Change in circulating klotho in response to weight loss, with and without exercise, in adults with overweight or obesity.

Introduction: Klotho is a protein associated with protection from aging-related diseases and health conditions. Obesity is associated with lower Klotho concentrations. Thus, this secondary analysis of adults with obesity examined 1) the change in serum Klotho concentration in response to a behavioral weight loss intervention by the magnitude of weight loss achieved; and 2) the association among serum Klotho concentration and weight, body composition, and cardiorespiratory fitness. Methods: Participants were randomized to either diet alone (DIET), diet plus 150 min of physical activity per week (DIET + PA150), or diet plus 250 min of physical activity per week (DIET + PA250). Participants [n = 152; age: 45.0 ± 7.9 years; body mass index (BMI): 32.4 ± 3.8 kg/m2] included in this secondary analysis provided blood samples at baseline, 6-, and 12 months, and were classified by weight loss response (Responder: achieved ≥10% weight loss at 6 or 12 months; Non-responder: achieved <5% weight loss at both 6 and 12 months). Serum Klotho was measured using a solid-phase sandwich enzyme-linked immunosorbent assay (ELISA). Analyses of covariance (ANCOVA's) were used to examine changes in weight, body composition, cardiorespiratory fitness, and Klotho concentration by weight loss response across the 12-month weight loss intervention. Results: Responders had a greater reduction in measures of weight and body composition, and a greater increase in cardiorespiratory fitness, compared to Non-Responders (p < 0.05). Change in Klotho concentration differed between Responders and Non-Responders (p < 0.05), with the increase in Klotho concentration from baseline to 6 months for Responders being statistically significant. The 6-month change in Klotho concentration was inversely associated with the 6-month change in weight (r s = -0.195), BMI (r s = -0.196), fat mass (r s = -0.184), and waist circumference (r s = -0.218) (p-values <0.05). Discussion: Findings provide evidence within the context of a behavioral intervention, with and without exercise, that change in Klotho concentration is significantly different between adults with weight loss ≥10% compared to <5% across 12 months. These findings suggest that weight loss and reduction in fat mass may be favorably associated with the change in Klotho concentration. This may reduce the risk of negative health consequences associated with accelerated aging in middle-aged adults.

Oxygen Consumption and Heart Rate Responses in Different Vinyasa Yoga Sequences.

Yoga is widely practiced for its numerous health benefits, and it can also increase energy expenditure. Vinyasa yoga, a system of hatha yoga, meets criteria for moderate-intensity physical activity. It is unclear whether the individual sequences produce different oxygen consumption (VO2) and heart rate responses. The purpose of the present study was therefore to evaluate potential differences in VO2 and heart rate responses across sequences of a 60-minute vinyasa session. Participants included 40 healthy male (n = 20) and female (n = 20) adults (age 30.9 ± 8.8 y) with self-reported yoga experience. The sequence implemented was based on Baron Baptiste's Journey into Power sequence. This vinyasa yoga practice included several sequences: integration, sun salutation, crescent lunges, balancing, standing, back bending, and restorative. VO2 (mL/kg/min) was measured by portable indirect calorimetry and expressed as metabolic equivalents (MET). Heart rate was measured using a Polar HR monitor and presented as a percentage of age-predicted maximal heart rate (APMHR). METs and APMHR differed significantly across sequences (each p < 0.001). METs for the integration, sun-salutation, crescent-lunges, balancing, standing, back-bending, and restorative sequences were significantly different from one another (p < 0.001); balancing and back-bending sequences, however, were similar. During the integration and restorative sequences, APMHR was similar (p = 1.00) and significantly lower compared to sun-salutation, crescent-lunge, balancing, standing, and back-bending sequences (each p < 0.001). METs and APMHR differed significantly across sequences of a vinyasa yoga practice. These data could inform an individualized yoga series based on current fitness levels to maintain or improve cardiorespiratory fitness.

Measurement of Barriers, Attitudes, and Expectations for Sitting Less in Pregnancy.

OBJECTIVE: Our objective was to develop, validate, and describe findings from an instrument to measure barriers, attitudes, and outcome expectations of sitting less in pregnant women. METHODS: This validation (sub-study 1) and descriptive study (sub-study 2) evaluated a new questionnaire measuring sedentary time in pregnant women (N=131) in each trimester. RESULTS: In sub-study 1, construct validity was supported by associations between device-measured sedentary time and questionnaire scores. An optimized questionnaire removed infrequently reported and non-correlated items. The original and optimized questionnaires with scoring instructions are provided. In sub-study 2, physical symptoms and work were most commonly reported as major reasons for sitting in pregnancy, followed by leisure, family, and social activities. Some women reported limiting sitting due to boredom/restlessness, to improve energy or health, and to control weight. In the third trimester, some women reported sitting more/less due to pain and encouragement from family, friends, and co-workers. Few women reported household chores or pregnancy risks as reasons to sit, felt sitting was healthy or necessary during pregnancy, or were encouraged to sit by healthcare providers. CONCLUSIONS: The developed questionnaire demonstrated validity and identified barriers to and expectations of sitting less during pregnancy. Prenatal interventions to reduce sitting should address general and pregnancy-specific barriers.

Effects of a personal trainer-led exercise intervention on physical activity, physical function, and quality of life of breast cancer survivors.

PURPOSE: Exercise is important to address physical and emotional effects of breast cancer treatment. This study examines effects of a personal trainer led exercise intervention on physical activity levels, physical function and quality of life (QoL) in breast cancer survivors. METHODS: Women post active breast cancer treatment were recruited from 2015 to 2017, randomized to immediate exercise or wait-list control, and received three personal training sessions for up to 30 weeks. Physical activity and function were assessed by pedometer, and tests of endurance, strength, and flexibility. Self-reported physical activity, physical activity self-efficacy, and QoL were also assessed. RESULTS: 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were aged (mean ± SD) 56 ± 10 years. On the endurance test, the exercise group significantly improved (increase of 18 ± 20 steps vs control 9 ± 12 steps) (p = 0.036). On the strength test, the exercise group significantly improved (increase of 4 ± 3 curls vs control 1 ± 3 curls) (p = 0.002). After intervention, change (mean ∆ ± SD) in the FACT-ES physical well-being subscale score was 1 ± 2 in the exercise group and - 1 ± 2 in the control group (p = 0.023). Improvement in Self-efficacy and Physical Activity (SEPA) score was significant with a change (mean ∆ ± SD) of 2 ± 5 for exercise vs 0 ± 5 for control (p = 0.047). The number of steps/day, back scratch test, weight, and self-reported physical activity did not significantly improve with intervention. CONCLUSIONS: The intervention yielded significant improvements in endurance and strength but not physical activity or quality of life. IMPLICATIONS FOR CANCER SURVIVORS: Future efforts to explore feasible ways to support patient's physical activity efforts need to be undertaken.

Feasibility of Integration of Yoga in a Behavioral Weight-Loss Intervention: A Randomized Trial.

OBJECTIVE: This study examined the feasibility and comparison of two styles of yoga within the context of a standard behavioral weight-loss intervention (SBWI). METHODS: Fifty adults with obesity (BMI: 31.3 ± 3.8 kg/m2 ) participated in this 6-month study that included a SBWI and a calorie- and fat-reduced diet. Randomization was to restorative Hatha (SBWI+RES) or Vinyasa (SBWI+VIN) yoga. Yoga was prescribed to increase from 20 to 40 to 60 minutes per session across the intervention. Weight was assessed at baseline and 6 months. Perceptions of yoga were assessed at the completion of the intervention. RESULTS: Adjusted weight loss was -3.4 kg (95% CI: -6.4 to -0.5) in SBWI+RES and -3.8 kg (95% CI: -6.8 to -0.9) in SBWI+VIN (P < 0.001), with no difference between groups. Of all participants, 74.4% reported that they would continue participation in yoga after the SBWI. Session duration was a barrier as yoga increased from 20 to 40 to 60 minutes per day, with 0%, 7.5%, and 48.8% reporting this barrier, respectively. CONCLUSIONS: Among adults with obesity, yoga participation, within the context of a SBWI, appears to be feasible, with weight loss not differing by style of yoga. Progressing to 60 minutes per session appears to be a barrier to engagement in yoga in this population.

Psychosocial factors associated with physical activity in patients who have undergone bariatric surgery.

BACKGROUND: Identifying psychosocial variables associated with physical activity may lead to the development of interventions that better address the challenges to participating in physical activity experienced by postbariatric surgery patients. OBJECTIVE: To examine associations between select psychosocial variables and physical activity in patients who had undergone bariatric surgery within the past 2 years. SETTINGS: Bariatric surgery candidates were recruited from the Greater Pittsburgh region. METHODS: Eighty-three patients who had undergone bariatric surgery self-reported current physical activity and select psychosocial constructs. In addition, participants provided retrospective information on physical activity and psychosocial constructs before surgery. RESULTS: Patients increased physical activity from baseline (median = 156.00 [25th, 75th percentiles: 53.00, 600.00] kcal/week) to post surgery (median = 976.00 [25th, 75th percentiles: 344.00, 1832.00] kcal/week) (P < .001). A number of pre- to postsurgery changes in psychosocial variables were associated with change in physical activity; however, only change in fitness orientation (P = .001), change in social support from friends (P = .005), and change in self-reported weight (P = .012) emerged as predictors of change in physical activity from pre- to postsurgery. Several postsurgery psychosocial factors were also significantly associated with postsurgery physical activity, but only postsurgery fitness orientation (P < .001), social support from co-workers (P = .002), and physical function (P = .023) emerged as predictive of the amount of postsurgical PA. CONCLUSIONS: Pre- and postbariatric surgery interventions aimed at increasing physical activity participation may need to target important constructs that include the encouragement of social support and strategies to enhance the effort individuals put forward to engage in physical activity, as well as a focus on enhancing physical function and awareness of weight status.

Recommendations for a Culturally Salient Web-based Physical Activity Program for African Americans.

BACKGROUND: Barriers to physical activity (PA) among African Americans (AAs) have been extensively studied, yet there is limited research on innovative PA interventions designed to address them. In recent years, many studies have used the internet to promote PA, but very few have included AAs. In this study, we sought the input of AA focus groups to inform the development of a web-based Physical Activity for The Heart (PATH) program for inactive AAs. METHODS: A qualitative design involving 4 focus groups stratified by sex and age was employed to explore AAs' needs and preferences for resources to be included in the PATH program. We employed an inductive approach to content analysis to analyze data using ATLAS.ti 7.5. RESULTS: Sixteen women and ten men (age 30-65 years) participated in the focus groups. Participants were obese (mean BMI 32.2 ± 5.4 kg/m2) with below average confidence rating (mean 46.4 ± 19.1%) on the Barriers Self-Efficacy Scale. Three main themes emerged from the data: 1) need to see similar others engaging in PA (workout videos featuring models with relatable body size, age, ethnicity), 2) flexible PA regimen (doable at any time/setting), and 3) age and sex differences in preferences for PA resources (religion, music, intensity). CONCLUSION: These data suggest that specific intervention components, i.e., PA models who match participants' profiles, flexibility and tailoring to age/gender groups, could improve uptake of web-based PA programs designed for inactive AAs. Therefore, a precision health approach needs to be employed when designing interventions to promote PA among inactive AAs.

Pattern of Daily Steps is Associated with Weight Loss: Secondary Analysis from the Step-Up Randomized Trial.

OBJECTIVE: The aim of this study was to examine the association between the amount, intensity, and pattern of steps·day-1 with weight loss. METHODS: Participants (N = 260; age = 42.8 ± 8.9 y; BMI = 32.8 ± 3.5 kg/m2 ) completed an 18-month weight-loss intervention that included a calorie-restricted diet and prescribed physical activity. Participants were categorized by 18-month weight loss as weight gain (GAIN), weight loss of 0% to < 5% (WL < 5%), 5% to < 10% (WL < 10%), or ≥ 10% (WL ≥ 10%). Steps·day-1 were measured at 0, 6, 12, and 18 months and defined as total steps·day-1 , total steps·day-1 of moderate-to-vigorous physical activity (MVPA) (≥3 metabolic equivalents) in bouts of ≥ 10 minutes (BOUT-MVPA), MVPA in bouts of < 10 minutes (NON-BOUT-MVPA), or non-MVPA steps·day-1 (NON-MVPA). RESULTS: There was a weight-loss category by time interaction (P < 0.0001) for total and BOUT-MVPA steps·day-1 . The total steps·day-1 at 18 months were WL ≥ 10% = 9,822 (95% CI: 9,073-10,571), WL < 10% = 8,612 (7,613-9,610), WL < 5% = 7,802 (6,782-8,822), and GAIN = 7,801 (6,549-9,053). BOUT-MVPA steps·day-1 at 18 months were WL ≥ 10% = 3,482 (2,982-3,981), WL < 10% = 1,949 (1,269-2,629), WL < 5% = 1,735 (1,045-2,426), and GAIN = 1,075 (210-1,941). Participants were also categorized based on achieving ≥ 10% weight loss at either 6 or 18 months, and a similar pattern was observed. CONCLUSIONS: These findings show that 10,000 steps·day-1 , with approximately 3,500 steps·day-1 performed as BOUT-MVPA, are associated with enhanced weight loss in a behavioral intervention.

Role of Physical Activity and Exercise in Treating Patients with Overweight and Obesity.

BACKGROUND: Overweight and obesity are significant public health concerns that are linked to numerous negative health consequences. Physical activity is an important lifestyle behavior that contributes to body weight regulation. CONTENT: Physical activity is inversely associated with weight gain and the incidence of obesity. Physical activity also contributes to additional weight loss when coupled with dietary modification, and it can result in modest weight loss when not coupled with dietary modification. Moreover, physical activity is associated with improved long-term weight loss and prevention of weight gain following initial weight loss. Current evidence supports that physical activity should be moderate to vigorous in intensity to influence body weight regulation. There is also a growing body of evidence that physical activity can be accumulated throughout the day in shorter periods of time rather than being performed during a structured and longer period, and that physical activity performed in this manner can be important for body weight regulation. SUMMARY: The literature supports the inclusion of physical activity as an important lifestyle behavior for regulating body weight. There are multiple intervention approaches that may be effective for enhancing physical activity engagement within the context of weight control.

Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial.

Background There is a significant health crisis with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs (SBWP). Mindfulness meditation (MM), with demonstrated benefits on physical, psychological health, and self-regulation behaviors was explored with SBWP. Methods Forty-six adults (BMI=32.5±3.7 kg/m2; age=45.2±8.2 years, 87 % female, 21.7 % African American) were randomly assigned to a 6-month SBWP only (n=24) or SBWP+MM (n=22) at a university-based physical activity and weight management research center in a northeastern US city. Participants were instructed to decrease intake (1200-1500 kcal/day), increase physical activity (300 min/wk), and attend weekly SBWP or SBWP+MM sessions. SBWP+MM had the same SBWP lessons with addition of focused MM training. Outcome measures collected at 0, 3, and 6 months included: weight, Block Food Frequency Questionnaire, Eating Behavior Inventory, Eating Inventory and Paffenbarger Physical Activity Questionnaire. Data were analyzed using linear mixed modeling for efficacy analysis of weight (primary) and eating, exercise and mindfulness (secondary outcomes). Results Retention rate was 76.1 % (n=35). A significant group by time interaction (p=0.03) was found for weight, with weight loss favoring SBWP+MM (-6.9 kg+2.9) over SBWP (-4.1 kg+2.8). Eating behaviors (p=0.02) and dietary restraint (p=0.02) improved significantly in SBWP+MM, compared to SBWP. MM enhanced weight loss by 2.8 kg potentially through greater improvements in eating behaviors and dietary restraint. Conclusions These findings support further study into the use of MM strategies with overweight and obese adults. The use of this low-cost, portable strategy with standard behavioral interventions could improve weight management outcomes.

Energy Expenditure in Vinyasa Yoga Versus Walking.

BACKGROUND: Whether the energy cost of vinyasa yoga meets the criteria for moderate-to-vigorous physical activity has not been established. PURPOSE: To compare energy expenditure during acute bouts of vinyasa yoga and 2 walking protocols. METHODS: Participants (20 males, 18 females) performed 60-minute sessions of vinyasa yoga (YOGA), treadmill walking at a self-selected brisk pace (SELF), and treadmill walking at a pace that matched the heart rate of the YOGA session (HR-Match). Energy expenditure was assessed via indirect calorimetry. RESULTS: Energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 79.5 ± 44.3 kcal; P < .001) and SELF (difference = 51.7 ± 62.6 kcal; P < .001), but not in SELF compared with HR-Match (difference = 27.8 ± 72.6 kcal; P = .054). A similar pattern was observed for metabolic equivalents (HR-Match = 4.7 ± 0.8, SELF = 4.4 ± 0.7, YOGA = 3.6 ± 0.6; P < .001). Analyses using only the initial 45 minutes from each of the sessions, which excluded the restorative component of YOGA, showed energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 68.0 ± 40.1 kcal; P < .001) but not compared with SELF (difference = 15.1 ± 48.7 kcal; P = .189). CONCLUSIONS: YOGA meets the criteria for moderate-intensity physical activity. Thus, YOGA may be a viable form of physical activity to achieve public health guidelines and to elicit health benefits.

Reducing Sedentary Behavior Versus Increasing Moderate-to-Vigorous Intensity Physical Activity in Older Adults.

OBJECTIVE: To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity (MVPA) in older adults. METHOD: Inactive older adults ( N = 38, 68 ± 7 years old, 71% female) were randomized to 12-week interventions targeting decreased sedentary behavior ( Sit Less) or increased MVPA ( Get Active). The SenseWear armband was used to objectively assess activity in real time. Assessments included a blinded armband, the Community Health Activites Model Program for Senior (CHAMPS) questionnaire, 400-meter walk, and the Short Physical Performance Battery (SPPB). RESULTS: Objectively measured MVPA increased in Get Active (75 ± 22 min/week, p < .001); self-reported MVPA increased in both groups ( p < .05). Sedentary behavior did not change in either group (all p > .05). Only the Sit Less group improved the SPPB score (0.5 ± 0.3, p = .046). DISCUSSION: Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks. Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed.

Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial.

Importance: Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss. Objective: To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss. Design, Setting, Participants: Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014. Interventions: Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self-monitoring of diet and physical activity using a website, and those randomized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity. Main Outcomes and Measures: The primary outcome of weight was measured over 24 months at 6-month intervals, and the primary hypothesis tested the change in weight between 2 groups at 24 months. Secondary outcomes included body composition, fitness, physical activity, and dietary intake. Results: Among the 471 participants randomized (body mass index [BMI], 25 to <40; age range, 18-35 years; 28.9% nonwhite, 77.2% women), 470 (233 in the standard intervention group, 237 in the enhanced intervention group) initiated the interventions as randomized, and 74.5% completed the study. For the enhanced intervention group, mean base line weight was 96.3 kg (95% CI, 94.2-98.5) and 24-month weight 92.8 kg (95% CI, 90.6- 95.0) [corrected]. For the standard intervention group, mean baseline weight was 95.2kg (95%CI,93.0-97.3)and24-month weight was 89.3 kg (95%CI, 87.1-91.5) [corrected]. Weight change at 24 months differed significantly by intervention group (estimated mean weight loss, 3.5 kg [95% CI, 2.6-4.5} in the enhanced intervention group and 5.9 kg [95% CI, 5.0-6.8] in the standard intervention group; difference, 2.4 kg [95% CI, 1.0-3.7]; P = .002). Both groups had significant improvements in body composition, fitness, physical activity, and diet, with no significant difference between groups. Conclusions and Relevance: Among young adults with a BMI between 25 and less than 40, the addition of a wearable technology device to a standard behavioral intervention resulted in less weight loss over 24 months. Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches. Trial Registration: clinicaltrials.gov Identifier: NCT01131871.

The Effect of Self-Efficacy on Behavior and Weight in a Behavioral Weight-Loss Intervention.

OBJECTIVE: To determine whether eating self-efficacy (ESE) and physical activity self-efficacy (PASE) are predictive of dietary intake, physical activity, and weight change within a behavioral weight-loss intervention, and whether dietary intake and physical activity mediate relationships between self-efficacy and weight change. METHOD: The study sample included 246 participants from a randomized trial with complete data on study variables at 12 months. ESE, PASE, calories consumed, minutes of moderate-to-vigorous physical activity (MVPA), and weight were measured at baseline, 6, and 12 months. RESULTS: ESE at baseline was associated with 12-month percent weight loss (PWL), and was mediated by average calories consumed at 6 and 12 months. Change in ESE from baseline to 6 months was associated with calories consumed at 12 months and 12-month percent weight loss, but the mediated relationship was not significant. Baseline PASE was not associated with average MVPA at 6 and 12 months or 12-month PWL, but change in PASE from baseline to 6 months was associated with 12-month PWL through its effect on MVPA at 12 months. CONCLUSION: Increases in ESE and PASE during the active phase of the intervention are predictive of dietary intake, physical activity and weight loss at later points, but further research should include explorations of the reciprocal relationship between behavior and self-efficacy to better inform intervention strategies that target self-efficacy and promote behavior change. (PsycINFO Database Record

Short-term weight loss with diet and physical activity in young adults: The IDEA study.

OBJECTIVE: This study examined the effect of a behavioral weight loss intervention (BWLI) on young adults (age = 18-35 years). METHODS: Participants (N = 470) enrolled in a 6-month BWLI that included weekly group sessions, a prescribed energy-restricted diet, and moderate to vigorous physical activity (MVPA). Assessments included weight, body composition, fitness, lipids, glucose, insulin, resting blood pressure and heart rate, physical activity, and dietary intake. Data are presented as median [25th, 75th percentiles]. RESULTS: Retention was 90% (N = 424; age: 30.9 [27.8, 33.7] years; BMI: 31.2 [28.4, 34.3] kg m(-2) ). Participants completed 87.5% [76.1%, 95.5%] of scheduled intervention contacts. Weight and body fat decreased while fitness increased (P < 0.0001). MVPA in bouts ≥10 min increased (P < 0.0001), though total MVPA did not change significantly. Sedentary time decreased (P = 0.03). Energy and percent fat intake decreased, while percent carbohydrate and protein intake increased (P < 0.0001). Systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides, glucose, and insulin decreased (P < 0.0001). CONCLUSIONS: A 6-month BWLI produced favorable changes in dietary intake and physical activity and elicited favorable changes in weight and other health outcomes in young adults. MVPA performed in bouts of ≥10 min was associated with greater weight loss, but sedentary behavior was not.

Racial Differences in Weight Loss Among Adults in a Behavioral Weight Loss Intervention: Role of Diet and Physical Activity.

BACKGROUND: African-Americans lose less weight during a behavioral intervention compared with Whites, which may be from differences in dietary intake or physical activity. METHODS: Subjects (30% African American, 70% White; n = 346; 42.4 ± 9.0 yrs.; BMI = 33.0 ± 3.7 kg/m2) in an 18-month weight loss intervention were randomized to a standard behavioral (SBWI) or a stepped-care (STEP) intervention. Weight, dietary intake, self-report and objective physical activity, and fitness were assessed at 0, 6, 12, and 18 months. RESULTS: Weight loss at 18 months was greater in Whites (-8.74 kg with 95% CI [-10.10, -7.35]) compared with African Americans (-5.62 kg with 95% CI [-7.86, -3.37]) (P = .03) in the SBWI group and the STEP group (White: -7.48 kg with 95% CI [-8.80, -6.17] vs. African American: -4.41kg with 95% CI [-6.41, -2.42]) (P = .01). Patterns of change in dietary intake were not different between groups. Objective physical activity (PA) changed over time (P < .0001) and was higher in Whites when compared with African Americans (P = .01). CONCLUSIONS: Whites lost more weight (3.10 kg) than African American adults. Although there were no differences in dietary intake, Whites had higher levels of objective PA and fitness. Thus, the discrepancy in weight loss may be due to differences in PA rather than dietary intake. However, the precise role of these factors warrants further investigation.

Objective vs. Self-report Sedentary Behavior in Overweight and Obese Young Adults.

BACKGROUND: Sedentary behavior (SED) has been measured almost exclusively by self-reported total SED or television time in longitudinal studies. This manuscript aimed to compare self-reported vs. objectively measured SED. METHODS: Among overweight and obese young adults enrolled in a weight loss trial, baseline SED was assessed by 3 methods: 1) a questionnaire assessing 8 common SEDs (SEDQ), 2) 1 question assessing SED from the Global Physical Activity Questionnaire (SEDGPAQ), and 3) a monitor worn on the arm (SEDOBJ). In addition, television time (SEDTV) was isolated from the SEDQ. SED measures were compared using Spearman's correlations, signed-rank tests, and Bland-Altman plots. RESULTS: In 448 participants, SEDQ and SEDGPAQ were only weakly associated with SEDOBJ (rs = 0.21; P < .001, rs = 0.32; P < .001, respectively). Compared with SEDOBJ, SEDQ more often overestimated SEDOBJ (median difference: 1.1 hours/day; P < .001), while SEDGPAQ more often underestimated SEDOBJ (median difference: -0.7 hours/day; P < .001). The correlation between SEDTV and SEDOBJ was not significantly different from 0 (rs = 0.08; P = .08). CONCLUSIONS: SEDQ and SEDGPAQ were weakly correlated with, and significantly different from, SEDOBJ in overweight and obese young adults. SEDTV was not related to SEDOBJ. The poor associations of self-reported and objectively measured SED could affect interpretation and comparison across studies relating SED to adverse health outcomes.

Objective Versus Self-Reported Physical Activity in Overweight and Obese Young Adults.

BACKGROUND: To compare moderate-to-vigorous intensity physical activity (MVPA) assessed via questionnaires to an objective measure of MVPA in overweight or obese young adults. METHODS: MVPA was assessed in 448 [median BMI = 31.2 (Interquartile Range: 28.5-34.3) kg/m2] young adults [median age: 30.9 (Interquartile Range: 27.8-33.7) years]. Measures included the SenseWear Armband (MVPAOBJ), the Paffenbarger Questionnaire (MVPAPAFF), and the Global Physical Activity Questionnaire (GPAQ). The GPAQ was used to compute total MVPA (MVPAGPAQ-TOTAL) and MVPA from transportation and recreation (MVPAGPAQ-REC). RESULTS: The association between MVPAOBJ and MVPAPAFF was rs = 0.40 (P < .0001). Associations between MVPAOBJ and MVPAGPAQ-TOTAL and MVPAGPAQ-REC were rs = 0.19 and rs = 0.32, respectively (P < .0001). MVPAGPAQ-TOTAL was significantly greater than MVPAOBJ (P < .0001). Median differences in MET-min/week between MVPAOBJ and MVPAPAFF or MVPAGPAQ-REC were not significantly different from zero. There was proportional bias between each self-reported measure of MVPA and MVPAOBJ. There were significant associations between all measures of MVPA and fitness. MVPAOBJ was significantly associated with BMI and percent body fat. CONCLUSIONS: Objective and self-reported measures of MVPA are weakly to moderately correlated, with substantial differences between measures. MVPAOBJ provided predictive validity with fitness, BMI, and percent body fat. Thus, an objective measure of MVPA may be preferred to self-report in young adults.

Time-based physical activity interventions for weight loss: a randomized trial.

PURPOSE: This study aims to examine whether enhancing standard behavioral weight loss interventions (standard behavioral weight loss program (SBWP)) with additional strategies at the initiation of intervention (ADOPT) or providing the additional strategies at predetermined times over the intervention period (MAINTAIN) enhances 18-month weight loss. METHODS: This was a clinical trial of participants (N = 195; mean ± SEM: age, 43.2 ± 8.6 yr; body mass index, 33.0 ± 3.4 kg·m) randomized to SBWP, ADOPT, or MAINTAIN. All participants were prescribed an energy-restricted diet and physical activity, with group intervention sessions delivered over 18 months. ADOPT participants received additional phone contact (months 1-3), supervised exercise (months 1-6), and behavior campaigns (months 4-9). MAINTAIN participants received additional phone contact (months 4-6), supervised exercise (months 7-12), and behavior campaigns (months 13-18). RESULTS: There was a significant group-time interaction for weight loss (P = 0.0032). SBWP participants lost 9.3 ± 0.9, 7.8 ± 1.1, and 5.9 ± 1.2 kg at 6, 12, and 18 months, respectively. ADOPT participants lost 8.9 ± 0.9, 7.6 ± 1.2, and 5.8 ± 1.2 kg, whereas MAINTAIN participants lost 9.7 ± 0.9, 11.0 ± 1.2, and 9.0 ± 1.2 kg at 6, 12, and 18 months, respectively. The group-time interactions for SBWP versus MAINTAIN (P = 0.0033) and for ADOPT versus MAINTAIN (P = 0.0075) were significant. There was a significant group-time interaction for change in fitness (P = 0.0060). The group-time interaction for MAINTAIN versus ADOPT (P = 0.0018) was significant, with a trend for MAINTAIN versus SBWP (P = 0.0525). CONCLUSIONS: MAINTAIN improves 18-month weight loss compared with SBWP and ADOPT, with statistical trends indicating that MAINTAIN results in greater improvements in fitness. These results suggest that time-based strategies emphasizing physical activity confer greater benefits when delivered later and over the full course of intervention. This provides valuable information for the implementation of time-based strategies for improving long-term weight loss and fitness in overweight and obese adults.