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Background: Increased resting heart rate (RHR) is a predictor of mortality. RHR is influenced by cardiorespiratory fitness (CRF). Little is known about the combined associations of RHR and CRF on cancer mortality. Methods: 50,108 men and women (mean age 43.8 years) were examined between 1974 and 2002 at the Cooper Clinic in Dallas, Texas. RHR was measured by electrocardiogram and categorized as <60, 60-69, 70-79, or =80 beats/minute. CRF was quantified by maximal treadmill test and dichotomized as unfit and fit corresponding to the lower 20% and the upper 80%, respectively, of the age- and sex-specific distribution of treadmill exercise duration. The National Death Index was used to ascertain vital status. Cox regression was used to compute HRs and 95% confidence intervals (CI) for cancer mortality across RHR categories. Results: During a mean follow-up of 15.0 ± 8.6 years, 1,090 cancer deaths occurred. Compared with RHR <60 beats/minute, individuals with RHR =80 beats/minute had a 35% increased risk of overall cancer mortality (HR, 1.35; 95% CI, 1.06-1.71) after adjusting for confounders, including CRF. Compared with "fit and RHR <80 beats/minute", HRs (95% CI) for cancer mortality were 1.41 (1.20-1.66), 1.51 (1.11-2.04), and 1.78 (1.30-2.43) in "unfit and RHR <80," "fit and RHR =80," and "unfit and RHR =80 beats/minute," respectively. Conclusions: RHR =80 beats/minute is associated with an increased risk of overall cancer mortality. High CRF may help lower the risk of cancer mortality among those with high RHR. [ABSTRACT FROM AUTHOR]

Background: Personal activity intelligence (PAI) is a metric developed to simplify a physically active lifestyle for the participants. Regardless of following today's advice for physical activity, a PAI score ≥100 per week at baseline, an increase in PAI score, and a sustained high PAI score over time were found to delay premature cardiovascular disease (CVD) and all-cause mortality in a large population of Norwegians. However, the association between long-term temporal change in PAI and mortality in other populations have not been investigated.Objective: To test whether temporal change in PAI is associated with CVD and all-cause mortality in a large population from the United States.Methods: We studied 17,613 relatively healthy participants who received at least two medical examinations in the Aerobics Center Longitudinal Study between 1974 and 2002. The participant's weekly PAI scores were estimated twice, and adjusted hazard ratios (AHR) and 95% confidence intervals (CI) for CVD and all-cause mortality related to changes in PAI between baseline and last examination were assessed using Cox proportional hazard regression analyses.Results: During a median follow-up time of 9.3 years [interquartile range, 2.6-16.6; 181,765 person-years], there were 1144 deaths, including 400 CVD deaths. We observed an inverse linear association between change in PAI and risk of CVD mortality (P=0.007 for linear trend, and P=0.35 for quadratic trend). Compared to participants with zero PAI at both examinations, multivariable-adjusted analyses demonstrated that participants who maintained high PAI scores (≥100 PAI at both examinations) had a 51% reduced risk of CVD mortality [AHR, 0.49: 95% CI, 0.26-0.95)], and 42% reduced risk of all-cause mortality [AHR, 0.58: 95% CI, 0.41-0.83)]. For participants who increased their PAI scores over time (PAI score of zero at first examination and ≥100 at last examination), the AHRs were 0.75 (95% CI, 0.55-1.02) for CVD mortality, and 0.82 (95% CI, 0.69-0.99) for all-cause mortality. Participants who maintained high PAI score had 4.8 (95% CI, 3.3-6.4) years of life gained. For those who increased their PAI score over time, the corresponding years gained were 1.8 years (95% CI, 0.1-3.5).Conclusion: Among relatively healthy participants, an increase in PAI and maintaining a high PAI score over time was associated with reduced risk of CVD and all-cause mortality.Condensed Abstract: Our objective was to investigate the association between temporal changes in PAI and mortality in a large population from the United States. In this prospective cohort study of 17,613 relatively healthy participants at baseline, maintaining a high PAI score and an increase in PAI score over an average period of 6.3 years was associated with a significant reduction in CVD and all-cause mortality. Based on our results, clinicians can easily recommend that patients obtain at least 100 PAI for most favourable protection against CVD- and all-cause mortality, but can also mention that significant benefits also occur at maintaining low-to-moderate PAI levels. [ABSTRACT FROM AUTHOR]

Importance: Personal activity intelligence (PAI) is a novel activity metric that can be integrated into self-assessment heart rate devices, and translates heart rate variations during exercise into a weekly score. Previous studies relating to PAI have been conducted in the same populations from Norway where the PAI metric has been derived, limiting generalizability of the results.Objective: To test whether PAI is associated with total and cause-specific mortality in a large cohort from the United States.Design: Aerobics Center Longitudinal Study (ACLS) - a prospective cohort between January 1974 and December 2002 with a mean follow-up of 14.5 years.Setting: Population-based.Participants: 56,175 relatively healthy participants (26.5% women) who underwent extensive preventive medical examinations at Cooper Clinic (Dallas, TX).Exposure: Personal activity intelligence (PAI) score per week was estimated and divided into 4 groups (PAI scores of 0, ≤50, 51-99, and ≥100).Main Outcomes and Measures: Total and cause-specific mortality.Results: During a median follow-up time of 14.9 (interquartile range, 6.7-21.4) years, there were 3434 total deaths including 1258 cardiovascular (CVD) deaths. Compared with the inactive (0 PAI) group, participants with a baseline weekly ≥100 PAI had lower risk of mortality: adjusted hazard ratio (AHR), 0.79: 95% CI, 0.71-0.87 for all-cause mortality, and AHR, 0.72: 95% CI, 0.60-0.87 for CVD mortality among men; AHR, 0.85: 95% CI, 0.64-1.12 for all-cause mortality, and AHR, 0.48: 95% CI, 0.26-0.91 for CVD mortality among women. For deaths from ischemic heart disease (IHD), PAI score ≥100 was associated with lower risk in both men and women (AHR, 0.70: 95% CI, 0.55-0.88). Obtaining ≥100 weekly PAI was also associated with significantly lower risk of CVD mortality in pre-specified age groups, and in participants with known CVD risk factors. Participants with ≥100 weekly PAI gained 4.2 (95% CI, 3.5-4.6) years of life when compared with those who were inactive at baseline.Conclusions and Relevance: PAI is associated with long-term all-cause, CVD, and IHD, mortality. Clinicians and the general population can incorporate PAI recommendations and thresholds in their physical activity prescriptions and weekly physical activity assessments, respectively, to maximize health outcomes.Key Points: Question: What is the association between personal activity intelligence (PAI), a novel activity metric, and mortality in a large cohort from the United States?Findings: In this prospective study of 56,175 healthy participants at baseline, followed-up for a mean of 14.5 years, ≥100 PAI score/week was associated with significant 21% lower risk of all-cause and 30% lower risk of CVD mortality in comparison with inactive people. Participants with ≥100 PAI/week lived on average 4.2 years longer compared with inactive. Meaning: PAI is associated with long-term all-cause and CVD mortality. Clinicians and general population may incorporate PAI recommendations into weekly physical activity assessments to maximize CVD prevention. [ABSTRACT FROM AUTHOR]

The purpose of this article is to propose ways in which to increase PA levels in students from elementary and secondary schools, based on the implications of research findings examining adults' attitudes, beliefs, outlooks and preferences on PA and exercise. In other words, can the information that we have learned from adults in their relationship towards PA and exercise be utilized to increase PA levels within the school environment? [ABSTRACT FROM AUTHOR]

Background: The benefits of aerobic exercise (AE) for cardiovascular disease (CVD) have been well documented. Resistance exercise (RE) has been traditionally examined for its effects on bone density, physical function, or metabolic health, yet few data exist regarding the benefits of RE, independent of and combined with AE, for CVD prevention. This randomized controlled trial, "Comparison of the Cardiovascular Benefits of Resistance, Aerobic, and Combined Exercise (CardioRACE)," is designed to determine the relative benefits of RE, AE, or combined RE plus AE training on CVD risk factors.Methods: Participants are 406 inactive men and women (35-70 years) with a body mass index of 25-40 kg/m2 and blood pressure (BP) of 120-139/80-89 mm Hg without taking antihypertensive medications. Participants are randomly assigned to RE only, AE only, combined RE and AE (CE), or a no exercise control group. Participants perform supervised exercise at 50%-80% of their relative maximum intensity for both AE and RE, 3 times a week for 60 minutes per session, for 1 year (all 3 groups are time matched).Results: The primary outcome is a composite z score including resting BP, low-density lipoprotein cholesterol (LDL-C), fasting glucose, and percent body fat, which is assessed at baseline, 6 months, and 12 months. Diet and outside physical activity are measured throughout the intervention for 1 year.Conclusion: CardioRACE (ClinicalTrials.govNCT03069092) will fill an important knowledge gap regarding the effects of RE, alone or in addition to the well-documented effects of AE. CardioRACE will help generate more comprehensive and synergistic clinical and public health strategies to prevent CVD. [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness (CRF) has been widely studied as a powerful and independent predictor of all-cause and disease-specific mortality. Sudden cardiac death (SCD) is recognized as a significant cause of mortality among the general population, including the general population without previous symptoms of any coronary heart disease (CHD). Consequently, SCD is an important public health problem, which constitutes a clinical challenge. Thus, prevention of SCD by detecting early risk factors could be a useful tool, contributing to the American Heart Association's goal of decreasing the incidence of SCD at the population level. The identification of these risk factors for CVD would facilitate the large-scale screening of those participants at higher risk of SCD. This systematic review collects information about the role of CRF on the risk of SCD at the available evidence, and analyzes the long-term influence of CRF as a risk factor and independent predictor of SCD. [ABSTRACT FROM AUTHOR]

The cardiovascular disease (CVD) pandemic has placed considerable strain on healthcare systems, quality of life, and physical function, while remaining the leading cause of death globally. Decades of scientific investigations have fortified the protective effects of cardiorespiratory fitness (CRF), exercise training, and physical activity (PA) against the development of CVD. This review will summarize recent efforts that have made significant strides in; 1) the application of novel analytic techniques to increase the predictive utility of CRF; 2) understanding the protective effects of long-term compliance to PA recommendations through large cohort studies with multiple points of assessment; 3) and understanding the potential harms associated with extreme volumes of PA. [ABSTRACT FROM AUTHOR]

The aims of the present article are to systematically review and meta-analyze the existing evidence on: 1) differences in physical activity (PA), sedentary behavior (SB), cardiorespiratory fitness (CRF) and muscular strength (MST) between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO); and 2) the prognosis of all-cause mortality and cardiovascular disease (CVD) mortality/morbidity in MHO individuals, compared with the best scenario possible, i.e., metabolically healthy normal-weight (MHNW), after adjusting for PA, SB, CRF or MST. Our systematic review identified 67 cross-sectional studies to address aim 1, and 11 longitudinal studies to address aim 2. The major findings and conclusions from the current meta-analysis are: 1) MHO individuals are more active, spend less time in SB, and have a higher level of CRF (yet no differences in MST) than MUO individuals, suggesting that their healthier metabolic profile could be at least partially due to these healthier lifestyle factors and attributes. 2) The meta-analysis of cohort studies which accounted for PA (N = 10 unique cohorts, 100% scored as high-quality) support the notion that MHO individuals have a 24-33% higher risk of all-cause mortality and CVD mortality/morbidity compared to MHNW individuals. This risk was borderline significant/non-significant, independent of the length of the follow-up and lower than that reported in previous meta-analyses in this topic including all type of studies, which could be indicating a modest reduction in the risk estimates as a consequence of accounting for PA. 3) Only one study has examined the role of CRF in the prognosis of MHO individuals. This study suggests that the differences in the risk of all-cause mortality and CVD mortality/morbidity between MHO and MHNW are largely explained by differences in CRF between these two phenotypes. [ABSTRACT FROM AUTHOR]

Introduction Numerous studies have examined associations between sedentary behavior (SED) and mental health outcomes, however minimal research has investigated the reciprocal relationship between mood and SED. The purpose of this study was to examine the reciprocal relationship of SED with mood in young adults. Methods 430 adults (49.3% male) aged 21–35 provided valid objective activity data, in addition to an assessment of their mood. SED is defined as less than 1.5 METS (waking hours only). In addition, participants’ mood status (Total Mood Disturbance, TMD) was assessed by the Profile of Mood State (POMS) and total stress was assessed by the Perceived Stress Scale (PSS). SED was assessed at baseline, 6-months and one-year, while mood and stress were assessed at baseline and one-year. Results A cross-lagged, autoregressive clustered model was used to examine simultaneous changes over time in both mood and SED allowing for both clustering and adjustment of covariates (e.g., PSS) over time. Data suggests that TMD decreased significantly over one-year, suggesting improvement in mood (p = 0.05). There were positive associations between SED and TMD; this association increased over time (p = 0.04). Mean SED remained stable over the course of the study (p = 0.71). However, higher TMD scores were associated with greater mean SED (p = 0.005), and this association remained stable over the study period (p = 0.95). Conclusion These results indicate a reciprocal relationship between mood and SED suggesting that a decrease in SED can improve mood, likewise, an improved mood may decrease SED. However, the stronger association is mood status predicting time spent in SED. [ABSTRACT FROM AUTHOR]

The purpose of this review was to provide an overview of the descriptive epidemiology of physical activity (PA) and exercise training in the United States. Overall, there is a low prevalence of meeting the current PA guidelines in all age, sex and race/ethnic groups. Among adults the prevalence of meeting the aerobic component of the guidelines is approximately 51%, whereas the prevalence of meeting both the aerobic and muscle-strengthening guidelines is approximately 23%. Approximately 27% of high school students meet the aerobic component of the pediatric guidelines (60 minutes of daily moderate-to-vigorous activity), and the proportion of youth meeting the guidelines decreases with advancing age. Further research is required to promote physically active lifestyles across the age spectrum in order to achieve optimal health benefits for the overall population. [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness (CRF) has been one of the most widely examined physiological variables, particularly as it relates to functional capacity and human performance. Over the past three decades, CRF has emerged as a strong, independent predictor of all-cause and disease-specific mortality. The evidence supporting the prognostic use of CRF is so powerful that the American Heart Association recently advocated for the routine assessment of CRF as a clinical vital sign. Interestingly, the continuity of evidence of the inverse relationship between CRF and mortality over the past decade exists despite a wide variation of methods used to assess CRF in these studies, ranging from the gold-standard method of directly measured maximal oxygen uptake (V02max) during cardiopulmonary exercise testing to estimation from exercise tests and non-exercise prediction equations. This review highlights new knowledge and the primary advances since 2009, with specific reference to the impact variations in CRF have on all-cause and disease-specific mortality. [ABSTRACT FROM AUTHOR]

The purpose of this review was to provide an overview of the descriptive epidemiology of physical activity (PA) and exercise training in the United States. Overall, there is a low prevalence of meeting the current PA guidelines in all age, sex and race/ethnic groups. Among adults the prevalence of meeting the aerobic component of the guidelines is approximately 51%, whereas the prevalence of meeting both the aerobic and muscle-strengthening guidelines is approximately 23%. Approximately 27% of high school students meet the aerobic component of the pediatric guidelines (60 minutes of daily moderate-to-vigorous activity), and the proportion of youth meeting the guidelines decreases with advancing age. Further research is required to promote physically active lifestyles across the age spectrum in order to achieve optimal health benefits for the overall population. [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness (CRF) has been one of the most widely examined physiological variables, particularly as it relates to functional capacity and human performance. Over the past three decades, CRF has emerged as a strong, independent predictor of all-cause and disease-specific mortality. The evidence supporting the prognostic use of CRF is so powerful that the American Heart Association recently advocated for the routine assessment of CRF as a clinical vital sign. Interestingly, the continuity of evidence of the inverse relationship between CRF and mortality over the past decade exists despite a wide variation of methods used to assess CRF in these studies, ranging from the gold-standard method of directly measured maximal oxygen uptake (VO2max) during cardiopulmonary exercise testing to estimation from exercise tests and non-exercise prediction equations. This review highlights new knowledge and the primary advances since 2009, with specific reference to the impact variations in CRF have on all-cause and disease-specific mortality. [ABSTRACT FROM AUTHOR]

Background: A small change in tea consumption at population level could have large impact on public health. However, the health benefits of tea intake among Americans are inconclusive. Objective: To evaluate the association between tea consumption and all-causes, cardiovascular disease (CVD) and cancer mortality in the Aerobics Center Longitudinal study (ACLS). Methods: 11808 participants (20-82 years) initially free of CVD and cancers enrolled in the ACLS and were followed for mortality. Participants provided baseline self-report of tea consumption (cups/day). During a median follow-up of 16 years, 842 participants died. Of others, 250 died from CVD, and 345 died from cancer, respectively. A Cox proportional hazard model was used to produce hazard ratio (HR) and 95% confidence interval (CI). Results: Compared with participants consuming no tea, tea drinkers had a survival advantage ( Log-2 = 10.2, df = 3, P = 0.017); however, the multivariate hazard ratios (HRs) of all-cause mortality for those drinking 1–7, 8–14, and >14 cups/week were 0.95 (95% CI, 0.81–1.12), 1.00 (95% CI, 0.82–1.22), and 0.98 (95% CI, 0.76–1.25), respectively (P for linear trend = 0.83). The multivariate HR were 1.16 (95% CI, 0.86–1.56), 1.22 (95% CI, 0.85–1.76), and 0.94 (95% CI, 0.56–1.54) for CVD mortality (P for linear trend = 0.47), and 0.97 (95% CI, 0.75–1.25), 0.85 (95% CI, 0.60–1.16), and 0.94 (95% CI, 0.64–1.38) for cancer mortality (P for trend = 0.62). Conclusions: There were week or null relationships between tea consumption and mortality due to all-cause, CVD disease or cancer were observed in ACLS. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to examine the validity of the 1971-2010 United States Department of Agriculture's (USDA's) loss-adjusted food availability (LAFA) per capita caloric consumption estimates. Estimated total daily energy expenditure (TEE) was calculated for nationally representative samples of US adults, 20-74 years, using the Institute of Medicine's predictive equations with "low-active" (TEE L-ACT) and "sedentary" (TEE SED) physical activity values. TEE estimates were subtracted from LAFA estimates to create disparity values (kcal/d). A validated mathematical model was applied to calculate expected weight change in reference individuals resulting from the disparity. From 1971-2010, the disparity between LAFA and TEE L-ACT varied by 394kcal/d-(P < 0.001), from -205kcal/d (95% CI: -214, -196) to +189kcal/d (95% CI: 168, 209). The disparity between LAFA and TEE SED varied by 412kcal/d (P < 0.001), from -84kcal/d (95% CI: -93, -76) to +328kcal/d (95% CI: 309, 348). Our model suggests that if LAFA estimates were actually consumed, reference individuals would have lost ~1-4kg/y from 1971-1980 (an accumulated loss of ~12 to ~36kg), and gained ~3-7kg/y from 1988-2010 (an accumulated gain of ~42 to ~98kg). These estimates differed from the actual measured increments of 10kg and 9kg in reference men and women, respectively, over the 39-year period. The USDA LAFA data provided inconsistent, divergent estimates of per capita caloric consumption over its 39-year history. The large, variable misestimation suggests that the USDA LAFA per capita caloric intake estimates lack validity and should not be used to inform public policy. [ABSTRACT FROM AUTHOR]

Objectives: Health disparities between subgroups may be partially due to differences in lifestyle behaviors such as sedentariness and physical activity. To obtain a more accurate description of these two lifestyle behaviors, accelerometry was employed among a large sample of white and black adults (ages 49-99 years) living in the United States.Design: Cross-sectional.Methods: 7967 participants from the REasons for Geographic and Racial Differences in Stroke cohort wore an Actical™ accelerometer ≥10h/day for ≥4 days. Time (mean minutes/day and proportion of total wear time) spent in sedentary behavior, light intensity physical activity, and moderate-vigorous intensity physical activity was compared by sex, age, body mass index, race, and geographic location.Results: Proportion of total wear time spent in sedentary behavior was 75-90%, light intensity physical activity was 10-23%, and moderate-vigorous intensity physical activity was 0-1.7% across subgroups. Mean moderate-vigorous intensity physical activity was 0-16min/day and associated with 3-12% accumulating ≥150min/wk using a 10-min bout criterion. Persons ≥85 years, those classified obese, persons living in the southeastern United States, and black women were the most inactive. The proportion achieving at least one 10-min bout of moderate-vigorous intensity physical activity per week was only 36%. The number of 10-min bouts/week was 1.5±0.08bouts/week. The distribution of weekly moderate-vigorous intensity physical activity was similar across nearly all subgroups with a distinct reverse J-shaped configuration.Conclusions: The vast majority of white and black midlife and older adults in this study engaged sparingly in moderate-vigorous intensity physical activity, accumulated tremendous amounts of sedentary behavior, and seldom engaged in continuous bouts of health-enhancing physical activity. [ABSTRACT FROM AUTHOR]

Objective: To describe African American and White women's perceptions of weight gain, physical activity, and nutrition during pregnancy and to explore differences in perceptions by race. Design: Qualitative interview study. Setting: Two Ob/Gyn clinics in South Carolina, USA. Participants: Thirty pregnant women (15 African American, 15 White) between 20 and 30 weeks gestation, equally represented across pre-pregnancy BMI categories (10 normal weight, 10 overweight, and 10 obese). Findings: White women more frequently described intentions to meet weight gain, physical activity, and dietary guidelines in pregnancy than African American women. African American women were more concerned with inadequate weight gain while White women more commonly expressed concerns about excessive weight gain. More White women discussed the importance of physical activity for weight management. Regardless of race, few women described risks of excessive weight gain or benefits of physical activity as it relates to the baby's health. The primary cited barrier of healthy eating was the high cost of fresh produce. Key conclusions and implications for practice: Several knowledge gaps as well as race differences were identified in women's perceptions and intentions toward weight gain, physical activity, and nutrition during pregnancy. Future interventions should seek to educate women about common misperceptions. It may be necessary to culturally tailor gestational weight gain interventions to optimise health outcomes. [ABSTRACT FROM AUTHOR]

Background: Medical professionals serve as influential sources of information and guidance for their patients. Medical school may be an opportune time to provide future physicians with training in physical activity (PA) so that it can be more effectively addressed in clinical practice. Methods: To assess the inclusion and amount of PA training in US medical school curricula, we attempted to conduct structured interviews with the program directors of the 171 accredited US medical education programs in the spring of 2013. Results: Seventy-four schools (allopathic, n = 64; osteopathic, n = 10) completed the structured interviews. Fifty-eight programs (78.4%) reported having PA training included as a part of their curriculum. Thirty-five (61.4%) and 25 (43.9%) programs included instruction on national aerobic and strength training guidelines, respectively. Thirty-one programs (56.4%) felt that they offered a sufficient level of PA-related training for their students to successfully counsel their patients in the future. Over the 4 years of medical school, an average of 8.1 (± 9.8) h of mandatory PA training was offered. Conclusion: Though many medical schools report providing some level of PA content, the time dedicated for this training is still low in comparison to other topics, such as nutrition education, which are featured more prominently. New and innovative ideas are needed for the integration of more, higher quality PA training for our next generation of medical practitioners. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to examine the association between resistance exercise and cardiovascular disease risk, independent of body composition, physical activity and aerobic capacity, in healthy women.Design: A cross-sectional analysis including 7321 women with no history of heart disease, hypertension or diabetes was performed.Methods: Participation in resistance exercise was self-reported and body weight and height was measured. A single cardiovascular disease risk score was established via factor analysis including percent body fat, mean arterial pressure, fasting glucose, total cholesterol and triglyceride levels. Physical activity level was determined based on questionnaire data and aerobic capacity was assessed via a maximal treadmill exercise test.Results: Women reporting resistance exercise had lower total cardiovascular disease risk at any age. Specifically, resistance exercise was associated with lower body fat, fasting glucose and total cholesterol. The association between resistance exercise and cardiovascular disease risk, however, remained only in normal weight women after adjusting for physical activity and aerobic capacity.Conclusion: Results of the present study underline the importance of resistance exercise as part of a healthy and active lifestyle in women across all ages. Our results suggest that resistance exercise may be particularly beneficial to independently improve cardiovascular disease risk profiles in women with normal weight. In overweight/obese women, total physical activity and aerobic capacity may have a stronger association with cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

Summary Purpose The purpose of this study was to examine differences in total daily energy expenditure (TDEE), energy expenditure in various intensities, as well as total daily energy intake (TDEI) and diet quality in normal weight, overweight and obese men and women. Further, the association of energy expenditure and energy intake with body fatness was examined. Methods The cross-sectional analysis included 430 adults (27.7 ± 3.8 years; 49.3% male). Body weight and height were measured according to standard procedures and percent body fat (BF) was assessed via dual X-ray absorptiometry. Energy expenditure was determined via the SenseWear Armband. Energy intake and the Healthy Eating Index (HEI) were calculated based on multiple 24-h recalls. Results Weight adjusted TDEI and TDEE were significantly lower in overweight and obese adults compared to their normal weight peers ( p < 0.001) and obese women had a lower HEI ( p = 0.006). Overweight and obese adults further displayed a higher proportion of energy expenditure spent in sedentary and in light activities ( p < 0.001), while the proportion of energy expenditure in moderate-to-vigorous physical activity (MVPA) was lower compared to their normal weight peers ( p < 0.001). The inverse relationship between BMI or BF and MVPA was stronger than the positive association between BMI or BF and the proportion of energy expended in sedentary or light pursuits ( r MPA = −0.45 to −0.67/ r MVPA = −0.51 to −0.66 vs. r Sedentary = 0.33 to 0.52/ r light = 0.36 to 0.47; p < 0.001). Conclusions These findings emphasise the importance of MPA and bouts of MVPA regarding the maintenance of a normal body weight. [ABSTRACT FROM AUTHOR]

Despite the strong and consistent evidence supporting that a high physical fitness (PF) level at any age is a major predictor of a healthier metabolic profile, major studies focused on the metabolically healthy but obese (MHO) phenotype have ignored the role of PF when examining this phenotype and its prognosis. Particularly, the role of its main health-related components such as higher cardiorespiratory fitness (CRF) and muscular fitness in the MHO phenotype needs to be reviewed in depth. The present review aimed to: 1) contribute to the characterization of the MHO phenotype by examining whether MHO individuals are fitter than metabolically abnormal obese (MAO) individuals in terms of CRF and other PF components; 2) review the role of CRF and other PF components in the prognosis of MHO. The studies reviewed suggest that a higher CRF level should be considered a characteristic of the MHO phenotype. Likewise, CRF seems to play a key role in the prognosis of the MHO individuals, yet this statement is based on a single study and future studies need to confirm or contrast these findings. Comparability of studies is difficult due to the different definitions used for MHO; consequently, the present review makes a proposal for harmonizing this definition in adults and in youth. Obesity is still related to an important number of comorbidities; therefore, the public health message remains to fight against both obesity and low CRF in both adult and pediatric populations. [ABSTRACT FROM AUTHOR]

This study examined whether the discrepancy between measured and self-identified good weight (weight discrepancy) predicts metabolic syndrome (MetSyn). This study included 6,413 participants enrolled in the Aerobics Center Longitudinal Study (mean follow-up: 4.8 ± 3.8 years). Weight discrepancy was defined as measured weight minus self-identified good weight. MetSyn was defined using standard definitions. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident MetSyn, by weight discrepancy category, were estimated using Cox proportional hazards regression. The multivariable-adjusted HR for MetSyn was 3.48 (95% CI = 2.48–4.86) for those who maintained higher weight discrepancy over time compared to individuals with lower weight discrepancy. Additional adjustment for body mass index did not change this interpretation (HR = 3.44; 95% CI = 2.46–4.82). Weight discrepancy may be a useful screening characteristic and target for future interventions to further reduce the risk of chronic weight-related disorders, included MetSyn. [ABSTRACT FROM AUTHOR]

OBJECTIVE:Weight dissatisfaction, defined as discordance between actual and goal weight, may be associated with increased risk for several obesity-related comorbidities. The purpose of the study was to examine the association between weight dissatisfaction and risk of developing Type 2 diabetes. METHOD: This longitudinal study used data from 9,584 adults enrolled in the Aerobics Center Longitudinal Study. Key variables included multiple measures of measured weight, self-reported goal weight, and incident diabetes. Weight dissatisfaction was defined as being above the median of measured weight minus goal weight. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetes incidence by weight dissatisfaction. RESULTS: HRs for time until diabetes diagnosis revealed that family history of diabetes (HR = 1.46, 95% CI [1.13, 1.90]), age (HR = 1.03, 95% CI [1.02, 1.04]), and weight dissatisfaction (HR = 1.83, 95% CI [1.50, 2.25]) at baseline were statistically significant predictors. Longitudinally, higher risk was observed in individuals who either stayed dissatisfied (HR = 2.98, 95% CI [1.98, 4.48]) or became dissatisfied (HR = 1.51, 95% CI [0.79, 2.89]), compared with those who stayed satisfied. After additional adjustment for BMI, the elevated HR for those who remained dissatisfied compared with those who remained satisfied persisted (HR = 2.85, 95% CI [1.89, 4.31]). CONCLUSIONS: Weight dissatisfaction, regardless of BMI, represents a potentially important psychophysiological modifier of the relationships between BMI and risk of Type 2 diabetes, and warrants greater attention in future studies of chronic disease risk. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To examine the association between participation in flexibility or muscle-strengthening activities with the development of low back pain. Design: Observational cohort study. Methods: The cohort included 4610 adults, 17% female, between 20 and 81 years of age (mean 46.6, standard deviation 4.96). The cohort was followed for a mean of 4.9 years for self-reported low back pain. All participants reported at baseline whether they performed flexibility or muscle-strengthening activities, including specific sub-types. Results: Neither general performance of flexibility or muscle-strengthening activities were associated with a higher incidence of low back pain compared to those who did not perform these activities. Those who reported stretching, as a specific flexibility activity were at a higher risk of developing low back pain compared with those who performed no flexibility exercises, reported callisthenic flexibility activities, or attended exercise classes. Those who reported using weight training machines, as part of muscle-strengthening activities, had a higher risk of reporting low back pain, compared with those who did not perform muscle-strengthening activities or performed callisthenic or free weight activities. Conclusions: In this sample, stretching or use of weight training machines is associated with increased risk of developing low back pain compared to use of free weights, callisthenics or exercise classes. [Copyright &y& Elsevier]

The effects of overweight and obesity on chronic diseases, particularly on cardiovascular disease (CVD), and its impact on increasing CVD risk factors and total CVD are reviewed. However despite the adverse effects of obesity on CVD risk factors and CVD, obesity has a surprising association with prognosis in patients with established diseases, often showing an “obesity,” where overweight (body mass index (BMI), 25 to 29.9 kg·m-2) and obese patients (BMI, ≥30 kg·m-2) with established CVD frequently have a better prognosis than that of their leaner counterparts (BMI, <25 kg·m-2) with the same diseases. Fitness-versus-fatness debate is summarized also, including the critical role that fitness plays to alter the relationship between adiposity and subsequent prognosis. [ABSTRACT FROM AUTHOR]