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Background: Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non‐caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self‐care, is predictive of health outcomes and CVD risk in several populations. However, it is not known whether health activation is associated with CVD risk in rural caregivers of patients with chronic illnesses nor is it clear whether sex moderates any association. Objectives: Our aims were to determine (1) whether health activation independently predicts 10‐year CVD risk; and (2) whether sex interacts with health activation in the prediction of 10‐year CVD risk among rural family caregivers (N = 247) of patients with chronic illnesses. Methods: Health activation was measured using the Patient Activation Measure. The predicted 10‐year risk of CVD was assessed using the Framingham Risk Score. Data were analyzed using nonlinear regression analysis. Results: Higher levels of health activation were significantly associated with decreased risk of developing CVD (p < 0.028). There was no interaction of sex with health activation on future CVD risk. However, male caregivers had greater risk of developing CVD in the next 10 years than female caregivers (p < 0.001). Conclusions: We demonstrated the importance of health activation to future CVD risk in rural family caregivers of patients with chronic illnesses. We also demonstrated that despite the higher risk of future CVD among male, the degree of association between health activation and CVD risk did not differ by sex. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine differences in heart rate recovery (HRRec) and oxygen consumption recovery (VO2 recovery) between young healthy-weight children and children with obesity following a maximal volitional graded exercise test (GXTmax). Method: Twenty healthy-weight children and 13 children with obesity completed body composition testing and performed a GXTmax. Immediately after the GXTmax, HRRec and VO[subscript 2] recovery were measured each minute for 5 consecutive minutes. Results: There were no statistically significant group differences in HRRec for the 5 min following maximal exercise, Wilks's Lambda = 0.885, F(4, 28) = 0.911, p = 0.471, between the healthy-weight children and children with obesity despite statistically significant differences in body fat percentage (BF%; healthy-weight children, 18.5 ± 6.1%; children with obesity, 41.1 ± 6.9%, p < 0.001) and aerobic capacity relative to body mass (VO[subscript 2] peak; healthy-weight children, 46.8 ± 8.2 mL/kg/min; children with obesity, 31.9 ± 4.7 mL/kg/min, p < 0.001). There were statistically significant differences in VO[subscript 2] recovery for the 5 min following exercise, Wilks's Lambda = 0.676, F(4, 26) = 3.117, p = 0.032. There were no statistically significant correlations between HRRec and body mass index (BMI), BF%, VO[subscript 2] peak, or physical activity. Conclusions: In a healthy pediatric population, obesity alone does not seem to significantly impact HRRec, and because HRRec was not related to obesity status, BMI, or BF%, it should not be used as the sole indicator of aerobic capacity or health status in children. Using more than one recovery variable (i.e., HRRec and VO[subscript 2] recovery) may provide greater insight into cardiorespiratory fitness in this population.

Objective: To compare anthropometric measures of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and sagittal abdominal diameter (SAD) as predictors of blood pressure in college students. Participants: Students (N = 116) were recruited from November 2012 to May 2014 at an urban university and rural community colleges. Methods: Students underwent a brief physical examination during which anthropometric measures were obtained and blood pressure was measured. Covariates were measured using self-reported questionnaires. Hierarchical multiple linear regressions were used for the data analysis. Results: All anthropometric measures were predictive of systolic (SBP) and diastolic blood pressure (DBP). WC was the strongest predictor of SBP (ß = 0.582, p < 0.01) explaining an additional 3-4% of the variance than BMI, WHtR, or SAD. The measures were similar in predicting DBP. WC predicted SBP independent of BMI. Conclusions: Clinicians should consider using WC to assess the risk for hypertension in college students.

BackgroundAmong patients with heart failure (HF), anxiety symptoms may co-exist with depressive symptoms. However, the extent of overlap and risk factors for anxiety symptoms have not been thoroughly described.PurposeThe aim of this study was to describe the coexistence of anxiety and depressive symptoms, and to determine the predictors of anxiety symptoms in patients with HF.MethodsThe sample consisted of 556 outpatients with HF (34% female, 62±12 years, 54% New York Heart Association (NYHA) class III/IV) enrolled in a multicenter HF quality of life registry. Anxiety symptoms were assessed with the Brief Symptom Inventory-anxiety subscale. Depressive symptoms were measured with the Beck Depression Inventory-II (BDI). We used a cut-point of 0.35 to categorize patients as having anxiety symptoms or no anxiety symptoms. Logistic regression was used to determine whether age, gender, minority status, educational level, functional status, comorbidities, depressive symptoms, and antidepressant use were predictors of anxiety symptoms.ResultsOne-third of patients had both depressive and anxiety symptoms. There was a dose-response relationship between depressive symptoms and anxiety symptoms; higher levels of depressive symptoms were associated with a higher level of anxiety symptoms. Younger age (odds ratio (OR)= 0.97, p=0.004, 95% confidence interval (CI) 0.95-0.99) and depressive symptoms (OR =1.25, p

ObjectiveThis study sought to compare the prevalence of anxiety, depression, and hostility among 3 clinically diverse elderly cardiac patient cohorts and a reference group of healthy elders.MethodsThis was a multicenter, comparative study. A total of 1167 individuals participated: 260 healthy elders, and 907 elderly cardiac patients who were at least 3 months past a hospitalization (478 heart-failure patients, 298 postmyocardial infarction patients, and 131 postcoronary artery bypass graft patients). Symptoms of anxiety, depression, and hostility were measured using the Multiple Affect Adjective Checklist.ResultsThe prevalence of anxiety, depression, and hostility was higher in patients in each of the cardiac patient groups than in the group of healthy elders. Almost three quarters of patients with heart failure reported experiencing symptoms of depression, and the heart-failure group manifested the greatest percentage of patients with depressive symptoms.ConclusionsThe high levels of emotional distress common in cardiac patients are not a function of aging, because healthy elders exhibit low levels of anxiety, depression, and hostility.

Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure (HF). Using a prospective, experimental design, the effects of 24 weeks of a low-level, home-based walking program on weight loss were studied in overweight and obese (body mass index > or =27 kg/m(2)) patients with advanced HF who were randomized to exercise (n = 48) and control (n = 51) groups. Weight changes between the 2 groups at baseline and 6 months were compared using repeated-measures analysis of variance. Patients were on average aged 53.3 +/- 10.1 years and predominantly male (75%), Caucasian (57%), and married (55%). Most patients were in New York Heart Association class III or IV (67%), with a mean ejection fraction of 25%. Patients in the exercise group showed significant weight reduction from baseline to 6 months compared with those in the control group (-6.37 +/- 11.7 vs -0.33 +/- 9.3 kg, p = 0.002). No significant differences were noted between the 2 groups in 6-minute walk distance or depression, although the changes were in the anticipated direction. Modest weight losses of >5% were associated with cardiopulmonary exercise test-documented workload levels at 6 months (r = 0.331, p = 0.006), as well as decreased depression (r = -0.315, p = 0.01) and hostility (r = -0.355, p = 0.005). The number of hospital admissions was significantly smaller for patients in the exercise group compared with those in the control group (0.63 +/- 0.94 vs 1.07 +/- 0.95, p