The Navajo Nation Healthy Diné Nation Act: Community Support of a 2% Tax on Unhealthy Foods.

CONTEXT: The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value ("junk foods") on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking. OBJECTIVE: To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences. DESIGN: Cross-sectional survey. SETTING: The Navajo Nation. PARTICIPANTS: A total of 234 Navajo Nation community members across 21 communities. OUTCOME MEASURES: The percentage of participants who were supportive of the HDNA. RESULTS: Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they "support" (37.4%) or "strongly support" (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for "very well" vs "not at all") had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001). CONCLUSIONS: The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not.

Navajo Nation Stores Show Resilience During COVID-19 Pandemic.

On April 8, 2020, the Navajo Nation issued an administrative order limiting business operations. Facing high coronavirus disease 2019 (COVID-19) rates and limited food infrastructure, a survey was conducted among Navajo Nation store managers to assess: (1) COVID-19 adaptations; (2) challenges; (3) changes in customer volume and purchasing; and (4) suggestions for additional support. Purposive sampling identified 29 stores in Navajo communities. Representatives from 20 stores (19 store managers/owners, 1 other; 7 grocery, and 13 convenience/other stores) were interviewed by phone or in-person to reach saturation (new information threshold < 5%). Responses were coded using frequencies and inductive thematic analysis. All 20 stores implemented COVID-19 guidelines (Centers for Disease Control and Prevention [CDC]/Navajo Nation) and most received orientation/support from local chapters, community organizations, or health centers. Stores implemented staff policies (50%, handwashing, vaccinations, protective personal equipment (PPE), sick leave, temperature checks), environmental changes (50%, hand sanitizer, checkout dividers), customer protocols (40%, limit customers, mask requirements, closed restrooms), and deep cleaning (40%). Most stores (65%) reported challenges including stress/anxiety, changing guidelines, supply chain and customer compliance; 30% reported infection or loss of staff. Weekday customer volume was slightly higher vs. pre-COVID, but weekend lower. Stores reported consistent or more healthy food purchases (50%), more nonfood essentials (20%), or shelf-stable foods (10%). Desired support included further orientation (30%), leadership support (20%), overtime/time to learn guidelines (20%), and signage/handouts (15%). Despite a high COVID-19 burden and limited food store infrastructure, Navajo Nation stores adapted by implementing staff, environmental and customer policies. Local support, staffing, and small store offerings were key factors in healthy food access.

Implementation of Indigenous Food Tax Policies in Stores on Navajo Nation.

In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was enacted and permanently approved in 2020; HDNA places a 2% surtax on unhealthy foods and beverages, while other 2014 legislation exempted healthy food items from the 6% regular sales tax. Little is known about Navajo Nation store manager/owner perspectives toward the HDNA and how best to support stores to implement the legislation. Purposive sampling was used to ensure a balanced sample of correct HDNA implementers, incorrect HDNA implementers, and stores which made healthy store changes over the past 6 years. Three community-based interviewers collected surveys by phone or in-person. Frequency of closed-ended questions was quantified, and open-ended responses were coded using thematic analysis. Of 29 identified sample stores, 20 were interviewed to reach saturation. Eleven of 20 stores made changes improving their healthy food environments. Barriers included lack of equipment (6/20) and low consumer demand (5/20). Facilitators included consumer awareness and increased produce supply options (5/20). Sixteen of 20 stores supported HDNA continuation. Facilitators to HDNA implementation included orientation and informational materials (6/20) and promotion of tax-free items (5/20). Barriers included confusion about the tax (6/20) and tax exemption (5/20). Suggestions for support included printed materials (6/20) and store training (5/20). HDNA benefits included greater awareness of healthy choices among staff (7/20) and customer-community members (2/20). Most managers and owners expressed receiving support for healthy store changes and HDNA, but also identified a need for added resources and support. Findings inform legislative action to promote timely and appropriate uptake of HDNA, and support equitable, healthy food systems.

Seasonal Variability in Weight Gain Among American Indian, Black, White, and Hispanic Children: A 3.5-Year Study.

INTRODUCTION: Several studies have reported that children gain more weight during the summer season. Despite high obesity rates, little research has included American Indian/Alaskan Native children, and few studies have been longitudinal. This observational study examines seasonal weight variability over 3.5 years among ethnically diverse children, including 2,184 American Indian/Alaskan Native children. METHODS: Children's height and weight were measured before and after the summer from 2012-2015 and analyzed in 2019-2020, including children with ≥2 consecutive measurements (N=7,890, mean age=8.4 [SD=2.8] years). Mixed-effects models tested whether the percentage of the 95th BMI percentile and BMI differed by season (summer versus the rest of the year) and ethnicity. RESULTS: American Indian/Alaskan Native (23.7%), Hispanic (19.8%), and Black (17.8%) children had significantly higher baseline obesity rates than White children (7.1%). The percentage of the 95th BMI percentile significantly increased during the summer compared with the percentage during the rest of the year, with the strongest effects for children who were obese (b=2.69, 95% CI=1.35, 4.03, p<0.001) or overweight (b=1.47, 95% CI=0.56, 2.35, p<0.01). In BMI units, summer BMI increase was 0.50 kg/m2 higher (obese model) and 0.27 kg/m2 higher (overweight) than that of the rest of the year. Seasonal effects were significantly less pronounced for American Indian/Alaskan Native children than for White children. CONCLUSIONS: Children gained significantly more weight during the summer season, with the strongest effects for children who were obese. American Indian/Alaskan Native children had less seasonal variability than White children, but higher overall obesity rates. These data underscore summer as a critical time for obesity prevention among children who are overweight/obese but suggest that seasonal patterns may vary for American Indian/Alaskan Native children.

AlterG Anti-Gravity Treadmill Accuracy of Unloading Is Affected by Support Frame Height.

ABSTRACT: de Heer, HD, Kaufman, A, Repka, CP, Rojas, K, Charley, B, and Bounds, R. AlterG Anti-Gravity Treadmill accuracy of unloading is affected by support frame height. J Strength Cond Res 35(10): 2910-2914, 2021-The AlterG Anti-Gravity Treadmill uses air pressure to provide partial body-weight support (BWS), lowering impact forces and metabolic demand of walking and running. Users wear specialized shorts that zip onto a bag supported by a metal bar frame covering the treadmill. The frame is placed at hip height in positions numbered 1-9, adjusted up or down based on preference. Machine accuracy in providing BWS is important to achieve desired training effects, but it is unknown whether frame placement impacts accuracy. Twenty subjects (10 men/women) were weighed in 10% increments from 0 to 60% BWS with the frame at hip height (iliac crest), the "neutral" position, and reweighed with the frame placed up to 3 numbers above or below hip height. Although the machine displayed the same proportion BWS, placing the frame higher than the neutral position resulted in significantly more support, whereas placing the frame lower led to less support. At 10% BWS, placing the frame 3 positions higher resulted in 3% more support compared with the neutral position (13.1% BWS, p < 0.001) and 3 positions lower in 4.7% less support (5.3% BWS, p < 0.001). Deviances were greater with more BWS. At 60% BWS, 3 positions higher than neutral resulted in 71.2% BWS (11.2% more than expected, p < 0.001) and 3 below 48.1% BWS (12.9% below expected, p < 0.001), total 24.1% difference. These findings suggest that the position of the support frame significantly impacts the AlterG accuracy in providing BWS, with placement higher than hip height resulting in more support than displayed by the machine and lower placement resulting in less support.

The Navajo Nation Healthy Diné Nation Act: A Two Percent Tax on Foods of Minimal-to-No Nutritious Value, 2015-2019.

Our study summarizes tax revenue and disbursements from the Navajo Nation Healthy Diné Nation Act of 2014, which included a 2% tax on foods of minimal-to-no nutritional value (junk food tax), the first in the United States and in any sovereign tribal nation. Since the tax was implemented in 2015, its gross revenue has been $7.58 million, including $1,887,323 in 2016, the first full year. Revenue decreased in absolute value by 3.2% in 2017, 1.2% in 2018, and 4.6% in 2019, a significant downward trend (P = .02). Revenue allocated for wellness projects averaged $13,171 annually for each local community, with over 99% successfully disbursed and more rural areas generating significantly less revenue. Our results provide context on expected revenue, decreases over time, and feasibility for tribal and rural communities considering similar policies.

Few adults with functional limitations advised to exercise more or lose weight in NHANES 2011-14 seek health professional assistance: An opportunity for physical therapists.

PURPOSE: Functional limitations are associated with decreased physical activity and increased body mass index. The purpose of this study was to assess the prevalence of functional limitations among adults who reported receiving health professional advice to exercise more or lose weight, and to assess involvement of health professionals, including physical therapists, in weight loss efforts with these individuals. DESIGN: A cross-sectional analysis of U.S. adults from the 2011 to 2014 National Health and Nutrition Examination Survey (n = 5,480). METHODS: Participant demographics, health history, and functional limitations were assessed via self-report and examination. Frequency distributions were calculated using SAS® analytical software, accounting for the complex survey design. Population estimates were calculated using the American Community Survey. RESULTS: 31.0% of individuals (n = 1,696), representing a population estimate of 35 million adults, advised to exercise more or lose weight by a health professional reported one or more functional limitation. Of the 31%, 57.6% attempted weight loss, and 40.1% used exercise for weight loss. Few sought health professional assistance. Physical therapists were not mentioned. CONCLUSIONS: Few individuals with functional limitations advised to lose weight or increase exercise seek health professional assistance for weight loss. Physical therapists have an opportunity to assist those with functional limitations with exercise prescription.

The 3-m Backwards Walk and Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure.

BACKGROUND AND PURPOSE: Several measures of fall risk have been previously developed and include forward walking, turning, and stepping motions. However, recent research has demonstrated that backwards walking is more sensitive at identifying age-related changes in mobility and balance compared with forward walking. No clinical test of backwards walking currently exists. Therefore, this article describes a novel clinical test of backwards walking, the 3-m backwards walk (3MBW), and assessed whether it was associated with 1-year retrospective falls in a population of healthy older adults. Diagnostic accuracy of the 3MBW was calculated at different cutoff points and compared with existing clinical tests. METHODS: This study was a retrospective cohort study including residents of a retirement community without a history of neurological deficits. Demographics, medical history, and falls in the past year were collected, and clinical tests included the 3MBW and the Timed Up and Go (TUG), the 5 times sit-to-stand, and the 4-square step test. Frequency distributions and t tests compared baseline characteristics of people who reported falling with people who did not. Diagnostic accuracy (sensitivity and specificity) was calculated for a series of cutoffs for the 3MBW, the TUG (≥8, 10, and 13.5 seconds), 5 times sit-to-stand (≥12 and ≥15 seconds), and 4-step square test (>15 seconds). Receiver operating curve analyses were used to define 3MBW optimal cutoffs, and the difference between the overall area under the curve (AUC) was statistically tested. SPSS 24.0 and MedCalc 17.1 were used for all analyses. RESULTS AND DISCUSSION: Fifty-nine adults with a mean (SD) age of 71.5 (7.6) years participated, with 25 people reporting falls in the past year. The mean (SD) time for the 3MBW was 4.0 (2.1) seconds. People who fell had a significantly slower 3MBW time (4.8 vs 3.5 seconds for people who did not fall, P = .015), but not a significantly slower 4-step square test (9.5 vs 8.1 seconds, P = .056), TUG (9.3 vs 8.0 seconds, P = .077), and 5 times sit-to-stand (12.5 vs 10.3 seconds, P = .121). The highest overall AUC for any measure was for the 3MBW at 3.5 seconds (0.707, 95% confidence interval = 0.570-0.821; sensitivity = 74%, specificity = 61%), which was significantly higher than the TUG at 8 seconds (AUC = 0.560, P = .023) and 13.5 seconds (AUC = 0.528, P = .011), the 4-step square test (AUC = 0.522, P = .004), but not significantly higher than the TUG at 10 seconds (P = .098) and the 5 times sit-to-stand at 12 (P = .092) or 15 seconds (P = .276). On the 3MBW, more than 75% of people who were faster than 3.0 seconds did not report any falls, and 94% of people who did not report falling were faster than 4.5 seconds. Of the people who were slower than 4.5 seconds, 81% reported falling. CONCLUSIONS: In a study of healthy older adults, the 3MBW demonstrated similar or better diagnostic accuracy for falls in the past year than most commonly used measures. People walking faster than 3.0 seconds on the 3MBW were unlikely to have reported falling, whereas people slower than 4.5 seconds were very likely to have reported falling. Further validation of the 3MBW in prospective studies, larger samples, and clinical populations is recommended.

Development of a culturally relevant physical activity intervention for Navajo cancer survivors.

Despite well-documented benefits of physical activity for cancer survivors, few interventions have been developed for Native American cancer survivors, the population with the poorest survival rates of any group. This paper describes the development and cultural adaptation of a physical activity intervention for Navajo cancer survivors using Intervention Mapping (IM). IM procedures were guided by the PEN-3 (Perceptions-Enablers-Nurturers) and Health Belief Models and informed by a qualitative study with 40 Navajo cancer survivors and family members. For each theoretical construct (perceived benefits, barriers, enablers of healthy behaviors, etc.), a measurable objective was identified. These objectives were then matched with intervention strategies. The IM process indicated the need for a highly culturally sensitive environment (site and providers), culturally acceptable measurements and materials, and integrating cultural and environmental activity preferences. Program objectives aligned directly with these areas. Intervention strategies included: (a) collaboration with providers sensitive to historical/cultural context and environmental barriers; (b) cultural adaptation of surveys, non-invasive physical measurements, no biospecimen storage; (c) materials, terminology and symbols embracing cultural values of return to harmony; (d) physical activities that are flexible and aligned with cultural preferences and environment/travel issues (e.g., outdoor walking; community and home-based options; portable, inexpensive resistance equipment; local resources; family/friends participation and more community cancer education); (e) clinical adaptations by site and symptoms. This study is the first to document the process of adaptation of a physical activity program for Navajo cancer survivors. Objectives and strategies incorporated via IM are expected to foster sustainability and enhance uptake, satisfaction, and adherence.

Supporting New Community-Based Participatory Research Partnerships.

Marginalized communities have a documented distrust of research grounded in negative portrayals in the academic literature. Yet, trusted partnerships, the foundation for Community-Based Participatory Research (CBPR), require time to build the capacity for joint decision-making, equitable involvement of academically trained and community investigators, and co-learning. Trust can be difficult to develop within the short time between a funding opportunity announcement and application submission. Resources to support community- and academic-based investigators' time to discuss contexts, concerns, integration of expertise and locally acceptable research designs and data collection are limited. The National Institutes of Health (NIH) funded Center for American Indian Resilience and the Southwest Health Equity Research Collaborative have implemented an internal funding mechanism to support community and academic-based investigators' travel cost and time to discuss complementary areas of interest and skills and to decide if moving forward with a partnership and a collaborative grant proposal would be beneficial to the community. The rationale and administration of this Community-Campus Partnership Support (CCPS) Program are described and four examples of supported efforts are provided. Centers and training programs frequently fund pilot grants to support junior investigators and/or exploratory research. This CCPS mechanism should be considered as precursor to pilot work, to stimulate partnership building without the pressure of an approaching grant application deadline.

An Online Intervention Increases Empathy, Resilience, and Work Engagement Among Physical Therapy Students.

Health professions students often experience burnout and loss of empathy that worsens as they progress through their education. This study explored the impact of an evidence-based online course on physical therapy student empathy, resilience, and work engagement during their clinical internships. Participants included 36 doctoral physical therapy students who were beginning a sequence of three consecutive internships following their didactic coursework. Participants were randomly assigned to an immediate or delayed intervention group and received the online course during the first or second of the three internships. Outcome measures included the Jefferson Scale of Empathy, Utrecht Work Engagement scale, and GRIT resilience scale. The immediate intervention group made significant improvements in all three measures between the first and second internships compared to the delayed intervention group. These improvements were maintained over the 10-week duration of the second internship. The delayed intervention group made no significant changes in the three measures during the first internship; however, these each improved significantly at the end of the second internship. The study results suggest that online training can positively enhance physical therapy student empathy, resilience, and work engagement.

Heart disease risk information, encouragement, and physical activity among Mexican-origin couples: Self- or spouse-driven change?

Family health history is an accessible, clinically-recommended genomic tool that improves health risk evaluation. It captures both genetic and modifiable risk factors that cluster within families. Thus, families represent a salient context for family health history-based interventions that motivate engagement in risk-reducing behaviors. While previous research has explored how individuals respond to their personal risk information, we extend this inquiry to consider how individuals respond to their spouse's risk information among a sample of Mexican-Americans. One hundred and sixty spouse-dyads within Mexican-heritage households received a pedigree or a pedigree and personalized risk assessments, with or without behavioral recommendations. Analyses of Covariance (ANCOVAs) were conducted to assess the relationship between risk feedback, both personal and spouse, and self-reported physical activity levels at 3-month and 10-month assessments, controlling for baseline levels. The effect of being identified as an encourager of spouse's healthy weight was also evaluated. Personal feedback had no effect on participants' physical activity at either 3- or 10-month assessments. However, husbands' risk information was associated with wives' physical activity levels at 3-month assessment, with women whose husbands received both increased risk feedback and behavioral recommendations engaging in significantly higher physical activity levels than all other women. At 10-month follow-up, physical activity levels for both husbands and wives differed depending on whether they encouraged their spouse's healthy weight. Spousal risk information may be a stronger source of motivation to improve physical activity patterns than personal risk information, particularly for women. Interventions that activate interpersonal encouragement among spouses may more successfully extend intervention effects.

Physical Therapy and Hospitalization Among Medicare Beneficiaries With Low Back Pain: A Retrospective Cohort Study.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The aim of this study was to evaluate associations between receipt and quantity of outpatient physical therapy (PT) during an episode of care and 30-day and 180-day hospital admissions for any condition and lumbar spine conditions. SUMMARY OF BACKGROUND DATA: Low back pain (LBP) is a common cause of hospitalization and the most common reason Medicare beneficiaries utilize outpatient PT. The association between PT and hospitalization among patients with LBP is unknown. METHODS: A national sample of Medicare Fee-for-Service claims included 413,608 beneficiaries with an International Classification of Disease 9th revision (ICD-9) code of LBP and 1,415,037 episodes of care between June 1, 2010, and June 30, 2011. Episodes were classified as PT episodes or non-PT episodes. Relative risk of hospitalization from the episode start date was caldulated, adjusting for health status (Charlson comorbidity index), prior care utilization (number of prior hospitalizations and total number of episodes), an indicator of LBP severity (number of LBP ICD-9 codes), and demographics (sex, race/ethnicity, age). RESULTS: The proportion of 30-day hospitalization for any condition was 3.42% for PT episodes of care and 6.54% for non-PT episodes. For 180-day hospitalization, proportions were 15.45% (PT) and 21.65% (non-PT). The adjusted relative risk reduction of PT (vs. non-PT) was 41% for 30 days [99% confidence interval (CI) 38-44] and 22% for 180 days (20-24). For admitting diagnoses of lumbar spine, reductions were 65% at 30 days and 32% at 180 days. More PT treatment days showed greater 30-day risk reductions. For any condition, compared with non-PT, reductions were 24% for 1 to 2 treatment days (lowest tertile), 45% for 3 to 7 days, and 65% for more than 8 days (highest tertile). Stronger effects were found for lumbar spine admissions. Associations between PT quantity and 180-day hospitalization were less consistent. Limitations of Medicare claims include the potential for inaccuracies, limited knowledge about disease severity, and which PT interventions were conducted. CONCLUSION: Receipt of PT during an episode had a 22% to 65% reduced relative risk of hospitalization, with greater short-term reductions for more PT treatment days. LEVEL OF EVIDENCE: 3.

What You Don't Know: Improving Family Health History Knowledge among Multigenerational Families of Mexican Origin.

BACKGROUND: This study investigated diabetes and heart disease family health history (FHH) knowledge and changes after providing personalized disease risk feedback. METHODS: A total of 497 adults from 162 families of Mexican origin were randomized by household to conditions based on feedback recipient and content. Each provided personal and relatives' diabetes and heart disease diagnoses and received feedback materials following baseline assessment. Multivariate models were fitted to identify factors associated with the rate of 'don't know' FHH responses. RESULTS: At baseline, US nativity was associated with a higher 'don't know' response rate (p = 0.002). Though confounded by country of birth, younger age showed a trend toward higher 'don't know' response rates. Overall, average 'don't know' response rates dropped from 20 to 15% following receipt of feedback (p < 0.001). An intervention effect was noted, as 'don't know' response rates decreased more in households where one family member (vs. all) received supplementary risk assessments (without behavioral recommendations; p = 0.011). CONCLUSIONS: Limited FHH knowledge was noted among those born in the US and younger participants, representing a key population to reach with intervention efforts. The intervention effect suggests that 'less is more', indicating the potential for too much information to limit health education program effectiveness.

Promotoras Can Facilitate Use of Recreational Community Resources: The Mi Corazón Mi Comunidad Cohort Study.

INTRODUCTION: Limited research has documented interventions aimed at promoting use of existing recreational community resources among underserved populations. This study (HEART [Health Education Awareness Research Team] Phase 2) reports findings of an intervention (Mi Corazón Mi Comunidad) where community health workers facilitated use of diet and exercise programming at local recreational facilities among Mexican American border residents. The aim was to evaluate overall attendance rates and to assess which factors predicted higher attendance. METHOD: The design was a cohort study. From 2009 to 2013, a total of 753 participants were recruited across 5 consecutive cohorts. The intervention consisted of organized physical activity and nutrition programming at parks and recreational facilities and a free YWCA membership. Attendance at all activities was objectively recorded. Regression analyses were used to evaluate whether demographic factors, health status, and health beliefs were associated with attendance. Results Participants included mostly females at high risk for cardiovascular disease (72.4% were overweight/obese and 64% were [pre-]hypertensive). A total of 83.6% of participants attended at least one session. On average, total attendance was 21.6 sessions (range: 19.1-25.2 sessions between the different cohorts), including 16.4 physical activity and 5.2 nutrition sessions. Females (p = .003) and older participants (p < .001) attended more sessions. Participants low in acculturation (vs. high) attended on average seven more sessions (p = .003). Greater self-efficacy (p < .001), perceived benefits (p = .038), and healthy intentions (p = .024) were associated with higher attendance. Conclusions The intervention was successful in promoting use of recreational facilities among border residents at high risk for cardiovascular disease. Findings were similar across five different cohorts.

Insurance Status Is a Greater Barrier Than Income or Acculturation to Chronic Disease Screening in the Mexican Origin Population in El Paso, Texas.

The purpose of this study was to determine the association between income, insurance status, acculturation, and preventive screening for diabetes, high blood pressure, and cholesterol in Mexican American adults living in El Paso, Texas. This is a secondary data analysis using data from El Paso, Texas, that was collected between November 2007 and May 2009. Bivariate and stepwise regression analysis was used to determine the relationships between income, insurance, and acculturation factors on preventive screenings. Findings indicate that insurance status was associated with blood pressure check, blood sugar check, cholesterol screening, and any preventive screening. The association for income $40,000 + was explained by insurance. The only significant acculturation variable was language use for cholesterol. Disparities in preventive health screening in Mexican Americans were associated with primary insurance coverage in El Paso, Texas. With the border region being among the most medically underserved and underinsured areas in the United States, the results from this study suggest policy efforts are essential to ensure equal access to resources to maintain good health. Intervention efforts may include increasing awareness of enrollment information for insurance programs through the Affordable Care Act.

C-reactive protein response to a vegan lifestyle intervention.

This brief lifestyle intervention, including a vegan diet rich in fresh fruits and vegetables, whole grains and various legumes, nuts and seeds, significantly improved health risk factors and reduced systemic inflammation as measured by circulating CRP. The degree of improvement was associated with baseline CRP such that higher levels predicted greater decreases. The interaction between gender and baseline CRP was significant and showed that males with higher baseline CRP levels appeared to have a more robust decrease in CRP due to the intervention than did their female counterparts. It is likely that the vegetable and high fiber content of a vegan diet reduces CRP in the presences of obesity. Neither the quantity of exercise nor the length of stay was significant predictors of CRP reduction. Additionally, those participants who had a vegan diet prior to the intervention had the lowest CRP risk coming into the program. Direct measure of body fat composition, estrogen and other inflammatory mediators such as IL-6 and TNF-alpha would enhance current understanding of the specific mechanisms of CRP reduction related to lifestyle interventions.

Accuracy of unloading with the anti-gravity treadmill.

Body weight (BW)-supported treadmill training has become increasingly popular in professional sports and rehabilitation. To date, little is known about the accuracy of the lower-body positive pressure treadmill. This study evaluated the accuracy of the BW support reported on the AlterG "Anti-Gravity" Treadmill across the spectrum of unloading, from full BW (100%) to 20% BW. Thirty-one adults (15 men and 16 women) with a mean age of 29.3 years (SD = 10.9), and a mean weight of 66.55 kg (SD = 12.68) were recruited. Participants were weighed outside the machine and then inside at 100-20% BW in 10% increments. Predicted BW, as presented by the AlterG equipment, was compared with measured BW. Significant differences between predicted and measured BW were found at all but 90% through 70% of BW. Differences were small (<5%), except at the extreme ends of the unloading spectrum. At 100% BW, the measured weight was lower than predicted (mean = 93.15%, SD = 1.21, p < 0.001 vs. predicted). At 30 and 20% BW, the measured weight was higher than predicted at 35.75% (SD = 2.89, p < 0.001), and 27.67% (SD = 3.76, p < 0.001), respectively. These findings suggest that there are significant differences between reported and measured BW support on the AlterG Anti-Gravity Treadmill®, with the largest differences (>5%) found at 100% BW and the greatest BW support (30 and 20% BW). These differences may be associated with changes in metabolic demand and maximum speed during walking or running and should be taken into consideration when using these devices for training and research purposes.