Shawn C. Franckowiak

Can inexpensive signs encourage the use of stairs? Results from a community intervention.

The American Heart Association recently added a sedentary lifestyle to its list of modifiable risk factors [1]. Reports suggest that only 22% of the U.S. adult population are active enough to derive health benefits from their physical activity and that one in four Americans are completely sedentary [2]. This finding may parallel the sharp increase in the prevalence of overweight persons over the past 12 years, from 25% in the National Health and Nutrition Examination Survey (NHANES II) in 1976-1980 to 33% in phase I of NHANES III in 1988-1991 [3]. The Centers for Disease Control and Prevention and the American College of Sports Medicine recently revised their recommendation regarding exercise to suggest that all Americans should accumulate 30 minutes or more of moderate-intensity physical activity on most or all days of the week [4]. Inactive people who increase their levels of physical activity are less likely to die of all causes and of cardiovascular disease than those who remain sedentary [5, 6]. Walking and taking the stairs instead of escalators or elevators may be two easy ways for seemingly healthy sedentary adults to become more moderately active [7-10]. In 1980, Brownell and associates [11] examined the effects of placing a sign that encouraged stair use for health benefits at the base of an escalator that was adjacent to a flight of stairs in a mall, train station, and bus terminal in Philadelphia. They reported that the sign resulted in statistically significant increases in stair use among 45 694 commuters. They also noted that overweight persons did not use the stairs as often as leaner persons before or after the sign was erected. Blamey and colleagues [12] recently examined the effects of encouraging stair use for health benefits in a Scottish train station and also found that a low-cost sign could result in statistically significantly increases in stair use by adults. We examined the trends among shoppers of different ages, ethnicities, sexes, and body weights in a shopping mall in which escalators and stairs were adjacent. We also observed the differential effects of adding signs at the base of the escalator that promoted stair use for health benefits or weight control. Methods Participants We observed 17 901 adult patrons of a mall located in a Baltimore suburb while they used the stairs or escalators. Because of the potential for artifactual influence on the decision process, persons carrying items larger than a briefcase were excluded. We also excluded persons carrying a baby or child and those judged to be younger than 18 years of age. Participants were unaware that they were part of a study investigating physical activity patterns. Design This observational study involved an initial baseline phase and two subsequent intervention phases that incorporated motivational signs displayed at the base of the escalator and stairs. Each of the three phases lasted 1 month. During the baseline phase, the frequency of stair use compared with use of the adjacent escalator was recorded. During the first interventional phase (health benefits), a 22 28 sign was placed on an easel beside the escalator and stairs. The sign featured a caricature of a heart at the top of a flight of stairs and the statement, Your heart needs exercise, use the stairs. During the second interventional phase (weight control), a similar-sized sign was placed on an easel. The sign featured a caricature of a woman at the top of a flight of stairs; she had a thin waistline and was wearing pants with a waist that was too large. The caption on the sign read, Improve your waistline, use the stairs. Setting In this suburban Baltimore mall, participants could use the escalator or the stairs to get to the second floor. A stairway was adjacent to ascending and descending escalators. The stairway consisted of 10 stairs, a 6-foot landing, and 10 more stairs. Observations were made during June, July, and August between 10:30 a.m. and 9:00 p.m. on all days of the week. Procedures Observations were made by one of the authors. A previous physical activity study [11] used many observers to ensure valid observation of all persons. However, the volume of mall traffic was never so heavy that more than one observer was needed to code the characteristics and choice of each person. Before the study began, the observer and the senior author spent one full day in the mall classifying shoppers by age and weight status to be sure that observations were as accurate as possible. The observer sat in an inconspicuous spot at the foot of the steps that allowed for clear observation. Frequency of stair use was recorded in the same way during each of the three phases. Each persons sex and ethnicity (black, white, or other) was recorded. In addition, persons were judged to be 40 years of age or older or younger than 40 years of age. Finally, the observer noted whether the person appeared overweight. Statistical Analysis The change in proportions of persons using the stairs from the baseline to the intervention phases of the study was analyzed by using the chi-square test and by computing 95% CIs around the differences in proportions between the comparison groups. The same procedure was used to examine intergroup differences (normal weight or overweight) within a given phase of the study. We also computed the number needed to treat (NNT), the number of shoppers who needed to be exposed to the sign to get one shopper to use the stairs, as 1/RD, where RD is expressed as the difference in proportions between the two comparison groups. Results are presented as the proportion of persons who opted to use the stairs rather than the escalator; 95% CIs are presented with associated P values and the NNT. Data were analyzed by using the SPSS for Windows (version 8.0) statistical package [13]. Results A total of 17 901 observations were made. Overall, the use of stairs at baseline was 4.8%. During the intervention period when the health benefits sign was displayed, stair use increased significantly to 6.9% (difference, 2.1 percentage points [CI, 1.3 to 2.8 percentage points]; NNT, 48). Compared with the baseline value, stair use also increased significantly to 7.2% when the weight-control sign was displayed (difference, 2.4 percentage points [CI, 1.5 to 3.2 percentage points]; NNT, 42). Stair use did not differ between the health benefits (6.9%) and the weight-control (7.2%) signs (difference, 0.3 percentage points [CI, 0.5 to 1.2 percentage points]; NNT, 333). Sex Table 1 and Table 3 shows the percentage of persons who used the stairs during the studys three phases as a function of age, sex, race, and body weight. Table 2 shows the change in stair use with the two signs and the change from the health benefits sign to the weight-control sign. A similar pattern emerged among men and women: Compared with baseline levels of stair use, both the health benefits sign and the weight-control sign increased stair use from 4.9% to 7.2% and 7.4%, respectively, among women and from 4.8% to 6.4% and 7.0%, respectively, among men). No sex-related differences were found when no sign or either type of sign was present. Table 1. Stair Use before and during Placement of Two Different Motivational Signs Table 3. Table 1 Continued Table 2. Changes in Stair Use among Groups of Shoppers in Response to Signs Promoting Stair Use Age At baseline, 4.6% of persons judged to be younger than 40 years of age used the stairs. Six percent took the stairs with the display of the health benefits sign (difference, 1.4 percentage points [CI, 0.3 to 2.4 percentage points]; NNT, 71), and 6.1% took the stairs in response to the weight-control sign (difference, 1.5 percentage points [CI, 0.3 to 2.7 percentage points]; NNT, 66), significantly increasing stair use relative to the baseline value (P = 0.015). No statistically significant difference in stair use was found between the health benefits sign and weight-control sign (difference, 0.1 percentage points [CI, 3.4 to 3.6 percentage points]). A similar pattern emerged among persons judged to be 40 years of age or older. At baseline, 5.1% of persons took the stairs; when the health benefits sign was erected, 8.1% chose to climb the stairs (difference, 3.0 percentage points [CI, 1.7 to 4.3 percentage points]; NNT, 33), and the weight-control sign increased stair use to 8.7% (difference, 3.6 percentage points [CI, 2.1 to 5.1 percentage points]; NNT, 28). Stair use did not significantly differ between the two signs (difference, 0.6 percentage points [CI, 0.8 to 2.1 percentage points]). Older shoppers were more likely than younger shoppers to take the stairs in response to both the health benefits sign (difference, 2.1 percentage points [CI, 0.9 to 3.2 percentage points]) and the weight-control sign (difference, 2.6 percentage points [CI, 1.1 to 4.1 percentage points]) (Figure 1). Figure 1. Patterns of stair use among shoppers judged to be younger than 40 years of age (white bars) or 40 years of age or older (striped bars). Body Weight Persons were stratified by body weight (not overweight or overweight). At baseline, 5.4% of shoppers judged to be not overweight used the stairs. The health benefits sign increased stair use to 7.2% (difference, 1.8 percentage points [CI, 1.2 to 4.7 percentage points]; NNT, 55), and the weight-control sign increased stair use to 6.9% (difference, 1.5 percentage points [CI, 0.3 to 2.6 percentage points]; NNT, 66). The same pattern emerged among persons judged to overweight: The health benefits sign significantly increased stair use from 3.8% to 6.3% [difference, 2.5 percentage points (CI, 1.2 to 3.7 percentage points); NNT, 40], and the weight-control sign increased stair use from 3.8% to 7.7% (difference, 3.9 percentage points [CI, 1.2 to 7.0 percentage points]; NNT, 40). In persons judged not to be overweight, stair use did not differ significantly between the health benefits sign (7.2%) and the weight-control sign (6.9%) (difference

Impact of weight loss on Health-Related Quality of Life

To examine the effect of treatment-induced weight loss on Health-Related Quality of Life (HRQL), 38 mildly-to-moderately overweight persons recruited to participate in a study to examine the efficacy of a lifestyle modification treatment program completed a sociodemographic questionnaire, the Beck Depression Inventory (BDI), the Medical Outcomes Study Short-Form Health Survey (SF-36, as an assessment of HRQL), and underwent a series of clinical evaluations prior to treatment. After baseline evaluations, participants were randomly assigned to either a program of lifestyle physical activity or a program of traditional aerobic activity. Participants again completed the SF-36 and BDI after the 13-week treatment program had ended. Weight loss averaged 8.6 ± 2.8 kg over the 13-week study. We found that weight loss was associated with significantly higher scores (enhanced HRQL), relative to baseline, on the physical functioning, role-physical, general health, vitality and mental health domains of the SF-36. The largest improvements were with respect to the vitality, general health perception and role-physical domains. There were no significant differences between the lifestyle and aerobic activity groups on any of the study measures. These data indicate that, at least in the short-term, weight loss appears to profoundly enhance HRQL.

Brief postoperative delirium in hip fracture patients affects functional outcome at three months.

It is unclear how brief postoperative delirium (DEL) affects functional outcomes. In this study, we sought to determine if patients with brief postoperative DEL (<6-wk duration) have different living situations when compared with non-DEL patients after hip fracture repair. In a prospective study, patients admitted to the geriatric hip fracture service were assessed every postoperative day for the presence of DEL using the confusion assessment method (CAM) score. Patients were reassessed at 6 wk and 3 mo postoperatively for CAM score, current living situation, and activities of daily living. Group comparisons were tested after dividing patients into two groups: DEL (DEL; [+] CAM at any time during the postoperative period while in the hospital); no-DEL (no DEL; [−] CAM throughout the postoperative period while in the hospital). The study included 92 patients of whom 26 (28%) were CAM (+) after surgery. At 6 wk follow-up, n = 81; at 3 mo follow-up, n = 76. Eight patients died during the study. At 6 wk and 3 mo, a larger percentage of DEL patients were not living with a family member (27% versus 8% patients not living with a family member at 3 mo follow-up in DEL and no-DEL, respectively). There was no difference in activities of daily living by 3 mo. We conclude that brief postoperative DEL lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently.

Weight loss and health-related quality of life: Results at 1-year follow-up

To evaluate the 1-year results of treatment-induced weight loss on health-related quality of life (HRQL), 32 mildly to moderately overweight persons who participated in a 13-week weight loss program completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36) at baseline, immediately after the program, and at 1-year follow-up. At 1 year, 65.6% of participants maintained at least some weight loss. The improvements on HRQL observed immediately after treatment on the physical functioning, role-physical, general health, vitality, and mental health scales of the SF-36 were maintained only on the general health and vitality scales at 1 year. There were no significant differences between weight maintainers and weight regainers on change from baseline to 1-year follow-up on HRQL. Our findings suggest that treatment-induced weight loss among mildly to moderately overweight persons improves HRQL and that at least some of these benefits are maintained at 1-year follow-up regardless of whether the weight loss is maintained.

Effects of a culturally sensitive sign on the use of stairs in African American commuters.

Summary.ObjectivesTo examine the effectiveness of a culturally sensitive sign to encourage stair use among African American commuters.Methods16 035 commuters were observed in their using either stairs or an adjacent escalator in a subway station. After baseline observation, a culturally sensitive sign to promote stair use was displayed beside the escalator/stairs. Demographic information and use of escalators/stairs were recorded.ResultsStair use increased from 15.8% to 21.5% with the sign. Caucasian commuters used the stairs 23.1% of the time at baseline, and increased to 28.3% with the sign. Among African Americans, stair use increased from 10.3% to 16.4% with the sign. African American women showed the greatest increases in stair use. Stair use remained elevated the week after the sign was removed in all commuters. Among African Americans, stair use returned to baseline within three weeks. Stair use increased significantly among both overweight and non-overweight Caucasians and African Americans.ConclusionCulturally sensitive interventions can promote physical activity among African Americans in an urban setting.Zusammenfassung.Auswirkungen eines kulturell sensitiven Hinweisschildes zur Treppenbenutzung bei afroamerikanischen PendlernFragestellungWelche Auswirkungen hat ein kulturell sensitives Hinweisschild zur Förderung des Treppensteigens bei afroamerikanischen Pendlern?Methoden16 035 Pendler wurden in einer U-Bahn-Station beim Treppensteigen bzw. beim Benutzen der Rolltreppe beobachtet. Nach der Baseline-Beobachtungzeit wurde neben der Treppe bzw. neben der Rolltreppe ein kulturell sensitives Hinweisschild aufgestellt, das zum Treppensteigen anregen sollte. Demografische Angaben und die Nutzung von Treppe bzw. Rolltreppe wurden erhoben.ResultateDie Nutzung der Treppe stieg von 15,8% auf 21,5% während das Schild aufgestellt war. Anfangs benutzten 23,1% der weissen Pendler die Treppe, während es mit Schild 28,3% waren. Bei den Afroamerikanern stieg die Nutzung der Treppe durch den Hinweis von 10,3% auf 16,4%. Afroamerikanische Frauen zeigten den grössten Anstieg bei der Nutzung der Treppe. Alle Pendler benutzten auch noch in der Woche nach Entfernung des Schildes öfter die Treppe als vorher. Bei den Afroamerikanern kehrte die Nutzung nach drei Wochen wieder zum Anfangswert zurück. Sowohl bei Übergewichtigen wie bei nicht Übergewichtigen Weissen und Afroamerikanern stieg die Treppennutzung signifikant an.SchlussfolgerungenKulturell sensitive Interventionen können die körperliche Aktivität bei der afroamerikanischen Bevölkerung in urbanen Gebieten fördern.Résumé.Effets d’une affiche montrant une femme afro américaine sur la promotion de l’utilisation des escaliers chez les pendulaires de cette origine ethniqueObjectifsExaminer l’efficacité d’une affiche promouvant l’utilisation des escaliers chez les pendulaires afro-américains et tenant compte de leurs spécificités culturelles.MéthodesObservation de 16 035 pendulaires en train d’utiliser soit les escaliers, soit les escaliers roulants d’une station de métro. Après une observation initiale, une affiche montrant une femme afro-américaine montant les escaliers a été posée près des escaliers et des escaliers roulants afin de promouvoir l’utilisation des escaliers. Des données démographiques ainsi que des données concernant l’utilisation des escaliers et des escaliers roulants ont été récoltées.RésultatsL’utilisation des escaliers a augmenté de 15.8% à 21.5% suite à l’introduction de l’affiche. L’utilisation des escaliers par les pendulaires d’origine caucasienne est passée de 23.1% à 28.3%, celle des afro-américains de 10.3% à 16.4%. L’augmentation a été la plus importante chez les femmes afroaméricaines. L’augmentation de l’utilisation des escaliers s’est prolongée chez tous les pendulaires sur la semaine suivant la suppression de l’affiche. Parmi les femmes afro-américaines, l’utilisation des escaliers est revenue à son niveau initial en trois semaines. L’utilisation des escaliers a augmenté significativement chez les pendulaires en surpoids et de poids normal (chez les pendulaires d’origine caucasienne aussi bien que chez les afro-américains).ConclusionsDes interventions culturellement adaptées peuvent promouvoir l’activité physique en milieu urbain chez les personnes afro-américaines.

U.S. military weight standards: what percentage of U.S. young adults meet the current standards?

PURPOSEnEach branch of the U.S. military enforces maximum allowable weight standards that must be met to join the military. We wanted to determine what percentage of U.S. civilians between the ages of 17 and 20 years met these standards.nnnMETHODSnThe height and weight of adults between the ages of 17 and 20 years, as measured in the nationally representative sample of the Third National Health and Nutritional Examination Survey, were matched against the height/weight charts of the military services. The percentage of men and women in each population subgroup who weighed more than the maximum allowable weight was calculated.nnnRESULTSnThe percentage of young adults whose weight exceeded the military weight standard ranged from 13% to 18% for men and 17% to 43% for women. When stratified by race, 15% to 20% of non-Hispanic white men and 12% to 36% of non-Hispanic white women were over the weight standards, 11% to 19% of non-Hispanic black men and 35% to 56% of non-Hispanic black women were over the standards, and 13% to 24% of Mexican American men and 26% to 55% of Mexican American women exceeded the military weight standards.nnnCONCLUSIONnA large percentage of the young adult population from which the U.S. volunteer military is drawn is over the military weight standards, particularly among minorities, who comprise a disproportionately large proportion of the military. There is a marked discrepancy between the weight standards for men and women, and the appropriateness of these standards needs to be assessed.

Hip Fracture Service—an Interdisciplinary Model of Care

1. Sohn AH, Ostrowsky BE, Sinkowitz-Cochran RL et al. Evaluation of a successful vancomycin-resistant Enterococcus prevention intervention in a community of health care facilities. Am J Infect Control 2001;29:53–57. 2. Ostrowsky BE, Trick WE, Sohn AH et al. Control of vancomycin-resistant Enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433. 3. Trick WE, DeMarais PL, Jarvis WR et al. Comparison of universal gloving to contact isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility, Abstract #S-M2–03. 4th International Decennial Conference for the Prevention of Nosocomial and Healthcare-Associated Infections. Atlanta, GA, 2001. 4. Strausbaugh LJ, Crossley KB, Nurse BA et al. Antimicrobial resistance in longterm-care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.

Novel neuropeptide Y1 and Y5 receptor gene variants: associations with serum triglyceride and high-density lipoprotein cholesterol levels

Neuropeptide Y (NPY) appears to play a critical role in the integration of appetite and energy expenditure through NPY Y1 and Y5 receptor subtypes. Moreover, the NPY Y1 receptor is highly expressed on human adipocytes, where it inhibits lipolysis. The genes encoding these receptors are transcribed co‐ordinately in opposite directions from a common promoter in a region of chromosome 4 that has been previously linked to triglyceride and small low‐density lipoprotein (LDL) particle concentration. Therefore, the purpose of this investigation was to examine the relationship between polymorphisms in the genes encoding NPY Y1 and Y5 and the development of obesity and dyslipidemia. We screened the promoter and coding regions and identified four polymorphic variants. One of these, a cytosine to thymine (C→T) substitution in the untranslated region between the genes for NPY Y1 and Y5 (allele frequency 0.11), was significantly associated with both lower fasting triglyceride level (152 vs 125u2003mg/dl), and higher high‐density lipoprotein (HDL) concentrations (49 vs 45u2003mg/dl) (pu2003<u20030.01) in 306 obese subjects. Given the stimulatory effect of NPY on adipocyte lipoprotein lipase (LPL) activity, and the lack of association of other polymorphisms with serum lipid levels, we hypothesize that this is a gain‐in‐function polymorphism.

Maximal heart rate prediction in adults that are overweight or obese.

Franckowiak, SC, Dobrosielski, DA, Reilley, SM, Walston, JD, and Andersen, RE. Maximal heart rate prediction in adults that are overweight or obese. J Strength Cond Res 25(5): 1407-1412, 2011-An accurate predictor of maximal heart rate (MHR) is necessary to prescribe safe and effective exercise in those considered overweight and obese when actual measurement of MHR is unavailable or contraindicated. To date, accuracy of MHR prediction equations in individuals that are overweight or obese has not been well established. The purpose of this study was to examine the accuracy of 3 equations for predicting MHR in adults that are overweight or obese. One hundred seventy-three sedentary adults that were overweight or obese enrolled in weight-loss study and performed a &OV0312;o2peak treadmill test before the start of the weight loss treatment. A total of 132 of the 173 participants met conditions for achieving maximal exercise testing criteria and were included in this study. Maximal heart rate values determined from &OV0312;o2peak treadmill tests were compared across gender, age, and weight status with the following prediction equations: (a) 220 − age, (b) 208 − 0.7 × age, and (c) 200 − 0.48 × age. Among 20- to 40-year-old participants, actual MHR averaged 180 ± 9 b·min−1 and was overestimated (p < 0.001) at 186 ± 5 b·min−1 with the 220 − age equation. Weight status did not affect predictive accuracy of any of the 3 equations. For all participants, the equation, 200−0.48 × age estimated MHR to be 178 ± 4 b·min−1, which was greater than the actual value (175 ± 12, p = 0.005). Prediction equations showed close agreement to actual MHR, with 208 − 0.7 × age being the most accurate.

OBESITY AND REPORTS OF NO LEISURE TIME ACTIVITY AMONG OLDER AMERICANS: RESULTS FROM THE THIRD NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

Physical inactivity is a cardiovascular risk factor that has a higher prevalence among overweight adults. The purpose of this study was to assess the prevalence of not participating in Leisure Time Physical Activity (LPTA) and the relationship to body weight class among older U.S. adults. A nationally representative cross-sectional survey with an in-person interview and medical examination was used. Between 1988 and 1994, 6569 adults 60 years of age or older responded to the household adult and family questionnaires as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. Overall, 39% of older U.S. adults fall in the overweight range and 23.3% are obese. Obese older adults were more likely than their overweight and healthy weight counterparts to report participating in no LTPA The prevalence of adults reporting no leisure time physical activity (LPTA) is lowest among non-Hispanic whites c...Physical inactivity is a cardiovascular risk factor that has a higher prevalence among overweight adults. The purpose of this study was to assess the prevalence of not participating in Leisure Time Physical Activity (LPTA) and the relationship to body weight class among older U.S. adults. A nationally representative cross-sectional survey with an in-person interview and medical examination was used. Between 1988 and 1994, 6569 adults 60 years of age or older responded to the household adult and family questionnaires as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. Overall, 39% of older U.S. adults fall in the overweight range and 23.3% are obese. Obese older adults were more likely than their overweight and healthy weight counterparts to report participating in no LTPA The prevalence of adults reporting no leisure time physical activity (LPTA) is lowest among non-Hispanic whites compared to non-Hispanic blacks and Mexican-Americans in each body mass index category. Future interventions should address strategies to promote an increase in leisure time physical activity among older adults, especially among underserved populations, and help them to prevent weight gain.