Self-reported sleep quality and exercise in polycystic ovary syndrome: A secondary analysis of a pilot randomized controlled trial.

OBJECTIVE: To examine the proportion of participants with poor sleep quality, evaluate the associations between sleep quality and anthropometric and cardiometabolic health markers, and evaluate the effect of high intensity interval training (HIIT) and continuous aerobic exercise training (CAET) on sleep quality in polycystic ovary syndrome (PCOS). DESIGN: Secondary analysis of a pilot randomized controlled trial. PATIENTS: Women with PCOS aged 18-40 years. MEASUREMENTS: The Pittsburgh Sleep Quality Index (PSQI) was measured at baseline and following a 6-month exercise intervention. A PSQI score >5 indicates poor sleep. Linear regression was used to evaluate the associations between PSQI score and anthropometric and cardiometabolic health markers, and the effect of exercise training on these associations. RESULTS: Thirty-four participants completed the PSQI at baseline, and 29 postintervention: no-exercise control (n = 9), HIIT (n = 12) and CAET (n = 8). At baseline, 79% had poor sleep quality. Baseline PSQI score was positively correlated with body mass index, waist circumference, body weight, haemoglobin A1c and insulin resistance. Mean PSQI score changes were -0.4 (SD 1.1), -0.7 (SD 0.6) and -0.5 (SD 0.9) for control, HIIT and CAET, respectively. For HIIT participants, change in PSQI score was associated with changes in body weight (B = .27, 95% CI 0.10-0.45) and waist circumference (B = .09, 95% CI 0.02-0.17). CONCLUSION: Most participants had poor sleep quality which was associated with poorer anthropometric and cardiometabolic health markers. There were no statistically significant changes in PSQI score with exercise training. With HIIT training, decreases in the sleep efficiency score were associated with reductions in body weight and waist circumference. Further studies are needed to determine the effect of exercise training on sleep quality.

Sociodemographic Factors Associated With Objectively Measured Moderate- to Vigorous-intensity Physical Activity in Adults With Type 2 Diabetes: Cross-sectional Results From the Canadian Health Measures Survey (2007 to 2017).

OBJECTIVES: Individuals with type 2 diabetes should engage in ≥150 min of moderate- to vigorous-intensity physical activity (MVPA) weekly, but most do not meet this guideline. Understanding how social determinants correlate with physical activity in adults with type 2 diabetes may improve development and delivery of physical activity interventions. This study aimed to explore associations between objectively measured MVPA with sociodemographic characteristics in adults with type 2 diabetes. METHODS: Cross-sectional data from cycles 1 through 5 of the Canadian Health Measures Survey were analyzed. Participants (N=876) 20 to 79 years of age with type 2 diabetes and ≥4 days of valid activity monitor wear were included. Proportions with 95% confidence intervals for objectively measured MVPA were compared according to sociodemographic characteristics. Ordinal logistic regression was used. Secondary outcomes included light-intensity physical activity, screen time and proportion of activity monitor wear time spent sedentary. RESULTS: Only 15.5% of women and 26.2% of men met Diabetes Canada physical activity guidelines, and approximately 75% of activity monitor wear time was spent in a sedentary state. Higher odds of achieving low levels of physical activity were observed among women who were former or current smokers (odds ratio [OR], 4.51; p<0.001), and among men who were ≥65 years of age (OR, 2.92; p<0.001), of middle (OR, 2.20; p<0.05) and lowest (OR, 3.06; p<0.05) income tertiles and current or former smokers (OR, 3.01; p<0.05). CONCLUSIONS: Sociodemographic factors are strongly associated with levels of MVPA in adults with type 2 diabetes. Sociodemographic information should be routinely collected by clinicians and used to inform more tailored and effective interventions for this patient population.

Prevalence of and risk factors for excess weight gain in pregnancy: a cross-sectional study using survey data.

BACKGROUND: Maternal weight gain during pregnancy is required for fetal development; however, excess gestational weight gain is associated with increased maternal and neonatal morbidity. We aimed to determine the proportion of Canadian women who gained excess weight during pregnancy and to identify risk factors for excess gestational weight gain. METHODS: Self-reported data on maternal weight gain were collected from the 2015/16 and 2017/18 cycles of the Canadian Community Health Survey (CCHS), a cross-sectional population-based survey. We included females aged 15 to 54 years with data on height, prepregnancy weight and gestational weight gain. We defined excess gestational weight gain in terms of preconception body mass index (BMI) according to the 2009 guideline of the US Institute of Medicine. We used logistic regression to evaluate potential risk factors for excess gestational weight gain. RESULTS: Of 1 335 615 Canadian women (weighted from approximately 9300 survey respondents), 422 043 (32%) gained excess weight during pregnancy. Women with obesity had 33% lower odds of gaining excess weight relative to women with overweight (odds ratio 0.67, 95% confidence interval 0.48-0.94). Risk factors for excess gestational weight gain were lower education level, white or Indigenous identity, smoking, mood disorder, anxiety disorder and Canadian citizenship. INTERPRETATION: One-third of Canadian women in this survey had excess gestational weight gain during pregnancy, and women with obesity had lower odds of gaining excess weight during pregnancy relative to women with overweight. Strategies are needed to reduce the proportion of Canadian women who gain excess weight during pregnancy, regardless of preconception BMI.

Comparative Success of Recruitment Strategies for an Exercise Intervention Trial Among Women With Polycystic Ovary Syndrome: Observational Study.

BACKGROUND: Effective and efficient participant recruitment is a key determinant of the success of a research program. Previously reported recruitment strategies have displayed variable success rates in studies on women with polycystic ovary syndrome (PCOS). OBJECTIVE: This study aimed to evaluate the effectiveness and cost per participant of the recruitment strategies that we used in a prospective randomized controlled trial to examine the effects of exercise training among inactive women with PCOS, who are aged 18-40 years. METHODS: The 4 recruitment methods we used were as follows: (1) referral by health care providers or by word of mouth, (2) media (eg, local newspaper stories and radio interviews), (3) Facebook advertisements, and (4) unpaid advertisements including posters and websites. The proportions of potential, eligible, and enrolled participants recruited with each method were determined and compared using tests of proportion. The time investment and cost per participant enrolled were calculated for each recruitment strategy. RESULTS: Of 200 potential participants screened, 98 (49%) were recruited from unpaid advertisements (posters and websites), 70 (35%) from Facebook advertisements, 16 (8%) by referral, and 16 (8%) from traditional media (newspaper and radio). Every potential participant was recruited from separate means (ie, no participant was approached through more than one recruitment method). A total of 109 (54.5%) women were deemed eligible for participation in the trial, and 60 (30.0%) were enrolled. The proportion of potential participants who completed the trial was higher for those recruited from traditional media than from Facebook advertisements (n=7/16, 44% vs n=13/70, 19%, respectively; P=.03) or unpaid advertisements (n=7/16, 44% vs n=13/98, 13%, respectively; P=.002). The cost per participant was Can $18.21 (US $14.46) for Facebook advertisements and Can $43.88 (US $34.85) for unpaid advertisements. There were no direct trial costs for referrals or traditional media. CONCLUSIONS: For this trial, each method was important for recruiting inactive women with PCOS because no participant reported learning about the trial through more than one method. Unpaid advertisements and Facebook advertisements helped recruit the largest number of participants in the trial, the former resulting in a higher cost per participant than the latter. TRIAL REGISTRATION: ClinicalTrials.gov NCT03362918; https://clinicaltrials.gov/ct2/show/NCT03362918.

Systematic review and meta-analysis: SGLT2 inhibitors, blood pressure and cardiovascular outcomes.

OBJECTIVE: Clinical trials suggest that SGLT2 inhibitors reduce the risk of cardiovascular mortality in patients with type 2 diabetes, however the mechanism is unclear. Our objective was to test the hypothesis that blood pressure reduction is one potential mechanism underlying the observed improvements in cardiovascular outcomes with SGLT2 inhibitors. METHODS: We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (inception-June 2019) for randomized controlled trials that reported the effect of SGLT2 inhibitors compared with placebo on cardiovascular outcomes in adults with type 2 diabetes. Two reviewers independently extracted data and assessed study quality. Random effects meta-analyses, stratified meta-analyses and meta-regressions were conducted to evaluate the association between blood pressure reduction in SGLT2 inhibitor treated patients and cardiovascular outcomes. RESULTS: Of 11,232 articles identified, 40 articles (n = 54,279 participants) were included. The relative risk of cardiovascular mortality was reduced by 18% with the use of SGLT2 inhibitors compared with placebo (RR 0.82; 95%CI 0.74, 0.91, I2 = 0.0%). Meta-regression analysis revealed no detectable difference in cardiovascular mortality (RR 0.93; 95%CI 0.88, 1.13, p = 0.483), 3-point major adverse cardiovascular events (p = 0.839) or congestive heart failure hospitalizations (p = 0.844) with change in mean systolic blood pressure. CONCLUSIONS: Cardiovascular events are reduced in participants with type 2 diabetes treated with SGLT2 inhibitors compared with placebo. There was no significant relationship between the risk of developing adverse cardiovascular events and blood pressure reduction with SGLT2 inhibitors. There is insufficient evidence to suggest that blood pressure reduction is a significant contributor to the cardiovascular benefits observed.

Exercise training and reproductive outcomes in women with polycystic ovary syndrome: A pilot randomized controlled trial.

OBJECTIVE: Exercise is recommended for polycystic ovary syndrome (PCOS), but the most effective exercise prescription is unclear. This trial compared effects of high-intensity interval training (HIIT), continuous aerobic exercise training (CAET) and no-exercise control on reproductive, anthropometric and cardiometabolic outcomes in PCOS. DESIGN: Pilot randomized controlled trial. PARTICIPANTS: Previously inactive women aged 18-40 years with PCOS. MEASUREMENTS: Feasibility outcomes included recruitment, retention, adherence to exercise and daily ovulation prediction kit (OPK) testing. Preliminary efficacy outcomes included reproductive, anthropometric and cardiometabolic health markers. RESULTS: Forty-seven women were randomized to no-exercise control (n = 17), HIIT (n = 16), or CAET (n = 14). Forty (85%) participants completed the trial. Median exercise adherence was 68% (IQR 53%, 86%). Median daily OPK-testing adherence in the first half of the intervention was 87% (IQR 61%, 97%) compared with 65% (IQR 0%, 96%) in the second half. Body mass index decreased significantly in CAET compared with control (-1.0 kg/m2 , p = .01) and HIIT (-0.9 kg/m2 , p = .04). Mean waist circumference decreased in all groups (-7.3 cm, -6.9 cm, -4.5 cm in HIIT, CAET and control) with no significant between-group differences. Mean LDL-C was significantly reduced for HIIT compared to CAET (-0.33 mmol/L, p = .03). HDL-C increased in HIIT compared with control (0.18 mmol/L, p = .04). CONCLUSIONS: There were feasibility challenges with adherence to daily ovulation assessment limiting the ability to analyse the effect of the exercise interventions on ovulation. CAET and HIIT were both effective at improving anthropometrics and some cardiometabolic health markers. Further studies need to determine optimal and acceptable exercise prescriptions for this population.

Long-Term Physical Activity Levels After the End of a Structured Exercise Intervention in Adults With Type 2 Diabetes and Prediabetes: A Systematic Review.

OBJECTIVES: Randomized, controlled trials have shown that exercise interventions reduce the incidence of type 2 diabetes in people with impaired glucose tolerance, and improve glycemic control, body composition and cardiorespiratory fitness in people with type 2 diabetes. We undertook the present systematic review to determine the extent to which participants in structured exercise trials continue to be physically active after the end of the interventions. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Central Register of Controlled Trials for randomized, controlled trials that reported objective or self-reported physical activity levels in people with type 2 diabetes or prediabetes a minimum of 3 months after the end of a structured exercise intervention. This systematic review was registered on PROSPERO (PROSPERO CRD42018089468). RESULTS: Of 14,649 articles retrieved, 5 randomized, controlled trials (including 549 participants) were included in this systematic review. One study revealed significant improvements in self-reported physical activity levels in the intervention group compared with the control group 1, 3 and 5 years after baseline assessments, and decreased waist circumference, weight and body mass index at 1 year, but not 3 or 5 years. The 4 remaining studies did not find between-group differences at follow-up timepoints between 6 months and 3 years. CONCLUSIONS: Future research should report physical activity levels at follow up to determine whether participation in a structured exercise intervention results in sustained increased physical activity levels. In addition, interventions should be evaluated for their effectiveness in improving adherence to long-term physical activity.

Significant Dose-Response between Exercise Adherence and Hemoglobin A1c Change.

INTRODUCTION: The Diabetes Aerobic and Resistance Exercise trial found that aerobic training and resistance training alone each reduced hemoglobin A1c (HbA1c) compared with nonexercising controls, and combined aerobic and resistance training caused greater HbA1c reduction than either training type alone. Our objective was to determine whether a dose-response relationship existed between frequency of exercise training and HbA1c change, and whether this varied by exercise modality or participant characteristics. METHODS: Post hoc analysis of data from 185 Diabetes Aerobic and Resistance Exercise trial participants with type 2 diabetes randomized to aerobic, resistance or combined training thrice weekly. Dose-response relationships between adherence (percent of prescribed training sessions completed) and HbA1c change were assessed with linear regression. RESULTS: Median overall adherence was 84.9% (interquartile range, 74.4%-93.6%). Higher exercise adherence was associated with greater HbA1c reduction; a 20% increase in adherence (e.g., an additional two sessions per month) was associated with a 0.15% (2 mmol·mol) decrease in HbA1c (ß = -0.0076, R = -0.170, P = 0.021). Significant dose-response relationships were identified for aerobic (ß = -0.0142, R = -0.313, P = 0.016) and combined training (ß = -0.0109, R = -0.259, P = 0.041), but not resistance training (ß = 0.0068, R = 0.153, P = 0.233). Dose-response relationships in all training groups combined were significant in subgroups younger than 55 yr (ß = -0.0113, R = -0.286, P = 0.005), males (ß = -0.0123, R = -0.234, P = 0.010), and baseline HbA1c ≥7.5% (58 mmol·mol) (ß = -0.013, R = -0.263, P = 0.011). CONCLUSIONS: There was a dose-response relationship between adherence to prescribed exercise and HbA1c reduction suggesting that glycemic control is improved more in individuals with type 2 diabetes with a higher training volume. Dose-response relationships existed for aerobic and combined training but not resistance training. These findings support aerobic and combined exercise prescriptions outlined in clinical practice guidelines.

PTSD and cognitive functioning: importance of including performance validity testing.

Many studies have observed an association between post-traumatic stress disorder (PTSD) and cognitive deficits across several domains including memory, attention, and executive functioning. The inclusion of response bias measures in these studies, however, remains largely unaddressed. The purpose of this study was to identify possible cognitive impairments correlated with PTSD in returning OEF/OIF/OND veterans after excluding individuals failing a well-validated performance validity test. Participants included 126 men and 8 women with a history of mild traumatic brain injury (TBI) referred for a comprehensive neuropsychological evaluation as part of a consortium of five Veterans Affairs hospitals. The PTSD CheckList (PCL) and Word Memory Test (WMT) were used to establish symptoms of PTSD and invalid performance, respectively. Groups were categorized as follows: Control (PCL < 50, pass WMT), PTSD-pass (PCL ≥ 50, pass WMT), and PTSD-fail (PCL ≥ 50, fail WMT). As hypothesized, failure on the WMT was associated with significantly poorer performance on almost all cognitive tests administered; however, no significant differences were detected between individuals with and without PTSD symptoms after separating out veterans failing the WMT. These findings highlight the importance of assessing respondent validity in future research examining cognitive functioning in psychiatric illness and warrant further consideration of prior studies reporting PTSD-associated cognitive deficits.

Performance on a neurocognitive measure of alerting differentiates ADHD combined and inattentive subtypes: a preliminary report.

The performance of 16 attention-deficit hyperactivity disorder (ADHD)/C, 26 ADHD/IA, and 24 control children was compared using a computer reaction time task designed to measure the effects of Posner's orienting, conflict and alerting attentional systems. No group differences in orienting or conflict were found. In contrast, children with ADHD/IA showed stronger alerting effects than those with ADHD/C, as indicated by relatively greater performance benefits following a warning cue. Although neither ADHD group differed significantly from controls on alerting, effect size comparisons indicated that children with ADHD/IA showed a somewhat larger (d=.57) and children with ADHD/C a somewhat smaller (d=.44) alerting effect relative to control children. The results are among the first to document unique patterns of attentional capacity for ADHD subtypes.

Five-factor personality dimensions, mood states, and cognitive performance in older adults.

In this study we examined the impact of personality traits and negative mood state on performance in several cognitive domains in a sample of 398 elderly community-dwelling individuals. Multiple linear regression analyses were used to examine the variance in cognitive measures explained by state depression and anxiety after controlling for the effects of demographic characteristics and five-factor model personality traits. Personality traits were found to contribute significantly to cognitive function, explaining 2-7% of the variance in ability across domains. Examination of the contributions of individual five-factor traits showed that Openness had a significant relationship with all indexes of verbal memory and with general cognitive ability. State anxiety and depression variables were found to play a very small part, however, in contributing to cognitive function.

Role of executive functioning in verbal and visual memory.

G. Tremont, S. Halpert, D. J. Javorsky, and R. A. Stern (2000) found that individuals with executive dysfunction were more impaired on less structured versus more structured verbal memory tasks. In the present study, the authors investigated the relationship between executive functions and memory in patients with a history of traumatic brain injury by examining the effect of executive functioning on more structured and less structured verbal and visual memory tasks at baseline and 1-year follow-up. Matched subgroups controlled for differences in severity of neuropsychological impairment unrelated to specific executive functions. The G. Tremont et al. (2000) findings were not replicated. Results showed that when acuteness and severity of injury were controlled, executive impairment played no significant role in performance on either more or less structured memory tasks. However, regardless of structure, executive functions played a role in visual memory performance, suggesting that visual memory may be a more fluid ability than verbal memory.

Parent-, teacher-, and self-rated motivational styles in ADHD subtypes.

The motivational styles of 25 children with attention-deficit/hyperactivity disorder, combined type (ADHD/C), 13 children with ADHD, inattentive type (ADHD/IA), and 25 nondiagnosed controls (NC) were compared using parent, teacher, and self-ratings. Both ADHD subtypes demonstrated motivational impairment characterized by a preference for easy work, less enjoyment of learning, less persistence, and a greater reliance on external than on internal standards to judge their performance relative to NC. Some motivational style differences between ADHD subtypes were also revealed, with the ADHD/C group more motivated by competitiveness and a desire to be perceived as superior to others and the ADHD/IA group less uncooperative and possibly more passive in their learning styles. When IQ was statistically controlled, these results were generally unchanged. The contributing role of motivational deficits to the generally poor academic functioning of children with ADHD is discussed, along with potential intervention implications of the divergent motivational styles of different ADHD subtypes.