The impact of exercise and cumulative physical activity on energy intake and diet quality in adults enrolled in the Midwest Exercise Trial for the Prevention of Weight Regain.

The purpose of this study was to assess impact of different volumes of exercise as well as cumulative moderate to vigorous physical activity (MVPA) on energy intake (EI) and diet quality, as assessed by the Healthy Eating Index-2010(HEI-2010), across a 12-month weight maintenance intervention. Participants were asked to attend group behavioural sessions, eat a diet designed for weight maintenance and exercise either 150, 225 or 300 min/week. Dietary intake was assessed by 3-d food records, and MVPA was assessed by accelerometry. Two hundred and twenty-four participants (42·5 years of age, 82 % female) provided valid dietary data for at least one time point. There was no evidence of group differences in EI, total HEI-2010 score or any of the HEI-2010 component scores (all P > 0·05). After adjusting for age, sex, time, group and group-by-time interactions, there was an effect of cumulative MVPA on EI (1·08, P = 0·04), total HEI-2010 scores (-0·02, P = 0·003), Na (-0·006, P = 0·002) and empty energy scores (-0·007, P = 0·004. There was evidence of a small relationship between cumulative daily EI and weight (ß: 0·00187, 95 % CI 0·001, P = 0·003). However, there was no evidence for a relationship between HEI total score (ß: -0·006, 95 % CI 0·07, 0·06) or component scores (all P > 0·05) and change in weight across time. The results of this study suggest that increased cumulative MVPA is associated with clinically insignificant increases in EI and decreases in HEI.

The Feasibility of Remotely Delivered Exercise Session in Adults With Alzheimer's Disease and Their Caregivers.

Adults with Alzheimer's disease (AD) and their caregivers represent a segment of the population with low levels of moderate-intensity physical activity (MPA) and limited options for increasing MPA. The purpose of this study was to evaluate the feasibility of a group video conference approach for increasing MPA in adults with AD and their caregivers. Adults with AD and their caregivers attended 30-min group exercise sessions three times per week for 12 weeks. Exercise sessions and support sessions were delivered in their homes on a tablet computer over video conferencing software. Nine adults with AD/caregiver dyads enrolled, and seven completed the 12-week intervention. Adults with AD attended 77.3% of the group exercise sessions, and caregivers attended 79.2% of group exercise sessions. Weekly MPA increased in both adults with AD (49%) and caregivers (30%). Exercise delivered by group video conferencing is a feasible and potentially effective approach for increasing MPA in adults with AD and their caregivers.

Weight management in adults with intellectual and developmental disabilities: A randomized controlled trial of two dietary approaches.

BACKGROUND: The prevalence of obesity among individuals with intellectual and developmental disabilities (IDD) is equal to or greater than the general population. METHODS: Overweight/obese adults (BMI ≥25 kg/m2 ) with mild-to-moderate intellectual and developmental disabilities were randomized to an enhanced stop light diet (eSLD = SLD + portion-controlled meals, n = 78) or a conventional diet (CD, n = 72) for an 18 months trial (6 months weight loss, 12 months maintenance). Participants were asked to increase physical activity (150 min/week), self-monitor diet and physical activity and attend counselling/educational sessions during monthly home visits. RESULTS: Weight loss (6 months) was significantly greater in the eSLD (-7.0% ± 5.0%) compared with the CD group (-3.8% ± 5.1%, p < .001). However, at 18 months, weight loss between groups did not differ significantly (eSLD = -6.7% ± 8.3%; CD = 6.4% ± 8.6%; p = .82). CONCLUSION: The eSLD and CD provided clinically meaningful weight loss over 18 months in adults with intellectual and developmental disabilities.

Physical activity and academic achievement across the curriculum: Results from a 3-year cluster-randomized trial.

We compared changes in academic achievement across 3years between children in elementary schools receiving the Academic Achievement and Physical Activity Across the Curriculum intervention (A+PAAC), in which classroom teachers were trained to deliver academic lessons using moderate-to-vigorous physical activity (MVPA) compared to a non-intervention control. Elementary schools in eastern Kansas (n=17) were cluster randomized to A+PAAC (N=9, target ≥100min/week) or control (N=8). Academic achievement (math, reading, spelling) was assessed using the Wechsler Individual Achievement Test-Third Edition (WIAT-III) in a sample of children (A+PAAC=316, Control=268) in grades 2 and 3 at baseline (Fall 2011) and repeated each spring across 3years. On average 55min/week of A+PACC lessons were delivered each week across the intervention. Baseline WIAT-III scores (math, reading, spelling) were significantly higher in students in A+PAAC compared with control schools and improved in both groups across 3years. However, linear mixed modeling, accounting for baseline between group differences in WIAT-III scores, ethnicity, family income, and cardiovascular fitness, found no significant impact of A+PAAC on any of the academic achievement outcomes as determined by non-significant group by time interactions. A+PAAC neither diminished or improved academic achievement across 3-years in elementary school children compared with controls. Our target of 100min/week of active lessons was not achieved; however, students attending A+PAAC schools received an additional 55min/week of MVPA which may be associated with both physical and mental health benefits, without a reduction in time devoted to academic instruction.

Breakfast Intake and Composition Is Associated with Superior Academic Achievement in Elementary Schoolchildren.

OBJECTIVE: To determine whether breakfast consumption or content affects academic achievement measured by standardized tests. METHODS: Baseline data were collected in fall of 2011 from 698 students (50.5% female, age = 7.5 ± 0.6 years) living in the state of Kansas. Academic achievement was assessed using 3 components from the Wechsler Individual Achievement Test (WIAT-III). Prior to taking the WIAT-III, participants completed a breakfast recall of all foods and drinks consumed that morning, which was analyzed using Nutrition Data System for Research (NDS-R). WIAT-III scores were compared between breakfast and non-breakfast consumers in a sample (n = 162) matched for age, sex, race, education level of both parents, household income, body mass index (BMI), and cardiovascular fitness, and Pearson correlations were calculated from all breakfast eaters (n = 617) between test performance and components of the breakfast. RESULTS: When compared to non-breakfast consumers, the breakfast consumers had significantly higher scores in all 3 WIAT-III components (all p < 0.05). In breakfast consumers, servings of fruit juice were negatively correlated with reading comprehension and fluency standard score and mathematics standard score (both p < 0.0001), and greater servings of whole grains were significantly related to higher scores in reading comprehension and fluency and mathematics (both p < 0.05). CONCLUSION: Both breakfast consumption and the content may be associated with improved standardized test performance in elementary school students.

Length of moderate-to-vigorous physical activity bouts and cardio-metabolic risk factors in elementary school children.

BACKGROUND: Accumulating moderate-to-vigorous physical activity (MVPA) in bouts of 10 min is associated with improved cardio-metabolic risk factors (CMRF) in adults. PURPOSE: To assess the association between the lengths of MVPA bouts and CMRF in elementary school age children. METHODS: The sample included 396, 2nd and 3rd grade students from eastern Kansas (182 boys, 214 girls; age 7.6 ± 0.6 years; Body Mass Index Percentile [BMI%ile]: 61.6 ± 9.3) in the fall of 2011. Analyses were conducted in 2014. MVPA bouts were defined as sporadic (<5 min), short (5-<10 min) or medium-to-long (≥10 min). Latent profile analysis was used to identify distinct subgroups (classes) based on the composition of MVPA bouts. Bayesian probability-based Wald chi-square test was used to compare CMRF between classes controlling for age, sex, BMI%ile, and total moderate and total vigorous PA. RESULTS: Three classes of accumulated physical activity were identified: A (n=78); 97% sporadic 2%, short, 1% medium-to-long bouts; B (n=174); 93% sporadic, 5% short, 2% medium-to-long; C (n=144); and 86% sporadic, 9% short, 5% medium-to-long bouts. Class C had significantly lower BMI%ile (57.3 ± 2.3 (SE)), waist circumference (WC; 55.8 ± 0.5 cm) compared with Class A (BMI%ile=70.9±0.5, p<0.01.030, WC=61.0 ± 1.0 cm, p=0.<0.01). Class B had significantly lower WC (56.6 ± 0.6 cm), p<0.01 than Class A. No significant differences between classes were shown in other outcomes. CONCLUSION: Children who accumulated MVPA with a higher percentage of short (5-<10 min) and medium-to-long bouts (≥10min) had lower BMI%ile, and WC compared with children who accumulated MVPA with a lower percentage short and medium-to-long bouts.

Exercise for everyone: a randomized controlled trial of project workout on wheels in promoting exercise among wheelchair users.

OBJECTIVE: To compare the effectiveness of 2 home-based behavioral interventions for wheelchair users to promote exercise adoption and maintenance over 12 months. DESIGN: Randomized controlled trial, with participants stratified into groups based on disability type (stable, episodic, progressive) and support partner availability. SETTING: Exercise occurred in participant-preferred locations (eg, home, recreation center), with physiological data collected at a university-based exercise laboratory. PARTICIPANTS: Inactive wheelchair users (N=128; 64 women) with sufficient upper arm mobility for arm-based exercise were enrolled. Participants on average were 45 years of age and lived with their impairment for 22 years, with spinal cord injury (46.1%) most commonly reported as causing mobility impairment. INTERVENTIONS: Both groups received home-based exercise interventions. The staff-supported group (n=69) received intensive exercise support, while the self-guided group (n=59) received minimal support. Both received exercise information, resistance bands, instructions to self-monitor exercise, regularly scheduled phone calls, and handwritten cards. MAIN OUTCOME MEASURES: The primary outcome derived from weekly self-reported exercise. Secondary outcomes included physical fitness (aerobic/muscular) and predictors of exercise participation. RESULTS: The staff-supported group reported significantly greater exercise (∼17min/wk) than the self-guided group over the year (t=10.6, P=.00), with no significant between-group difference in aerobic capacity (t=.76, P=.45) and strength (t=1.5, P=.14). CONCLUSIONS: Although the staff-supported group reported only moderately more exercise, the difference is potentially clinically significant because they also exercised more frequently. The staff-supported approach holds promise for encouraging exercise among wheelchair users, yet additional support may be necessary to achieve more exercise to meet national recommendations.

Weight management in rural health clinics: Results from the randomized midwest diet and exercise trial.

Introduction: Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team. Methods: Rural living adults with overweight/obesity (n = 187, age âˆ¼ 50 years 82% female, body mass index ∼35 kg/m2) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly âˆ¼ 45 min sessions with 7-14 participants (n = 71), IP, which included weekly âˆ¼ 15 min individual sessions (n = 80), or EUC, which included one-45 min in-person session at baseline. Results: Weight loss at 6 months was clinically relevant, that is, ≥5% in the GP (-11.4 kg, 11.7%) and the IP arms (-9.1 kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6 month weight loss was significantly greater in the IP versus EUC arms (-6.5 kg. p ≤ 0.025) but did not differ between the GP and IP arms (-2.4 kg, p > 0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively. Conclusions: Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6 months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).

An Individual vs Parent Supported Physical Activity Intervention in Adolescents with Intellectual Disabilities.

INTRODUCTION: Moderate-to-vigorous physical activity (MVPA) is inadequate in adolescents with intellectual and developmental disabilities (IDD). This report describes the results of an 18-mo. clinical trial in adolescents with IDD which compared changes in accelerometer assessed daily MVPA, gross motor quotient and leg press strength between participants randomized to an exercise intervention delivered to adolescents only (AO) or to the adolescent and a parent (A + P). METHODS: The 18-mo. trial included a 6-mo. active intervention, 6-mo. maintenance interventions, and a 6-mo. no-contact follow-up. Adolescents in both arms were asked to attend 40 min. remotely delivered group video exercise sessions (0-6 mos. =3 sessions·wk-1., 7-12 mos. =1 session·wk-1). In the A + P arm, one parent/guardian was asked to attend all group remote video exercise sessions and a monthly remotely delivered 30-min. educations/support session with their adolescent across the 12-mo. intervention. RESULTS: Adolescents (n = 116) with IDD (age ~ 16 yrs., 52% female) were randomized to the AO (n = 59) or A + P (n = 57) arms. Mixed modeling, controlling for baseline MVPA and season, indicated minimal but statistically significant changes in MVPA across 6 (p = 0.006), 12 (p < 0.001), and 18 mos. (p < 0.001). However, the change in MVPA in the two intervention arms did not differ significantly at any time point (all p > 0.05). Similarly, gross motor quotient and leg press strength improved significantly over time (p < 0.001) and these changes did not differ between intervention arms (all p > 0.05). CONCLUSIONS: Parental involvement had no impact on changes in daily MVPA, gross motor quotient or leg press strength in response to a remotely delivered exercise intervention in adolescents with IDD.

Physical activity and academic achievement across the curriculum (A + PAAC): rationale and design of a 3-year, cluster-randomized trial.

BACKGROUND: Improving academic achievement and reducing the rates of obesity in elementary school students are both of considerable interest. Increased physical activity during academic instruction time during school offers a potential intervention to address both issues. A program titled "Physical Activity Across the Curriculum" (PAAC) was developed in which classroom teachers in 22 elementary schools were trained to deliver academic instruction using physical activity with a primary aim of preventing increased BMI. A secondary analysis of data assessed the impact of PAAC on academic achievement using the Weschler Individual Achievement Test-II and significant improvements were shown for reading, math and spelling in students who participated in PAAC. Based on the results from PAAC, an adequately powered trial will be conducted to assess differences in academic achievement between intervention and control schools called, "Academic Achievement and Physical Activity Across the Curriculum (A + PAAC)." METHODS/DESIGN: Seventeen elementary schools were cluster randomized to A + PAAC or control for a 3-year trial. Classroom teachers were trained to deliver academic instruction through moderate-to-vigorous physical activity with a target of 100+ minutes of A + PAAC activities per week. The primary outcome measure is academic achievement measured by the Weschler Individual Achievement Test-III, which was administered at baseline (Fall 2011) and will be repeated in the spring of each year by assessors blinded to condition. Potential mediators of any association between A + PAAC and academic achievement will be examined on the same schedule and include changes in cognitive function, cardiovascular fitness, daily physical activity, BMI, and attention-to-task. An extensive process analysis will be conducted to document the fidelity of the intervention. School and student recruitment/randomization, teacher training, and baseline testing for A + PAAC have been completed. Nine schools were randomized to the intervention and 8 to control. A random sample of students in each school, stratified by gender and grade (A + PAAC = 370, Control = 317), was selected for outcome assessments from those who provided parental consent/child assent. Baseline data by intervention group are presented. DISCUSSION: If successful, the A + PAAC approach could be easily and inexpensively scaled and disseminated across elementary schools to improve both educational quality and health. FUNDING SOURCE: R01- DK85317. TRIAL REGISTRATION: US NIH Clinical Trials, http://NCT01699295.

A 6-month trial of resistance training with milk supplementation in adolescents: effects on body composition.

Fluid milk consumed in conjunction with resistance training (RT) provides additional protein and calcium, which may enhance the effect of RT on body composition. However, the literature on this topic is inconsistent with limited data in adolescents. Therefore, we examined the effects of a supervised RT program (6 mo, 3 d/ wk, 7 exercises, 40-85% 1-repetition maximum) with daily milk supplementation (24 oz/day, one 16-oz dose immediately post-RT) on weight, fat mass (FM), and fat-free mass (FFM) assessed via dual-energy X-ray absorptiometry (baseline, 3 mo, 6 mo) in a sample of middle-school students who were randomly assigned to 1 of 3 supplement groups: milk, isocaloric carbohydrate (100% fruit juice), or water (control). Thirty-nine boys and 69 girls (mean age = 13.6 yr, mean BMI percentile = 85th) completed the study: milk n = 36, juice n = 34, water n = 38. The results showed no significant differences between groups for change in body weight (milk = 3.4 ± 3.7 kg, juice = 4.2 ± 3.1 kg, water = 2.3 ±2.9 kg), FM (milk = 1.1 ±2.8 kg, juice = 1.6 ± 2.5 kg, water = 0.4 ±3.6 kg), or FFM (milk = 2.2 ± 1.9 kg, juice = 2.7 ± 1.9 kg, water = 1.7 ± 2.9 kg) over 6 mo. FFM accounted for a high proportion of the increased weight (milk = 62%, juice = 64%, water = 74%). These results from a sample of predominantly overweight adolescents do not support the hypothesis that RT with milk supplementation enhances changes in body composition compared with RT alone.

Pre-post intervention exploring cognitive function and relationships with weight loss, intervention adherence and dropout.

Objective: To evaluate the association between baseline cognitive function, intervention dropout, adherence and 3-month weight loss (WL) when controlling for confounding demographic variables. Methods: 107 (Mage = 40.9 yrs.), BMI in the overweight and obese range (BMI = 35.6 kg/m2), men (N = 17) and women (N = 90) completed a 3-month WL intervention. Participants attended weekly behavioral sessions, comply with a reduced calorie diet, and complete 100 min of physical activity (PA)/wk. Cognitive function tasks at baseline included Flanker (attention), Stroop (executive control) and working memory, demographics, body weight and cardiovascular fitness were assessed at baseline. Session attendance, adherence to PA and diet were recorded weekly. Results: Baseline attention was positively correlated with age (p < .05), education (p < .05), attendance (p < .05), diet (p < .05) and PA (p < .05). Baseline executive control (p < .05) and working memory (p < .05) were each associated with % WL. Baseline executive control (p < .01) and working memory (p < .001) were also each associated with education. ANOVA indicated that baseline attention (p < .01) was associated with WL, specifically for comparing those who achieved 5-10% WL (p < .01) and those who achieved greater than 10% WL (p < .01) to those who dropped. Significance: Results suggest that stronger baseline attention is associated with completion of a 3-mo. WL intervention. Executive control and working memory are associated with amount of WL achieved. NCT registration: US NIH Clinical Trials, NCT01664715.

The Family Nutrition and Physical Activity Survey: Comparisons with Obesity and Physical Activity in Adolescents with Autism Spectrum Disorder.

Adolescents with autism spectrum disorder (ASD) are at a heightened risk for obesity. Family-level measures of nutrition and physical activity may help explain factors contributing to disproportionate rates of weight gain. Twenty adolescents with ASD participated in baseline testing for a study to assess the feasibility of remotely-delivered yoga. Parents completed the Family Nutrition and Physical Activity (FNPA) survey and anthropometrics and physical activity were assessed in the adolescents. A median split was applied to the FNPA score to create high and low obesogenic environments and nonparametric O'Brien's multiple endpoint tests were used to evaluate the differences. Between-group differences were found in anthropometrics (p = 0.01) but not physical activity (p = 0.72). Implications for a multifaceted family-based approach to obesity prevention are discussed.

The association of increased body mass index on cardiorespiratory fitness, physical activity, and cognition in adults with down syndrome.

BACKGROUND: Obesity is a significant risk factor for Alzheimer's disease; however, this association has not been explored in adults with Down syndrome. OBJECTIVE: To examine the association of obesity, assessed by body mass index (BMI), with factors related to Alzheimer's disease risk including cardiorespiratory fitness, physical activity, and cognition in adults with Down syndrome. METHODS: Adults with Down syndrome attended a laboratory visit where BMI, cardiorespiratory fitness (VO2 peak), and cognitive function (CANTAB® DS Battery) were obtained. Physical activity (accelerometer) was collected over the week following the laboratory visit. Wilcoxon rank sum tests were used to evaluate differences in cardiorespiratory fitness, sedentary time, moderate-to-vigorous physical activity (MVPA), and cognition between adults with obesity (BMI≥ 30 kg/m2) and those with healthy weight or overweight (BMI <30 kg/m2). Spearman correlations and linear regressions were used to measure the impact of BMI on cardiorespiratory fitness, MVPA, sedentary time, and cognition. RESULTS: Data was collected for 79 adults with Down syndrome (26.7 ± 9.0 years of age, 54% female, 54% with obesity). VO2 peak was significantly lower in participants with obesity (18.4 ± 2.5 ml/kg/min) compared to those with healthy weight or overweight (22.9 ± 4.0 ml/kg/min, p < 0.001). BMI was negatively associated with cardiorespiratory fitness (rho = -0.614, p < 0.001). No associations were observed between BMI and physical activity or cognition. CONCLUSIONS: Lower BMI was associated with improved cardiorespiratory fitness. However, no associations were observed between BMI and cognition or physical activity. NCT REGISTRATION: NCT04048759.

The prevalence of obesity and lifestyle behaviors of parents of youth with intellectual and developmental disabilities.

BACKGROUND: Parents of youth with intellectual and developmental disabilities (IDD) may have a higher prevalence of overweight and obesity and poorer weight management behaviors compared to the general population. OBJECTIVE: To describe the prevalence of overweight/obesity and related socioeconomic and lifestyle factors including diet quality, physical activity, and reported health habits in parents of youth with IDD. METHODS: We assessed: BMI (kg/m2), moderate-to-vigorous physical activity (MVPA), fruit and vegetable intake (FVI), parental diet and physical activity habits, and socioeconomic characteristics. Associations of BMI on MVPA and FVI were assessed with Spearman's correlation; differences in BMI by parental diet and physical activity habits were assessed with Kruskall-Wallis tests; and the relationships of BMI to household income, race, and education were assessed with Kendall Tau-b and Mann Whitney U tests. RESULTS: Data was obtained from 110 parents (97.3% female) who were study partners for their adolescents/young adults with IDD participating in a weight loss clinical trial. Approximately 81% of parents were overweight or obese (25.7% overweight, 55.1% obese), with 46.3% and 20% meeting the recommended U.S. guidelines for MVPA and FVI, respectively. Higher FVI and higher income were significantly associated with lower parent BMI. BMI was significantly lower in parents who reported to be physically active and choose healthy food. CONCLUSION: We observed a high prevalence of overweight/obesity, low FVI and low levels of MVPA in parents of adolescents with IDD. These observations suggest that interventions designed to address these factors have the potential to improve the health and wellbeing of both parents and adolescents with IDD. CLINICAL TRIALS NUMBER: NCT02561754.

A Remotely Delivered Yoga Intervention for Adolescents with Autism Spectrum Disorder: Feasibility and Effectiveness for Improving Skills Related to Physical Activity.

This study evaluated the feasibility of remotely delivered yoga for improving four physical activity-related skills: motor skills, strength, balance, and flexibility in adolescents with autism spectrum disorder (ASD). Nineteen of 20 participants enrolled (age 13.2 ± 2.2 years; 60% male) completed the 12-week intervention and attended 83% of the scheduled yoga sessions. Overall, physical activity-related skills improved pre to post intervention (Φ = 0.90, p = 0.005, 95% CI 0.72-1.0). Specifically, significant increases in leg strength (12.5%, p = 0.039), flexibility (40.3%, p = 0.008), and dynamic balance on the right (11.1%, p = 0.001) and left legs (8.1%, p = 0.003) were observed across 12 weeks. These results demonstrate the feasibility and potential effectiveness of yoga to improve physical activity-related skills in adolescents with ASD.

The association between cardiovascular health and cognition in adults with Down syndrome.

INTRODUCTION: Evidence in the general population suggests that predictors of cardiovascular health such as moderate to vigorous physical activity (MVPA), cardiorespiratory fitness, and systolic blood pressure are associated with cognitive function. Studies supporting these associations in adults with Down syndrome (DS) are limited. The purpose of this study was to examine the associations between systolic blood pressure, cardiorespiratory fitness, and MVPA on cognition in adults with DS. METHODS: This is a cross-sectional analysis using baseline data from a trial in adults with DS. Participants attended a laboratory visit where resting blood pressure, cardiorespiratory fitness (VO2 Peak), and cognitive function (CANTAB® DS Battery) were obtained. The cognitive battery included tests measuring multitasking, episodic memory, and reaction time. Physical activity (accelerometer) was collected over the week following the laboratory visit. Pearson correlations and linear regressions were used to measure the impact of systolic blood pressure, cardiorespiratory fitness, and MVPA on cognitive outcomes. RESULTS: Complete data was available for 72 adults with DS (26.8 ± 9.3 years of age, 57% female). At baseline, VO2 Peak (21.1 ± 4.2 ml/kg/min) and MVPA were low (14.4 ± 14.4 min/day), and systolic blood pressure was 118.3 ± 13.3 mmHg. VO2 Peak was correlated with simple movement time (rho = - 0.28, p = 0.03) but was not significant using a linear regression controlling for age and sex. Systolic blood pressure was significantly associated with episodic memory (first attempt memory score: ß = - 0.11, p = 0.002; total errors: ß = 0.58, p = 0.001) and reaction time (five-choice movement time: ß = 4.11, p = 0.03; simple movement time: ß = 6.14, p = 0.005) using age- and sex-adjusted linear regressions. No associations were observed between MVPA and multitasking, episodic memory, or reaction time. CONCLUSION: Predictors of cardiovascular health, including cardiorespiratory fitness and systolic blood pressure, were associated with some aspects of cognition in adults with DS. While future research should examine the role of improved cardiovascular health on delaying decreases in cognitive function and dementia in adults with DS, we recommend that health care providers convey the importance of exercise and cardiovascular health to their patients with DS. TRIAL REGISTRATION: NCT04048759, registered on August 7, 2019.

A randomized trial comparing diet and delivery strategies for weight management in adolescents with intellectual disabilities.

BACKGROUND: The literature evaluating multi-component interventions for long-term weight loss in adolescents with intellectual disabilities (ID) is extremely limited. OBJECTIVES: To compare the effectiveness of two delivery strategies, face-to-face (FTF) or remote delivery (RD), and two diets, enhanced Stop Light diet (eSLD) or conventional diet (CD) on weight change across 12 and 18 months. in response to an 18 months. weight management intervention (6 months Weight loss/12 months. Weight maintenance) in adolescents with ID. METHODS: Adolescents with ID were randomized to one of three arms: FTF /CD, RD/CD, RD/eSLD and asked to attend individual education sessions with a health educator which were delivered during FTF home visits or remotely using video conferencing. The CD followed the US dietary guidelines. The eSLD utilized the Stop Light guide and was enhanced with portion-controlled meals. Participants were also asked to increase their physical activity (PA) and to self-monitor diet, PA and body weight across the 18-month. RESULTS: Weight was obtained from 92(84%) and 89(81%) randomized adolescents at 12 and 18 months, respectively. Weight change across 12 months. Differed significantly by diet (RD/eSLD: -7.0% vs. RD/CD: -1.1%, p = 0.002) but not by delivery strategy (FTF/CD: +1.1% vs. RD/CD: -1.1%, p = 0.21). Weight change across 18 months. Was minimal in all intervention arms and did not differ by diet (RD/eSLD: -2.6% vs. RD/CD: -0.5%; p = 0.28) or delivery strategy (FTF/CD: +1.6% vs. RD/CD: -0.5%; p = 0.47). CONCLUSIONS: Additional research is required to identify effective strategies to improve long-term weight loss in adolescents with ID.

Truth be told: evidence of wheelchair users' accuracy in reporting their height and weight.

OBJECTIVES: To examine whether wheelchair users' self-reports of height and weight differed significantly from direct measurements and whether weight category classifications differed substantially when based on self-reported or measured values. DESIGN: Single group, cross-sectional analysis. Analyses included paired t tests, chi-square test, analysis of variance, and Bland-Altman agreement analyses. SETTING: A university-based exercise lab. PARTICIPANTS: Community-dwelling wheelchair users (N=125). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participants' self-reported and measured height, weight, and body mass index. RESULTS: Paired t tests revealed that there were significant differences between wheelchair users' self-reported and measured values for height (difference of 3.1±7.6cm [1.2±3.0in]), weight (-1.7±6.5kg [-3.6±14.2lb]), and BMI (-1.6±3.3). These discrepancies also led to substantial misclassification into weight categories, with reliance on self-reported BMI underestimating the weight status of 20% of the sample. CONCLUSIONS: Our findings suggest that similar to the general population, wheelchair users are prone to errors when reporting their height and weight and that these errors may exceed those noted in the general population.

Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities.

The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0-6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Six-month weight loss was not different between groups (CE-Zoom® = -5.99 ± 8.0 kg, -5.4%, FB = -1.68 ± 3.3 kg, -1.6% p = 0.13). Participants achieving ≥5% weight loss was greater in the CE-Zoom® (44%) compared with the FB group (7%, p = 0.04). Participants achieving the NDPP program goal for physical activity (≥150 min/week) did not differ (CE-Zoom® = 75%, FB = 67%, p = 0.91). This pilot trial demonstrated the potential feasibility and effectiveness of the NDPP delivered by CE personnel in a group remote format (Zoom®) to adults with prediabetes living in rural areas.