24 months at 6-month intervals, and the primary hypothesis tested the change in weight between 2 groups at 24 months. Secondary outcomes included body composition, fitness, physical activity, and dietary intake. Results Among the 471 participants randomized (body mass index [BMI], 25 to <40; age range, 18-35 years; 28.9% nonwhite, 77.2% women), 470 (233 in the standard intervention group, 237 in the enhanced intervention group) initiated the interventions as randomized, and 74.5% completed the study. For the enhanced intervention group, mean base line weight was 96.3 kg (95% CI, 94.2-98.5) and 24-month weight 92.8 kg (95% CI, 90.6- 95.0) [corrected]. For the standard intervention group, mean baseline weight was 95.2kg (95%CI,93.0-97.3)and24-month weight was 89.3 kg (95%CI, 87.1-91.5) [corrected]. Weight change at 24 months differed significantly by intervention group (estimated mean weight loss, 3.5 kg [95% CI, 2.6-4.5} in the enhanced intervention group and 5.9 kg [95% CI, 5.0-6.8] in the standard intervention group; difference, 2.4 kg [95% CI, 1.0-3.7]; P = .002). Both groups had significant improvements in body composition, fitness, physical activity, and diet, with no significant difference between groups. Conclusions and Relevance Among young adults with a BMI between 25 and less than 40, the addition of a wearable technology device to a standard behavioral intervention resulted in less weight loss over 24 months. Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches. Trial Registration clinicaltrials.gov Identifier: NCT01131871.

Short-Term Weight Loss with Diet and Physical Activity in Young Adults: the IDEA Study

This study examined the effect of a behavioral weight loss intervention (BWLI) on young adults (age = 18‐35 years).

Reducing Sedentary Behavior Versus Increasing Moderate-to-Vigorous Intensity Physical Activity in Older Adults: A 12-Week Randomized, Clinical Trial.

Objective: To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity (MVPA) in older adults. Method: Inactive older adults (N = 38, 68 ± 7 years old, 71% female) were randomized to 12-week interventions targeting decreased sedentary behavior (Sit Less) or increased MVPA (Get Active). The SenseWear armband was used to objectively assess activity in real time. Assessments included a blinded armband, the Community Health Activites Model Program for Senior (CHAMPS) questionnaire, 400-meter walk, and the Short Physical Performance Battery (SPPB). Results: Objectively measured MVPA increased in Get Active (75 ± 22 min/week, p < .001); self-reported MVPA increased in both groups (p < .05). Sedentary behavior did not change in either group (all p > .05). Only the Sit Less group improved the SPPB score (0.5 ± 0.3, p = .046). Discussion: Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks. Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed.

Energy Expenditure During Acute Periods of Sitting, Standing, and Walking

BACKGROUND Identifying strategies to increase energy expenditure (EE) may help combat the harmful effects of sedentary behavior. This study examined EE during sitting, standing, and walking. METHODS Participants (N = 74) were randomized to 2 of the following activities: sitting using a laptop computer (SIT-C), sitting watching television (SIT-T), standing watching television (STAND), and walking at a self-selected pace ≤3.0 (mph) (WALK). Each activity lasted 15 minutes with a 3-minute transition period between activities. The experimental conditions were: SIT-C to STAND (N = 18), SIT-T to WALK (N = 18), STAND to SIT-C (N = 20), and WALK to SIT-T (N = 18). EE was measured using indirect calorimetry. RESULTS Based on the first activity performed, EE during WALK (55.92 ± 14.19 kcal) was significantly greater than SIT-C (19.63 ± 6.90 kcal), SIT-T (18.66 ± 4.01 kcal), and STAND (21.92 ± 5.08 kcal) (P < .001). Cumulative EE in SIT-T to WALK (74.50 ± 17.88 kcal) and WALK to SIT-T (82.72 ± 21.70 kcal) was significantly greater than EE in SIT-C to STAND (45.38 ± 14.78 kcal) and STAND to SIT-C (45.64 ± 9.69 kcal) (P < .001). CONCLUSION Substituting periods of sitting or standing with walking significantly increases EE, but substituting periods of sitting with standing may not affect EE. Thus, the potential benefits of standing as opposed to sitting need further investigation beyond the role of EE.

Objective Versus Self-Reported Physical Activity in Overweight and Obese Young Adults.

BACKGROUND To compare moderate-to-vigorous intensity physical activity (MVPA) assessed via questionnaires to an objective measure of MVPA in overweight or obese young adults. METHODS MVPA was assessed in 448 [median BMI = 31.2 (Interquartile Range: 28.5-34.3) kg/m2] young adults [median age: 30.9 (Interquartile Range: 27.8-33.7) years]. Measures included the SenseWear Armband (MVPAOBJ), the Paffenbarger Questionnaire (MVPAPAFF), and the Global Physical Activity Questionnaire (GPAQ). The GPAQ was used to compute total MVPA (MVPAGPAQ-TOTAL) and MVPA from transportation and recreation (MVPAGPAQ-REC). RESULTS The association between MVPAOBJ and MVPAPAFF was rs = 0.40 (P < .0001). Associations between MVPAOBJ and MVPAGPAQ-TOTAL and MVPAGPAQ-REC were rs = 0.19 and rs = 0.32, respectively (P < .0001). MVPAGPAQ-TOTAL was significantly greater than MVPAOBJ (P < .0001). Median differences in MET-min/week between MVPAOBJ and MVPAPAFF or MVPAGPAQ-REC were not significantly different from zero. There was proportional bias between each self-reported measure of MVPA and MVPAOBJ. There were significant associations between all measures of MVPA and fitness. MVPAOBJ was significantly associated with BMI and percent body fat. CONCLUSIONS Objective and self-reported measures of MVPA are weakly to moderately correlated, with substantial differences between measures. MVPAOBJ provided predictive validity with fitness, BMI, and percent body fat. Thus, an objective measure of MVPA may be preferred to self-report in young adults.

TRADITIONAL EXERCISES DO NOT HAVE A SIGNIFICANT IMPACT ON ABDOMINAL PEAK FORCE IN HEALTHY YOUNG ADULTS

Pintar, JA, Learman, KE, and Rogers, R. Traditional exercises do not have a significant impact on abdominal peak force in healthy young adults. J Strength Cond Res 23(7): 2083-2089, 2009- The abdominals are vital to activities of daily living, for the prevention of lumbar pathologies, and during sport performance. The purpose of this study was to determine if training without external resistance was a sufficient overload to improve abdominal strength as defined by peak force. Seventy-one healthy men and women (age 19-40 years) participated in the 11-week study. Subjects were matched on baseline abdominal strength and then randomly assigned to 1 of 3 categories based on the number of days they performed abdominal exercises (0 days, 3 days, or 6 days per week). The results indicated that performing abdominal exercises 3 or 6 times per week did not improve either concentric or eccentric strength. These results suggest that the exercises used during this study were not enough of a stimulus to significantly improve concentric or eccentric strength values in either exercise group.

Objective vs. Self-report Sedentary Behavior in Overweight and Obese Young Adults

BACKGROUND Sedentary behavior (SED) has been measured almost exclusively by self-reported total SED or television time in longitudinal studies. This manuscript aimed to compare self-reported vs. objectively measured SED. METHODS Among overweight and obese young adults enrolled in a weight loss trial, baseline SED was assessed by 3 methods: 1) a questionnaire assessing 8 common SEDs (SEDQ), 2) 1 question assessing SED from the Global Physical Activity Questionnaire (SEDGPAQ), and 3) a monitor worn on the arm (SEDOBJ). In addition, television time (SEDTV) was isolated from the SEDQ. SED measures were compared using Spearmans correlations, signed-rank tests, and Bland-Altman plots. RESULTS In 448 participants, SEDQ and SEDGPAQ were only weakly associated with SEDOBJ (rs = 0.21; P < .001, rs = 0.32; P < .001, respectively). Compared with SEDOBJ, SEDQ more often overestimated SEDOBJ (median difference: 1.1 hours/day; P < .001), while SEDGPAQ more often underestimated SEDOBJ (median difference: -0.7 hours/day; P < .001). The correlation between SEDTV and SEDOBJ was not significantly different from 0 (rs = 0.08; P = .08). CONCLUSIONS SEDQ and SEDGPAQ were weakly correlated with, and significantly different from, SEDOBJ in overweight and obese young adults. SEDTV was not related to SEDOBJ. The poor associations of self-reported and objectively measured SED could affect interpretation and comparison across studies relating SED to adverse health outcomes.

Role of Physical Activity and Exercise in Treating Patients with Overweight and Obesity

BACKGROUND Overweight and obesity are significant public health concerns that are linked to numerous negative health consequences. Physical activity is an important lifestyle behavior that contributes to body weight regulation. CONTENT Physical activity is inversely associated with weight gain and the incidence of obesity. Physical activity also contributes to additional weight loss when coupled with dietary modification, and it can result in modest weight loss when not coupled with dietary modification. Moreover, physical activity is associated with improved long-term weight loss and prevention of weight gain following initial weight loss. Current evidence supports that physical activity should be moderate to vigorous in intensity to influence body weight regulation. There is also a growing body of evidence that physical activity can be accumulated throughout the day in shorter periods of time rather than being performed during a structured and longer period, and that physical activity performed in this manner can be important for body weight regulation. SUMMARY The literature supports the inclusion of physical activity as an important lifestyle behavior for regulating body weight. There are multiple intervention approaches that may be effective for enhancing physical activity engagement within the context of weight control.

Energy Expenditure in Vinyasa Yoga Versus Walking

BACKGROUND Whether the energy cost of vinyasa yoga meets the criteria for moderate-to-vigorous physical activity has not been established. PURPOSE To compare energy expenditure during acute bouts of vinyasa yoga and 2 walking protocols. METHODS Participants (20 males, 18 females) performed 60-minute sessions of vinyasa yoga (YOGA), treadmill walking at a self-selected brisk pace (SELF), and treadmill walking at a pace that matched the heart rate of the YOGA session (HR-Match). Energy expenditure was assessed via indirect calorimetry. RESULTS Energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 79.5 ± 44.3 kcal; P < .001) and SELF (difference = 51.7 ± 62.6 kcal; P < .001), but not in SELF compared with HR-Match (difference = 27.8 ± 72.6 kcal; P = .054). A similar pattern was observed for metabolic equivalents (HR-Match = 4.7 ± 0.8, SELF = 4.4 ± 0.7, YOGA = 3.6 ± 0.6; P < .001). Analyses using only the initial 45 minutes from each of the sessions, which excluded the restorative component of YOGA, showed energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 68.0 ± 40.1 kcal; P < .001) but not compared with SELF (difference = 15.1 ± 48.7 kcal; P = .189). CONCLUSIONS YOGA meets the criteria for moderate-intensity physical activity. Thus, YOGA may be a viable form of physical activity to achieve public health guidelines and to elicit health benefits.

Effects of supervised and unsupervised physical activity programmes for weight loss

Physical activity is important for weight management. However, it remains unclear what type of physical activity prescription/programme is optimal for increasing physical activity during a standard behavioural weight loss intervention. This study examined changes in physical activity after a 12‐week supervised programme prescribed in minutes per week (SUP‐PA), an unsupervised programme prescribed in minutes per week (UNSUP‐PA) and an unsupervised programme prescribed in steps per day (STEP).