The predictive value of resting heart rate in identifying undiagnosed diabetes in Korean adults: Korea National Health and Nutrition Examination Survey / 한국역학회지

OBJECTIVES@#The purpose of this study was (1) to examine whether the addition of resting heart rate (RHR) to the existing undiagnosed diabetes mellitus (UnDM) prediction model would improve predictability, and (2) to develop and validate UnDM prediction models by using only easily assessable variables such as gender, RHR, age, and waist circumference (WC). @*METHODS@#Korea National Health and Nutrition Examination Survey (KNHANES) 2010, 2012, 2014, 2016 data were used to develop the model (model building set, n=19,675), while the data from 2011, 2013, 2015, 2017 were used to validate the model (validation set, n=19,917). UnDM was defined as a fasting glucose level ≥126 mg/dL or glycated hemoglobin ≥6.5%; however, doctors have not diagnosed it. Statistical package for the social sciences logistic regression analysis was used to determine the predictors of UnDM. @*RESULTS@#RHR, age, and WC were associated with UnDM. When RHR was added to the existing model, sensitivity was reduced (86 vs. 73%), specificity was increased (49 vs. 65%), and a higher Youden index (35 vs. 38) was expressed. When only gender, RHR, age, and WC were used in the model, a sensitivity, specificity, and Youden index of 70%, 67%, and 37, respectively, were observed. @*CONCLUSIONS@#Adding RHR to the existing UnDM prediction model improved specificity and the Youden index. Furthermore, when the prediction model only used gender, RHR, age, and WC, the outcomes were not inferior to those of the existing prediction model.

Characteristics of Defecation Function Related Quality of Life According to Cancer Location in Colorectal Cancer Survivors

Purpose@#The purpose of this study is to explore defecation functions related quality of life (QoL) according to the location of cancer in colorectal cancer survivors. @*Methods@#A total of 120 colorectal cancer survivors (67 colon vs. 53 rectum, mean age: 55.3±10.3 years, 46.7% male) who completed treatment were recruited from a tertiary hospital. QoL and defecation function related QoL were surveyed using the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) and EORTC QLQ- colorectal cancer specific core (CR29) questionnaire. Physical activity (PA) levels of participants were surveyed using a global PA questionnaire. @*Results@#There was no statistical difference in general QoL according to the location of cancer, but significant differences were observed in defecation function related QoL. When cancer location is closer to the anus, survivors experience more defecation dysfunction, negatively associated with QoL (Hemicolectomy: 67.71±14.07, anterior resection: 92.22±15.18, lower anterior resection: 151.85±17.20, and ultra-low anterior resection: 263.73±42.69). @*Conclusion@#When location of cancer is closer to the anus, colorectal survivors experience significantly more defecation dysfunction and poorer QoL. Strategies to reduce defecation dysfunction according to the location of cancer among colorectal cancer patients should be developed.

Exercise Barriers and Facilitators After Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction

Purpose@#The purpose of this study was to understand the experience of exercise participation among patients following transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction surgery. @*Methods@#A phenomenological method was used in this study. Exercise experiences for twelve patients, who had undergone TRAM flap breast reconstruction, were collected through focus group interviews. @*Results@#The factors that contributed to exercise barriers in the experience of TRAM flap breast reconstruction patient exercise participation were categorized into 3 groups: ‘fear of exercise after surgery’, ‘weakened emotional condition’, and ‘lack of exercise information’. Exercise facilitators after TRAM flap breast reconstruction were also categorized into 3 groups: ‘desire to improve appearance’, ‘feasiable exercise program’, and ‘exercise experience’. @*Conclusion@#The results of this study reveal the exercise barriers and facilitators for patients following TRAM flap breast reconstruction, which should be considered to develop effective exercise programs.

Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes?

Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.

Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes?

Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.

Exercise Participation Experiences of Colorectal Cancer Survivors

PURPOSE: The purpose of this study was to investigate the exercise participation experiences of colorectal cancer survivors. METHODS: A phenomenological method was used in this study. Ten adult colorectal cancer survivors were recruited and data were collected through in-depth interviews. RESULTS: The factors involved in the experiences of colorectal cancer survivors' exercise participation were categorized into 3 parts: (1) mental depression and isolation due to physical change, (2) barriers of exercise, (3) exercise participation for recovery. Though participants were aware of their changed body after cancer treatment and faced difficulties participating in exercise, they want to overcome these challenges through exercise participation. CONCLUSION: The results of this study show the exercise participation experiences of colorectal cancer survivors. Based on these findings, exercise maintenance can be promoted more effectively, and a higher exercise adherence of colorectal cancer survivors can be achieved.

The Effects of Diet Alone or in Combination with Exercise in Patients with Prehypertension and Hypertension: a Randomized Controlled Trial

BACKGROUND AND OBJECTIVES@#Supervised lifestyle interventions, including dietary and exercise programs, may be infeasible to implement in real-world settings. Therefore, this study aimed to evaluate the effectiveness of a home-based lifestyle modification intervention on blood pressure (BP) management.@*METHODS@#Eighty-five patients aged over 20 years and diagnosed with prehypertension or mild hypertension were randomly assigned to an advice-only comparison group (C group, n=28), a Dietary Approaches to Stop Hypertension (DASH) diet education group (D group, n=30), or a DASH and home-based exercise group (D+Ex group, n=27). The intervention lasted for 8 weeks. The primary outcome was the difference in office systolic blood pressure (SBP) before and after the study period (Trial registry at ClinicalTrials.gov, NCT01637909).@*RESULTS@#Seventy-two participants (87.8%) completed the trial. The degree of change in office SBP did not significantly differ among the intervention groups; however, the D+Ex group demonstrated a tendency toward decreased SBP. Upon analysis of 24-hour ambulatory BP measurements, daytime ambulatory SBP was significantly lower in the D+Ex group (134 mmHg; 95% confidence interval [CI], 131 to 137; p=0.011) than in the C group (139.5 mmHg; 95% CI, 130.9 to 137), and daytime ambulatory SBP was significantly decreased in the D+Ex group (−5.2 mmHg; 95% CI, −8.3 to −2.1; p=0.011) compared to the C group (0.4 mmHg, 95% CI, −2.5 to 3.3).@*CONCLUSIONS@#In conclusion, lifestyle modification emphasizing both diet and exercise was effective for lowering BP and should be favored over diet-only modifications.

The Effects of Diet Alone or in Combination with Exercise in Patients with Prehypertension and Hypertension: a Randomized Controlled Trial

BACKGROUND AND OBJECTIVES: Supervised lifestyle interventions, including dietary and exercise programs, may be infeasible to implement in real-world settings. Therefore, this study aimed to evaluate the effectiveness of a home-based lifestyle modification intervention on blood pressure (BP) management. METHODS: Eighty-five patients aged over 20 years and diagnosed with prehypertension or mild hypertension were randomly assigned to an advice-only comparison group (C group, n=28), a Dietary Approaches to Stop Hypertension (DASH) diet education group (D group, n=30), or a DASH and home-based exercise group (D+Ex group, n=27). The intervention lasted for 8 weeks. The primary outcome was the difference in office systolic blood pressure (SBP) before and after the study period (Trial registry at ClinicalTrials.gov, NCT01637909). RESULTS: Seventy-two participants (87.8%) completed the trial. The degree of change in office SBP did not significantly differ among the intervention groups; however, the D+Ex group demonstrated a tendency toward decreased SBP. Upon analysis of 24-hour ambulatory BP measurements, daytime ambulatory SBP was significantly lower in the D+Ex group (134 mmHg; 95% confidence interval [CI], 131 to 137; p=0.011) than in the C group (139.5 mmHg; 95% CI, 130.9 to 137), and daytime ambulatory SBP was significantly decreased in the D+Ex group (−5.2 mmHg; 95% CI, −8.3 to −2.1; p=0.011) compared to the C group (0.4 mmHg, 95% CI, −2.5 to 3.3). CONCLUSIONS: In conclusion, lifestyle modification emphasizing both diet and exercise was effective for lowering BP and should be favored over diet-only modifications.

The Effect of Post-operative Exercise in Colorectal Cancer Patients: A Pilot Randomized Controlled Trial (RCT) Study

PURPOSE: The purpose of this study was to examine the effect of post-operative exercise on body composition, psychological factors, time to flatus and length of hospital stay in stage 1~3 colorectal cancer patients. METHODS: A total of 35 post surgery patients were recruited and randomly assigned to the exercise or controlled group. Participants in the exercise group exercised twice a day while participants in the control group followed the clinical pathways (CP). RESULTS: A total of 25 participants completed the trial. Post-operative exercise resulted in a clinically meaningful, but statistically insignificant reduction in body weight (Exercise: -1.10±1.63 kg vs. CP: -0.63±1.16 kg; p=.111), fat mass (Exercise: -1.43±0.95 kg vs. CP: 0.64±4.29 kg; p=.100). When participants' body composition were compared to their baseline values at the baseline, only the exercise group experienced a significant reduction in body weight, body mass index (BMI) and fat mass. In addition, post-operative exercise significantly improved health related quality of life (Exercise: 2.27±2.08 vs CP: -12.82±22.47; p=.008). However, there was no difference in time to flatus and the length of hospital stay between groups. CONCLUSION: The current pilot study suggests that the post-operative exercise program was safe and produced for health related quality of life improvements in colorectal cancer patients.

The Relationship between Resting Heart Rate and Prevalence of Metabolic Syndrome and Type 2 Diabetes Mellitus in Korean Adults: The Fifth Korea National Health and Nutrition Examination Survey (2012)

BACKGROUND: The purpose of this study was to examine the association between resting heart rate (RHR), the risk factors and prevalences of metabolic syndrome (MetS) and type 2 diabetes (T2D) in Korean adults. METHODS: A cross sectional analysis was performed on data from the 2012 Korea National Health and Nutrition Examination Survey (KNHANES V) using frequency analysis, analysis of covariance (ANCOVA), and logistic regression. Participants were stratified according to RHR into 5 groups; or =90 bpm. RESULTS: The results show that risk factors of MetS and T2D increased as RHR increased. Compared to those with a RHR of or =90 bpm by 1.46 (95% confidence interval [CI] 1.03-2.08), 2.05 (95% CI, 1.42-2.96), 2.34 (95% CI, 1.57-3.48), and 2.34 (95% CI, 1.23-4.47), respectively. Similarly, compared to those with a RHR of or =90 bpm by 1.01 (95% CI, 0.72-1.41), 1.44 (95% CI, 1.02-2.05), 1.83 (95% CI, 1.25-2.68), and 2.40 (95% CI, 1.30-4.44), respectively. CONCLUSION: In conclusion, RHR was significantly associated with risk factors and prevalences of MetS and T2D. This study suggests that RHR is associated with MetS and T2D and can be used to predict such diseases.

Effects of Voluntary Running-Wheel Exercise on Insulin, Oxidative Stress and Advanced Glycation End Products in High-Fat Diet-Induced Obese Mice

BACKGROUND: Obesity-induced insulin resistance is an important risk factor for type 2 diabetes and cardiovascular disease. However, as potential mechanisms of increased insulin, how oxidative stress (OS) advanced glycation end-products (AGEs) can be changed through exercise is not fully understood. METHODS: A total of 36 C57BL/6 mice were fed either a high-fat diet (HFD; n=19) or chow diet (Chow; n=17) for 7 weeks. The two groups were then divided into voluntary running wheel exercise or no-exercise subgroups each, and the four groups were provided with another 8 weeks of intervention: 1) HFD+exercise (HE; n=11), 2) HFD+no exercise (HN; n=8), 3) Chow+exercise (CE; n=8), and 4) Chow+no exercise (CN; n=9). Body weight, fasting insulin level, and AGEs were measured before and after intervention. ANOVA and Pearson's multiple correlation coefficients were used for statistical analysis using SPSS statistics software version 20.0. RESULTS: The HE group showed significantly greater weight reduction (P<0.01), while CE and CN did not show significantly different weight reductions between each other. Also, the fasting insulin level was significantly lower in the HE group than in the HN group. The 7-week HFD intervention significantly increased OS and AGEs. However, 8 weeks of exercise did not significantly change OS and AGEs among the groups. CONCLUSION: The findings of the current study suggest that OS and AGEs may not be related to the pathway of exercise-induced improvement in insulin levels in obese mice.

Low Levels of Physical Activity Are Associated with Increased Metabolic Syndrome Risk Factors in Korean Adults

BACKGROUND: Low levels of physical activity (PA) are strongly associated with the development of metabolic syndrome (MetS) and chronic diseases. However, few studies have examined this association in Koreans. The primary purpose of this study was to examine the associations between PA and MetS risks in Korean adults. METHODS: A total of 1,016 Korean adults (494 males and 522 females) participated in this study. PA levels were assessed using the International PA Questionnaire. MetS risk factors were determined using clinically established diagnostic criteria. RESULTS: Compared with the highest PA group, the group with the lowest level of PA was at greater risk of high triglyceride (TG) in males (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.07 to 3.24) and of hemoglobin A1c > or =5.5% in females (OR, 1.75; 95% CI, 1.00 to 3.04) after adjusting for age and body mass index. Compared with subjects who met the PA guidelines, those who did not meet the guidelines were more likely to have low high density lipoprotein cholesterol in both males (OR, 1.69; 95% CI, 1.11 to 2.58), and females (OR, 1.82; 95% CI, 1.20 to 2.77). Furthermore, those who did not meet the PA guidelines were at increased risk of high TG levels in males (OR, 1.69; 95% CI, 1.23 to 2.86) and abnormal fasting glucose (OR, 1.93; 95% CI, 1.17 to 3.20) and MetS (OR, 2.10; 95% CI, 1.15 to 3.84) in females. CONCLUSION: Increased levels of PA are significantly associated with a decreased risk of abnormal MetS components.

Epidemiology of Physical Activity Participation and Type 2 Diabetes in Korea / 임상당뇨병

To date, numerous investigations have identified the role of exercise and physical activity in prevention and treatment of Type 2 diabetes and cardiovascular disease (CVD). This review paper analyzed epidemiological findings which investigated the effects of obesity, physical activity participation and the level of fitness levels on prevalence and risk factors of Type 2 diabetes and CVD. These studies showed that not only prevention of obesity, but also participation of physical activity and maintenance of good level of fitness are important to prevent and treat Type 2 diabetes and CVD. In addition, prevention of obesity and improvement of high fitness levels at early ages (childhood and adolescence) are important to prevent the prevalence and incidence of Type 2 diabetes and CVD.

Associations between Fatness, Fitness, IGF and IMT among Obese Korean Male Adolescents

BACKGROUND: The purpose of this study was to investigate the association between obesity, fitness levels and cardiovascular (CVD) risk factors, and to identify the correlation between of insulin-like growth factor (IGF)-1, IGF binding protein-3 (IGFBP-3), and carotid intima media thickness (IMT) in Korean adolescents. METHODS: A total of 225 high school males with a mean age of 16.96+/-0.23 years participated in this study, and their fatness and fitness levels, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, IGF-1, IGFBP-3, and IMT were measured. RESULTS: The results showed that total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting insulin, HOMA-IR, IGF-1, and IGFBP-3 levels were significantly higher in the most obese group than in the other two groups (tertiles). Muscular and cardiopulmonary fitness were negatively associated with weight, body mass index (BMI), fat mass, body fat, waist circumference (WC), fasting insulin, HOMA-IR, and IMT. IGF-1 and IGFBP-3 levels were correlated with WC, hip circumference (HC), fasting glucose, TG, HDL-C, fasting insulin, and HOMA-IR. IMT levels were significantly associated with weight, BMI, muscle mass, fat mass, percent body fat, WC, HC, systolic blood pressure, diastolic blood pressure and high-sensitivity C-reactive protein. CONCLUSION: There was a significant association between increased obesity and decreased fitness and HOMA-IR, IGF, and IMT among adolescents.

The Relationship between the Level of Fatness and Fitness during Adolescence and the Risk Factors of Metabolic Disorders in Adulthood / 당뇨병

BACKGROUND: The purpose of the current study was to investigate the association between the level of obesity and physical fitness (PF) during adolescence and the risk factors of metabolic disorders during adulthood. METHODS: In the current analysis, 3,993 Korean adults (mean age, 38.70 +/- 1.69 years) were recruited. The level of body index (BI) and PF were examined during adolescence through high school record, and their health examination data, including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose (FG), total cholesterol (TC), and current body mass index (BMI) were obtained from National Health Insurance Corporation Data. Gender-specific analyses were administered to compare health exam data across the level of BI, the level of PF, and a mixed level of BI and PF. RESULTS: Most obese males during high school had statistically higher SBP, DBP, FG, and BMI in adulthood, and most obese females had higher BMI, as compared to most lean males or females. Least fit males during high school had statistically higher BMI in adulthood, and least fit females had statistically higher SBP, DBP, FG, TC, and BMI, as compared to most fit males or females. There was a significant relationship between the mixed level of BI and PF and SBP, DBP, TC and current BMI in both genders. CONCLUSION: Maintaining a healthy level of body weight and PF during adolescence is recommended to prevent the development of metabolic diseases in adulthood.

Association between Obesity and Physical Fitness, and Hemoglobin A1c Level and Metabolic Syndrome in Korean Adults / 당뇨병

BACKGROUND: The purpose of the current study was to investigate the association of obesity level, physical fitness level, hemoglobin A1c (HbA1c) level and metabolic syndrome (MetS) risk factors among Korean adults. METHODS: A total of 557 adults (272 males and 285 females) who underwent medical check-up at local hospital were recruited. In addition to regular health check-up, cardiopulmonary fitness, muscular endurance were measured and their association were analyzed. RESULTS: The prevalence of MetS was 31.7% for males and 23.7% for females. Females with the higher muscular endurance had lower waist circumference, triglyceride level, and HbA1c level than those with the lower muscular endurance. Males with the higher level of cardiopulmonary fitness had lower diastolic blood pressure, lower high-sensitivity C-reactive protein level and higher high density lipoprotein cholesterol level than males with the lower level of cardiopulmonary fitness. Females with the higher level of cardiopulmonary fitness had lower body weight, body mass index, systolic blood pressure, and fasting blood glucose level than females with the lower level of cardiopulmonary fitness. Participants with the higher level of adiposity and the lower level of physical fitness were 5.26 times (95% confidence interval [CI], 2.19 to 12.62), 5.71 times (95% CI, 2.23 to 14.60) more likely to have MetS, respectively, in male and female compared to participants who were neither obese nor have the lower level of fitness. CONCLUSION: This study suggests that maintaining a healthy body weight as well as a certain level of fitness is important for the prevention of MetS.

Erratum: Author's Name Correction / 당뇨병

No abstract available.

Effects of Walking and Physical Activity on Glucose Regulation among Type 2 Diabetics / 당뇨병

BACKGROUND: Physical activity, especially walking is strongly recommended to control blood glucose among type 2 diabetic patients. Furthermore, physical activity is one of the most important tools to prevent secondary diabetes complications among type 2 diabetic patients such as retinopathy, nephropathy, neuropathy etc. The purpose of the study was to examine the association between the level of walking and physical activity and glucose control among Korean adults with type 2 diabetes. METHODS: A total of 250 patients with type 2 diabetes (98 males and 152 females) were recruited (mean age = 62.1 +/- 10.2 years) in the current study. The height, weight, waist and hip circumference were measured, and the level of physical activity and total walking hour were measured by physical activity scale for elderly (PASE). High density lipoprotein cholesterol (HDL-C), total cholesterol, triglyceride, fasting glucose and oral glucose tolerance test, creatinine, uric acid, total protein, albumin, hemoglobin A1c were measured. RESULTS: After adjusting for potential covariates such as age, education, occupation income, smoking, and drinking, male patients who spent least time in walking were more likely to have 2 hour serum glucose level in oral glucose tolerance above 200 mg/dL than counterparts who spent most time in walking with age adjusted (Relative Risk (RR) = 11.75, 95% Confidence Interval (CI) = 1.94-71.00). Male patients who were in the least active group were 5.92 time (95% CI = 1.39-25.28) more likely to have 2 hour serum glucose level in oral glucose tolerance over 200 mg/dL than counterparts in the most active group. However, there was no significant finding in females. CONCLUSIONS: The current study showed that physical activity and walking are effective method to maintain glucose tolerance among type 2 diabetic male patients.