Associations between Sleep Characteristics and Cardiovascular Risk Factors in Adolescents Living with Type 1 Diabetes.

Adolescents living with type 1 diabetes (T1D) have an increased risk of developing cardiovascular disease. Sleep patterns have physiological and behavioral impacts on diabetes outcomes. This study aimed to investigate the associations between sleep patterns and CVD risk factors in adolescents living with T1D and their peers living without T1D. This cross-sectional study assessed CVD risk factors and sleep characteristics (and their associations) in adolescents, aged 12-18 years, living with T1D (n = 48) and their peers (n = 19) without T1D. Outcomes included blood pressure, lipid profiles, and sleep characteristics (accelerometry). Statistical differences between groups were determined with chi-square or independent samples t-tests. The associations between sleep characteristics and CVD risk factors were assessed with multivariate linear regression analyses. We found no significant differences between the two groups in terms of sleep duration, efficiency, sleep onset and offset, and frequency of awakenings, and there were associations between sleep efficiency and LDL-C (ß = -0.045, p = 0.018, model R2 = 0.230) and triglycerides (ß = -0.027, p = 0.012, model R2 = 0.222) after adjusting confounders (diabetes status, sex, age, pubertal stage) in all participants. In conclusion, adolescents with T1D and without T1D sleep less than the recommended eight hours per night. The associations between sleep efficiency and LDL-C and triglycerides are independent of sleep duration, regardless of sex, age, and pubertal stage.

Relationship of Fitness Combine Results and National Hockey League Performance: A 25-Year Analysis.

PURPOSE: Along with past performance, professional teams consider physical fitness and physiological potential in determining the value of prospective draft picks. The National Hockey League (NHL) Combine fitness results have been examined for their ability to predict draft order, but not bona fide hockey performance. Therefore, we sought to identify the relationships of combine fitness test results to short- and long-term NHL performance. METHODS: During NHL Combine fitness testing (1994-2007), a standardized battery of tests was conducted. Player performance (1995-2020) was quantified using career cumulative points, time on ice, transitional period to playing in the NHL, and NHL career length. Forward and defensive positions were considered separately. Goalies were not considered. Stepwise linear regression analysis was used to identify fitness variables that predict NHL success. RESULTS: Overall models ranged in their predictive ability from 2% to 16%. The transitional period was predicted by peak leg power and aerobic capacity (V˙O2max; forwards, R2 = .03, and defense, R2 = .06, both P < .01). Points and time on ice within seasons 1 to 3 were predicted by peak leg power and V˙O2max for forwards and defense (R2 = .02-.09, P < .01). Among players accumulating 10 NHL seasons, cumulative points were inversely related to upper-body push-strength-related variables in forwards (R2 = .11) and defense (R2 = .16; both P < .01). CONCLUSIONS: The NHL Combine fitness testing offers meaningful data that can inform the likelihood of future success. Peak leg power and V˙O2max predict league entry and early career success. Counterintuitively, upper-body strength is inversely related to long-term performance, which may offer insight into recruitment strategies, player development, or differential team roles.

A Comparison of On-Ice External Load Measures Between Subelite and Elite Female Ice Hockey Players.

ABSTRACT: Douglas, AS, Rotondi, MA, Baker, J, Jamnik, VK, and Macpherson, AK. A comparison of on-ice external load measures between subelite and elite female ice hockey players. J Strength Cond Res 36(7): 1978-1983, 2022-This study quantified and examined differences in measures of on-ice external load for subelite and elite female ice hockey players. External load variables were collected from subelite (N = 21) and elite (N = 24) athletes using Catapult S5 monitors during the preseason. A total of 574 data files were analyzed from training and competition during the training camp. Significant differences between groups were found across all variables. Differences in training between the 2 groups ranged from trivial (forwards PlayerLoad, p = 0.03, effect-size [ES] = 0.18) to large (forwards Explosive Efforts [EEs], p < 0.001, ES = 1.64; defense EEs, p < 0.001, ES = 1.40). Match comparisons yielded similar results, with differences ranging from small (defense Low Skating Load [SL], p = 0.05, ES = 0.49; Medium SL, p = 0.04, ES = 0.52) to very large (forwards PlayerLoad, p < 0.001. ES = 2.25; PlayerLoad·min-1, p < 0.001, ES = 2.66; EEs, p < 0.001, ES = 2.03; Medium SL, p < 0.001, ES = 2.31; SL·min-1, p < 0.001, ES = 2.67), respectively. The differences in external load measures of intensity demonstrate the need to alter training programs of subelite ice athletes to ensure they can meet the demands of elite ice hockey. As athletes advance along the development pathway, considerable focus of their off-ice training should be to improve qualities that enhance their ability to perform high-intensity on-ice movements.

Association between physical activity level and cardiovascular risk factors in adolescents living with type 1 diabetes mellitus: a cross-sectional study.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM. METHODS: This cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses. RESULTS: Results were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25-75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1, p = 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1, p = 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1 p = 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1, p = 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1, p = 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs, p = 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00-124.14) vs (53.19 (35.68-63.16) min, p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74-16.22) vs 8.56 (6.18-10.12) %, p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (ß = 0.29, p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (ß = - 0.001, p = 0.018, model R2 = 0.205) and METs (ß = - 0.359, p = 0.015, model R2 = 0.208), and positively associated with time spent in sedentary behaviour (ß = 0.002, p = 0.041, model R2 = 0.156) in persons living with T1DM. CONCLUSIONS: Chinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.

On-Ice Measures of External Load in Relation to Match Outcome in Elite Female Ice Hockey.

The aim of this study is to investigate the differences between select on-ice measures using inertial movement sensors based on match outcome, and to determine changes in player movements across three periods of play. Data were collected during one season of competition in elite female ice hockey players (N = 20). Two-factor mixed effects ANOVAs for each skating position were performed to investigate the differences in match outcome, as well as differences in external load measures during the course of a match. For match outcome, there was a small difference for forwards in explosive ratio (p = 0.02, ES = 0.26) and percentage high force strides (p = 0.04, ES = 0.50). When viewed across three periods of a match, moderate differences were found in skating load (p = 0.01, ES = 0.75), explosive efforts (p = 0.04, ES = 0.63), and explosive ratio (p = 0.002, ES = 0.87) for forwards, and in PlayerLoad (p = 0.01, ES = 0.70), explosive efforts (p = 0.04, ES = 0.63), and explosive ratio (p = 0.01, ES = 0.70) for defense. When examining the relevance to match outcome, external load measures associated with intensity appear to be an important factor among forwards. These results may be helpful for coaches and sport scientists when making decisions pertaining to training and competition strategies.

On-Ice Physical Demands of World-Class Women's Ice Hockey: From Training to Competition.

PURPOSE: To compare on-ice external and internal training loads in world-class women's ice hockey during training and competition. METHODS: On-ice training loads were collected during 1 season from 25 world-class ice hockey players via wearable technology. A total of 105 on-ice sessions were recorded, which consisted of 61 training sessions and 44 matches. Paired and unpaired t tests compared training and competition data between and across playing positions. RESULTS: For training data, there was a difference between positions for PlayerLoad (P < .001, effect size [ES] = 0.32), PlayerLoad·minute-1 (P < .001, ES = 0.55), explosive efforts (P < .001, ES = 0.63), and training impulse (P < .001, ES = 0.48). For the competition data, there were also differences between positions for PlayerLoad (P < .001, ES = 0.26), PlayerLoad·minute-1 (P < .001, ES = 0.38), explosive efforts (P < .001, ES = 0.64), and training impulse (P < .001, ES = 1.47). Similar results were found when positions were viewed independently; competition had greater load and intensity across both positions for PlayerLoad, training impulse, and explosive efforts (P < .001, ES = 1.59-2.98) and with PlayerLoad·minute-1 (P = .016, ES = 0.25) for the defense. CONCLUSIONS: There are clear differences in the volume and intensity of external and internal workloads between training and competition sessions. These differences were also evident when comparing the playing positions, with defense having lower outputs than forwards. These initial results can be used to design position-specific drills that replicate match demands for ice hockey athletes.

Readiness for Firefighting: A Heart Transplant Patient's Quest to Return to Work.

Heart transplantation patients generally demonstrate exercise capacities that are below the minimal standards for firefighting. Therefore, it is unlikely that heart transplantation patients will receive medical and/or employer clearance for active duty. We report a case of a firefighter who sought to return to full-time active duty following heart transplantation. We examined his physiological readiness to return to work during occupation-specific testing. Remarkably, the patient was able to meet the minimal requirements for full active firefighting. This finding provides direct evidence to support the potential of transplant patients returning to active duty in physiologically demanding occupations.

Do moderate- to vigorous-intensity accelerometer count thresholds correspond to relative moderate- to vigorous-intensity physical activity?

We aimed to predict % maximal oxygen consumption at absolute accelerometer thresholds and to estimate and compare durations of objective physical activity (PA) among body mass index (BMI) categories using thresholds that account for cardiorespiratory fitness. Eight hundred twenty-eight adults (53.5% male; age, 33.9 ± 0.3 years) from the National Health and Nutrition Examination Survey 2003-2004 were analyzed. Metabolic equivalent values at absolute thresholds were converted to percentage of maximal oxygen consumption, and accelerometer counts corresponding to 40% or 60% maximal oxygen consumption were determined using 4 energy expenditure prediction equations. Absolute thresholds underestimated PA intensity for all adults; however, because of lower fitness, individuals with overweight and obesity work at significantly higher percentage of maximal oxygen consumption at the absolute thresholds and require significantly lower accelerometer counts to reach relative moderate and vigorous PA intensities compared with those with normal weight (P < 0.05). However, moderate-to-vigorous physical activity (MVPA) durations were shorter when using relative thresholds compared with absolute thresholds (in all BMI groups, P < 0.05), and they were shorter among individuals with obesity compared with those with normal weight when using relative thresholds (P < 0.05). Regardless of the thresholds used, a greater proportion of individuals with normal weight met the PA guideline of 150 min·week-1 of MVPA compared with individuals with obesity (absolute: 21.3% vs 6.7%; Yngve: 4.0% vs 0.2%; Swartz: 10.7% vs 3.9%; Hendelman: 4.7% vs 0.2%; Freedson: 6.4% vs 0.5%; P < 0.05). Current absolute thresholds of accelerometry-derived PA may overestimate MVPA for all BMI categories when compared with relative thresholds that account for cardiorespiratory fitness. Given the large variability in our results, more work is needed to better understand how to use accelerometers for evaluating PA at the population level.

Physical employment standard for Canadian wildland fire fighters; identifying and characterising critical initial attack response tasks.

Physical employment standards evaluate whether a worker possesses the physical abilities to safely and efficiently perform all critical on-the-job tasks. Initial Attack (IA) wildland fire fighters (WFF) must perform such critical tasks in all terrains. Following a physical demands analysis, IA WFF (n = 946 out of a possible 965) from all fire jurisdictions ranked the most demanding tasks and identified mountains, muskeg and rolling hills as the most challenging terrains. Experimental trials found the oxygen cost (mean ± SD V˙ O2 mL·kg-1·min-1) while performing the hose pack back carry to be 40 ± 7 in steep mountains, 34 ± 5 in muskeg and 34 ± 2 in rolling hills (n = 168). Back-carrying and hand-carrying a 28.5 kg pump, back-carrying a 25 kg hose pack and advancing charged hose were the most demanding tasks. Performing the same emergency IA WFF tasks was significantly more demanding in mountains (p ≤ 0.05), and these higher demands must be taken into account when developing a physical employment standard for Canadian wildland fire fighters. Practitioner Summary: Physical employment standards evaluate whether an applicant or incumbent possesses the physical and physiological abilities to safely and efficiently perform the critical on-the-job tasks. This paper details the process used to undertake a physical demands analysis and characterise tasks for the development of a  circuit test and fitness employment standard for IA WFF.

Physical employment standard for Canadian wildland firefighters: examining test-retest reliability and the impact of familiarisation and physical fitness training.

To assess the impact of repeat performances (familiarisation) plus exercise training on completion time for the Ontario Wildland Firefighter (WFF) Fitness Test circuit (WFX-FIT), normally active general population participants (n = 145) were familiarised to the protocol then randomised into (i) exercise training, (ii) circuit only weekly performances or (iii) controls. At Baseline, the WFX-FIT pass rate for all groups combined was 11% for females and 73% for males, indicating that the Ontario WFX-FIT standard had a possible adverse impact on females. Following test familiarisation, mean circuit completion times improved by 11.9% and 10.2% for females and males, respectively. There were significant improvements in completion time for females (19.8%) and males (16.9%) who trained, plus females (12.2%) and males (9.8%) who performed the circuit only, while control participants were unchanged. Post training, the pass rate of the training group was 80% for females and 100% for males. Practitioner Summary: This paper details the impact of familiarisation plus exercise training as accommodation to mitigate potential adverse impact on initial attack wildland firefighter test performance. The results underscore the importance of test familiarisation opportunities and physical fitness training programmes that are specific to the demands of the job.

Physical employment standard for Canadian wildland fire fighters; developing and validating the test protocol.

Developing the Canadian initial attack (IA) wildland fire fighter (WFF) physical employment standard (WFX-FIT) began in a previous investigation with a physical demands analysis in which hand and back carrying a 28.5 kg pump, back carrying a 25 kg hose pack and advancing charged hose were identified as the critical IA emergency tasks. In the present study, a circuit was created incorporating simulations of the critical tasks with faster completion times required for provinces with more arduous terrains. The oxygen cost (mean ± SD VO2 mL∙kg-1∙min-1) of performing IA WFF tasks sequentially on the job was 37 ± 6 compared to 37 ± 4 when performing the WFX-FIT, indicating strong construct validity. Content validation ratings comparing the likeness of on-the-job tasks to simulated tasks in the WFX-FIT provided strong agreement. These validations confirm that the physical demands involved in performing the WFX-FIT are the same as IA wildland fire fighting. Practitioner Summary: This paper details the process used to develop and validate the physical employment standard for jurisdictional employment and national exchange of IA WFF. The range of cut-scores reflects the differences in jurisdictional physical demands due to terrain difficulty, fire management policy on fire risk and forest value index.

Aerobic Exercise Training Modalities and Prediabetes Risk Reduction.

PURPOSE: Prediabetes is linked to several modifiable risk factors, in particular, physical activity participation. The optimal prescription for physical activity remains uncertain. This pilot study aimed to investigate the effectiveness of continuous moderate intensity (CON) versus high-intensity interval training (HIIT) in persons with prediabetes. Outcome measures included glycated hemoglobin (A1C), body composition, musculoskeletal and aerobic fitness. METHODS: Participants (n = 35) were recruited and screened using a questionnaire plus capillary blood point-of-care A1C analysis. After baseline screening/exclusions, 21 participants were randomly assigned to either HIIT or CON training three times per week for 12 wk. All participants also undertook resistance training two times per week. A1C, an oral glucose tolerance test, select measures of physical and physiological fitness were assessed at baseline and follow-up. RESULTS: There were no significant differences in improvements in select metabolic indicators to training between CON and HIT groups. Pooled participant data showed a mean reduction in A1C of 0.5% (95% confidence interval [CI] = 0.3%-0.7%), whereas ß-cell function (%ß) improved by 28.9% (95% CI = 16.5%-39.2%) and insulin sensitivity (%S) decreased by 34.8 (95% CI = 57.8%-11.8), as assessed by the Homeostatic Model Assessment. Significant reductions in waist circumference of 4.5 cm (P < 0.001) and a 20% (P < 0.001) improvement in aerobic fitness were also observed in both training groups. CONCLUSION: The completion of a 12-wk exercise program involving both resistance training and either HIIT or CON training results in improved glycemic control, visceral adiposity, and aerobic fitness in persons with prediabetes.

Accelerometer thresholds: Accounting for body mass reduces discrepancies between measures of physical activity for individuals with overweight and obesity.

The objective of this study was to explore whether accelerometer thresholds that are adjusted to account for differences in body mass influence discrepancies between self-report and accelerometer-measured physical activity (PA) volume for individuals with overweight and obesity. We analyzed 6164 adults from the National Health and Nutrition Examination Survey between 2003-2006. Established accelerometer thresholds were adjusted to account for differences in body mass to produce a similar energy expenditure (EE) rate as individuals with normal weight. Moderate-, vigorous-, and moderate- to vigorous-intensity PA (MVPA) durations were measured using established and adjusted accelerometer thresholds and compared with self-report. Durations of self-report were longer than accelerometer-measured MVPA using established thresholds (normal weight: 57.8 ± 2.4 vs 9.0 ± 0.5 min/day, overweight: 56.1 ± 2.7 vs 7.4 ± 0.5 min/day, and obesity: 46.5 ± 2.2 vs 3.7 ± 0.3 min/day). Durations of subjective and objective PA were negatively associated with body mass index (BMI) (P < 0.05). Using adjusted thresholds increased MVPA durations, and reduced discrepancies between accelerometer and self-report measures for overweight and obese groups by 6.0 ± 0.3 min/day and 17.7 ± 0.8 min/day, respectively (P < 0.05). Using accelerometer thresholds that represent equal EE rates across BMI categories reduced the discrepancies between durations of subjective and objective PA for overweight and obese groups. However, accelerometer-measured PA generally remained shorter than durations of self-report within all BMI categories. Further research may be necessary to improve analytical approaches when using objective measures of PA for individuals with overweight or obesity.

Community-Based Culturally Preferred Physical Activity Intervention Targeting Populations at High Risk for Type 2 Diabetes: Results and Implications.

OBJECTIVES: In Canada, an ageing population, obesity rates and high risk among certain ethnocultural populations are driving diabetes prevalence. Given the burden associated with type 2 diabetes and its link to modifiable risk factors, this study aimed to implement culturally preferred physical activities at the community level, targeting individuals at high risk for type 2 diabetes. Glycated hemoglobin (A1C) levels were used to detect potential improvements in glycemic control. METHODS: Participants were screened for diabetes risk using a questionnaire and capillary point-of-care A1C blood testing. Participants were offered community-based physical activity classes 2 to 3 times per week for 6 months. A subset of participants (n=84) provided additional measurements. RESULTS: In total, 718 subjects were reached during recruitment. Substantial participant dropout took place, and 487 participants were exposed to the intervention. Among those who participated in the physical activity and provided follow up, mean A1C levels were reduced by 0.17 (p=0.002) after 3 months (n=84) and by 0.06 (p=0.35; n=49) after 6 months. The homeostatic model assessment (HOMA-beta) showed a significant improvement of 23.6% after 3 months (n=20; p=0.03) and 45.2% after 6 months (n=12; p=0.02). Resting systolic blood pressure and diastolic blood pressure plus combined hand-grip strength improved after 6 months (n=12). CONCLUSIONS: Implementation of this community-based, culturally preferred physical activity program presented several challenges and was associated with significant participant dropout. After considering participant dropout, the relatively small group who participated and provided follow-up measures showed improvements various physiologic measures. Despite efforts to enhance accessibility, it appears that several barriers to physical activity participation remain and need to be explored to enhance the success of future programs.

Exercise and the Development of the Artificial Pancreas: One of the More Difficult Series of Hurdles.

Regular physical activity (PA) promotes numerous health benefits for people living with type 1 diabetes (T1D). However, PA also complicates blood glucose control. Factors affecting blood glucose fluctuations during PA include activity type, intensity and duration as well as the amount of insulin and food in the body at the time of the activity. To maintain equilibrium with blood glucose concentrations during PA, the rate of glucose appearance (Ra) to disappearance (Rd) in the bloodstream must be balanced. In nondiabetics, there is a rise in glucagon and a reduction in insulin release at the onset of mild to moderate aerobic PA. During intense aerobic -anaerobic work, insulin release first decreases and then rises rapidly in early recovery to offset a more dramatic increase in counterregulatory hormones and metabolites. An "exercise smart" artificial pancreas (AP) must be capable of sensing glucose and perhaps other physiological responses to various types and intensities of PA. The emergence of this new technology may benefit active persons with T1D who are prone to hypo and hyperglycemia.

Integration of the functional movement screen into the National Hockey League Combine.

The sport of ice hockey requires coordination of complex skills involving musculoskeletal and physiological abilities while simultaneously exposing players to a high risk for injury. The Functional Movement Screen (FMS) was developed to assess fundamental movement patterns that underlie both sport performance and injury risk. The top 111 elite junior hockey players from around the world took part in the 2013 National Hockey League Entry Draft Combine (NHL Combine). The FMS was integrated into the comprehensive medical and physiological fitness evaluations at the request of strength and conditioning coaches with affiliations to NHL teams. The inclusion of the FMS aimed to help develop strategies that could maximize its utility among elite hockey players and to encourage or inform further research in this field. This study evaluated the outcomes of integrating the FMS into the NHL Combine and identified any links to other medical plus physical and physiological fitness assessment outcomes. These potential associations may provide valuable information to identify elements of future training programs that are individualized to athletes' specific needs. The results of the FMS (total score and number of asymmetries identified) were significantly correlated to various body composition measures, aerobic and anaerobic fitness, leg power, timing of recent workouts, and the presence of lingering injury at the time of the NHL Combine. Although statistically significant correlations were observed, the implications of the FMS assessment outcomes remain difficult to quantify until ongoing assessment of FMS patterns, tracking of injuries, and hockey performance are available.

Identifying persons at risk for developing type 2 diabetes in a concentrated population of high risk ethnicities in Canada using a risk assessment questionnaire and point-of-care capillary blood HbA1c measurement.

BACKGROUND: Amidst the growing health care burden created by diabetes, this study aimed to assess the utility of a prediabetes/type 2 diabetes risk questionnaire in high risk ethnic communities in Toronto Canada. METHODS: Participants (n = 691) provided questionnaire responses and capillary blood tests collected via fingerstick and results were analysed for HbA1c using the Bio-Rad in2it point-of-care device. The Bland-Altman method was used to compare point-of-care HbA1c analysis (Bio-Rad, boronate affinity chromatography) to that using high performance liquid chromatography. ANOVA and linear regression were performed to investigate the relationship between questionnaire and blood data. RESULTS: Mean (± SD) HbA1c was 5.99% ± 0.84 and the Bland-Altman analysis revealed no significant biases HbA1c (bias = 0.039, 95% limits of agreement = -1.14 to 1.22). ANOVA showed that with increasing risk classification based on questionnaire answers (with the exception of "moderate"-to-"high"), there was a significant increase in mean HbA1c (Welch Statistic 30.449, p < 0.001). Linear regression revealed that the number of high risk parents, age category, BMI, physical activity participation and previous diagnosis of high blood sugar were significant contributors (p < 0.05) to the variance in HbA1c. CONCLUSIONS: Though not a substitute for established diagnostic protocols, the use of a risk questionnaire can be an accurate, low cost, educational and time efficient method for assessment of type 2 diabetes risk. The early detection of prediabetes and type 2 diabetes is vital to increased awareness and opportunity for intervention with the goal of preventing or delaying the progression of type 2 diabetes and the known associated complications.

Individuals underestimate moderate and vigorous intensity physical activity.

BACKGROUND: It is unclear whether the common physical activity (PA) intensity descriptors used in PA guidelines worldwide align with the associated percent heart rate maximum method used for prescribing relative PA intensities consistently between sexes, ethnicities, age categories and across body mass index (BMI) classifications. OBJECTIVES: The objectives of this study were to determine whether individuals properly select light, moderate and vigorous intensity PA using the intensity descriptions in PA guidelines and determine if there are differences in estimation across sex, ethnicity, age and BMI classifications. METHODS: 129 adults were instructed to walk/jog at a "light," "moderate" and "vigorous effort" in a randomized order. The PA intensities were categorized as being below, at or above the following %HRmax ranges of: 50-63% for light, 64-76% for moderate and 77-93% for vigorous effort. RESULTS: On average, people correctly estimated light effort as 51.5±8.3%HRmax but underestimated moderate effort as 58.7±10.7%HRmax and vigorous effort as 69.9±11.9%HRmax. Participants walked at a light intensity (57.4±10.5%HRmax) when asked to walk at a pace that provided health benefits, wherein 52% of participants walked at a light effort pace, 19% walked at a moderate effort and 5% walked at a vigorous effort pace. These results did not differ by sex, ethnicity or BMI class. However, younger adults underestimated moderate and vigorous intensity more so than middle-aged adults (P<0.05). CONCLUSION: When the common PA guideline descriptors were aligned with the associated %HRmax ranges, the majority of participants underestimated the intensity of PA that is needed to obtain health benefits. Thus, new subjective descriptions for moderate and vigorous intensity may be warranted to aid individuals in correctly interpreting PA intensities.

Relationship between obesity and obesity-related morbidities weakens with aging.

BACKGROUND: A weak relationship exists between obesity and mortality risk in older populations, however, the influence of age on the relationship between obesity and morbidity is unclear. The objective of this study was to determine the influence of age on the relationship between obesity and cardiovascular disease, type 2 diabetes, dyslipidemia, and hypertension. METHODS: Data from the Third National Health and Nutrition Examination Survey (1988-1994) were used. Individuals were classified into specific age (young: 18-40; middle: 40-65; old: 65-75; and very old: ≥75 years) and body mass index (BMI; 18.5-24.9, >25-29.9, ≥ 30kg/m(2)) categories. Cardiovascular disease, type 2 diabetes, dyslipidemia, and hypertension were categorized using measured metabolic risk factors, physician diagnosis, or medication use. RESULTS: Age modified the relationship between BMI and cardiovascular disease (Age × BMI interaction, p = .049), dyslipidemia (Age × BMI interaction, p = .035 for men, p < .001 for women), and hypertension (Age × BMI interaction, p = .023) in women but not in men (p = .167). However, age did not modify the relationship between BMI and type 2 diabetes (Age × BMI interaction, p = .177). BMI was strongly associated with increased relative risk of cardiovascular disease, dyslipidemia, type 2 diabetes, and hypertension in the young and middle aged, however, the association between BMI and these metabolic conditions were much more attenuated with increasing age. CONCLUSION: A stronger association between obesity and prevalent metabolic conditions exists in young and middle-aged populations than in old and very old populations. Longitudinal studies are needed to verify these findings and to confirm the benefits of weight loss on health across the life span.

The Prediabetes Detection and Physical Activity Intervention Delivery (PRE-PAID) program.

Inspired by increases in the prevalence and incidence of prediabetes, the Pre-diabetes Detection and Physical Activity Intervention Delivery Project (PRE-PAID) is a multiphasic program that identifies persons at high risk for developing type 2 diabetes, provides an opportunity for culturally appropriate, community-based physical activity and facilitates training of qualified exercise professionals on diabetes screening as well as prediabetes-specific training recommendations. This article provides an overview of the PRE-PAID project and includes some preliminary screening data, as well as lessons learned from the implementation of community-based physical activity programs that target specific, high-risk ethnicities. Recommendations and special considerations involving physical activity that targets persons with prediabetes also are discussed. A total of 691 individuals have undergone the PRE-PAID risk-identification process, which involves a brief questionnaire and point-of-care finger-prick hemoglobin A1C testing. The mean hemoglobin A1C level was 6.0±0.90% (mean ± standard deviation). Questionnaire scores showed that, on average, the individuals screened had 3 to 5 typical risk factors for type 2 diabetes, such as high body mass index, waist circumference, physical inactivity or family history of diabetes. Community-specific breakdowns of these results also are presented in this article. Sharing experiences from the PRE-PAID project can help formulate a framework for future prediabetes screening and physical activity interventions that are community based, target persons with prediabetes and are culturally appropriate.