Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial.

BACKGROUND: Few weight loss interventions are evaluated for longer than a year, and even fewer employ social and mobile technologies commonly used among young adults. We assessed the efficacy of a 2 year, theory-based, weight loss intervention that was remotely and adaptively delivered via integrated user experiences with Facebook, mobile apps, text messaging, emails, a website, and technology-mediated communication with a health coach (the SMART intervention). METHODS: In this parallel-group, randomised, controlled trial, we enrolled overweight or obese college students (aged 18-35 years) from three universities in San Diego, CA, USA. Participants were randomly assigned (1:1) to receive either the intervention (SMART intervention group) or general information about health and wellness (control group). We used computer-based permuted-block randomisation with block sizes of four, stratified by sex, ethnicity, and college. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured weight in kg at 24 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. Objectively measured weight at 6, 12, and 18 months was included as a secondary outcome. The trial is registered with ClinicalTrials.gov, number NCT01200459. FINDINGS: Between May 18, 2011, and May 17, 2012, 404 individuals were randomly assigned to the intervention (n=202) or control (n=202). Participants' mean (SD) age was 22·7 (3·8) years. 284 (70%) participants were female and 125 (31%) were Hispanic. Mean (SD) body-mass index at baseline was 29·0 (2·8) kg/m(2). At 24 months, weight was assessed in 341 (84%) participants, but all 404 were included in analyses. Weight, adjusted for sex, ethnicity, and college, was not significantly different between the groups at 24 months (-0·79 kg [95% CI -2·02 to 0·43], p=0·204). However, weight was significantly less in the intervention group compared with the control group at 6 months (-1·33 kg [95% CI -2·36 to -0·30], p=0·011) and 12 months (-1·33 kg [-2·30 to -0·35], p=0·008), but not 18 months (-0·67 kg [95% CI -1·69 to 0·35], p=0·200). One serious adverse event in the intervention group (gallstones) could be attributable to rapid and excessive weight loss. INTERPRETATION: Social and mobile technologies did not facilitate sustained reductions in weight among young adults, although these approaches might facilitate limited short-term weight loss. FUNDING: The National Heart, Lung, and Blood Institute of the National Institutes of Health (U01 HL096715).

The Role of Stress in Understanding Differences in Sedentary Behavior in Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

BACKGROUND: Chronic stress and/or lifetime traumatic stress can create a self-reinforcing cycle of unhealthy behaviors, such as overeating and sedentary behavior, that can lead to further increases in stress. This study examined the relationship between stress and sedentary behavior in a sample of Hispanic/Latino adults (N = 4244) from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. METHODS: Stress was measured as the number of ongoing difficulties lasting 6 months or more and as lifetime exposure to traumatic events. Sedentary behavior was measured by self-report and with accelerometer. Multivariable regression models examined associations of stress measures with time spent in sedentary behaviors adjusting by potential confounders. RESULTS: Those who reported more than one chronic stressor spent, on average, 8 to 10 additional minutes per day in objectively measured sedentary activities (P < .05), whereas those with more than one lifetime traumatic stressor spent (after we adjusted for confounders) 10 to 14 additional minutes in sedentary activities (P < .01) compared with those who did not report any stressors. Statistical interactions between the 2 stress measures and age or sex were not significant. CONCLUSION: Interventions aimed at reducing sedentary behaviors might consider incorporating stress reduction into their approaches.

Clinical trial management of participant recruitment, enrollment, engagement, and retention in the SMART study using a Marketing and Information Technology (MARKIT) model.

Advances in information technology and near ubiquity of the Internet have spawned novel modes of communication and unprecedented insights into human behavior via the digital footprint. Health behavior randomized controlled trials (RCTs), especially technology-based, can leverage these advances to improve the overall clinical trials management process and benefit from improvements at every stage, from recruitment and enrollment to engagement and retention. In this paper, we report the results for recruitment and retention of participants in the SMART study and introduce a new model for clinical trials management that is a result of interdisciplinary team science. The MARKIT model brings together best practices from information technology, marketing, and clinical research into a single framework to maximize efforts for recruitment, enrollment, engagement, and retention of participants into a RCT. These practices may have contributed to the study's on-time recruitment that was within budget, 86% retention at 24 months, and a minimum of 57% engagement with the intervention over the 2-year RCT. Use of technology in combination with marketing practices may enable investigators to reach a larger and more diverse community of participants to take part in technology-based clinical trials, help maximize limited resources, and lead to more cost-effective and efficient clinical trial management of study participants as modes of communication evolve among the target population of participants.

Accelerometer-measured sedentary time among Hispanic adults: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Excessive sedentary behavior is associated with negative health outcomes independent of physical activity. Objective estimates of time spent in sedentary behaviors are lacking among adults from diverse Hispanic/Latino backgrounds. The objective of this study was to describe accelerometer-assessed sedentary time in a large, representative sample of Hispanic/Latino adults living in the United States, and compare sedentary estimates by Hispanic/Latino background, sociodemographic characteristics and weight categories. This study utilized baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) that included adults aged 18-74 years from four metropolitan areas (N = 16,415). Measured with the Actical accelerometer over 6 days, 76.9% (n = 12,631) of participants had > 10 h/day and > 3 days of data. Participants spent 11.9 h/day (SD 3.0), or 74% of their monitored time in sedentary behaviors. Adjusting for differences in wear time, adults of Mexican background were the least (11.6 h/day), whereas adults of Dominican background were the most (12.3 h/day), sedentary. Women were more sedentary than men, and older adults were more sedentary than younger adults. Household income was positively associated, whereas employment was negatively associated, with sedentary time. There were no differences in sedentary time by weight categories, marital status, or proxies of acculturation. To reduce sedentariness among these populations, future research should examine how the accumulation of various sedentary behaviors differs by background and region, and which sedentary behaviors are amenable to intervention.

Accelerometer adherence and performance in a cohort study of US Hispanic adults.

PURPOSE: This study described participant adherence to wearing the accelerometer and accelerometer performance in a cohort study of adults. METHODS: From 2008 to 2011, 16,415 US Hispanic/Latino adults age 18-74 yr enrolled in the Hispanic Community Health Study/Study of Latinos. Immediately after the baseline visit, participants wore an Actical accelerometer for 1 wk. This study explored correlates of accelerometer participation and adherence, defined as wearing it for at least three of a possible six days for ≥10 h·d. Accelerometer performance was assessed by exploring the number of different values of accelerometer counts per minute for each participant. RESULTS: Overall, 92.3% (n = 15,153) had at least 1 d with accelerometer data and 77.7% (n = 12,750) were adherent. Both accelerometer participation and adherence were higher among participants who were married or partnered, reported a higher household income, were first-generation immigrants, or reported lower sitting time. Participation was also higher among those with no stair limitations. Adherence was higher among participants who were male, older, employed or retired, not US born, preferred Spanish over English, reported higher work activity or lower recreational activity, and with a lower body mass index. Among the sample that met the adherence definition, the maximum recorded count per minute was 12,000, and there were a total of 5846 different counts per minute. On average, participants had 112.5 different counts per minute over 6 d (median, 106; interquartile range, 91-122). The number of different counts per minute was higher among men, younger ages, normal weight, and those with higher accelerometer-assessed physical activity. CONCLUSION: Several correlates differed between accelerometer participation and adherence. These characteristics could be targeted in future studies to improve accelerometer wear. The performance of the accelerometer provided insight into creating a more accurate nonwear algorithm.

A prospective study of sedentary behavior and changes in the body mass index distribution.

PURPOSE: We aimed to determine whether baseline sedentary behavior was associated with changes in body mass index (BMI) over 9 yr. METHODS: Participants were enrolled into the National Institutes of Health American Association of Retired Persons (NIH-AARP) Diet and Health study in 1995-1996 (median age, 63 yr), and BMI was reported at baseline and 9 yr later (n = 158,436). Sitting time (<3 (referent), 3-4, 5-6, 7-8, or ≥9 h·d), television viewing (none, <1, 1-2, 3-4, 5-6, 7-8, or ≥9 h·d), and the covariates (age, sex, race, education, smoking, moderate-to-vigorous physical activity, caloric intake, and sleep duration) were reported at baseline. We used longitudinal quantile regression to model changes at the 10th, 25th, 50th, 75th, and 90th BMI percentiles. RESULTS: More sitting at baseline was associated with additional increases in BMI over time, and the association was stronger at the upper BMI percentiles (e.g., <3 (referent) vs 5-6 h·d of sitting additional increases: 50th percentile = 0.41 kg·m and 95% confidence interval (CI) = 0.34-0.48; 90th percentile = 0.85 kg·m and 95% CI = 0.72-0.98). Similar associations were observed between more television viewing at baseline and additional increases in BMI over time (e.g., no television (referent) vs 3-4 h·d of television: 50th percentile = 1.96 kg·m and 95% CI = 1.77-2.15; 90th percentile = 2.11 kg·m and 95% CI = 1.49-2.73). CONCLUSIONS: Reducing sedentary behavior could help prevent an increase in BMI in adulthood especially at the upper percentiles of the BMI distribution and thereby reduce the prevalence of obesity.

Objectively measured physical activity is related to cognitive function in older adults.

OBJECTIVES: To explore the relationship between cognitive functioning and time spent at different intensities of physical activity (PA) in free-living older adults. DESIGN: Cross sectional analyses. SETTING: Continuing care retirement communities. PARTICIPANTS: Older adults residing in seven continuing care retirement communities in San Diego County with an average age of 83; 70% were female, and 35% had a graduate-level education (N = 217). MEASUREMENTS: PA was measured objectively using hip worn accelerometers with data aggregated to the minute level. Three cut points were used to assess low light-intensity PA (LLPA), high light-intensity PA (HLPA), and moderate- to vigorous-intensity PA (MVPA). The Trail Making Test (TMT) Parts A and B were completed, and time for each test (seconds) and time for Part B minus time for Part A (seconds) were used as measures of cognitive function. Variables were log-transformed and entered into linear regression models adjusting for demographic factors (age, education, sex) and other PA intensity variables. RESULTS: LLPA was not related to any TMT test score. HLPA was significantly related to TMT A, B, and B minus A but only in unadjusted models. MVPA was related to TMT B and B minus A after adjusting for demographic variables. CONCLUSION: There may be a dose response between PA intensity and cognitive functioning in older adults. The stronger findings supporting a relationship between MVPA and cognitive functioning are consistent with previous observational and intervention studies.

Weight-related child behavioral interventions in Brazil: a systematic review.

CONTEXT: Between 1974 and 1997, the prevalence of overweight increased 300% among Brazilian children and adolescents. A systematic review was conducted between January 2010 and December 2011 of obesity-related interventions targeting Brazilian children and adolescents. EVIDENCE ACQUISITION: Manuscripts from 1965 to December 2010 were evaluated based on inclusion criteria including evaluating obesity-related outcomes and at least 50% of participants living in Brazil. Methods were adapted from the CDC's Community Guide. Evidence was based on the number of available studies, study design, execution, quality, and effect size. EVIDENCE SYNTHESIS: Sixteen articles were abstracted; five met final inclusion criteria. All intervention samples (range n=14-78; mean n=40.6) included overweight or obese children aged 8-17 years. The intervention duration range was 3-6 months, and dose frequency ranged from two to five times per week. Three of the five interventions included healthy eating and physical activity; two included only physical activity. Two interventions studies were rated as having greatest design suitability. Only one intervention had the greatest design suitability and a large effect size. CONCLUSIONS: Intervention approaches that combined physical activity and healthy eating had the strongest effects. However, small sample bias, 95% CIs of primary effects, and poor-to-moderate quality of research designs and implementation suggest the combined evidence is best rated as Insufficient. This prohibits the recommendation of specific strategies or settings. Findings suggest that more well-designed evidence-based childhood obesity interventions in Brazil are needed and that promising, but yet unproven, interventions should be evaluated rigorously.

Sleep, type 2 diabetes, dyslipidemia, and hypertension in elderly Alzheimer's caregivers.

Research indicates that very short or long durations of sleep and inefficient sleep are associated with higher total cholesterol and risk of type 2 diabetes and hypertension. This study tested the hypothesis that inefficient sleep or short/long sleep durations are associated with an elevated prevalence of type 2 diabetes, dyslipidemia, and hypertension in a community-dwelling sample of elderly Alzheimer's caregivers. Participants were 126 caregivers for spouses with Alzheimer's disease who underwent in-home sleep assessment by wrist actigraphy for 72 consecutive hours. Sleep data were averaged across the 3 days/nights; nighttime sleep and daytime napping were computed. Morning fasting blood samples were collected to determine measures of blood lipids and glucose. The average of three resting blood pressure measurements was used to estimate mean resting blood pressure. Logistic regression models including covariates related to sleep and metabolic regulation indicated that nighttime sleep duration, percent sleep at night, and daytime naps were not significantly associated with odds of having diabetes (OR, 0.92; 95% CI, 0.56-1.53; OR, 0.93; 95% CI, 0.83-1.03; OR, 1.75; 95% CI, 0.74-4.11, respectively), dyslipidemia (OR, 0.83; 95% CI, 0.57-1.20; OR, 0.99; 95% CI, 0.92-1.07; OR, 0.64; 95% CI, 0.33-1.24, respectively), or hypertension (OR, 0.97; 95%CI, 0.62-1.52; OR, 1.02; 95% CI, 0.93-1.11; OR, 1.10; 95% CI, 0.44-2.74, respectively). When categorical and combined sleep parameters were examined, there were no significant associations with any of the metabolic conditions (all p>0.05). The current study suggests that in an elderly sample of Alzheimer's caregivers, nighttime sleep duration, nighttime sleep efficiency and daytime naps are not significantly associated with prevalent type 2 diabetes, dyslipidemia, or hypertension. As several of the associations demonstrated clinically relevant magnitudes of the associations, larger studies to more fully test these hypotheses are warranted.

Using the SenseCam to improve classifications of sedentary behavior in free-living settings.

BACKGROUND: Studies have shown relationships between important health outcomes and sedentary behavior, independent of physical activity. There are known errors in tools employed to assess sedentary behavior. Studies of accelerometers have been limited to laboratory environments. PURPOSE: To assess a broad range of sedentary behaviors in free-living adults using accelerometers and a Microsoft SenseCam that can provide an objective observation of sedentary behaviors through first person-view images. METHODS: Participants were 40 university employees who wore a SenseCam and Actigraph accelerometer for 3-5 days. Images were coded for sitting and standing posture and 12 activity types. Data were merged and aggregated to a 60-second epoch. Accelerometer counts per minute (cpm) of <100 were compared with coded behaviors. Sensitivity and specificity analyses were performed. Data were collected in June and July 2011 and analyzed in April 2012. RESULTS: TV viewing, other screen use, and administrative activities were correctly classified by the 100-cpm cutpoint. However, standing behaviors also fell under this threshold, and driving behaviors exceeded it. Multiple behaviors occurred simultaneously. A nearly 30-minute per day difference was found in sedentary behavior estimates based on the accelerometer versus the SenseCam. CONCLUSIONS: Researchers should be aware of the strengths and weaknesses of the 100-cpm accelerometer cutpoint for identifying sedentary behavior. The SenseCam may be a useful tool in free-living conditions to better understand health behaviors such as sitting.

An ethical framework for automated, wearable cameras in health behavior research.

Technologic advances mean automated, wearable cameras are now feasible for investigating health behaviors in a public health context. This paper attempts to identify and discuss the ethical implications of such research, in relation to existing guidelines for ethical research in traditional visual methodologies. Research using automated, wearable cameras can be very intrusive, generating unprecedented levels of image data, some of it potentially unflattering or unwanted. Participants and third parties they encounter may feel uncomfortable or that their privacy has been affected negatively. This paper attempts to formalize the protection of all according to best ethical principles through the development of an ethical framework. Respect for autonomy, through appropriate approaches to informed consent and adequate privacy and confidentiality controls, allows for ethical research, which has the potential to confer substantial benefits on the field of health behavior research.

Effects of Behavioral Contingencies on Adolescent Active Videogame Play and Overall Activity: A Randomized Trial.

OBJECTIVE: This study evaluated the effect of four active videogames (AVGs) varying in behavioral contingencies (behavior-consequence relations) on adolescent AVG play and overall activity levels over 4 weeks. MATERIALS AND METHODS: Each AVG, manufactured by SSD/Xavix(®) (Shiseido Co. of Japan, Tokyo, Japan), was coded and scored for the number of positive and aversive behavioral contingencies within the games. "Bowling" and "Tennis" were classified as having "higher contingency scores," and "Boxing" and aerobic fitness training were classified as having "lower contingency scores." Adolescents (n=63; 11-15 years old; 62% male; 38% Hispanic; 44% overweight or obese) were randomized to play one of the four AVGs at home and recorded game play sessions in a paper log. Baseline and week 4 assessments were completed at home; week 1, 2, and 3 assessments were completed by telephone. Accelerometers were worn during baseline and weeks 1 and 4. RESULTS: Accelerometer-measured sedentary and light activity hours/day were stable over time, whereas moderate-vigorous physical activity minutes/day increased in the higher contingency group and decreased in the lower contingency group (interaction effect, 6.43, P=0.024). Reported game play minutes decreased in both groups from week 1 to week 4 (-29.42 minutes, P=0.001). DISCUSSION: There was some support for the hypothesis that AVGs with more behavioral contingencies, compared with AVGs with fewer behavioral contingencies, result in more physical activity. However, overall AVG play decreased substantially after the first week. Further study is needed to better understand how behavioral contingencies can be used in AVGs to enhance their potential to provide health benefits to game players.

Fruit and vegetable intake and eating behaviors mediate the effect of a randomized text-message based weight loss program.

INTRODUCTION: We hypothesized that fruit/vegetable intake and eating behaviors mediate the relationship between experimental condition and weight loss in a randomized trial evaluating a text-message based weight loss program. METHODS: Overweight/obese individuals from San Diego, CA (N = 52 with complete data) were randomly assigned in 2007 into one of two groups for four months: 1) the intervention group that received 2-5 weight management text-messages p/day; 2) the usual-care comparison group. Three 24-hour recalls assessed fruit/vegetable intake change and the eating behavior inventory (EBI) measured change in eating behaviors. Regression path models tested intervention mediation. RESULTS: Direct effects of the intervention were found for change in body weight (b = -3.84, R(2) = 0.074), fruit/vegetable intake (b = 2.00, R(2) = 0.083), and EBI scores (b = 7.15, R(2) = 0.229) (ps < 0.05). The treatment group to weight change path was not statistically significant (b = -0.673, R(2) = 0.208) when fruit/vegetable intake change and EBI score change were specified as intervention mediators in the model. The total indirect effect was 3.17 lb indicating that the indirect paths explained 82.6% of the total effect on weight change. DISCUSSION: Fruit/vegetable intake and eating behaviors mediated the intervention's effect on weight change. The findings suggest that sending text-messages that promote healthy eating strategies resulted in moderate short-term weight loss.

Using step cadence goals to increase moderate-to-vigorous-intensity physical activity.

BACKGROUND: Increasing moderate-to-vigorous-intensity physical activity (MVPA) is an important public health goal. Pedometers are evidence-based devices for increasing daily activity, but studies have not evaluated the comparative efficacy of step cadence goals for increasing MVPA. PURPOSE: This study aimed to evaluate the efficacy of three pedometer-based step goals for increasing MVPA. METHODS: Latina women (n = 180; 18-55 yr, mean body mass index = 31.1, SD = 6.5) were recruited to 12 community centers, which were randomly assigned to one of three conditions. Each group received an identical 12-wk theory-based physical activity (PA) intervention that differed only on the type of daily step goal: 1) a self-selected goal (SELF); 2) a goal of 10,000 steps per day (FREQUENCY); or 3) a goal of 3000 steps in 30 min (CADENCE). Accelerometer-based PA was measured at baseline and after 12 wk. RESULTS: Adjusted multilevel pattern-mixture models using generalized estimating equations revealed that participants in the CADENCE condition engaged in similar levels of postintervention MVPA to those in the SELF and FREQUENCY goal conditions. However, MVPA of participants in the CADENCE condition was more likely to occur in bouts lasting greater than 10 consecutive minutes compared with the MVPA of participants in the SELF (P = 0.01) or FREQUENCY (P = 0001) conditions. CONCLUSIONS: PA interventions should consider including a step cadence goal to help individuals accumulate bout-based MVPA and meet national PA guidelines.

Metabolism and breast cancer risk: frontiers in research and practice.

Fifty years ago the causes of cancer were largely unknown. Since then, it has become clear that a strong relationship exists between obesity and many cancers, particularly postmenopausal breast cancer. A major challenge in understanding the link between obesity and cancer risk has been elucidating the biological basis underlying the association. Although this remains unresolved, the main candidate systems linking adiposity and cancer risk are insulin and the insulin-like growth factor-1 axis, endogenous reproductive hormones, and chronic inflammation. Our purpose is to provide a mechanistic overview of the hypothesized relationship between diet, physical activity, and obesity with breast cancer risk and progression. In addition, we will provide examples of recently funded randomized clinical trials examining metabolic risk factors in relation to breast cancer risk and survival. Additional research is warranted to validate the strength and consistency of the relationships among diet, these biomarkers, and breast cancer risk. As these relationships become clearer, future studies will be needed to develop effective intervention programs to prevent breast cancer and improve cancer prognosis by promoting a healthy lifestyle.

Evaluation of a multi-component group exercise program for adults with arthritis: Fitness and Exercise for People with Arthritis (FEPA).

BACKGROUND: Research supports the favorable effects of exercise on physical and psychosocial outcomes in those with arthritis. Few easily disseminated, multi-component, arthritis-specific programs have been evaluated using both physical function and psychosocial measures. Fitness and Exercise for People with Arthritis (FEPA) is a new community-based, 3-month, instructor supervised multi-component exercise program for individuals with arthritis designed to increase strength, flexibility, balance, and aerobic conditioning, while emphasizing joint-protection and proper biomechanics. PURPOSE: To conduct a preliminary evaluation of the effects of the FEPA program on physical function and arthritis-related outcomes in individuals with arthritis. METHOD: Middle-aged (n = 31, M(age) = 54.8 ± 7.2) and older (n = 79, M(age) = 76.0 ± 6.6) adults with arthritis completed the instructor led FEPA program in community senior centers, churches, and adult education settings. Changes in physical function, measured using the arm curl, back-scratch test, 8-foot up-and-go, and 6 min walk and self-reported arthritis-related pain, perceived physical function, affect, and self-efficacy for symptom management were assessed using RM ANOVA. RESULTS: Significant improvements (ps < .05) in all physical function measures were found in the older group. In the middle-aged group, significant improvements (ps < .05) were found in the 8-foot up-and-go and 6 min walk. Self-reported physical function, pain perceptions, and self-efficacy for pain management significantly improved (ps < .05) in middle-aged participants, while only self-reported pain perceptions significantly improved in the older group. CONCLUSIONS: FEPA shows promise for improving health-related outcomes in those with arthritis, and has potential for sustainability in community settings.

Methods of Measurement in epidemiology: sedentary Behaviour.

BACKGROUND: Research examining sedentary behaviour as a potentially independent risk factor for chronic disease morbidity and mortality has expanded rapidly in recent years. METHODS: We present a narrative overview of the sedentary behaviour measurement literature. Subjective and objective methods of measuring sedentary behaviour suitable for use in population-based research with children and adults are examined. The validity and reliability of each method is considered, gaps in the literature specific to each method identified and potential future directions discussed. RESULTS: To date, subjective approaches to sedentary behaviour measurement, e.g. questionnaires, have focused predominantly on TV viewing or other screen-based behaviours. Typically, such measures demonstrate moderate reliability but slight to moderate validity. Accelerometry is increasingly being used for sedentary behaviour assessments; this approach overcomes some of the limitations of subjective methods, but detection of specific postures and postural changes by this method is somewhat limited. Instruments developed specifically for the assessment of body posture have demonstrated good reliability and validity in the limited research conducted to date. Miniaturization of monitoring devices, interoperability between measurement and communication technologies and advanced analytical approaches are potential avenues for future developments in this field. CONCLUSIONS: High-quality measurement is essential in all elements of sedentary behaviour epidemiology, from determining associations with health outcomes to the development and evaluation of behaviour change interventions. Sedentary behaviour measurement remains relatively under-developed, although new instruments, both objective and subjective, show considerable promise and warrant further testing.

Applying the ecological model of behavior change to a physical activity trial in retirement communities: description of the study protocol.

OBJECTIVES: To describe the intervention protocol for the first multilevel ecological intervention for physical activity in retirement communities that addresses individual, interpersonal and community influences on behavior change. DESIGN: A cluster randomized controlled trial design was employed with two study arms: a physical activity intervention and an attention control successful aging condition. SETTING: Sixteen continuing care retirement communities in San Diego County. PARTICIPANTS: Three hundred twenty older adults, aged 65 years and older, are being recruited to participate in the trial. In addition, peer leaders are being recruited to lead some study activities, especially to sustain the intervention after study activities ceased. INTERVENTION: Participants in the physical activity trial receive individual, interpersonal and community intervention components. The individual level components include pedometers, goal setting and individual phone counseling. The interpersonal level components include group education sessions and peer-led activities. The community level components include resource audits and enumeration, tailored walking maps, and community improvement projects. The successful aging group receives individual and group attention about successful aging topics. MEASUREMENTS: The main outcome is light to moderate physical activity, measured objectively by accelerometry. Other objective outcomes included physical functioning, blood pressure, physical fitness, and cognitive functioning. Self report measures include depressive symptoms and health related quality of life. RESULTS: The intervention is being delivered successfully in the communities and compliance rates are high. CONCLUSION: Ecological Models call for interventions that address multiple levels of the model. Previous studies have not included components at each level and retirement communities provide a model environment to demonstrate how to implement such an intervention.

Sedentary behavior and adiposity-associated inflammation: the Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: Sedentary behavior is associated with adiposity and cardiometabolic risk. PURPOSE: To determine the associations between sedentary behavior and measures of adiposity-associated inflammation. METHODS: Between 2002 and 2005, a total of 1543 Multi-Ethnic Study of Atherosclerosis participants completed detailed health history questionnaires, underwent physical measurements, and had blood assayed for adiponectin, leptin, tumor necrosis factor-alpha (TNF-α) and resistin. Analyses included linear regression completed in 2010. The mean age was 64.3 years and nearly 50% were female. Forty-one percent were non-Hispanic white, 24% Hispanic-American, 20% African-American, and 14% Chinese-American. RESULTS: In linear regression analyses and with adjustment for age, gender, ethnicity, education, BMI, smoking, alcohol consumption, hypertension, diabetes mellitus, dyslipidemia, hormone therapy and waist circumference, sedentary behavior was associated with higher natural log ("ln") of leptin and ln TNF-α but a lower ln adiponectin-to-leptin ratio (ß=0.07, ß=0.03 and -0.07, p<0.05 for all). Compared to the first tertile, and after the same adjustment, the second and third tertiles of sedentary behavior were associated with higher levels of ln leptin (ß=0.11 and ß=0.12, respectively; p<0.05 for both) but lower levels of the adiponectin-to-leptin ratio (ß=-0.09 and -0.11, respectively; p<0.05 for both). CONCLUSIONS: Sedentary behavior is associated with unfavorable levels of adiposity-associated inflammation.