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Background. The repeated loss and regain of body weight, referred to as weight cycling, may be associated with negative health complications. Given today's obesity epidemic and related interventions to address obesity, it is increasingly important to understand contexts and factors associated with weight loss maintenance. This study examined BMI among individuals who had previously participated in a 12-week, evidence-based, nationally disseminated nutrition and physical activity program designed for overweight and obese middle-aged and older women. Methods. Data were collected using follow-up surveys. Complete height and weight data were available for baseline, 12-week program completion (post-program) and follow-up (approximately 3 years later) for 154 women (response rate = 27.5%; BMI characteristics did not differ between responders and nonresponders). Results. Mean BMI decreased significantly from baseline to post-program (-0.5, P < 0.001) and post-program to follow-up (-0.7, P < 0.001). Seventy-five percent of survey respondents maintained or decreased BMI post-program to follow-up. Self-efficacy and social support for healthy eating behaviors (but not physical activity) were associated with BMI maintenance or additional weight loss. Conclusions. These findings support the durability of weight loss following participation in a relatively short-term intervention.

Objectives. We tested a community-based intervention designed to reduce cardiovascular disease risk in sedentary midlife and older women who were overweight or obese. Methods. In a randomized controlled trial conducted in 8 counties in Arkansas and Kansas, counties were assigned to the intervention (a 12-week twice-weekly heart health program) group or to the delayed-intervention control group. Ten to fifteen women were selected from each site, and participants' weight, waist circumference, diet, physical activity, and self-efficacy were measured before and after the intervention. Data were analyzed with multiple regressions. Results. Compared with the control group, participants in the intervention group had a significant decrease in body weight (-2.1 kg; 95% confidence interval [CI]=-3.2, -1.0), waist circumference (-2.3 in; 95% CI=-4.2, -0.5), and energy intake (-390 kcal/day; 95% CI=-598, -183); an increase in activity (+1637 steps/day; 95% CI=712, 2562); and an increase in self-efficacy for dietary and physical activity behaviors. Conclusions. Our results suggest that a community-based program can improve self-efficacy, increase physical activity, and decrease energy intake, resulting in decreased waist circumference and body weight among at-risk women. (doi: 10.2105/AJPH.2008.145581)

This cluster-randomized trial was designed to determine the efficacy of a 6-month exercise-nutritional supplement program (ENP) on physical function and nutritional status for older adults and the feasibility of implementing this program in a senior living setting. Twenty senior-living facilities were randomized to either a 3 day per week group-based ENP led by a trained facility staff member or a health education program (SAP). Participants (N = 121) completed a short physical performance battery, 400-m walk, handgrip strength test, and mini-nutrition assessment. 25-hydroxyvitamin D [25(OH)D], insulin-like growth-factor 1 (IGF-1), and activity level were also measured. The ENP did not significantly improve physical function or nutritional status compared with the SAP. Compared with baseline, participants in the ENP engaged in 39 min less physical activity per week at 6 months. Several facility characteristics hindered implementation of the ENP. This study highlights the complexity of implementing an evidence-based program in a field setting. [ABSTRACT FROM AUTHOR]

Three-compartment model: critical evaluation based on neutron activation analysis. Am J Physiol Endocrinol Metab 287: E962-E969, 2004. First published June 8, 2004; doi:10.1152/ ajpendo.00104.2004.--There is renewed interest in Siri's classic three-compartment (3C) body composition model, requiring body volume (BV) and total body water (TBW) estimates, because dual-energy X-ray absorptiometry (DEXA) and in vivo neutron activation (IVNA) systems cannot accommodate subjects with severe obesity. However, the 3C model assumption of a constant ratio ([alpha]) of mineral (M) to total body protein (TBPro) and related residual mass density ([D.sub.RES]) based on cadaver analyses might not be valid across groups differing in sex, race, age, and weight. The aim of this study was to derive new 3C model coefficients in vivo and to compare these estimates to those derived by Siri. Healthy adults (n = 323) were evaluated with IVNA and DEXA and the measured components used to derive [alpha] and [D.sub.RES]. For all subjects combined, values of [alpha] and [D.sub.RES] (means [+ or -] SD, 0.351 [+ or -] 0.043; 1.565 [+ or -] 0.023 kg/l) were similar to Siri's proposed values of 0.35 and 1.565 kg/l, respectively. However, [alpha] and [D.sub.RES] varied significantly as a function of sex, race, weight, and age. Expected errors in percent body fat arising by application of Siri's model were illustrated in a second group of 264 adults, including some whose size exceeded DEXA limits but whose BV and TBW had been measured by hydrodensitometry and [sup.2][H.sub.2]]O dilution, respectively. Extrapolation of predictions by newly developed models to very high weights allows percent fat error estimation when Siri's model is applied in morbidly obese subjects. The present study results provide a critical evaluation of potential errors in the classic 3C model and present new formulas for use in selected populations. body composition models; obesity; total body water: underwater weighing

Background. This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. Methods. We conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged [greater than equal] 70 years) with self-reported and laboratory based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk). Results. 70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 [+ or -] 13.4% in exercisers and decreased by 2.8 [+ or -] 13.6% in controls (p = .02). EPESE improved by 26.2 [+ or -] 37.5% in exercisers and decreased by 1.2 [+ or -] 22.1% in controls (p = .001). Dynamic balance improved by 33.8 [+ or -] 14.4% in exercisers versus 11.5 [+ or -] 23.7% in controls (p = .0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance. Conclusions. Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional perfomance occured along with improvements in balance but without a significant change in muscle strength or endurance.

Objective To increase fruit, vegetable, and calcium-rich food consumption in community-dwelling, functionally impaired elderly. Design Six-month, home-based nutrition intervention study. Subjects Seventy men and women older than age 69 years were randomized to either a nutrition education intervention (n=38) or a control group that received an exercise intervention (n=32). Intervention Nutrition education was designed to increase fruit, vegetable, and calcium-rich food consumption. Main Outcome Measures Food intake was assessed by a food frequency questionnaire. Fasting blood measures of nutrients and carotenoids were performed. Statistical Analysis Two-group randomized controlled trial with pre-test and post-test design and intention-to-treat analysis. Analysis of covariance to was used to assess differences between the two groups. Baseline and change partial correlation coefficients were performed between intake and blood nutrient levels. Paired tests were conducted to test within-group changes. Results Compared with the exercise group, subjects in nutrition group increased their self-reported intake of fruits by 1.1±0.2 (mean ±SEM) servings per day (2.8 to 3.9, P=.0l), vegetables 1.1±0.2 servings per day (2.3 to 3,4, P=.001), and milk/dairy 0.9±0.2 servings per day (3.0 to 3.9, P=.001). There was an increase in the dietary intake of αcarotene and βcarotene in the nutrition group and this correlated with the increase in blood concentrations of αcarotene and β-carotene (P≤ 02; γ=0.33 and γ=0.33, respectively). Conclusion The results of this study suggest that it is possible to improve the dietary intake of community dwelling elders to include more fruits, vegetables, and calcium-rich foods. Recommendations for increasing consumption of fruits, vegetables, and calcium-rich foods should be specific and individualized to meet the dietary pattern and lifestyle of the individual. Compliance should be encouraged with record keeping as well as through continuous monitoring and positive reinforcement., Research has shown that diets high in fruits and vegetables are linked to decreased risk of cancer, heart disease, hypertension, macular degeneration, stroke, diabetes, and constipation. In addition, osteoporosis is [...]

Objective A narrow range of food choices may lead to dietary inadequacies, a particular concern in elderly people. We hypothesized that consumption of a more diverse diet would predict better nutritional status in frail elderly persons. Subjects Subjects included 98 frail nursing home residents (36 men, 62 women), mean age 87.1±5.5 (72 to 98) years. Methods 3-day dietary variety scores ranging from 23 to 48 and fruit and vegetable variety scores ranging from 5 to 20 were calculated from weighed 3-day food records as the number of different food or fruit and vegetable choices consumed. A higher score indicates a more varied diet. Nutritional status was assessed by weight, height, body mass index (BMI), skinfold thickness, circumference measures calculated mean arm muscle area, total body water, computerized tomography of the thigh, and total body potassium, as well as nutritional analysis, biochemical measures, and subject medical history. Statistical methods Univariate regression analyses were performed to investigate the relationship between clinical and nutrition variables. Multiple linear regressions were used to develop models relating dietary variety scores to possible etiologic factors as well as indicators of nutritional status. Models were controlled for age, BMI, and energy intake when appropriate. Results Mean dietary variety score was 35.2±4.5, and mean fruit and vegetable variety score was 11.3±3.0. Higher dietary variety score was associated with higher energy intake (β=20.5, P Conclusions The results of this study suggest that a highly varied diet in elderly nursing home residents is associated with better nutritional status as assessed by nutrient intake, biochemical measures, and body composition measures. Dietary variety score is a straightforward tool for screening and identifying people at nutritional risk, as well as a mechanism for monitoring response to nutritional, medical, and environmental interventions. Preventive measures to improve dietary variety, as measured by the dietary variety score, should be evaluated and introduced before nutrition and health complications arise. J Am Diet Assoc. 2002;102: 1096-1104., Consuming a wide variety of foods is considered one of the key components of dietary adequacy. The 2000 Dietary Guidelines for Americans includes two messages about variety: 'Eat a variety [...]

High-intensity strength training may preserve bone mass and may increase muscle strength, muscle mass, and balance in older women, which may reduce the risk of osteoporotic fractures. Researchers examined and tested 20 postmenopausal women who engaged in five different high-intensity strength training exercises two days per week and 19 postmenopausal women who did not perform the strength exercises. At the one-year follow-up, the average bone mineral density (BMD) of the hip and lower spine increased in the women who participated in strength training and decreased in the other women. The average total body bone mineral content (BMC) increased by 2 grams (g) in the strength training participants and decreased by 33 g in the other women. The total body muscle mass increased by an average of 1.2 kilograms (kg) in the women who performed the strength training exercises and decreased by an average of 0.5 kg in the others. Women who engaged in strength training also had greater muscle strength and balance than their counterparts., Objective.--To determine how multiple risk factors for osteoporotic fractures could be modified by high-intensity strength training exercises in postmenopausal women. Design.--Randomized controlled trial of 1-year duration. Setting.--Exercise laboratory at Tufts University, Boston, Mass. Population.--Forty postmenopausal white women, 50 to 70 years of age, participated in the study; 39 women completed the study. The subjects were sedentary and estrogen-deplete. Interventions.--High-intensity strength training exercises 2 days per week using five different exercises (n = 20) vs untreated controls (n = 19). Main Outcome Measures.--Dual energy x-ray absorptiometry for bone status, one repetition maximum for muscle strength, 24-hour urinary creatinine for muscle mass, and backward tandem walk for dynamic balance. Results.--Femoral neck bone mineral density and lumbar spine bone mineral density increased by 0.005 [+ or -] 3.6%), respectively, in the strength-trained women and 0.009 [+ or -] 0.033 g/[cm.sup.2] (1.0% [+ or -] 3.6%), respectively, in the strength-trained women and decreased by -0.022 [+ or -] 0.035 g/[cm.sup.2] (-2.5% [+ or -] 3.8%) and -0.019 [+ or -] 0.035 g/[cm.sup.2] (-1.8% [+ or -] 3.5%), respectively, in the controls (P = .02 and .04). Total body bone mineral content was preserved in the strength-trained women (+2.0 [+ or -] 68 g; 0.0% [+ or -] 3.0%) and tended to decrease in the controls (-33 + 77 g; -1.2% [+ or -] 3.4%, P = .12). Muscle mass, muscle strength, and dynamic balance increased in the strength-trained women and decreased in the controls (P = .03 to < .001). Conclusions.--High-intensity strength training exercises are an effective and feasible means to preserve bone density while improving muscle mass, strength, and balance in postmenopausal women.

High-intensity resistance exercise training may improve the muscle strength and mass and decrease frailty in elderly people. In a study of 100 frail nursing home residents aged 72 to 98, an experimental group performed high-intensity progressive resistance exercises of the hip and knee muscles for 10 weeks and also consumed a nutritional supplement. Muscle strength measurements, including gait velocity, stair-climbing ability, and overall physical activity, improved in the experimental group, but not in a group performing placebo activities such as aerobic or flexibility exercises. The nutritional supplement was not found to have an effect, either positive or negative. The results of the study suggest that the musculoskeletal system of the elderly person can overcome previous disuse when challenged by resistance training, and can realize significant improvement in mobility and overall activity.

Abstract Background Leadership is critical to making changes at multiple levels of the social ecological model, including the environmental and policy levels, and will therefore likely contribute to solutions to the obesity epidemic and other public health issues. The literature describing the relative leadership styles and strengths of women versus men is mixed and virtually all research comes from sectors outside of public health. The purpose of this qualitative study is to identify specific leadership skills and characteristics in women who have successfully created change predominantly within the food and physical activity environments in their communities and beyond. The second purpose of this study is to understand best practices for training and nurturing women leaders, to maximize their effectiveness in creating social change. Methods Key informant interviews were conducted with 16 women leaders in the public health sector from November 2008 through February 2010. The sample represented a broad spectrum of leaders from across the United States, identified through web searches and through networks of academic and professional colleagues. Most were working on improving the food and physical activity environments within their communities. Questions were designed to determine leaders’ career path, motivation, characteristics, definition of success, and challenges. The initial coding framework was based on the questioning structure. Using a grounded theory approach, additional themes were added to the framework as they emerged. The NVivo program was used to help code the data. Results Respondents possessed a vision, a strong drive to carry it out, and an ability to mobilize others around the vision. Their definitions of success most often included changing the lives of others in a sustainable way. Persistence and communications skills were important to their success. The mentoring they received was critical. Challenges included fundraising and drifting from their original mission. Conclusions These findings may be used to help develop or inform a model of women’s leadership in public health and to improve the training and nurturance of leaders who promote health in their communities and beyond.