Fatness but Not Fitness Linked to BrainAge: Longitudinal Changes in Brain Aging during an Exercise Intervention.

PURPOSE: Fitness, physical activity, body composition, and sleep have all been proposed to explain differences in brain health. We hypothesized that an exercise intervention would result in improved fitness and body composition and would be associated with improved structural brain health. METHODS: In a randomized controlled trial, we studied 485 older adults who engaged in an exercise intervention ( n = 225) or a nonexercise comparison condition ( n = 260). Using magnetic resonance imaging, we estimated the physiological age of the brain (BrainAge) and derived a predicted age difference compared with chronological age (brain-predicted age difference (BrainPAD)). Aerobic capacity, physical activity, sleep, and body composition were assessed and their impact on BrainPAD explored. RESULTS: There were no significant differences between experimental groups for any variable at any time point. The intervention group gained fitness, improved body composition, and increased total sleep time but did not have significant changes in BrainPAD. Analyses of changes in BrainPAD independent of group assignment indicated significant associations with changes in body fat percentage ( r (479) = 0.154, P = 0.001), and visceral adipose tissue (VAT) ( r (478) = 0.141, P = 0.002), but not fitness ( r (406) = -0.075, P = 0.129), sleep ( r (467) range, -0.017 to 0.063; P range, 0.171 to 0.710), or physical activity ( r (471) = -0.035, P = 0.444). With linear regression, changes in body fat percentage and VAT significantly predicted changes in BrainPAD ( ß = 0.948, P = 0.003) with 1-kg change in VAT predicting 0.948 yr of change in BrainPAD. CONCLUSIONS: In cognitively normal older adults, exercise did not appear to impact BrainPAD, although it was effective in improving fitness and body composition. Changes in body composition, but not fitness, physical activity, or sleep impacted BrainPAD. These findings suggest that focus on weight control, particularly reduction of central obesity, could be an interventional target to promote healthier brains.

Support for inadvertent undereating in female adolescent athletes with clinical indicators of low energy availability.

OBJECTIVES: This study evaluated pathways to low energy availability in a sample of female adolescent athletes (n = 464). DESIGN: Cross-sectional. METHODS: Participants (age 13-18 y) underwent assessments for height, weight, eating attitudes and behaviors, and menstrual function. Bone mineral density and body composition were evaluated by dual-energy x-ray absorptiometry in a subset of participants (n = 209). Athletes were classified with clinical indicators of low energy availability if they met criteria for 1) primary or secondary amenorrhea or 2) clinical underweight status (body mass index-for-age < 5th percentile). Disordered eating was assessed using the Eating Disorder Examination Questionnaire. RESULTS: Thirty (6.5%) athletes exhibited clinical indicators of low energy availability, with higher estimates in leanness than non-leanness sports (10.9% vs. 2.1%, p < 0.005). Among athletes with clinical indicators of low energy availability, 80% (n = 24) did not meet criteria for disordered eating, eating disorder, or report the desire to lose weight. Athletes with (vs. without) clinical indicators of low energy availability exhibited lower lumbar spine (-1.30 ±â€¯1.38 vs. -0.07 ±â€¯1.21, p < 0.001) and total body (-0.30 ±â€¯0.98 vs. 0.53 ±â€¯0.97, p < 0.006) bone mineral density Z-scores. CONCLUSIONS: A majority of female adolescent athletes with clinical indicators of low energy availability did not exhibit characteristics consistent with intentional dietary restriction, supporting the significance of the inadvertent pathway to low energy availability and need for increased nutrition education in this population.

Associations of Lean Mass, Muscular Strength, and Physical Function with Trabecular Bone Score in Older Adults.

INTRODUCTION/BACKGROUND: Trabecular bone score (TBS) is an indirect measurement of bone quality and microarchitecture determined from dual-energy X-ray absorptiometry (DXA) imaging of the lumbar spine. TBS predicts fracture risk independent of bone mass/density, suggesting this assessment of bone quality adds value to the understanding of patients' bone health. While lean mass and muscular strength have been associated with higher bone density and lower fracture risk among older adults, the literature is limited regarding the relationship of lean mass and strength with TBS. The purpose of this study was to determine associations of DXA-determined total body and trunk lean mass, maximal muscular strength, and gait speed as a measure of physical function, with TBS in 141 older adults (65-84 yr, 72.5 +/- 5.1 yr, 74% women). METHODOLOGY: Assessments included lumbar spine (L1-L4) bone density and total body and trunk lean mass by DXA, lower body (leg press) and upper body (seated row) strength by one repetition maximum tests, hand grip strength, and usual gait speed. TBS was derived from the lumbar spine DXA scan. Multivariable linear regression determined the contribution of proposed predictors to TBS. RESULTS: After adjusting for age, sex, and lumbar spine bone density, upper body strength significantly predicted TBS (unadjusted/adjusted R2= 0.16/ 0.11, ß coefficient =0.378, p=0.005), while total body lean mass index showed a trend in the expected direction (ß coefficient =0.243, p=0.053). Gait speed and grip strength were not associated with TBS (p>0.05). CONCLUSION: Maximum strength of primarily back muscles measured as the seated row appears important to bone quality as measured by TBS, independent of bone density. Additional research on exercise training targeting back strength is needed to determine its clinical utility in preventing vertebral fractures among older adults.

Effects of Mindfulness Training and Exercise on Cognitive Function in Older Adults: A Randomized Clinical Trial.

Importance: Episodic memory and executive function are essential aspects of cognitive functioning that decline with aging. This decline may be ameliorable with lifestyle interventions. Objective: To determine whether mindfulness-based stress reduction (MBSR), exercise, or a combination of both improve cognitive function in older adults. Design, Setting, and Participants: This 2 × 2 factorial randomized clinical trial was conducted at 2 US sites (Washington University in St Louis and University of California, San Diego). A total of 585 older adults (aged 65-84 y) with subjective cognitive concerns, but not dementia, were randomized (enrollment from November 19, 2015, to January 23, 2019; final follow-up on March 16, 2020). Interventions: Participants were randomized to undergo the following interventions: MBSR with a target of 60 minutes daily of meditation (n = 150); exercise with aerobic, strength, and functional components with a target of at least 300 minutes weekly (n = 138); combined MBSR and exercise (n = 144); or a health education control group (n = 153). Interventions lasted 18 months and consisted of group-based classes and home practice. Main Outcomes and Measures: The 2 primary outcomes were composites of episodic memory and executive function (standardized to a mean [SD] of 0 [1]; higher composite scores indicate better cognitive performance) from neuropsychological testing; the primary end point was 6 months and the secondary end point was 18 months. There were 5 reported secondary outcomes: hippocampal volume and dorsolateral prefrontal cortex thickness and surface area from structural magnetic resonance imaging and functional cognitive capacity and self-reported cognitive concerns. Results: Among 585 randomized participants (mean age, 71.5 years; 424 [72.5%] women), 568 (97.1%) completed 6 months in the trial and 475 (81.2%) completed 18 months. At 6 months, there was no significant effect of mindfulness training or exercise on episodic memory (MBSR vs no MBSR: 0.44 vs 0.48; mean difference, -0.04 points [95% CI, -0.15 to 0.07]; P = .50; exercise vs no exercise: 0.49 vs 0.42; difference, 0.07 [95% CI, -0.04 to 0.17]; P = .23) or executive function (MBSR vs no MBSR: 0.39 vs 0.31; mean difference, 0.08 points [95% CI, -0.02 to 0.19]; P = .12; exercise vs no exercise: 0.39 vs 0.32; difference, 0.07 [95% CI, -0.03 to 0.18]; P = .17) and there were no intervention effects at the secondary end point of 18 months. There was no significant interaction between mindfulness training and exercise (P = .93 for memory and P = .29 for executive function) at 6 months. Of the 5 prespecified secondary outcomes, none showed a significant improvement with either intervention compared with those not receiving the intervention. Conclusions and Relevance: Among older adults with subjective cognitive concerns, mindfulness training, exercise, or both did not result in significant differences in improvement in episodic memory or executive function at 6 months. The findings do not support the use of these interventions for improving cognition in older adults with subjective cognitive concerns. Trial Registration: ClinicalTrials.gov Identifier: NCT02665481.

Adolescent Endurance Runners Exhibit Suboptimal Energy Availability and Intakes of Key Nutrients.

Backgroud: Despite the evidence of an elevated prevalence of low bone mass in adolescent endurance runners, reports on dietary intake in this population is limited.Objectives: This study aimed to evaluate energy availability (EA) and dietary intake among 72 (n = 60 female, n = 12 male) high school cross-country runners.Methods: The sample consisted of a combined dataset of two cohorts. In both cohorts, the Block Food Frequency Questionnaire (FFQ; 2005 & 2014 versions) assessed dietary intake. Fat free mass was assessed using dual-energy x-ray absorptiometry or bioelectrical impedance analysis.Results: Mean EA was less than recommended (45 kcal/kgFFM/day) among male (35.8 ± 14.4 kcal/kg FFM/day) and female endurance runners (29.6 ± 17.4 kcal/kgFFM/day), with 30.0% of males and 60.0% of females meeting criteria for low EA (<30 kcal/kgFFM/day). Calorie intake for male (2,614.2 ± 861.8 kcal/day) and female (1,879.5 ± 723.6 kcal/day) endurance runners fell below the estimated energy requirement for "active" boys (>3,100 kcal/day) and girls (>2,300 kcal/day). Female endurance runners' relative carbohydrate intake (4.9 ± 2.1 g/kg/day) also fell below recommended levels (6-10 g/kg/day). Male and female endurance runners exhibited below-recommended intakes of calcium, vitamin D, potassium, fruit, vegetables, grains, and dairy. Compared to male endurance runners, female endurance runners demonstrated lower relative intakes of energy (kcal/kg/day), protein (g/kg/day), fat (g/kg/day), fiber, vegetables, total protein, and oils.Conclusion: This study provides evidence of the nutritional risk of adolescent endurance runners and underscores the importance of nutritional support efforts in this population.

Fatness, fitness and the aging brain: A cross sectional study of the associations between a physiological estimate of brain age and physical fitness, activity, sleep, and body composition.

Introduction: Changes in brain structure and function occur with aging. However, there is substantial heterogeneity both in terms of when these changes begin, and the rate at which they progress. Understanding the mechanisms and/or behaviors underlying this heterogeneity may allow us to act to target and slow negative changes associated with aging. Methods: Using T1 weighted MRI images, we applied a novel algorithm to determine the physiological age of the brain (brain-predicted age) and the predicted age difference between this physiologically based estimate and chronological age (BrainPAD) to 551 sedentary adults aged 65 to 84 with self-reported cognitive complaint measured at baseline as part of a larger study. We also assessed maximal aerobic capacity with a graded exercise test, physical activity and sleep with accelerometers, and body composition with dual energy x-ray absorptiometry. Associations were explored both linearly and logistically using categorical groupings. Results: Visceral Adipose Tissue (VAT), Total Sleep Time (TST) and maximal aerobic capacity all showed significant associations with BrainPAD. Greater VAT was associated with higher (i.e,. older than chronological) BrainPAD (r = 0.149 p = 0.001)Greater TST was associated with higher BrainPAD (r = 0.087 p = 0.042) and greater aerobic capacity was associated with lower BrainPAD (r = - 0.088 p = 0.040). With linear regression, both VAT and TST remained significant (p = 0.036 and 0.008 respectively). Each kg of VAT predicted a 0.741 year increase in BrainPAD, and each hour of increased TST predicted a 0.735 year increase in BrainPAD. Maximal aerobic capacity did not retain statistical significance in fully adjusted linear models. Discussion: Accumulation of visceral adipose tissue and greater total sleep time, but not aerobic capacity, total daily physical activity, or sleep quantity and/or quality are associated with brains that are physiologically older than would be expected based upon chronological age alone (BrainPAD).

Disordered Eating, Development of Menstrual Irregularity, and Reduced Bone Mass Change After a 3-Year Follow-Up In Female Adolescent Endurance Runners.

This prospective study evaluated the 3-year change in menstrual function and bone mass among 40 female adolescent endurance runners (age 15.9 ± 1.0 years) according to baseline disordered eating status. Three years after initial data collection, runners underwent follow-up measures including the Eating Disorder Examination Questionnaire and a survey evaluating menstrual function, running training, injury history, and prior sports participation. Dual-energy X-ray absorptiometry was used to measure bone mineral density and body composition. Runners with a weight concern, shape concern, or global score ≥4.0 or reporting >1 pathologic behavior in the past 28 days were classified with disordered eating. Compared with runners with normal Eating Disorder Examination Questionnaire scores at baseline, runners with disordered eating at baseline reported fewer menstrual cycles/year (6.4 ± 4.5 vs. 10.5 ± 2.8, p = .005), more years of amenorrhea (1.6 ± 1.4 vs. 0.3 ± 0.5, p = .03), and a higher proportion of menstrual irregularity (75.0% vs. 31.3%, p = .02) and failed to increase lumbar spine or total hip bone mineral density at the 3-year follow-up. In a multivariate model including body mass index and menstrual cycles in the past year at baseline, baseline shape concern score (B = -0.57, p value = .001) was inversely related to the annual number of menstrual cycles between assessments. Weight concern score (B = -0.40, p value = .005) was inversely associated with lumbar spine bone mineral density Z-score change between assessments according to a multivariate model adjusting for age and body mass index. These finding support associations between disordered eating at baseline and future menstrual irregularities or reduced accrual of lumbar spine bone mass in female adolescent endurance runners.

Balance performance and related soft tissue components across three age groups.

With the aging process, falls and related injuries are common and unwanted events among older women. Lost balance is the last step before the frequent experience of falls. After menopause, women's bone conditions regarding health and balance performance steeply decline often resulting in serious injury. Our purpose in the study is to identify balance performance and its associations with soft tissue components among Korean-American (KA) women with three menopausal conditions. Researchers conducted a cross-sectional study with 63 KA women divided into three age groups: 25-35 years (young), 45-55 years old (middle), and 65+ years (old). Lean and fat mass on the entire body, appendicular and gynoid areas were measured by using the dual X-ray absorptiometry. Static and dynamic balance and physical performance (floor sit to stand) were tested. We found that with increased aging, lean mass, fat and body mass index were changed; balance and physical performance decreased significantly. In regression models, age and fat ratio of android/gynoid changes explain static balance and physical performance; appendicular lean mass predicted dynamic balance. With advancing age, maintaining lean mass and proportion of fat accumulation is critical for stable balance.

Quantification of Scan Analysis Errors in GE Lunar DXA Visceral Adiposity in Adults.

Utilization of dual-energy X-ray absorptiometry is increasing in clinical settings and the fitness industry as a viable tool to assess total and regional body composition, including visceral adiposity. Previous research using small samples (<50) has described several pitfalls in patient positioning, scan acquisition, and/or analysis that alter regional body composition values. Our aim was to quantify the largest probable error in measures of total, android, gynoid, and visceral fat caused by incorrect placement of the head cut-line, in a large sample of adults. Total body images (N = 436) from 196 women and 67 men (20-85 years) scanned on a GE Lunar Prodigy densitometer were analyzed using enCORE software in 2 ways: (1) placing the head cut-line just beneath the bony protuberance of the chin according to manufacturer recommendation (correct method); (2) placing the head cut-line at the lowest point below the chin and just above the soft tissue at the shoulders (incorrect method). All other cut-lines were fixed. Mean differences in adiposity were examined using Lin's concordance correlation coefficient; equality of means and variances were evaluated using Bradley-Blackwood F-tests. The limits of agreement were displayed as Bland-Altman plots and calculated as the mean difference ±1.96 times the standard deviation of the difference. Correlation coefficients for paired comparisons of adiposity for correct vs incorrect cut-line placement ranged from 0.983-0.999 for all variables (all p < 0.001). Significant mean differences were 172 ± 130, 201 ± 168, 65 ± 122, and -143 ± 336 g for android, gynoid, visceral, and total fat mass, respectively (all p < 0.0001). These differences exceeded our site's least significant change in 66%, 37%, 29%, and 4% of participant scans for android, gynoid, visceral, and total fat mass, respectively. Our findings underscore the importance of careful review of the manufacturer's auto analysis and consistency in conducting serial scans to ensure accurate and precise measures of regional body fat.

Cognitive dietary restraint score is associated with lower energy, carbohydrate, fat, and grain intake among female adolescent endurance runners.

This cross-sectional study investigated associations between cognitive dietary restraint (CDR), energy, macronutrient and food group intake, menstrual function, and bone density in female adolescent endurance runners. Participants were forty female adolescent endurance runners. The independent variable was CDR, as assessed by the Three Factor Eating Questionnaire (TFEQ). Runners with CDR subscale scores ≥11 were classified with elevated CDR. The main outcomes measured were dietary intake measured by 24-hour recall for 7 days, menstrual history, and bone mineral density (BMD). Twelve of 40 participants (30.0%) met criteria for elevated CDR. Compared to runners with normal CDR, runners with elevated CDR scores reported consuming lower energy (kcal/kg/day) (37.5 ± 8.6 vs. 44.0 ± 9.6, p = 0.052), lower carbohydrate (g/kg/day) (5.3 ± 1.3 vs. 6.3 ± 1.3, p = 0.042), more fiber (g/day) (24.9 ± 6.7 vs. 20.0 ± 5.3, p = 0.018), more servings of fruit (3.3 ± 1.4 vs. 1.9 ± 1.2, p = 0.003), more servings of vegetables (2.7 ± 1.4 vs. 1.7 ± 0.7, p = 0.004), and fewer servings of grain (7.6 ± 2.4 vs. 9.8 ± 2.4, p = 0.009) per day. Runners with elevated CDR exhibited significantly lower lumbar spine BMD Z-scores (adjusting for BMI) (-0.78 ± 0.19 vs. -0.22 ± 0.12, p = 0.016) than runners with normal CDR. Menstrual history did not significantly differ based on CDR status. Elevated CDR may increase risk of dietary patterns associated with consuming inadequate levels of energy, key nutrients, and developing low BMD in endurance runners. Trial Registration:ClinicalTrials.gov Identifier: NCT01059968.

Sport Specialization and Low Bone Mineral Density in Female High School Distance Runners.

CONTEXT: Sport specialization may contribute to sport injury and menstrual dysfunction in female high school distance runners. Despite the recent growth in sport specialization, including among high school-aged runners, the association of sport specialization with bone mineral density (BMD) remains poorly described. OBJECTIVE: To evaluate whether sport specialization was associated with BMD in female high school distance runners. DESIGN: Cross-sectional study. SETTING: Six high schools. PATIENTS OR OTHER PARTICIPANTS: Sixty-four female runners (age = 15.6 ± 1.4 years) who competed in cross-country or track distance events and were not currently on birth control medication. MAIN OUTCOME MEASURE(S): Each runner completed a survey on menstrual history and sport participation. Height and weight were measured, and dual-energy x-ray absorptiometry was used to measure whole-body, spine, and hip BMD. Each runner was assigned a sport specialization status: low (participation in ≥1 nonrunning sport and distance-running sport(s) for ≤8 mo/y); moderate (participation in both distance-running sport(s) ≥9 mo/y and ≥1 nonrunning sport(s) or limited to distance-running sport(s) for ≤8 mo/y); or high (participation only in distance-running sport(s) for ≥9 mo/y). Multivariable logistic regression was performed to determine the adjusted odds ratio and 95% confidence interval for sport specialization to BMD values, adjusting for body mass index and gynecological age. RESULTS: Overall, 21.9%, 37.5%, and 40.6% of participants were high, moderate, or low sport specializers, respectively. Low BMD (spine or whole-body BMD z score < -1.0 [standardized by age and sex normative values]) was present in 23 (35.9%) runners. Compared with low sport specializers, high sport specializers were 5 times more likely (adjusted odds ratio = 5.42, 95% confidence interval = 1.3, 23.3; P = .02) to have low BMD. CONCLUSIONS: A high level of sport specialization in high school female distance runners may be associated with a heightened risk for low BMD. Further investigation of this association is warranted due to the health concerns about low BMD in adolescent female runners.

Longitudinal Decline in Cardiorespiratory Fitness With Age Among Male Firefighters in San Diego, California, 2005-2015.

OBJECTIVES: To determine age-associated changes in cardiorespiratory fitness (CRF) among firefighters. METHODS: Male firefighters (n = 1169) underwent annual evaluations from 2005 to 2015 in San Diego, California. We assessed CRF, the ability to deliver and use oxygen, during a maximal graded exercise test and recorded it in metabolic equivalents (METs; 1 MET = 3.5 ml/kg/min). We investigated differences in baseline CRF among 10-year age groups and patterns of change over follow-up using cross-sectional and longitudinal analyses, respectively. RESULTS: Both analyses support an inverse relationship between CRF and age. Mean baseline CRF decreased from 15.7 ±1.7 to 11.7 ±1.9 METs in the younger than 30 years and 50 years and older age groups, respectively. There was no interaction between body fat and age in predicting CRF (Page × body fat = .09). Longitudinally, there was a nonlinear decrease in CRF, which differed across age groups: the youngest age group demonstrated the greatest decrease in CRF. CONCLUSIONS: Results support a negative, nonlinear association between age and CRF without modification by body fatness. Public Health Implications. Fire departments should recognize the health and safety risks of declining CRF and institutionalize programs to promote firefighter fitness.

Lessons Learned From a Feasibility Study Delivered in 2 WIC Sites to Promote Physical Activity Among Pregnant Latinas.

OBJECTIVE: To assess the feasibility, including demand for and acceptability of a physical activity (PA) intervention among pregnant Latinas recruited at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: Women <20 weeks gestation and self-reporting <150 minutes of PA/wk were recruited from 2 WIC locations in Southern California. The 9-wk, promotora-led intervention included 1-hour sessions and 2 walking groups/wk. RESULTS: WIC was supportive of recruitment, intervention, and evaluation activities. Of an estimated pool of 525 women at <20 wks gestation, 141 expressed interest, 108 were screened for eligibility, and 21 were enrolled. Of the 21 who enrolled, 12 completed the postintervention assessment (7 in the participant group and 5 in the nonparticipant group). CONCLUSIONS AND IMPLICATIONS: Demand and acceptability will need to be improved before this intervention can be considered feasible, potentially by extending eligibility and improving access to intervention.

A randomized controlled trial of orthodontist-based brief advice to prevent child obesity.

OBJECTIVE: We conducted a randomized controlled trial to test whether brief exercise and diet advice provided during child patient visits to their orthodontic office could improve diet, physical activity, and age-and-gender-adjusted BMI. METHODS: We enrolled orthodontic offices in Southern California and Tijuana, Mexico, and recruited their patients aged 8-16 to participate in a two-year study. At each office visit, staff provided the children with "prescriptions" for improving diet and exercise behaviors. Multilevel models, which adjusted for clustering, determined differential group effects on health outcomes, and moderation of effects. RESULTS: We found differential change in BMI favoring the intervention group, but only among male participants (p < 0.001; Cohen's d = 0.085). Of four dietary variables, only junk food consumption changed differentially, in favor of the intervention group (p = 0.020; d = 0.122); the effect was significant among overweight/obese (p = 0.001; d = 0.335) but not normal weight participants. Physical activity declined non-differentially in both groups and both genders. CONCLUSION: The intervention, based on the Geoffrey Rose strategy, had limited success in achieving its aims. IMPLICATIONS: Orthodontists can deliver non-dental prevention advice to complement other health-practitioner-delivered advice. Higher fidelity to trial design is needed to adequately test the efficacy of clinician-based brief advice on preventing child obesity and/or reversing obesity.

Intervention Effects on Latinas' Physical Activity and Other Health Indicators.

INTRODUCTION: U.S. Latinas do not engage in sufficient leisure-time physical activity. This study examined whether adding promotor-facilitated healthy lifestyle classes to an exercise intervention would promote exercise session attendance and improve health indicators. METHODS: The Familias Sanas y Activas II (Healthy and Active Families II) study used a within-subjects, longitudinal design, with measures at baseline and at 6 and 12 months post-baseline. The intervention was developed by the San Diego Prevention Research Center and implemented between May 2011 and June 2014 in South San Diego County. Three organizations each hired a part-time coordinator and trained volunteer promotores (six to ten per organization) to deliver the intervention in various community locations. A convenience sample of 442 Latinas were in the evaluation cohort. Measured variables included a step test, blood pressure, waist circumference, height, and weight; physical activity was self-reported. RESULTS: Attendance at healthy lifestyle classes was positively associated with exercise session attendance (p≤0.001). Mixed effects models showed improvements in systolic and diastolic blood pressure (p≤0.001); waist circumference (p≤0.001); weight (p≤0.05); and BMI (p≤0.05) between baseline and 12 months. At 12 months, fewer participants met clinical guidelines for being hypertensive and having an at-risk waist circumference. Exercise session attendance was associated with improved fitness (p≤0.05) and increased self-reported MET minutes of leisure-time physical activity (p≤0.01). CONCLUSIONS: The intervention represents an effective strategy for improving the health status of Latinas, a population with significant health disparities, including high obesity rates. Research efforts are needed to assess methods for scaling up such interventions.

Understanding the Capacity for Exercise in Post-Bariatric Patients.

PURPOSE: The aim of this study is to conduct a pilot randomized trial testing an exercise program specifically adapted for post-bariatric patients. METHODS: A total of 51 post-bariatric patients, 6-24 months post-surgery, were randomly assigned to usual care control (n = 25) or the exercise intervention (n = 26). The intervention included twice weekly 60-min group exercise classes with functional strength, flexibility, and aerobic activities; at least 3 days per week of self-directed exercise; daily pedometer; recording of steps and activities; and weekly telephone counseling. There was also a 6-month maintenance period. RESULTS: Patients were 49 ± 12 years old, 84 % female, 59 % non-Hispanic white, with a BMI of 32.9 ± 5.7 kg/m2 and percent excess BMI loss since surgery of 56 ± 35 %. Patients were 14 ± 5 months post-surgery. A total of 44 patients (86 %) completed both phases of the program and all assessments. The following measures improved significantly for intervention participants with no significant change in control participants: yards walked in 6 min, seconds for 8-foot up-and-go, number of arm curls, and distance in inches for chair sit-and-reach. Intervention changes remained after 6 months of maintenance. CONCLUSIONS: When compared to patients in usual care, a specially adapted exercise program for post-bariatric patients resulted in significant improvements in objectively monitored health outcomes. This program was delivered in a clinical setting and could be implemented in a variety of settings to improve health outcomes for post-bariatric patients.

Mobile and Wearable Device Features that Matter in Promoting Physical Activity.

BACKGROUND: As wearable sensors/devices become increasingly popular to promote physical activity (PA), research is needed to examine how and which components of these devices people use to increase their PA levels. AIMS: (1) To assess usability and level of engagement with the Fitbit One and daily SMS-based prompts in a 6-week PA intervention, and (2) to examine whether use/ level of engagement with specific intervention components were associated with PA change. METHODS: Data were analyzed from a randomized controlled trial that compared (1) a wearable sensor/ device (Fitbit One) plus SMS-based PA prompts, and (2) Fitbit One only, among overweight/ obese adults (N = 67). We calculated average scores from Likert-type response items that assessed usability and level of engagement with device features (e.g., tracker, website, mobile app, and SMS-based prompts), and assessed whether such factors were associated with change in steps/day (using Actigraph GT3X+). RESULTS: Participants reported the Fitbit One was easy to use and the tracker helped to be more active. Those who used the Fitbit mobile app (36%) vs. those who did not (64%) had an increase in steps at 6-week follow-up, even after adjusting for previous web/app use: +545 steps/ day (SE = 265) vs. -28 steps/ day (SE = 242) (p = .04). CONCLUSIONS: Level of engagement with the Fitbit One, particularly the mobile app, was associated with increased steps. Mobile apps can instantly display summaries of PA performance and could optimize self-regulation to activate change. More research is needed to determine whether such modalities might be cost-effective in future intervention research and practice.

Body Mass-Related Predictors of the Female Athlete Triad Among Adolescent Athletes.

Early detection of the female athlete triad is essential for the long-term health of adolescent female athletes. The purpose of this study was to assess relationships between common anthropometric markers (ideal body weight [IBW] via the Hamwi formula, youth-percentile body mass index [BMI], adult BMI categories, and body fat percentage [BF%]) and triad components, (low energy availability [EA], measured by dietary restraint [DR], menstrual dysfunction [MD], low bone mineral density [BMD]). In the sample (n = 320) of adolescent female athletes (age 15.9± 1.2 y), Spearman's rho correlations and multiple logistic regression analyses evaluated associations between anthropometric clinical cutoffs and triad components. All underweight categories for the anthropometric measures predicted greater likelihood of MD and low BMD. Athletes with an IBW >85% were nearly 4 times more likely to report MD (OR = 3.7, 95% CI [1.8, 7.9]) and had low BMD (OR = 4.1, 95% CI [1.2, 14.2]). Those in <5th percentile for their age-specific BMI were 9 times more likely to report MD (OR 9.1, 95% CI [1.8, 46.9]) and had low BMD than those in the 50th to 85th percentile. Athletes with a high BF% were almost 3 times more likely to report DR (OR = 2.8, 95% CI [1.4, 6.1]). Our study indicates that low age-adjusted BMI and low IBW may serve as evidence-based clinical indicators that may be practically evaluated in the field, predicting MD and low BMD in adolescents. These measures should be tested for their ability as tools to minimize the risk for the triad.

Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial.

BACKGROUND: Studies have shown self-monitoring can modify health behaviors, including physical activity (PA). This study tested the utility of a wearable sensor/device (Fitbit(®) One™; Fitbit Inc., San Francisco, CA) and short message service (SMS) text-messaging prompts to increase PA in overweight and obese adults. MATERIALS AND METHODS: Sixty-seven adults wore a Fitbit One tracker for 6 weeks; half were randomized to also receive three daily SMS-based PA prompts. The Fitbit One consisted of a wearable tracker for instant feedback on performance and a Web site/mobile application (app) for detailed summaries. Outcome measures were objectively measured steps and minutes of PA by intensity using two accelerometers: Actigraph™ (Pensacola, FL) GT3X+ (primary measure) at baseline and Week 6 and Fitbit One (secondary measure) at baseline and Weeks 1, 2, 3, 4, 5, and 6. RESULTS: Mixed-model repeated-measures analysis of primary measures indicated a significant within-group increase of +4.3 (standard error [SE]=2.0) min/week of moderate- to vigorous-intensity PA (MVPA) at 6-week follow-up (p=0.04) in the comparison group (Fitbit only), but no study group differences across PA levels. Secondary measures indicated the SMS text-messaging effect lasted for only 1 week: the intervention group increased by +1,266 steps (SE=491; p=0.01), +17.8 min/week MVPA (SE=8.5; p=0.04), and +38.3 min/week total PA (SE=15.9; p=0.02) compared with no changes in the comparison group, and these between-group differences were significant for steps (p=0.01), fairly/very active minutes (p<0.01), and total active minutes (p=0.02). CONCLUSIONS: These data suggest that the Fitbit One achieved a small increase in MVPA at follow-up and that the SMS-based PA prompts were insufficient in increasing PA beyond 1 week. Future studies can test this intervention in those requiring less help and/or test strategies to increase participants' engagement levels.

Baseline Depressive Symptoms, Completion of Study Assessments, and Behavior Change in a Long-Term Dietary Intervention Among Breast Cancer Survivors.

BACKGROUND: Depressive symptoms can lower adherence and change in dietary studies. Behavioral activation may reduce these effects. PURPOSE: This study aims to assess relationships among depressive symptoms on adherence and dietary change in the Women's Healthy Eating and Living (WHEL) Study METHODS: Secondary analyses from the WHEL Study, which achieved major dietary change in breast cancer survivors (N = 2817), were conducted. Logistic regressions were undertaken of baseline depressive symptoms (six-item Center for Epidemiologic Studies Depression Scale (CES-D)) with (1) completion of 1- and 4-year study assessments and (2) validated change in dietary behavior in the intervention group. RESULTS: In the comparison group (vs. intervention), depressive symptoms lowered completion of dietary recalls and clinic visits [4 years: odds ratio (OR) = 2.0; 95 % confidence interval (CI) = 1.4-3.0]. The behaviorally oriented intervention achieved major change in those furthest from study targets, although changes were lower in those with depressive symptoms: fruit/vegetable (+37.2 %), fiber (+49.0 %), and fat (-22.4 %). CONCLUSIONS: Behavioral activation in dietary change interventions can overcome the impact of depressive symptoms.