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We recently reported that a 12-week internet weight loss program produced greater weight losses than education control in overweight/obese people living with HIV (PLWH) (4.4 kg vs 1.0 kg; p

Mental health and emotional disorders are often associated with higher mortality risk. Whether higher cardiorespiratory fitness (CRF) reduces the risk for all-cause mortality in individuals with emotional distress is not well known.Participants were 5240 men (mean age 46.5±9.5 years) with emotional distress (including depression, anxiety, thoughts of suicide, or a history of psychiatric or psychological counseling) who completed an extensive medical examination between 1987 and 2002, and were followed for all-cause mortality through December 31, 2003. Cardiorespiratory fitness was quantified as maximal treadmill exercise test duration and was grouped for analysis as low, moderate, and high. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs.During a median of 8.7 years (range, 1.0-16.9 years) and 46,217 person-years of follow-up, there were 128 deaths from any cause. Age- and examination year-adjusted all-cause mortality rates per 10,000 person-years according to low, moderate, and high CRF groups were 64.7 (95% CI, 44.9-89.3), 28.0 (95% CI, 23.8-31.5), and 19.6 (95% CI, 17.1-21.6) (trend P.001) in men who reported any emotional distress. Overall, the multivariable-adjusted HRs and 95% CIs across incremental CRF categories were 1.00 (referent), 0.54 (0.32-0.90), and 0.47 (0.26-0.85), linear trend P =.03.Among men with emotional distress, higher CRF is associated with lower risk of dying, independent of other clinical mortality predictors. Our findings underscore the importance of promoting physical activity to maintain a healthful level of CRF in individuals with emotional distress.

The burden of comorbid depression among adults with arthritis is of concern. The purpose of this study is to understand how a self-directed exercise intervention among adults with arthritis exerted its effects on depressive symptoms by performing serial mediation analyses. Methods Participants were randomized to a self-directed exercise program or to self-directed nutrition program (control). Self-reported physical activity, arthritis symptoms (pain, stiffness, fatigue), disability, and depressive symptoms were measured at baseline and 12 weeks. Serial mediation models were conducted to examine the indirect effects of the exercise intervention on changes in depressive symptoms through changes in physical activity and changes in arthritis symptoms/disability (i.e., intervention group→increased physical activity → decreased arthritis symptoms/disability → decreased depressive symptoms). Results A total of 315 participants with complete data were included in these analyses. Results from the serial mediation models found significant indirect effects of the exercise intervention on decreases in depressive symptoms through (1) increases in physical activity and decreases in pain, and (2) increases in physical activity and decreases in disability. There were no significant indirect effects through (1) increases in physical activity and decreases in fatigue, or (2) increases in physical activity and decreases in stiffness. Conclusions This study highlights the importance of physical activity in reducing depressive symptoms, and the means by which it helps (i.e., reducing pain and disability). Understanding these pathways may help researchers design more efficacious interventions.

SummaryBackground Human immunodeficiency virus infection and obesity are pro-inflammatory conditions that, when occurring together, may pose a synergistic risk for diabetes and cardiovascular disease. Purpose The aim of the current study was (i) to document the prevalence of obesity in HIV+ patients treated at the Miriam Hospital Immunology Center (Providence, RI) and (ii) to investigate the relationship between obesity and comorbidities. Methods The study population consisted of 1,489 HIV+ adults (70% men; average age 48 ± 11 years) treated between 01/01/2012 and 06/30/2014. Separate logistic regressions tested the associations between overweight and obesity and comorbid diagnoses (diabetes, hypertension and cardiovascular disease), as compared with normal weight. Covariates included age, gender and smoking status. Results Approximately 37% of patients were overweight (body mass index 25.0–29.9), and an additional 28% were obese (body mass index ≥30.0). Obesity was associated with higher odds of comorbid diabetes (OR = 3.26, CI = 1.98–5.39) and hypertension (OR = 2.11, CI = 1.49–2.98). There was no significant association between obesity and the presence of cardiovascular disease (OR = 1.12, CI = 0.66–1.90). Overweight was associated only with higher odds of comorbid diabetes (OR = 1.72; CI = 1.02–2.88). Conclusion Our findings demonstrate a heightened risk of comorbidities in overweight and obese HIV+ patients. Future studies should investigate whether weight loss interventions for this population can reduce cardiovascular and metabolic risk factors as they do in other populations.

Objectives To examine the clinical meaningfulness of changes observed in functional performance from two self-directed interventions targeting adults with arthritis. Study design Randomized controlled trial. Methods Participants ( n = 312) were randomized to a 12-week self-directed exercise or nutrition intervention. Objective measures of functional performance (6-minute walk, seated reach, grip strength, 30-second chair stand, gait speed, balance) were obtained at baseline, 12 weeks, and nine months. Minimally (≥0.20 standard deviation) and substantially (≥0.50) meaningful changes in functional performance were examined. Changes in the percent ‘impaired’ and at risk for losing independence using established standards, and associations between physical activity and impairment/risk status were also examined. Group × Time interactions were not significant; therefore groups were combined in all analyses. Results Minimally (31–71%) and substantially (13–54%) meaningful changes in function were shown. There was a significant decrease in the percentage of participants ‘impaired’ on the 30-second chair stand (both time points) and gait speed (nine months). The percentage of participants at risk for losing independence significantly decreased for the 30-second chair stand (both time points) and the 6-minute walk (nine months). Those engaging in ≥2 h of leisure-time physical activity were significantly less likely to be impaired on the 6-minute walk, 30-second chair stand, and gait speed at 12 weeks, and the 6-minute walk at nine months. Conclusions Interventions that can slow functional declines, and ideally result in clinically meaningful improvements in functional performance among adults with arthritis are needed. Meaningful improvements in various indicators of functional performance can result from self-directed exercise and nutrition programs. These types of programs have the potential for wide-spread dissemination, and thus broad reach.

Being overweight or obese might be a risk factor for developing depression. It is also possible that low cardiorespiratory fitness, rather than overweight or obesity, is the better predictor of depressive symptom onset. Adults in the Aerobics Center Longitudinal Study (Dallas, Texas) underwent fitness and fatness assessments between 1979 and 1998 and later completed a questionnaire about depressive symptoms in 1990, 1995, or 1999. Separate logistic regression models were used to test the associations between 3 fatness measures (body mass index, waist circumference, and percentage of body fat) and the onset of depressive symptoms. Analyses were repeated using fitness as the predictor variable. Additional analyses were performed to study the joint association of fatness and fitness with the onset of depressive symptoms. After controlling for fitness, no measure of fatness was associated with the onset of depressive symptoms. In joint analyses, low fitness was more strongly associated with the onset of elevated depressive symptoms than was fatness, regardless of the measure of fatness used. Overall, results from the present study suggest that low fitness is more strongly associated with the onset of elevated depressive symptoms than is fatness. To reduce the risk of developing depression, individuals should be encouraged to improve their fitness regardless of body fatness.

Accurate assessment of dietary intake and physical activity is a vital component for quality research in public health, nutrition, and exercise science. However, accurate and consistent methodology for the assessment of these components remains a major challenge. Classic methods use self-report to capture dietary intake and physical activity in healthy adult populations. However, these tools, such as questionnaires or food and activity records and recalls, have been shown to underestimate energy intake and expenditure as compared with direct measures like doubly labeled water. This paper summarizes recent technological advancements, such as remote sensing devices, digital photography, and multisensor devices, which have the potential to improve the assessment of dietary intake and physical activity in free-living adults. This review will provide researchers with emerging evidence in support of these technologies, as well as a quick reference for selecting the “right-sized” assessment method based on study design, target population, outcome variables of interest, and economic and time considerations. Theme information This article is part of a theme issue entitled Innovative Tools for Assessing Diet and Physical Activity for Health Promotion, which is sponsored by the North American branch of the International Life Sciences Institute.

Background and Purpose: There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance. Methods: A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties. Results and Discussion: A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD. Conclusions: The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.

Obesity compounds the negative health effects of human immunodeficiency virus (HIV) infection. We conducted the first randomized trial of behavioral weight loss for HIV-infected patients (n = 40). Participants randomized to an Internet behavioral weight loss program had greater 12-week weight loss (mean, 4.4 ± 5.4 kg vs 1.0 ± 3.3 kg; P = .02) and improvements in quality of life than controls. CLINICAL TRIALS REGISTRATION: NCT02421406.

Previous findings are inconclusive regarding the mediators of physical activity behavior change. To test self-efficacy and social support as mediators of Active Choices, a telephone-delivered physical activity intervention, and Active Living Every Day, a group-based physical activity intervention, implemented with midlife and older adults in community settings. MacKinnon's product of coefficients was used to examine social support and self-efficacy as mediators of change in physical activity. The proportion of the total effect mediated was calculated. Each model controlled for age, gender, race (white vs. non-white), body mass index (BMI), and education (high school graduate or less vs. at least some college). Increases in self-efficacy mediated increases in physical activity among Active Choices (n = 709) and Active Living Every Day (n = 849) participants. For Active Living Every Day, increases in social support also mediated increases in physical activity in single mediator models. Increasing self-efficacy and social support may help increase physical activity levels in older adults.

Physical activity (PA) professionals and participants recognize enhanced quality of life (QoL) as a benefit of and motivator for PA. However, QoL measures are often problematic and rarely consider the participants'perspective. This paper focuses on recent findings from a larger project on the role of QoL in PA and health promotion. More specifically, we focus on the views of participants and potential participants to better understand the relationship of PA and QoL. In earlier stages of the project we began with a conceptual model of QoL and developed a survey. We now focus on participants' views and ask two questions: 1) what is QoL? and 2) how does PA relate to QoL? We first asked those questions of a large sample of university students and community participants as open-ended survey items, and then asked focus groups of community participants. Overall, participants' responses reflected the multidimensional, integrative QoL model, but the responses and patterns provided information that may not be picked up with typical survey measures. Findings suggest that PA contributes to multiple aspects of QoL, that social and emotional benefits are primary motivators and outcomes for participants, and that the meaning of QoL and PA benefits is subjective and contextualized, varying across individuals and settings. Programs that directly target and highlight the multiple dimensions and integrative QoL, while considering the individual participants and contexts, may enhance both PA motivation and participants' health and QoL.

In light of ever-present partisan division in the US political system, it is critical that researchers gain a better under-standing of potential biological differences that exist between self-professed Democrats and Republicans. In the current pilot experiment, we examined differences within the human mirror neuron system (hMNS), a network linked to a host of social and emotional abilities, in a small group of self-identified Republicans and Democrats. We found clear differences between these two groups with respect to resting-state brain connectivity within the hMNS. These neural differences were not systematically related to differences in empathy. Our findings are consistent with the idea that other factors, such as one’s preferential type of social connectivity (broad vs. tight), may have driven the reported findings. These data provide novel insights regarding our knowledge of the biological basis of party identification, and suggest specific directions for future research.

Acute exercise benefits cognition, and some evidence suggests that brain-derived neurotrophic factor (BDNF) plays a role in this effect. The purpose of this study was to explore the dose–response relationship between exercise intensity, memory, and BDNF. Young adults completed 3 exercise sessions at different intensities relative to ventilator threshold (Vt) (VO2max, Vt – 20%, Vt + 20%). For each session, participants exercised for approximately 30 min. Following exercise, they performed the Rey Auditory Verbal Learning Test (RAVLT) to assess short-term memory, learning, and long-term memory recall. Twenty-four hours later, they completed the RAVLT recognition trial, which provided another measure of long-term memory. Blood was drawn before exercise, immediately postexercise, and after the 30-min recall test. Results indicated that long-term memory as assessed after the 24-hr delay differed as a function of exercise intensity with the largest benefits observed following maximal intensity exercise. BDNF data showed a significant increase in response to exercise; however, there were no differences relative to exercise intensity and there were no significant associations between BDNF and memory. Future research is warranted so that we can better understand how to use exercise to benefit cognitive performance.

This study examined whether inactive, overweight/obese women experience consistent affective responses to moderate-intensity exercise. Twenty-eight women participated in 3 identical (same treadmill grade and speed within a subject) 30-min exercise sessions. The Feeling Scale (FS), Positive and Negative Affect Schedule and Subjective Exercise Experience Scale were administered pre- and postexercise and FS was also administered every 5 min during exercise. All measures exhibited less than optimal agreement in pre-to-postexercise change within an individual across the 3 sessions (ICCs = 0.02–0.60), even after controlling for within-subject variations in heart rate. Only FS exhibited “good” consistency when controlling for preexercise values (ICC = 0.72). However, the mean FS score during exercise was highly consistent within an individual (ICC = 0.83). Thus, an individual’s affective response to an exercise session does not provide reliable information about how they will respond to subsequent exercise sessions. Taking the average of FS measurements during exercise may yield more consistent findings.

We appreciate Dr. Mukamal's thoughtful commentary (1) on our paper (2). We are in agreement with Dr. Mukamal on a number of points, but wish to re-affirm and clarify our stance on others. In his commentary, Dr. Mukamal says, “To some degree, this [fit versus fat] debate is poorly suited to epidemiologic inquiry” (1, p. 321). He stresses that it is difficult to ascertain repeated, quality measurements of fitness in epidemiologic studies. This point speaks to the importance of our paper and others published on the topic using data from the Aerobics Center Longitudinal Study cohort (3–6), from which “reasonable measures of both fitness and fatness” are available, as Dr. Mukamal notes (1, p. 322). In speaking of fitness and fatness, Dr. Mukamal notes that “their strong interrelationships raise legitimate questions about the clinical utility of trying to parse their separate roles too finely” (1, p. 321). Perhaps in terms of clinical utility, his statement is sound; if obese patients begin exercising and lose weight, it is unnecessary to pick apart which physiological adaptations are responsible for the numerous downstream health benefits. From a messaging perspective, though, we believe it is critical to understand which factor, low fitness or high fatness, is a stronger predictor of negative health outcomes. As many persons struggling with weight management can attest, being active does not always translate to weight loss. Alternatively, underactive persons in the “normal” range of body mass index should not be made to believe that “skinny” means “healthy” because of a cultural and clinical emphasis on weight loss. If fitness is a better predictor of negative health outcomes than is fatness (as has been shown repeatedly (7)), clinicians and public health professionals alike have a responsibility to emphasize that leading an active lifestyle is more important than having a body mass index in the “normal” range. Dr. Mukamal's critique of our study focuses on the possibility that responses to 2 items from the Center for Epidemiologic Studies Depression Scale (“inability to ‘get going’” and “the feeling that everything is an effort”) might have been influenced by lack of fitness. We explicitly acknowledged this possibility in the limitations section of our paper. We also would like to stress that fatigue and loss of energy are core symptoms of depression and that it would be inappropriate to claim that “unfit” participants endorsing these items are doing so because of their fitness level rather than their mental health status. Further, these questions could be interpreted by participants as referring to a lack of motivation or concentration, in other words, a psychological “inability to get going” and “feeling that everything is an effort” rather than physical fatigue. As Dr. Mukamal points out, depression is complex and multidimensional. It is also prevalent and debilitating. We cannot shy away from studying modifiable risk factors, such as cardiorespiratory fitness and fatness, simply because they might overlap with a few of the many possible symptoms of depression. Dr. Mukamal mentions that, when possible, subscales of larger instruments might be helpful in studying relationships among specific aspects of complex diseases. We agree but recognize that many epidemiologists interested in the fitness-depression relationship might not have this option. In these cases, the overlap between the exposure (fitness) and the composite outcome variable should always be acknowledged and considered (as in our article), but it should not be viewed as damning. These variables are clearly separate entities, and understanding their relationship has important implications for public health.

Background:Preventing and/or delaying cognitive impairment is a public health priority. To increase awareness of and participation in behaviors that may help maintain cognitive function or reduce risk of impairment, we need to understand public perceptions about risk and protective factors.Methods:We conducted a scoping review of studies examining the public's perceptions about risk and protective factors related to cognitive health and impairment published since the 2007National Public Health Road Map to Maintaining Cognitive Health.Results:A search of five databases yielded 1,115 documents published between June 2007 and December 2013. Initial review of abstracts identified 90 potentially eligible studies. After full-article review, 30 met inclusion criteria; four additional articles identified in reference lists also met inclusion criteria. Of the 34, 16 studies addressed Alzheimer's disease (AD) specifically, 15 dementia broadly, 5 mild to moderate cognitive impairment, and 8 normal functioning, with some content overlap. Across studies, respondents reported genetics (n= 14 studies), older age (n= 8), stress (n= 7), brain/head injury (n= 6), and mental illness/brain disease (n= 6) as perceived risk factors for AD and dementia. Protective factors most commonly identified for maintaining cognitive health were intellectual/mental stimulation (n= 13), physical activity (n= 12), healthy diet (n= 10), and social/leisure activities (n= 10).Conclusions:Studies identified genetics and older age as key perceived risk factors more so than behaviors such as smoking. Individuals perceived that numerous lifestyle factors (e.g. intellectual stimulation, physical activity) could protect against cognitive impairment, AD, and/or dementia. Results can inform national and international education efforts about AD and other dementias.

Objective To examine associations between relative, friend, and partner support, as well as size and source of weekly social network, and mortality risk in the Aerobics Center Longitudinal Study. Patients and Methods In a mail-back survey completed between January 1, 1990, and December 31, 1990, adult participants in the Aerobics Center Longitudinal Study (N=12,709) answered questions on whether they received social support from relatives, friends, and spouse/partner (yes or no for each) and on the number of friends and relatives they had contact with at least once per week. Participants were followed until December 31, 2003, or until the date of death. Cox proportional hazards regression analyses evaluated the strength of the associations, controlling for covariates. Results Participants (3220 [25%] women) averaged 53.0±11.3 years of age at baseline. During a median follow-up of 13.5 years, 1139 deaths occurred. Receiving social support from relatives reduced mortality risk by 19% (hazard ratio [HR], 0.81; 95% CI, 0.68-0.95). Receiving spousal/partner support also reduced mortality risk by 19% (HR, 0.81; 95% CI, 0.66-0.99). Receiving social support from friends was not associated with mortality risk (HR, 0.90; 95% CI, 0.75-1.09); however, participants reporting social contact with 6 or 7 friends on a weekly basis had a 24% lower mortality risk than did those in contact with 0 or 1 friend (HR, 0.76; 95% CI, 0.58-0.98). Contact with 2 to 5 or 8 or more friends was not associated with mortality risk, nor was the number of weekly contacts with relatives. Conclusion Receiving social support from one's spouse/partner and relatives and maintaining weekly social interaction with 6 to 7 friends reduced mortality risk. Such data may inform interventions to improve long-term survival.

Objectives There is an implicit assumption that increased physical activity (PA) levels are responsible for the mental health benefits resulting from participation in PA programs. Other factors associated with participation may in fact be responsible. The purpose of this study was to examine whether changes in PA mediated the effects of two PA programs (Active Choices [AC] and Active Living Every Day [ALED]) on mental health outcomes. Study design Secondary data analyses of quasi-experimental study. Methods A sub-sample of older adults who participated in AC ( n = 744) and ALED ( n = 853) were included in the current analyses. MacKinnon's product of coefficients was used to test change in PA as a mediator of the relationship between program dose and change in mental health outcomes (depressive symptoms, stress, and number of days with poor mental health). Results Change in PA explained 19% (AC) and 13% (ALED) of the absolute effects of program dose on depressive symptoms, 18% (AC) and 14% (ALED) of the effects on stress, and 37% (ALED) of the effects on days with poor mental health. Conclusions Mounting evidence from both epidemiological studies and controlled trials suggests that PA can improve mental health. This study adds that increasing PA levels may improve mental health in older adults in ‘real-world' settings.

Arthritis is the most common cause of disability among US adults. Few studies have comprehensively examined factors associated with disability in this population.To investigate the relationship between a number of disease and non-disease related factors and disability in sample of adults with self-reported doctor-diagnosed arthritis.Participants (n = 396) taking part in a randomized controlled trial of arthritis self-management completed a comprehensive survey assessing a number of demographic, arthritis-specific, health-related, behavioral, and psychological variables at baseline. Disability, as measured by the Health Assessment Questionnaire (HAQ), was also measured. Hierarchical regression models examined the independent associations between blocks of variables and disability.Demographic variables (R(2) = 0.13), arthritis-specific demographics (i.e., type, medication use; ΔR(2) = 0.16), physical health-related variables (ΔR(2) = 0.06), arthritis-specific symptoms (ΔR(2) = 0.12), health behaviors (ΔR(2) = 0.00), and psychological variables (ΔR(2) = 0.03) explained 50% of the variance in disability score (R(2) = 0.50). With the exception of health behaviors, the addition of each block of variables significantly improved the model, explaining additional variance in HAQ scores (p 0.0001). In the final model, older age, less than a high school education, rheumatoid arthritis, greater arthritis duration, taking steroids, taking narcotics, greater pain, greater stiffness, greater depressive symptoms, and lower arthritis self-efficacy were associated with greater disability whereas male gender, fibromyalgia, and excellent/very good health were associated with less disability.A number of disease and non-disease related variables were associated with disability. These findings suggest that disability in adults with arthritis may be a complicated phenomenon; such complexity may make decreasing disability in this population challenging.