Primary prevention of metabolic syndrome in the community using an evidence-based exercise program

2013 ◽  
Vol 57 (4) ◽  
pp. 392-395 ◽  
Author(s):  
Lance C. Dalleck ◽  
Gary P. Van Guilder ◽  
Esther M. Quinn ◽  
Don L. Bredle
Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Lance C Dalleck ◽  
Tara B Richardson ◽  
Gary P Van Guilder

Introduction: It has been estimated that 32% of obese adults in the US are metabolically healthy. This subset of individuals, referred to as metabolically healthy but obese (MHO), appear to be more resistant to the adverse cardiometabolic consequences faced by their metabolically abnormal obese (MAO) counterparts. Cross-sectional observations indicate that increased physical activity and higher fitness contribute to the protective metabolic characteristics in this subset of obese individuals. However, to date no study has investigated whether a community-based exercise intervention designed to increase exercise volume and fitness can transition MAO adults to a MHO phenotype. Identifying the therapeutic dose of exercise required to convert a MAO person to metabolically healthy would yield important clinical information for the primary prevention of cardiovascular disease. Hypothesis: We assessed the following hypotheses: (1) community-based exercise training would transition MAO adults to metabolically healthy, and (2) the odds of successful transition to a metabolically healthy phenotype would be larger for obese individuals who [[Unable to Display Character: &#8211;]] (a) performed the highest volume of exercise, and (b) experienced the greatest increase in fitness. Methods: Three-hundred thirty-two healthy adults (190 women, 142 men; aged 28-88 years) engaged in a supervised 14-week community-based exercise program designed to favorably modify cardiovascular disease risk factors. Components of the metabolic syndrome (National Cholesterol Education Program ATP III criteria) were measured before and after the exercise program. Obese (BMI ≥ 30 kg·m 2 ) adults who met 2-4 criteria for metabolic syndrome were classified as metabolically abnormal. Metabolically healthy was defined if obese adults met 0 to 1 criteria for metabolic syndrome. Results: Baseline point prevalence of MAO was 20.5% (N = 68). There was a significant reduction (p<0.05) in point prevalence of MAO to 12.3% by post program as 27/68 individuals (40%) transitioned to MHO. Compared to the lowest quartiles of relative energy expenditure and change in fitness, participants in the highest quartiles were 21.8 (95% CI 4.4[[Unable to Display Character: &#8211;]]108.0; p<0.05) and 8.2 (95% CI 3.1[[Unable to Display Character: &#8211;]]21.6; p<0.05) times more likely to transition from MAO to MHO, respectively. Conclusions: These findings indicate that supervised community exercise can transition MAO adults to a MHO phenotype. MAO adults who engaged in higher volumes of exercise and those who demonstrated greater improvements in fitness were significantly more likely to become metabolically healthy. Importantly, the unfavourable metabolic characteristics of obesity are not irreversible. Community exercise should be considered an effective model for the primary prevention of cardiovascular disease in MAO adults.


2012 ◽  
Vol 125 (5) ◽  
pp. 440-446 ◽  
Author(s):  
C. Michael Minder ◽  
Michael J. Blaha ◽  
Aaron Horne ◽  
Erin D. Michos ◽  
Sanjay Kaul ◽  
...  

2018 ◽  
Vol 27 (2) ◽  
pp. 114-116 ◽  
Author(s):  
Anne Cockcroft ◽  
Leagajang Kgakole ◽  
Nobantu Marokoane ◽  
Neil Andersson

Traditional doctors have been largely ignored in HIV prevention, particularly primary prevention. As part of a structural intervention programme to reduce HIV risk among young women in Botswana, we trained 147 traditional doctors in four districts as well as government health education assistants (HEAs) and teachers to run discussion groups in the community and schools, using an evidence-based eight-episode audio-drama, covering gender roles, gender violence, and how these are related to HIV risk. One year later, we contacted 43 of the 87 trained traditional doctors in two districts. Most (32) were running discussion groups with men and women, with links to the local HEAs and teachers. They were adept at recruiting men to their groups, often a challenge with community interventions, and reported positive changes in attitudes and behaviour of group participants. Traditional doctors can play an important role in primary prevention of gender violence and HIV.


2013 ◽  
Vol 19 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Kimberly Bellon ◽  
Stephanie Kolakowsky-Hayner ◽  
David Chen ◽  
Shari McDowell ◽  
Bridget Bitterman ◽  
...  

2021 ◽  
Author(s):  
Nancy Gell ◽  
Elise Hoffman ◽  
Kushang Patel

BACKGROUND Tele-exercise has emerged as a way for older adults to participate in group exercise during the COVID-19 pandemic. Yet, little is known about the technology support needs of older adults for accessing tele-exercise. OBJECTIVE Examine the interests and needs of older adults for transition to tele-exercise, 2) Identify barriers and facilitators of tele-exercise uptake and continued participation, and 3) Describe technology support challenges and successes encountered among older adults beginning tele-exercise. METHODS We used an exploratory sequential mixed method study design. Participants were older adults with symptomatic knee osteoarthritis (n=44) who started participating in remotely delivered Enhance Fitness. Prior to the start of classes, a subsample of participants (n=10) completed semi-structured phone interviews about technology support needs and barriers and facilitators for technology adoption. All participants completed surveys including the PROMIS-57, the Senior Technology Acceptance Model scale, and a technology needs assessment. The study team recorded technology challenges encountered when participants engaged in tele-exercise classes and attendance rates. RESULTS Four themes emerged from the interviews: Participants desire features in a tele-exercise program that foster accountability; importance of direct access to helpful people who can troubleshoot and provide guidance with technology; opportunities to participate in high value activities motivates willingness to persevere through technology concerns; and belief in the ability to learn new things supersedes technology-related anxiety. Among participants in the tele-exercise classes (mean age 74.0 years ± 6.3; 86.4% female; mean of 2.5 ± 0.9 chronic conditions), 70.5% had a computer with a webcam, but 40.9% had little or no experience with videoconferencing. Initial technology orientation sessions lasted, on average, 19.3 (±10.3) minutes and 23.9% required a follow-up assistance call. During the first two weeks of tele-exercise, 47.6% required technical assistance which decreased to 11.9% for weeks 3-16. Median attendance was 100% for the first six sessions and 93% for the subsequent 42 sessions. CONCLUSIONS With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of stand-by technical assistance, particularly during the first two weeks of classes. Continued development of best practices in this area may allow previously hard-to reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. CLINICALTRIAL NCT04099394


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