The Efficacy of Individualized, Community-Based Physical Activity to Aid Smoking Cessation: A Randomized Controlled Trial.

Objective: The efficacy of individualized, community-based physical activity as an adjunctive smoking cessation treatment to enhance long-term smoking cessation rates was evaluated for the Lifestyle Enhancement Program (LEAP). Methods: The study was a two-arm, parallel-group, randomized controlled trial. All participants (n = 392) received cessation counseling and a nicotine patch and were randomized to physical activity (n = 199; YMCA membership and personalized exercise programming from a health coach) or an equal contact frequency wellness curriculum (n = 193). Physical activity treatment was individualized and flexible (with each participant selecting types of activities and intensity levels and being encouraged to exercise at the YMCA and at home, as well as to use "lifestyle" activity). The primary outcome (biochemically verified prolonged abstinence at 7-weeks (end of treatment) and 6- and 12-months postcessation) and secondary outcomes (7-day point prevalent tobacco abstinence (PPA), total minutes per week of leisure time physical activity and strength training) were assessed at baseline, 7 weeks, 6 months, and 12 months. Results: Prolonged abstinence in the physical activity and wellness groups was 19.6% and 25.4%, respectively, at 7-weeks, 15.1% and 16.6% at 6-months, and 14.1% and 17.1% at 12 months (all between-group P values >0.18). Similarly, PPA rates did not differ significantly between groups at any follow-up. Change from baseline leisure-time activity plus strength training increased significantly in the physical activity group at 7 weeks (P = 0.04). Across treatment groups, an increase in the number of minutes per week in strength training from baseline to 7 weeks predicted prolonged abstinence at 12 months (P ≤ 0.001). Further analyses revealed that social support, fewer years smoked, and less temptation to smoke were associated with prolonged abstinence over 12 months in both groups. Conclusions: Community-based physical activity programming, delivered as adjunctive treatment with behavioral/pharmacological cessation treatment, did not improve long-term quit rates compared to adjunctive wellness counseling plus behavioral/pharmacological cessation treatment. This trial is registered with https://beta.clinicaltrials.gov/study/NCT00403312, registration no. NCT00403312.

Bone Accrual in Children and Adolescent Nonelite Swimmers: A 2-Year Longitudinal Study.

OBJECTIVE: To examine differences in bone mass between children and adolescents swimming competitively at nonelite levels (locally and regionally) and nonathletes and to assess changes in bone mass in these 2 groups over 24 months after taking into consideration several known confounders of bone mass. DESIGN: Observational prospective study. PARTICIPANTS: White nonelite swimmers (n = 128) and nonathletes (n = 106) 8 to 18 years of age from Memphis, Tennessee, USA. MAIN OUTCOME MEASURES: Participants underwent dual-energy x-ray absorptiometry to assess total body and hip bone mineral content (BMC) at baseline and 12 and 24 months later. RESULTS: At baseline, swimmers had 4.2% and 6.1% higher adjusted BMC for the total body and hip, respectively, compared with nonathletes (P values < 0.027). Averaging across assessment points, swimmers had 73.5 and 2.2 g higher BMC for the total body and hip, respectively, than nonathletes. Although there was a significant annual increase in total body and hip BMC in both groups (33.5 and 0.7 g, respectively), there was no difference in annualized bone accrual between swimmers and nonathletes for either total body BMC (swim by time effect; P = 0.213) or hip BMC (P = 0.265). CONCLUSIONS: Competitive swimming at nonelite levels during childhood and adolescence does not seem to compromise bone accrual.

Identification of facilitators and barriers to participation in weight gain prevention research by African American girls.

OBJECTIVE: The purpose of the current study is to describe the development, implementation, and success of recruitment and adherence strategies of 303 African American preadolescent girls and their primary caregiver in the Girls health Enrichment Multi-site Studies (GEMS) program. METHODS: A socio-ecologic model was used to guide selection and implementation of recruitment and retention strategies which were continuously monitored and revised in response. Strategy mode and frequency associated with program enrollment, engagement, and retention were analyzed. RESULTS: Successful recruitment approaches included radio messages (23.1%), school fliers (20.1%), and friend referral (15%). Initially 463 potential participants responded, 320 girls were screened, and 303 enrolled. Significant increases in participant accrual were observed between Wave 4 (n=28) and Wave 5 (n=91) after using a team recruitment approach. Implementing case management strategies and providing make-up sessions also served to keep participants current and engaged in the program. In year 2, community field trips replaced the more structured sessions providing participants with experiential learning opportunities. Overall intervention attendance rates ranged from 79.7% to 90.5% among waves. Further, 75.9% and 80.2%, respectively, of participants attended 1-year and 2-year follow-ups. CONCLUSION: Multiple recruitment strategies and flexible, responsive approaches to recruitment and retention guided by the socio-ecologic model facilitated optimal implementation of an intervention for preadolescent girls. Through the application of the socio-ecologic model researchers and program leaders will be able to identify strategies to enhance the probability of successful outcomes.

Comparison of nutritional intake in US adolescent swimmers and non-athletes.

Swimming is a very popular sport among adolescents in the US. Little is known about the diet of competitive adolescent swimmers in the US but data from other countries indicate several inadequacies, including excessive intake of fat and lower than recommended intake of carbohydrate and several micronutrients that may affect athletic performance and bone accrual. We assessed usual diet, using a food frequency questionnaire and calcium checklist, among 191 adolescent males and females [91 swimmers (mean 13.7, s = 2.5 years) and 100 non-athletes (mean 14.4, s = 2.8 years)]. For both males and females, swimmers and non-athletes generally had similar average intakes of macro- and micro-nutrients, including higher than recommended amounts of total fat (36%) and saturated fat (12%), and inadequate amounts of calcium, vitamin D, and daily servings of fruits, vegetables, grains, and dairy products. This first study of nutritional intake among adolescent swimmers in the US suggests that dietary habits of adolescents who swim competitively may jeopardize optimal athletic performance and place them at risk for future chronic diseases, including osteoporosis.

The Memphis Girls' health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls.

OBJECTIVE: To determine the efficacy of a 2-year obesity prevention program in African American girls. DESIGN: Memphis GEMS (Girls' health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention. SETTING: Local community centers and YWCAs (Young Women's Christian Associations) in Memphis, Tennessee. PARTICIPANTS: Girls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher. INTERVENTIONS: Group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention). MAIN OUTCOME MEASURE: The BMI at 2 years. RESULTS: The BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years. CONCLUSIONS: The lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.

Measurement of body composition in 8-10-year-old African-American girls: a comparison of dual-energy X-ray absorptiometry and foot-to-foot bioimpedance methods.

OBJECTIVE: The purpose of this study was to evaluate body composition outcomes of foot-to-foot (FF) bioelectrical impedance (BIA) and dual-energy x-ray (DEXA) in 8 to 10-year-old African-American girls and, if different, to develop and cross-validate specific BIA prediction equations for this at-risk group. METHODS: DEXA and FF-BIA body composition outcomes were analyzed in 183, 8-10-year-old African-American girls from the Memphis site of the Girls health Enrichment Multi-site Study (GEMS). RESULTS: Mean body composition outcomes by FF-BIA and DEXA were significantly different (p<0.0001); therefore, population-specific equations were developed and cross-validated using split-sample, cross-validation methods. When equations were used, BIA and DEXA outcomes were significantly correlated (percent body fat [r=0.931], fat mass [r=0.985], and fat-free mass [r=0.944]). Mean predicted BIA measurements for body fat, fat mass, and fat-free mass were essentially equal to their counterpart DEXA measurements (t[182]=- 0.013, p = 0.897, t[182]=- 0.06, p=0.956, and t[182]=- 0.26, p=0.792, respectively). The Bland-Altman analysis revealed a significant slope for percent fat (p=0.009) and slopes approaching significance for fat mass (p=0.07) and fat-free mass (p=0.06). CONCLUSION: Although FF-BIA and DEXA are not directly interchangeable in young African-American girls, these equations accurately estimated average percent fat, fat mass, and fat-free mass of the cross-validation sample of African-American girls. However, the application of this equation may result in potential underestimation or overestimation of fat with respect to DEXA measures in some populations.

Self-perception and body image associations with body mass index among 8-10-year-old African American girls.

OBJECTIVES: The purpose of this study was to examine relationships among body mass index (BMI), self-perceptions, and body image discrepancy in African American (AA) girls. METHODS: Baseline self-perception and BMI data were collected by trained staff from 303 preadolescent AA girls participating in the girls health enrichment multi-site studies. Correlations and multivariable logistic regression analyses were performed to identify relationships of BMI with self-perception factors. RESULTS: Girls with a BMI at or above the 85th percentile were more likely to have greater body image discrepancy and participate in weight control behaviors than girls with a BMI below the 85th percentile. Body image discrepancy was not related to self-esteem, but was positively correlated with physical activity self-concept and self-efficacy, and diet self-efficacy. CONCLUSION: Girls with higher BMI had greater body image discrepancy and were less confident in abilities to be active and eat healthy. Findings may inform the development of obesity interventions for preadolescents.

The relationship between caffeine and blood pressure in preadolescent African American girls.

BACKGROUND: While high caffeine consumption has been shown to be associated with increased blood pressure in controlled experiments, the relationship between caffeine consumption and blood pressure in preadolescent (ages 6-11 years) and adolescent (ages 12-19 years) children has not been well studied. The primary objective of this study was to assess the cross-sectional relationship between caffeine intake and blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet. METHODS: Demographic, 24-hour dietary recall, and blood pressure data collected at baseline from 303 African American girls aged 8-10 years in the Girls health Enrichment Multisite Studies (GEMS) cohort were analyzed by using linear and multiple regression models. RESULTS: Dietary caffeine intake was not associated with either systolic or diastolic blood pressure (P=.33 and P=.36, respectively). However, consistent with the literature, height and body mass index were each positively and independently associated with systolic blood pressure (both P<.0001). Height and amount of sodium intake were positively associated with diastolic blood pressure (P=.01 and P=.02, respectively). CONCLUSIONS: Dietary caffeine intake in low amounts is not associated with elevated blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet.

Early sexual maturation, body composition, and obesity in African-American girls.

OBJECTIVE: To describe associations between sexual maturation and body composition in a sample of African-American girls who were participants in phase 1 pilot interventions of the Girls Health Enrichment Multisite Studies. RESEARCH METHODS AND PROCEDURES: Stature, weight, and waist circumference were measured. Pubic hair and breast development were assessed, and body composition was measured by DXA for 147 African-American girls who were 8 to 10 years of age from three field centers. Participants had BMI > or =25th percentile for age (one site) or BMI > or =50th percentile for age. RESULTS: Girls Health Enrichment Multisite Studies girls had greater BMI, fat mass, and percentage body fat than national norms and relatively earlier initiation of breast development and pubic hair. Increasing stages of breast development, but not stages of pubic hair, were related to increased stature, waist circumference, BMI, lean mass, fat mass, and percentage of body fat. Pubescent girls (breast stage > or = 2) were greater than six times as likely to be classified as at risk of overweight (BMI > or = 85th percentile) and greater than eight times as likely to be classified as overweight (BMI > or = 95th percentile) as prepubescent counterparts. Adjusted odds ratios for advanced breast development [breast stage > or = 2 (8 years) or > or = 3 (9 and 10 years)] were 3.6 for risk of overweight and for overweight compared to girls with average or less than average breast development. DISCUSSION: Sexual maturation is important to consider in understanding the classification of overweight and the development of obesity during adolescence. Breast development and pubic hair development should be considered separately for their associations with growth and body composition.

Assessing weight-related biochemical cardiovascular risk factors in African-American girls.

OBJECTIVE: Hyperinsulinemia/insulin resistance is a risk factor for future type 2 diabetes. Fasting insulin and blood lipids serve as direct indicators of subsequent risk and as biochemical markers of metabolically significant adiposity. We examined the feasibility of obtaining fasting blood samples and report correlates of these biochemical markers in an understudied population sample. RESEARCH METHODS AND PROCEDURES: Fasting samples were requested from African-American girls, 8.00 to 10.99 years of age, for insulin, glucose, and lipid concentrations. Indices of insulin sensitivity and secretion were calculated and correlated with anthropometric, dietary, physical activity, and body composition data. RESULTS: Samples were obtained from 119 of 210 (57%) girls, varying from 5% to 86% across the four field centers. Glucose ranged from 71 to 104 mg/dL. Eleven percent had insulin concentrations >20 mU/liter. One girl had a triglyceride concentration >130 mg/dL. Thirteen percent had total cholesterol >200 mg/dL, whereas all subjects had high-density lipoprotein (HDL)-cholesterol of > or =35 mg/dL. Fourteen percent had low-density lipoprotein levels >130 mg/dL. Insulin concentrations showed consistently strong associations with measures of body weight (rs = 0.54 to 0.67); glucose, HDL, and LDL showed weaker correlations (rs = -0.11 to 0.22). Insulin concentration was highly correlated with indices of both insulin secretion and resistance (rs = 0.99). DISCUSSION: Fasting blood samples in young African-American girls were obtained with reasonable cooperation in three of the four field centers involved in this community-based study. Fasting insulin, glucose, LDL, and HDL concentrations may help evaluate future diabetes and cardiovascular risk in children of this age.

Reliability and validity of a brief questionnaire to assess calcium intake in female collegiate athletes.

Calcium intake often is inadequate in female collegiate athletes, increasing the risk for training injuries and future osteoporosis. Thus, a brief and accurate assessment tool to quickly measure calcium intake in athletes is needed. We evaluated the reliability and validity, compared to 6 days of diet records (DRs), of the Rapid Assessment Method (RAM), a self-administered calcium checklist. Seventy-six female collegiate athletes (mean age = 18.8 yrs, range= 17- 21; 97 % Caucasian) were recruited from basketball, cross-country, field hockey, soccer, and volleyball teams. Athletes completed a RAM at the start of the training season to assess calcium intake during the past week. Two weeks later, a second RAM was completed to assess reliability, and athletes began 6 days of diet records (DRs) collection. At completion of DRs, athletes completed a final RAM, corresponding to the same time period as DRs, to assess agreement between the 2 instruments. The RAM demonstrated adequate test-retest reliability over 2 weeks (n= 56; Intraclass correlation [ICC] = 0.54, p < 0.0001) and adequate agreement with DRs (n = 34; ICC = 0.41, p = 0.0067). Calcium intake was below recommended levels, and mean estimates did not differ significantly on the RAM (823 +/- 387 mg/d) and DRs (822 +/- 330 mg/d; p = 0.988). Adequacy of calcium intake from both DRs and the RAM was classified as "inadequate" (<1000 mg/d) and "adequate" (> or = 1000 mg/d). Agreement between the RAM and DRs for adequacy classification was fair (ICC= 0.30, p = 0.042), with the RAM identifying 84% of athletes judged to have inadequate calcium intake based on DRs. The RAM briefly and accurately estimates calcium intake in female collegiate athletes compared to DRs.

Side-to-side comparisons of bone mineral density in upper and lower limbs of collegiate athletes.

This cross-sectional study investigated the effects of participation in various sports on side-to-side (contralateral) differences in bone mineral density (BMD) of the upper and lower limbs. The BMD of the arms and legs was measured using dual energy X-ray absorptiometry. The subjects were 184 collegiate athletes, both men and women, who participated in NCAA Division I-A baseball, basketball, football, golf, soccer, tennis, cross-country, indoor/outdoor track, and volleyball. Results revealed greater BMD of the right arms compared with the left arms for all teams, with the most pronounced differences observed in men's and women's tennis and men's baseball. Differences in the lower limbs were less common. No significant differences in lower limb BMD were found in the women. In men, differences in lower limb BMD were found in the football and tennis teams, with the nondominant leg having greater bone mass. Recognition of contralateral differences in bone density may be of particular interest to strength and conditioning professionals as they consider the need to include bilateral and unilateral training programs in an effort to maximize performance and minimize stress-related injuries.

Bone mineral density in triathletes over a competitive season.

There is evidence from previous cross-sectional studies that high volumes of certain sports, including running, swimming and cycling, may have a negative impact on bone mineral density. The aim of the present study was to evaluate prospectively the effects of high athletic training in individuals who engage in high volumes of all three of these activities (triathletes). Bone mineral density for the total body, arms and legs was determined by dual-energy X-ray absorptiometry in 21 competitive triathletes (9 men, 12 women) at the beginning of the training season and 24 weeks later. Age, body mass index, calcium intake and training volume were also recorded to examine potential mediators of bone mineral density change. Men had greater bone mineral density at all sites than women. No significant changes were observed over the 24 weeks for either total body or leg bone mineral density. Bone mineral density in both arms increased by approximately 2% in men (P < 0.03), but no change was observed for women. Change in bone mineral density at all sites was unrelated to age, body mass index, calcium intake and training volume. The results suggest that adverse changes in bone mineral density do not occur over the course of 6 months of training in competitive triathletes.

History of sport participation in relation to obesity and related health behaviors in women.

BACKGROUND: Organized sport participation in youth is a common form of physical activity; yet, little is known about how it is associated with adult obesity and related health behaviors. The purpose of this study was to investigate whether a history of youth sport participation was related to adult obesity, physical activity, and dietary intake among women. METHODS: Participating women (209 African American, 277 Caucasian; ages 18-39), recruited from the community, completed laboratory measures, a paper and pencil survey assessing past sport participation and current physical activity level, and dietary records. RESULTS: Linear regression revealed that a history of sport participation predicted lower adult body mass index and higher total and sport activity levels for both ethnic groups and higher work-related physical activity among Caucasians (all P < 0.001). Past sports participation did not predict dietary intake. CONCLUSIONS: The results suggest that girls' participation in sports may lay the foundation for adult health and health behaviors and that sports participation could be an important component of obesity prevention programs.