Timothy E. Kirby

A Prospective Evaluation of the Effects of a 12-Week Outpatient Exercise Program on Clinical and Behavioral Outcomes in Patients with Epilepsy

Purpose. We hypothesized that patients randomized to an exercise program would demonstrate a measurable improvement in behavioral outcomes with no adverse clinical outcomes, as compared with control patients.Methods. This randomized, prospective, parallel, and controlled study spanned 12 weeks. Twenty-eight patients were randomized either to participate in a supervised exercise program (Exercise) or to continue their current level of activity with no planned intervention (Control). The Exercise group worked with an exercise physiologist three times per week. At specific intervals, behavioral (QOLIE-89, POMS, PSDQ, Self-Esteem) and clinical (seizure activity, antiepileptic drug (AED) concentrations) outcomes were measured.Results. Twenty-three patients completed the study (Exercise n = 14, Control n = 9). Of the four patients in the Exercise group with active seizures, two had no change, one had an increase, and one had a decrease in seizure activity. Of the three patients in the Control group with active seizures, one had no change, one had an increase, and one had a decrease in seizure activity. In all patients, there was <26% coefficient of variation in AED concentrations over the 12-week study, suggesting little or no impact of the exercise intervention. The overall quality of life and two domain scores improved from baseline to Week 12 in the Exercise group (P = 0.031), while the Control group score did not change (P = 0.943). In the Exercise group, there were several measures of physical self-concept and vigor that improved and total mood disturbance decreased from the beginning to the end of the program.Conclusion. This is the first randomized, controlled study of exercise in patients with epilepsy. Behavioral outcomes are positively influenced by moderate exercise and there is no impact on seizure frequency. This suggests that exercise should not be discouraged in the care of epilepsy patients. The ability to offer an exercise program adds a health promotion component to the current plan of care provided by our comprehensive epilepsy program.

Importance of aerobic fitness in cardiovascular risks in sedentary overweight and obese African-American women

Background: Whether the level of aerobic fitness significantly impacts cardiovascular disease (CVD) risks in healthy, nondiabetic, overweight or obese African-American women remains uncertain. Objective: To examine the clinical and metabolic risk factors of CVD in nondiabetic, sedentary overweight or obese African-American women with varying degrees of aerobic fitness. Methods: Forty-eight African-American women, with mean age of 43 ± 4.2 years and body mass index of 32.3 ± 3.6 kg/m2, participated in the study. Fasting and 2-hr postprandial serum glucose, insulin, and C-peptide levels were obtained during oral glucose tolerance test. Insulin sensitivity was calculated by Homeostasis Model Assessment (HOMA-IR). Aerobic fitness was categorized empirically as very low aerobic fitness (VLAF; n = 17, VO2max < 21 ml/kg/min), low aerobic fitness (LAF; n = 12, between 21 and 24.4 ml/kg/min), and moderate aerobic fitness (MAF; n = 19, >24.4 ml/kg/min). Results: Significant differences were found in serum glucose, insulin, and C-peptide levels, and HOMA-IR in the VLAF vs. LAF and MAF groups. Mean HOMA-IR was statistically greater in the VLAF and LAF when compared to MAF. Mean fasting serum cholesterol, triglycerides, and low-density lipoprotein cholesterol levels were higher in the VLAF group compared to the MAF group, whereas high-density lipoprotein cholesterol was lower in the VLAF group. Despite differences in the obesity indices and insulin resistance in the three groups, the atherogenic lipids and lipoproteins were within normal limits, irrespective of degree of VO2max. Discussion: Modest aerobic fitness has significant impact on insulin sensitivity and atherogenic lipids and lipoprotein parameters and the overall risks for CVD in sedentary overweight or obese African-American women. Whether modest physical fitness translates into prevention of type 2 diabetes and CVD in African-American women remains to be determined.

A Comparison of Military Circumference Equations to Skinfold-Based Equations to Estimate Body Composition

UNLABELLED Circumference-based military equations (CBEs) were compared with a skinfold-based equation (SBE) to estimate body fat. OBJECTIVE We determined the correlation between CBEs and SBE, evaluated the efficacy of CBE methods, and examined the difference in methods to identify noncompliant personnel. Circumference and skinfold measurements were taken in sequential order for 1,191 male civil service employees (37.9 +/- 7.9 years). RESULTS Percent body fat was estimated for SBE (18.4 +/- 6.1) and three different CBEs: Marine Corps (19.6 +/- 5.8), Navy/Air Force (20.4 +/- 5.8), and Army (20.6 +/- 5.2). A moderate correlation coefficient existed between SBE and CBEs (r = 0.76-0.79). A greater body fat percentage was estimated in noncompliant personnel with circumference methods. CONCLUSIONS Data moderately correlate CBEs and SBE. However, CBEs predict higher estimates, resulting in a greater number of personnel classified as noncompliant.