Physical inactivity among parents of children with and without Down syndrome: the National Health Interview Survey.

BACKGROUND: Emerging evidence suggests that parents of children with intellectual disabilities have poorer physical health than parents of typically developing children. However, it is unclear why. The purpose of this study was to examine differences in physical inactivity among a population-based sample of parents of children with and without Down syndrome. METHODS: Data for this analysis come from 11 waves (2005-2016) of the National Health Interview Survey, a U.S. nationally representative survey. Minutes per week of leisure-time physical activity were ascertained by self-report with physical inactivity defined as reporting no leisure-time physical activity. Parents were classified as (1) parents of typically developing children, (2) parents of children with Down syndrome, (3) parents of children with a developmental disability that had a high functional impact (autism, cerebral palsy, vision impairment or hearing impairment), (4) parents of children with an intellectual or developmental disability, but who did not have Down syndrome or a high-impact developmental disabilities, and (5) parents of children with other special health care needs. RESULTS: Parents of children with Down syndrome were more likely to be physically inactive compared with parents of typical children (odds ratio [OR]: 1.51 [95% confidence interval, CI: 1.08, 2.12]) and had the lowest likelihood among all subgroups of parents to children with developmental disabilities or special health care needs. Parents of children with Down syndrome also had a significantly greater likelihood of being physically inactive compared with parents of children with other special health care needs (OR: 1.56 [95% CI: 1.11, 2.19]), with developmental disabilities without high functional impact (OR: 1.58 [95% CI: 1.12, 2.24]) and with developmental disabilities with high functional impact (OR: 1.46 [95% CI: 1.03, 2.08]). CONCLUSION: Parents of children with Down syndrome are more likely to be physically inactive compared with parents of typically developing children and parents of children with other developmental disabilities or special health care needs. These findings suggest that parents of children with Down syndrome are a population in urgent need for interventions/programmes that promote physical activity, particularly as child well-being is linked to caregiver health.

Leisure-time physical activity and all-cause mortality among adults with intellectual disability: the National Health Interview Survey.

BACKGROUND: Adults with intellectual disabilities (IDs) have higher rates of morbidity and mortality compared with the general population, necessitating a need to identify modifiable targets for intervention to mitigate risk. While the benefits of leisure-time physical activity (PA) are well established in the general population; there is a dearth of evidence confirming its health benefits among adults with IDs. The purpose of this study was to examine the association between leisure-time PA and all-cause mortality among a population-based sample of adults with IDs. METHODS: A total of 413 adults with IDs from 17 waves (1997-2014) of the National Health Interview Survey, a U.S. nationally representative survey, were studied. Minutes per week of leisure-time PA was ascertained by self-report and classified as poor, intermediate or ideal levels of PA. RESULTS: Over a median follow-up of 7.2 years, 60 participants died. In a multivariable-adjusted model, higher levels of leisure-time PA were dose-dependently associated with a lower risk of all-cause mortality (P-trend = 0.008). The multivariable-adjusted hazard ratios (95% confidence interval) for all-cause mortality comparing participants with intermediate and ideal versus poor levels of PA were 0.43 (0.18, 1.04) and 0.30 (0.10, 0.87), respectively. CONCLUSION: These findings show that leisure-time PA confers mortality benefit in adults with IDs and should be considered as a priority target for promoting health and longevity in this population.

An interpretable health behavioral intervention policy for mobile device users.

An increasing number of people use mobile devices to monitor their behavior, such as exercise, and record their health status, such as psychological stress. However, these devices rarely provide ongoing support to help users understand how their behavior contributes to changes in their health status. To address this challenge, we aim to develop an interpretable policy for physical activity recommendations that reduce a user's perceived psychological stress, over a given time horizon. We formulate this problem as a sequential decision-making problem and solve it using a new method that we refer to as threshold Q-learning (TQL). The advantage of the TQL method over traditional Q-learning is that it is "doubly robust" and interpretable. This interpretability is achieved by making model assumptions and incorporating threshold selection into the learning process. Our simulation results indicate that the TQL method performs better than the Q-learning method given model misspecification. Our analyses are performed on data collected from 79 healthy adults over a 7 week period, where the data comprise physical activity patterns collected from mobile devices and self-assessed stress levels of the users. This work serves as a first step toward a computational health coaching solution for mobile device users.

Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions.

'Masked hypertension' is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15-30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared with sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustained hypertension (elevated clinic and ambulatory BP). The confluence of increased cardiovascular risk and a failure to be diagnosed by the conventional approach of clinic BP measurement makes masked hypertension a significant public health concern. However, many important questions remain. First, the definition of masked hypertension varies across studies. Further, the best approach in the clinical setting to exclude masked hypertension also remains unknown. It is unclear whether home BP monitoring is an adequate substitute for ambulatory BP monitoring in identifying masked hypertension. Few studies have examined the mechanistic pathways that may explain masked hypertension. Finally, scarce data are available on the best approach to treating individuals with masked hypertension. Herein, we review the current literature on masked hypertension including definition, prevalence, clinical implications, special patient populations, correlates, issues related to diagnosis, treatment and areas for future research.

Visit-to-visit and 24-h blood pressure variability: association with endothelial and smooth muscle function in African Americans.

The purpose of this study was to investigate the association of visit-to-visit and 24-h blood pressure (BP) variability with markers of endothelial injury and vascular function. We recruited 72 African Americans who were non-diabetic, non-smoking and free of cardiovascular (CV) and renal disease. Office BP was measured at three visits and 24-h ambulatory BP monitoring was conducted to measure visit-to-visit and 24-h BP variability, respectively. The 5-min time-course of brachial artery flow-mediated dilation and nitroglycerin-mediated dilation were assessed as measures of endothelial and smooth muscle function. Fasted blood samples were analyzed for circulating endothelial microparticles (EMPs). Significantly lower CD31+CD42- EMPs were found in participants with high visit-to-visit systolic blood pressure (SBP) variability or high 24-h diastolic blood pressure (DBP) variability. Participants with high visit-to-visit DBP variability had significantly lower flow-mediated dilation and higher nitroglycerin-mediated dilation at multiple time-points. When analyzed as continuous variables, 24-h mean arterial pressure variability was inversely associated with CD62+ EMPs; visit-to-visit DBP variability was inversely associated with flow-mediated dilation normalized by smooth muscle function and was positively associated with nitroglycerin-mediated dilation; and 24-h DBP variability was positively associated with nitroglycerin-mediated dilation. All associations were independent of age, gender, body mass index and mean BP. In conclusion, in this cohort of African Americans visit-to-visit and 24-h BP variability were associated with measures of endothelial injury, endothelial function and smooth muscle function. These results suggest that BP variability may influence the pathogenesis of CV disease, in part, through influences on vascular health.

OXIDATIVE STRESS RESPONSE TO SHORT DURATION BOUT OF SUBMAXIMAL AEROBIC EXERCISE IN HEALTHY YOUNG ADULTS.

PURPOSE: The purpose of this study was to investigate the oxidative stress response to a short duration bout of submaximal exercise in a cohort of healthy young adults. METHODS: 15 apparently healthy college age males and females completed a modified Bruce-protocol treadmill test to 75-80% of their heart rate reserve. Blood samples collected immediately before (pre-exercise), immediately after, 30, 60 and 120 minutes post-exercise were assayed for total antioxidant capacity (TAC), superoxide disumutase (SOD), thiobarbituric acid-reactive substances (TBARS), and protein carbonyls (PC). RESULTS: SOD activity was significantly increased from pre-exercise levels at 30 minutes (77%), 60 minutes (33%), and 120 minutes (37%) post-exercise. TAC levels were also significantly increased from pre-exercise levels at 60 minutes (30%) and 120 minutes (33%) post-exercise. There were no significant changes in biomarkers for reactive oxygen/nitrogen species (RONS) mediated damage (TBARS and PC) across all post-exercise time points. CONCLUSIONS: In a cohort of healthy young adults, a short duration bout of submaximal aerobic exercise elicited increases in antioxidant activity/concentration, but did not evoke changes in oxidative stress-induced damage. These results may suggest that: (1) short duration bouts of submaximal aerobic exercise are sufficient to induce RONS generation; and (2) the antioxidant defense system is capable of protecting against enhanced RONS production induced by a short duration, submaximal exercise bout in healthy young adults.