A second chance: meanings of body weight, diet, and physical activity to women who have experienced cancer.

OBJECTIVE: To understand the meanings of diet, physical activity, and body weight in the context of women's cancer experiences. DESIGN: Grounded theory using 15 qualitative interviews and 3 focus groups. SETTING: Grassroots community cancer organizations in the northeastern United States. PARTICIPANTS: Thirty-six white women cancer survivors; 86% had experienced breast cancer. MAIN OUTCOME MEASURES: Participants' views of the meanings of body weight, diet, and physical activity in the context of the cancer. ANALYSIS: Procedures adapted from the constant comparative method of qualitative analysis using iterative open coding. RESULTS: Themes emerged along 3 intersecting dimensions: vulnerability and control, stress and living well, and uncertainty and confidence. Diet and body weight were seen as sources of increased vulnerability and distress. Uncertainty about diet heightened distress and lack of control. Physical activity was seen as a way to regain control and reduce distress. CONCLUSIONS AND IMPLICATIONS: Emergent themes of vulnerability-control, stress-living well, and uncertainty-confidence may aid in understanding and promoting health behaviors in the growing population of cancer survivors. Messages that resonated with participants included taking ownership over one's body, physical activity as stress reduction, healthy eating for overall health and quality of life, and a second chance to get it right.

Evaluation of dietary energy intake and physical activity in dogs undergoing a controlled weight-loss program.

OBJECTIVE: To quantify physical activity and dietary energy intake in dogs enrolled in a controlled weight-loss program and assess relationships between energy intake and physical activity, sex, age, body weight, and body condition score (BCS). DESIGN: Prospective clinical study. ANIMALS: 35 client-owned obese dogs (BCS > 7/9). PROCEDURES: Dogs were fed a therapeutic diet with energy intake restrictions to maintain weight loss of approximately 2%/wk. Collar-mounted pedometers were used to record the number of steps taken daily as a measure of activity. Body weight and BCS were assessed at the beginning of the weight-loss program and every 2 weeks thereafter throughout the study. Relationships between energy intake and sex, age, activity, BCS, and body weight at the end of the study were assessed via multivariable linear regression. Variables were compared among dogs stratified post hoc into inactive and active groups on the basis of mean number of steps taken (< or > 7,250 steps/d, respectively). RESULTS: Mean ± SD daily energy intake per unit of metabolic body weight (kg(0.75)) of active dogs was significantly greater than that of inactive dogs (53.6 ± 15.2 kcal/kg(0.75) vs 42.2 ± 9.7 kcal/kg(0.75), respectively) while maintaining weight-loss goals. In regression analysis, only the number of steps per day was significantly associated with energy intake. CONCLUSIONS AND CLINICAL RELEVANCE: Increased physical activity was associated with higher energy intake while maintaining weight-loss goals. Each 1,000-step interval was associated with a 1 kcal/kg(0.75) increase in energy intake.

Process evaluation of an environmental walking and healthy eating pilot in small rural worksites.

Small Steps are Easier Together (SS) was a pilot environmental intervention in small rural worksites in Upstate New York in collaboration with Extension educators. Worksite leaders teamed with co-workers to select and implement environmental changes to increase walking steps over individual baseline and to choose healthy eating options over 10 weeks. Participants were 226 primarily white, women employees in 5 sites. A mixed methods process evaluation, conducted to identify determinants of intervention effectiveness and to explain differences in outcomes across worksites, included surveys, self-reports of walking and eating, interviews, focus groups, and an intervention log. The evaluation assessed reach, characteristics of recruited participants, dose delivered, dose received, and context and compared sites on walking and eating outcomes. Emergent elements of participant-reported dose received included: active leadership, visible environmental changes, critical mass of participants, public display of accomplishments, accountability to co-workers, and group decision making. Participants at sites with high reach and dose were significantly more likely than sites with low reach and dose to achieve intervention goals. Although this small pilot needs replication, these findings describe how these evaluation methods can be applied and analyzed in an environmental intervention and provide information on trends in the data.

Use of pedometers to measure the relationship of dog walking to body condition score in obese and non-obese dogs.

The objective of the present study was to utilise an accurate canine pedometer methodology and to assess the relationship between activity and body condition score (BCS) in dogs. Initial methodology validation used videography and pedometer step measurements to assess actual steps taken in comparison with pedometer readings for twenty large, medium and small dogs. During the validation, dogs considered to be medium or large breed showed no significant difference between pedometer readings and actual steps taken. A total of seventy-seven obese and non-obese dogs over 35 cm (14 inches) shoulder height and over 10 kg were recruited from a dog obesity clinic and a community sample to assess daily walking activity. Body condition scoring and pedometer steps were assessed on three separate weeks during a 10-week period. During the activity monitoring, daily step counts ranged from 5555 to 39 970 steps/d among the seventy-seven medium and large dogs. Dogs' BCS were inversely correlated with average daily steps (Spearman's ρ = - 0.442, P < 0.0001). The present study identified a significant inverse correlation between daily walking steps and BCS over a range from 4 to 9 out of 9 (P < 0.0001).

Perceptions of the environment for eating and exercise in a rural community.

OBJECTIVE: To understand how members of a rural community perceive the effect of the built, natural, and social environments on their food choice and physical activity behaviors. METHODS: A constructivist community environmental assessment was conducted including 17 individual qualitative interviews, 2 focus groups, and photo elicitation (n = 27) in a rural northeastern community where over 60% of the adult population is overweight or obese. RESULTS: Participants described social, natural, and physical environmental factors that influenced their food choice and physical activity behaviors. Overweight and obesity were variably presented as an individual and/or a collective problem. Participants described conflicting goals for food choice and physical activity in the community, and an interrelationship between the social and physical environments. CONCLUSIONS AND IMPLICATIONS: A community environmental assessment provides a view of the physical and social environments from the perspective of community residents that can serve as a foundation for locally tailored, community-based approaches to obesity prevention.

Small Steps Are Easier Together: a goal-based ecological intervention to increase walking by women in rural worksites.

OBJECTIVE: Small Steps Are Easier Together (SmStep) was a locally-instituted, ecologically based intervention to increase walking by women. METHODS: Participants were recruited from 10 worksites in rural New York State in collaboration with worksite leaders and Cooperative Extension educators. Worksite leaders were oriented and chose site specific strategies. Participants used pedometers and personalized daily and weekly step goals. Participants reported steps on web logs and received weekly e-mail reports over 10 weeks in the spring of 2008. RESULTS: Of 188 enrollees, 114 (61%) reported steps. Weekly goals were met by 53% of reporters. Intention to treat analysis revealed a mean increase of 1503 daily steps. Movement to a higher step zone over their baseline zone was found for: 52% of the sedentary (n=80); 29% of the low active (n=65); 13% of the somewhat active (n=28); and 18% of the active participants (n=10). This placed 36% of enrollees at the somewhat active or higher zones (23% at baseline, p<0.005). CONCLUSION: Workers increased walking steps through a goal-based intervention in rural worksites. The SmStep intervention provides a model for a group-based, locally determined, ecological strategy to increase worksite walking supported by local community educators and remote messaging using email and a web site.

Regulation of arginase expression by T-helper II cytokines and isoproterenol.

BACKGROUND: Trauma causes a release of catecholamines, transforming growth factor-beta (TGF-beta), and T-helper II cytokines (TH2). Individually, these substances also induce arginase in macrophages. The purpose of this study was to determine the synergistic interactions between isoproterenol, TGF-beta, and TH2 cytokines on arginase expression in macrophages. METHODS: Confluent RAW 264.7 macrophages were incubated with various combinations of interleukins 4, 10, and 13 (IL-4, IL-10, IL-13), and TGF-beta with isoproterenol over 48 hours. Arginase activity, as well as arginase I expression by Western blot and reverse transcriptase-polymerase chain reaction, were measured. RESULTS: Although isoproterenol, IL-4, IL-10, and IL-13 individually induced arginase, significant synergy between the combination of isoproterenol with either TGF-beta or the TH2 cytokines was observed. All cytokines except IL-10 also induced arginase I protein and mRNA. Arginase II protein was detected in cells exposed to IL-10. CONCLUSIONS: We conclude that isoproterenol synergizes with IL-4, IL-13, and TGF-beta to increase arginase I mRNA and protein, as well as arginase activity in RAW 264.7 macrophages. Further, IL-10 synergizes with isoproterenol to increase arginase activity and arginase II protein. These synergistic mechanisms may compete with nitric oxide synthase for l-arginine substrate, thus shunting away available arginine from nitric oxide production and contributing to cellular immunosuppression observed after trauma.