Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia.

PURPOSE: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. METHODS: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA). RESULTS: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. CONCLUSIONS: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors' specific needs and risk factors.

Heart failure following blood cancer therapy in pediatric and adult populations.

AIM: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. METHODS: Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. RESULTS: Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. CONCLUSION: The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.

Neighbourhood Environmental Attributes Associated with Walking in South Australian Adults: Differences between Urban and Rural Areas.

Although the health benefits of walking are well established, participation is lower in rural areas compared to urban areas. Most studies on walkability and walking have been conducted in urban areas, thus little is known about the relevance of walkability to rural areas. A computer-assisted telephone survey of 2402 adults (aged ≥18 years) was conducted to determine walking behaviour and perceptions of neighbourhood walkability. Data were stratified by urban (n = 1738) and rural (n = 664). A greater proportion of respondents reported no walking in rural (25.8%) compared to urban areas (18.5%). Compared to urban areas, rural areas had lower walkability scores and urban residents reported higher frequency of walking. The association of perceived walkability with walking was significant only in urban areas. These results suggest that environmental factors associated with walking in urban areas may not be relevant in rural areas. Appropriate walkability measures specific to rural areas should be further researched.

Public attitudes to government intervention to regulate food advertising, especially to children.

The World Health Organization has called on governments to implement recommendations on the marketing of foods and beverages to children. This study describes high public support for government intervention in marketing of unhealthy food to children and suggests more effort is needed to harness public opinion to influence policy development.

Walking for recreation and transport by geographic remoteness in South Australian adults.

OBJECTIVE: To determine differences in walking for recreation and transport between Accessibility/Remoteness Index of Australia (ARIA) categories, in South Australian adults. DESIGN: Cross-sectional self-reported data from adult telephone survey respondents between April and May in 2012 and 2013. SETTING: Population of South Australia. PARTICIPANTS: A total of 4004 adults (aged over 18 years) participated: n = 1956 men and n = 2048 women. Area of residence was categorised using ARIA (major city, inner regional, outer regional and remote/very remote). MAIN OUTCOME MEASURE(S): Self-reported participation in walking for transport and recreation/exercise as the number of times and minutes per week. Data were analysed using Kruskal-Wallis test for median minutes and negative binomial regression for times walked with adjustment for socioeconomic status, age and body mass index. RESULTS: Average age was 47.8 ± 18.5 years, 51.1% were women, 70.9% lived in the major cities, 14.6% in inner regional, 10.8% in outer regional and 3.6% in remote/very remote areas. Relative to major city, times walked for recreation was lower for only remote/very remote residents (incidence rate ratio (IRR) 0.74 (95%CI 0.59-0.92), P = 0.008). This difference was only observed for men (IRR 0.54 (95%CI 0.39-0.73), P < 0.001). Relative to major city, times walked for transport was less for inner regional (IRR 0.74 (95%CI 0.67-0.85), P < 0.001) and outer regional (IRR 0.64 (95%CI 0.56-0.74), P < 0.001) only. This difference in transport walking was seen in both men and women. CONCLUSION: Frequency of walking varied by purpose, level of remoteness and sex. As walking is the focus of population-level health promotion, more detailed understanding of the aetiology of regular walking is needed.

There is No Association Between the Omega-3 Index and Depressive Symptoms in Patients With Heart Disease Who Are Low Fish Consumers.

BACKGROUND: Long chain Omega-3 polyunsaturated fatty acids (LCn3PUFAs) may improve cardiovascular health and depression. This study investigated the relationships between erythrocyte membrane LCn3PUFA status, depression and angina symptoms in patients with heart disease. METHODS: We recruited 91 patients (65 males and 26 females, mean age 59.2±10.3 years) with heart disease and depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D ≥ 16) and low fish/fish oil intakes. The Omega-3 Index (EPA+DHA) of erythrocyte membranes (as a percentage of total fatty acids) was assessed by gas chromatography. Depression status was measured by both self-report and clinician-report scales; CES-D and the Hamilton depression scale (HAM-D). Angina symptoms were measured using the Seattle Angina Questionnaire and the Canadian Cardiovascular Society Classification for Angina Pectoris. RESULTS: The mean Omega-3 Index was 4.8±1.0% (±SD). Depression scores measured by CES-D and HAM-D were 29.2±8.8 (moderate to severe) and 11.0±5.7 (mild) (arbitrary units) respectively reflecting a different perception of depressive symptoms between patients and clinicians. Angina status was inversely associated with depression scores (r>-0.26, P<0.03). There were no significant relationships between individual LCn3PUFA or the Omega-3 Index and either the depression scores or the angina symptoms. CONCLUSION: Worse angina status was associated with worse depression, but the Omega-3 Index was not associated with symptoms of depression or angina in patients with heart disease.

Cardiotoxicity and cardiovascular disease risk assessment for patients receiving breast cancer treatment.

BACKGROUND: Cardiotoxicity from anticancer therapy affects heart function and structure. Cardiotoxicity can also lead to accelerated development of chronic diseases, especially in the presence of risk factors. METHODS: This study aimed to develop and pilot a combined cardiovascular disease and cardiotoxicity risk assessment questionnaire to quantify the potential extent of risk factors in breast cancer patients prior to treatment. The questionnaire underwent content and face validity evaluation by an expert panel followed by pilot testing in a sample of breast cancer patients (n = 36). Questionnaires were self-administered while attending chemotherapy clinic, in the presence of a research assistant. RESULTS: Mean age of participants was 54.8 years (range 36-72 years). Participants reported CVD risk factors including diabetes 2.8%, hypertension 19.8%, hypercholesterolaemia 11% and sleep apnoea 5%. Lifestyle risk factors, included not eating the recommended serves of vegetables (100%) or fruit (78%) per day; smoking (13%) and regularly consuming alcohol (75%). Twenty five percent reported being physically inactive, 61%, overweight or obese, 24%, little or no social support and 30% recorded high to very high psychological distress. Participants were highly (75%) reluctant to undertake lifestyle changes; i.e. changing alcohol consumption; dietary habits; good emotional/mental health strategies; improving physical activity; quitting smoking; learning about heart-health and weight loss. CONCLUSION: This study is an important step towards prevention and management of treatment-associated cardiotoxicity after breast cancer diagnosis. We recommend that our questionnaire is providing important data that should be included in cancer registries so that researchers can establish the relationship between CVD risk profile and cardiotoxicity outcomes and that this study revealed important teaching opportunities that could be used to examine the impact on health literacy and help patients better understand the consequences of cancer treatment.

Characteristics of patients with haematological and breast cancer (1996-2009) who died of heart failure-related causes after cancer therapy.

AIMS: To describe the characteristics and time to death of patients with breast or haematological cancer who died of heart failure (HF) after cancer therapy. Patients with an index admission for HF who died of HF-related causes (IAHF) and those with no index admission for HF who died of HF-related causes (NIAHF) were compared. METHODS AND RESULTS: We performed a linked data analysis of cancer registry, death registry, and hospital administration records (n = 15 987). Index HF admission must have occurred after cancer diagnosis. Of the 4894 patients who were deceased (30.6% of cohort), 734 died of HF-related causes (50.1% female) of which 279 (38.0%) had at least one IAHF (41.9% female) post-cancer diagnosis. Median age was 71 years [interquartile range (IQR) 62-78] for IAHF and 66 years (IQR 56-74) for NIAHF. There were fewer chemotherapy separations for IAHF patients (median = 4, IQR 2-9) compared with NIAHF patients (median = 6, IQR 2-12). Of the IAHF patients, 71% had died within 1 year of the index HF admission. There was no significant difference in HF-related mortality in IAHF patients compared with NIAHF (HR, 1.10, 95% CI, 0.94-1.29, P = 0.225). CONCLUSIONS: The profile of IAHF patients who died of HF-related causes after cancer treatment matched the current profile of HF in the general population (over half were aged ≥70 years). However, NIAHF were younger (62% were aged ≤69 years), female patients with breast cancer that died of HF-related causes before hospital admission for HF-related causes-a group that may have been undiagnosed or undertreated until death.

Self-Reported Physical Activity Using the International Physical Activity Questionnaire (IPAQ) in Australian Adults with Type 2 Diabetes, with and Without Peripheral Neuropathy.

OBJECTIVES: The aim of this study was to survey the level of self-reported physical activity in people with type 2 diabetes, with and without peripheral neuropathy. METHODS: A sample of South Australian adults (n=481) 33 to 88 years of age who had type 2 diabetes, including 55 people with peripheral neuropathy, completed the International Physical Activity Questionnaire (IPAQ). Levels of self-reported physical activity were compared between those with and without peripheral neuropathy. RESULTS: People with type 2 diabetes and peripheral neuropathy (median [Mdn]=1433; interquartile range [IQR]=495 to 3390 metabolic equivalent minutes per week [MET-min/wk]) were less physically active than those without peripheral neuropathy (Mdn=2106; IQR=876 to 4380 MET-min/wk) (p=0.04). A total of 49% of people with type 2 diabetes and peripheral neuropathy met physical activity recommendations of 150 minutes of at least moderate activity per week, compared to 57% of people with type 2 diabetes alone. CONCLUSIONS: These findings demonstrate that people with type 2 diabetes and peripheral neuropathy reported being significantly less active than people with type 2 diabetes alone. People with type 2 diabetes and peripheral neuropathy need to be encouraged to perform higher levels of physical activity for biologic, physical and psychological benefits. Further studies using objective measures of physical activity are required to support these results.

Associations of awareness of physical activity recommendations for health and self-reported physical activity behaviours among adult South Australians.

OBJECTIVES: Despite widespread media campaigns to encourage physical activity (PA), participation is poor among Australian adults. This study aimed to explore the prevalence of and relationships between awareness of PA recommendations and PA participation. DESIGN: Cross-sectional study of n=2402 South Australian adults (aged≥18 years) via a computer-assisted telephone interview. METHODS: PA recommendation awareness was determined by asking for the number of minutes of PA recommended for health benefits and whether PA is needed to make you 'puff and pant' to confer a health benefit. Respondents were defined as sufficiently active if they reported ≥150min/week of PA as measured by the Active Australia Survey. RESULTS: A total of 43.0% correctly identified that 30min of PA is recommended per day (Recommendation 1) and 43.3% correctly disagreed/strongly disagreed that PA is needed to make you 'puff and pant' (Recommendation 2). Overall, 60.6% of respondents were sufficiently active. Of those who correctly identified Recommendation 1, 53.2% reported participating in sufficient PA, significantly fewer than those who did not know Recommendation 1 (69.6%) (χ(2)=64.74 (4), p<0.001). There was no difference in levels of sufficient PA between those who correctly identified Recommendation 2 and those who did not. CONCLUSIONS: There was relatively low awareness of PA recommendations among South Australian adults. More research is needed in how recommendations are promoted and how they impact PA behaviours. PA recommendations are based on the best available epidemiological evidence but largely fail to guide the choices people currently make about PA.

Facilitating or getting in the way? The effect of clinicians' knowledge, values and beliefs on referral and participation.

BACKGROUND: Despite the compelling evidence of the benefits of cardiac rehabilitation (CR) on risk factor modification, quality of life and mortality reduction, a significant proportion of eligible patients are not referred or do not participate. Factors influencing CR referral and participation are complex and are likely patient, referral system and clinician-related. Little is known about clinician-related factors, which include attitudes, values and beliefs towards CR, or how these factors affect patient referral and attendance. This review examines the current evidence in the literature in relation to clinicians' attitudes, values and beliefs about CR. METHODS: A review of the literature was conducted on studies in relation to clinicians' attitudes, values and beliefs toward CR. An expert consensus methodology was used to develop the concepts presented in this paper. RESULTS: Besides guidelines, a range of other factors influence clinicians' view about CR. This review suggests that clinicians lacking cardiac qualifications may have limited knowledge and awareness of CR and its benefits. Low agreement among clinicians on who is more likely to benefit from CR was also identified. Clinicians' personal lifestyle and health belief, the availability and quality of local the CR programme, and the lack of a standard administrative process of referral can also hinder the referral of patients to CR. CONCLUSIONS: Clinician-related factors are important to consider in relation to CR referral and participation. Education for clinicians, discussion of local services and the support of an efficacious system at programme and organisation levels are essential.

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure.

INTRODUCTION: There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. METHODS: This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. RESULTS: Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients. CONCLUSIONS: By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

Differences in chronic conditions and lifestyle behaviour between people with a history of cancer and matched controls.

OBJECTIVE: To determine whether people with a history of cancer have a higher prevalence of chronic conditions or different lifestyle behaviour compared with controls. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, self-reported data from a telephone survey conducted between 1 January 2010 and 31 March 2012 of adult residents of South Australia who self-reported a previous cancer diagnosis (cases) and randomly selected age- and sex-matched residents with no cancer diagnosis (controls). MAIN OUTCOME MEASURES: Self-reported medically diagnosed cardiovascular disease, hypertension, hyperlipidaemia, diabetes and osteoporosis; lifestyle behaviour (smoking, physical activity and diet); body mass index (BMI); psychological distress and self-reported health. RESULTS: A total of 2103 cases and 4185 controls were included in the analyses. For men, after adjusting for age, cancer survivors were more likely than controls to have ever had cardiovascular disease (P<0.001), high blood pressure (P=0.001), high cholesterol (P<0.001) and diabetes (P=0.04). These associations remained significant after controlling for socioeconomic status (SES), with the exception of high blood pressure (P=0.09). For women, there was an increased prevalence of high cholesterol (P=0.005), diabetes (P=0.02) and osteoporosis (P=0.005) in cancer cases, but after adjusting for SES, these associations were no longer significant. Women with a previous cancer diagnosis were more likely than controls to have ever smoked, after adjusting for SES (P=0.001). There were no other differences in lifestyle behaviour or BMI between cases and controls for men or women. CONCLUSION: Despite similar lifestyle habits and BMI, the prevalence of chronic conditions was significantly higher among people with a history of cancer than among controls without cancer. This supports the importance of chronic disease management as part of health care after a diagnosis of cancer.

Dairy foods and dairy protein consumption is inversely related to markers of adiposity in obese men and women.

A number of intervention studies have reported that the prevalence of obesity may be in part inversely related to dairy food consumption while others report no association. We sought to examine relationships between energy, protein and calcium consumption from dairy foods (milk, yoghurt, cheese, dairy spreads, ice-cream) and adiposity including body mass index (BMI), waist (WC) and hip circumference (HC), and direct measures of body composition using dual energy X-ray absorptiometry (% body fat and abdominal fat) in an opportunistic sample of 720 overweight/obese Australian men and women. Mean (SD) age, weight and BMI of the population were 51 ± 10 year, 94 ± 18 kg and 32.4 ± 5.7 kg/m2, respectively. Reduced fat milk was the most commonly consumed dairy product (235 ± 200 g/day), followed by whole milk (63 ± 128 g/day) and yoghurt (53 ± 66 g/day). Overall dairy food consumption (g/day) was inversely associated with BMI, % body fat and WC (all p < 0.05). Dairy protein and dairy calcium (g/day) were both inversely associated with all adiposity measures (all p < 0.05). Yoghurt consumption (g/day) was inversely associated with % body fat, abdominal fat, WC and HC (all p < 0.05), while reduced fat milk consumption was inversely associated with BMI, WC, HC and % body fat (all p < 0.05). Within a sample of obese adults, consumption of dairy products, dairy protein, and calcium was associated with more favourable body composition.

Chronic resveratrol consumption improves brachial flow-mediated dilatation in healthy obese adults.

BACKGROUND: We have previously demonstrated acute dose-dependent increases of flow-mediated dilatation (FMD) in the brachial artery after resveratrol consumption in mildly hypertensive, overweight/obese adults. Resveratrol supplementation has also been shown to increase cerebral blood flow acutely, without affecting cognition. OBJECTIVES: To evaluate the effects of chronic resveratrol supplementation on both FMD and cognitive performance. METHOD: Twenty-eight obese but otherwise healthy adults (BMI: 33.3 ± 0.6 kg/m) were randomized to take a single 75 mg capsule of trans-resveratrol (Resvida) or placebo daily for 6 weeks each in a double-blind crossover supplementation trial. Blood pressure, arterial compliance, FMD, and performance on the Stroop Color-Word Test were assessed at the end of each 6-week intervention period while fasted and at least 18 h after taking the last daily capsule. An additional capsule of the same supplement was then taken. FMD assessment was repeated 1 h later. RESULTS: Chronic resveratrol supplementation for 6 weeks was well tolerated and resulted in a 23% increase in FMD compared with placebo (P=0.021, paired t-test). The extent of increase correlated negatively with baseline FMD (r=-0.47, P=0.01). A single dose of resveratrol (75 mg) following chronic resveratrol supplementation resulted in a 35% greater acute FMD response than the equivalent placebo supplementation. These FMD improvements remained significant after adjusting for baseline FMD. Blood pressure, arterial compliance, and all components of the Stroop Color-Word Test were unaffected by chronic resveratrol supplementation. CONCLUSION: Daily resveratrol consumption was well tolerated and has the potential to maintain healthy circulatory function in obese adults.

Transcranial Doppler ultrasound to assess cerebrovascular reactivity: reliability, reproducibility and effect of posture.

Transcranial Doppler ultrasound (TCD) allows measurement of blood flow velocities in the intracranial vessels, and can be used to assess cerebral vasodilator responses to a hypercapnic stimulus. The reliability of this technique has not been established, nor is there agreement about whether the technique should be performed in sitting or lying postures. We tested the intra- and inter-rater reliability of measures of cerebrovascular reactivity (CVR) in 10 healthy adults, in sitting and lying postures. Participants underwent triplicate bilateral ultrasound assessment of flow velocities in the middle cerebral arteries whilst sitting and lying supine prior to and during inhalation of Carbogen (5% CO2, 95% O2) for 2 min. This procedure was performed twice by each of two raters for a total of four sessions. CVR was calculated as the difference between baseline and the peak blood flow velocity attained during CO2 inhalation. Intraclass correlation coefficients (ICCs) for intra-rater reliability were greater sitting than lying for both raters (e.g. Rater 1 ICC sitting = 0.822, lying = 0.734), and inter-rater reliability was also greater in sitting (e.g. sitting ICC = 0.504, lying = 0.081). These results suggest that assessment of CVR using TCD should be performed with participants sitting in order to maximise CVR measurement reliability.

Chronic consumption of a wild green oat extract (Neuravena) improves brachial flow-mediated dilatation and cerebrovascular responsiveness in older adults.

BACKGROUND: Heart health benefits have been attributed to regular consumption of oats. Preclinical evidence suggests that a wild green oat extract (WGOE) may improve vasodilator function, but this is yet to be evaluated in humans. OBJECTIVE: To determine whether regular daily consumption of WGOE can influence vasodilator function in systemic and cerebral arteries. METHODS: Thirty-seven healthy older adults (>60 years) completed a 24-week randomized, double-blind, placebo-controlled two-way crossover dietary intervention with 1500 mg/day of encapsulated WGOE or placebo. All assessments were conducted at the end of each 12-week intervention arm, after participants had fasted for at least 4 h and at least 18 h after they had taken their last dose of supplement. Flow-mediated dilatation (FMD) of the brachial artery and hypercapnia-induced increases of blood flow in the middle cerebral artery were used to measure systemic and cerebral vasodilator responsiveness (CVR), respectively. RESULTS: Compared with placebo, WGOE supplementation increased CVR and FMD to a similar extent (42 and 41%, respectively, P < 0.01 for both). The improvements in CVR and FMD were not correlated. Resting blood pressure did not alter with supplementation. Dose and treatment duration were well tolerated by participants. CONCLUSION: WGOE supplementation can improve vasodilator function in systemic and cerebral arteries, suggesting a potential role in the maintenance of cardiovascular health.

Chronic effects of a wild green oat extract supplementation on cognitive performance in older adults: a randomised, double-blind, placebo-controlled, crossover trial.

BACKGROUND AND AIM: Preliminary evaluation of a wild green oat extract (WGOE) (Neuravena(®) ELFA(®)955, Frutarom, Switzerland) revealed an acute cognitive benefit of supplementation. This study investigated whether regular daily WGOE supplementation would result in sustained cognitive improvements. METHOD: A 12-week randomised, double-blind, placebo-controlled cross-over trial of WGOE supplementation (1500 mg/day) versus placebo was undertaken in 37 healthy adults aged 67 ± 0.8 years (mean ± SEM). Cognitive assessments included the Stroop colour-word test, letter cancellation, the rule-shift task, a computerised multi-tasking test battery and the trail-making task. All assessments were conducted in Week 12 and repeated in Week 24 whilst subjects were fasted and at least 18 h after taking the last dose of supplement. RESULT: Chronic WGOE supplementation did not affect any measures of cognition. CONCLUSION: It appears that the cognitive benefit of acute WGOE supplementation does not persist with chronic treatment in older adults with normal cognition. It remains to be seen whether sustained effects of WGOE supplementation may be more evident in those with mild cognitive impairment.

Acute effects of an Avena sativa herb extract on responses to the Stroop Color-Word test.

BACKGROUND AND AIMS: Extracts from oat (Avena sativa) herb may benefit cognitive performance. This study investigated whether Neuravena(®), an oat herb extract, could acutely improve responses to the Stroop Color-Word test, a measure of attention and concentration and the ability to maintain task focus. SUBJECTS AND METHODS: Elderly volunteers with below-average cognitive performance consumed single doses (0, 1600, and 2400 mg) of oat herb extract at weekly intervals in a double-blind, randomized, crossover comparison. Resting blood pressure (BP) was assessed before and after supplementation, and a Stroop test was performed. RESULTS: Significantly fewer errors were made during the color-naming component of the Stroop test after consuming the 1600-mg dose than after the 0-mg or 2400-mg doses (F (1,36)=18.85, p<0.001). In 7 subjects with suspected cognitive impairment, Stroop interference score was also improved by the 1600-mg dose compared to 0- and 2400-mg doses (F (1, 34)=2.40, p<0.01). Resting BP was unaffected by supplementation. CONCLUSIONS: Taking 1600 mg of oat herb extract may acutely improve attention and concentration and the ability to maintain task focus in older adults with differing levels of cognitive status.

Impact of cocoa flavanol consumption on blood pressure responsiveness to exercise.

Impaired endothelial vasodilatation may contribute to the exaggerated blood pressure (BP) responses to exercise in individuals who are overweight/obese. The present study investigated whether consumption of cocoa flavanols, which improve endothelium-dependent flow-mediated dilatation (FMD), can modify BP responsiveness to exercise. Twenty-one volunteers (eight females and thirteen males, 54.9 (se 2.2) years, BMI 31.6 (se 0.8) kg/m2, systolic BP 134 (se 2) mmHg, diastolic BP (DBP) 87 (se 2) mmHg) were randomised to consume single servings of either a high-flavanol (HF, 701 mg) or a low-flavanol (LF, 22 mg) cocoa beverage in a double-blind, cross-over design with 3-7-d washout between treatments. Two hours after cocoa consumption, FMD was measured, followed by continuous beat-to-beat assessment (Finapres) of BP before and during 10 min of cycling at 75 % of age-predicted maximum heart rate. Averaged data from two assessments on each type of beverage were compared by analysis of covariance using pre-exercise BP as the covariate. Pre-exercise BP was similar after taking LF and HF (153 (se 3)/88 (se 3) v. 153 (se 4)/87 (se 2) mmHg, respectively, P>0.05). However, the BP response to exercise (area under BP curve) was attenuated by HF compared with LF. BP increases were 68 % lower for DBP (P = 0.03) and 14 % lower for mean BP (P = 0.05). FMD measurements were higher after taking HF than after taking LF (6.1 (se 0.6) % v. 3.4 (se 0.5) %, P < 0.001). By facilitating vasodilation and attenuating exercise-induced increases in BP, cocoa flavanols may decrease cardiovascular risk and enhance the cardiovascular benefits of moderate intensity exercise in at-risk individuals.