Criterion Validity and Reliability of 2 Brief Physical Activity Questionnaires in Ethnically Diverse Adults.

PURPOSE: The study compares moderate- to vigorous-intensity physical activity (MVPA) as evaluated by the Exercise Vital Signs (EVS) and Physical Activity Vital Signs (PAVS) questionnaires to accelerometry, and evaluates the reliability of the questionnaires in ethnically diverse adults. METHODS: Ninety-nine participants (mean age 38.1 y; 49.5% women; Hispanics 43.8%; European American 18.8%; African American 14.6%) were included in the analyses. Participants wore an accelerometer at the hip for at least 7 days and completed the EVS and PAVS questionnaires at the beginning (T1) and at the end (T2) of the 7 days. Associations between the questionnaires and accelerometry were examined using Spearman rho. The reliability of the questionnaires was evaluated using intraclass correlation coefficient. Sensitivity and specificity were also calculated. RESULTS: Weak positive correlations were observed between the accelerometer MVPA and the EVS MVPA at T2 (ρ = .263, P = .013), and the PAVS MVPA at T2 (ρ = .327, P = .003). The sensitivity of the EVS and PAVS was 73.2% and 82.6%, respectively. The specificity for each questionnaire was 35.3%. The reliability for the EVS questionnaire (intraclass correlation coefficient = .855; 95% CI, .791-.901; P < .001) was good, while the reliability of the PAVS questionnaire (intraclass correlation coefficient = .652; 95% CI, .511-.758; P < .001) was moderate. CONCLUSION: Caution should be used when utilizing the EVS and PAVS questionnaires in ethnically diverse adults.

Characterizing Heart Rate Variability Response to Maximal Exercise Testing in People with Huntington's Disease.

Background: Huntington's disease (HD) is an autosomal dominant, neurodegenerative disease that involves dysfunction in the autonomic nervous system (ANS). Heart rate variability (HRV) is a valid and noninvasive measure for ANS dysfunction, yet no study has characterized HRV response to exercise in people with HD. Objective: Characterize HRV response to exercise in individuals with HD and explore its implications for exercise prescription and cardiac dysautonomia mechanisms. Methods: 19 participants with HD were recruited as part of a cohort of individuals enrolled in the Physical Activity and Exercise Outcomes in Huntington's Disease (PACE-HD) study at Teachers College, Columbia University (TC). 13 non-HD age- and gender-matched control participants were also recruited from TC. HRV was recorded with a Polar H10 heart rate (HR) monitor before, during, and after a ramp cycle-ergometer exercise test. Results: Participants with HD showed reduced HR peak (p < 0.01) and HR reserve (p < 0.001) compared with controls. Participants with HD demonstrated reduced root mean square of successive differences between normal-to-normal intervals (RMSSD) and successive differences of normal-to-normal intervals (SDSD) at rest (p < 0.001). Participants with HD also showed differences for low frequency (LF) power (p < 0.01), high frequency (HF) normalized units (nu) (p < 0.05), LF (nu) (p < 0.001), and HF/LF ratio (p < 0.05) compared with controls. Conclusions: We found reduced aerobic exercise capacity and sympathovagal dysautonomia both at rest and during post-exercise recovery in people with HD, suggesting modified exercise prescription may be required for people with HD. Further investigations focusing on cardiac dysautonomia and underlying mechanisms of sympathovagal dysautonomia in people with HD are warranted.

Comparison of traditional vs. lighter load strength training on fat-free mass, strength, power and affective responses in middle and older-aged adults: A pilot randomized trial.

OBJECTIVES: Strength training is widely recommended to improve strength, muscle mass and power. However, the feasibility and potential efficacy of strength training using lighter loads near failure on these outcomes in middle and older-aged adults remains unclear. METHODS: 23 community-living adults were randomized into two groups: Traditional strength training (ST) (8-12 repetitions) or a lighter load, higher repetitions (LLHR) (20-24 repetitions) group. Participants performed a full-body workout (twice a week) with 8 exercises at a perceived exertion of 7-8 (0-10 scale) for 10 weeks. Post-testing was performed by an assessor blinded to group assignments. An analysis of covariance (ANCOVA) was used to examine between group differences using baseline values as a covariate. RESULTS: The study involved individuals with a mean age of 59 years, of which 61 % were women. The LLHR group demonstrated a high attendance rate of 92 % (9.5 %) and reported leg press exercise RPE of 7.1 (0.53), along with a session feeling scale of 2.0 (1.7). There was a trivial difference in fat free mass (FFM) favoring LLHR vs ST [0.27 kg 95 % CI (-0.87, 1.42)]. The ST group exhibited superior increases in leg press 1 repetition maximum (1RM) strength [-14 kg (-23, -5)], while the LLHR group showed greater strength endurance increases (65 % 1RM) [8 repetitions (2, 14)]. Leg press power [41 W (-42, 124)] and exercise efficacy [-3.8 (-21.2, 13.5)] demonstrated trivial between-group differences. CONCLUSION: A pragmatic, full-body strength training program with lighter loads taken close to failure appears to be a viable option for promoting muscular adaptations in middle- and older-aged adults. These results are exploratory and require a larger trial for confirmation.

Comparison of Power Training vs Traditional Strength Training on Physical Function in Older Adults: A Systematic Review and Meta-analysis.

Importance: Strength training exercise is recommended for improving physical function in older adults. However, whether strength training (lifting and lowering weights under control) and power training (PT) (lifting weights fast and lowering under control) are associated with improved physical function in older adults is not clear. Objective: To evaluate whether PT vs traditional strength training is associated with physical function improvement in older adults. Data Sources: Systematic searches of MEDLINE, Embase, Cochrane Central, CINAHL, PsycInfo, PEDro, and SPORTDiscus were conducted from database inception to October 20, 2021. Study Selection: Randomized clinical trials (RCTs) that compared strength training with instructions to move the weight as fast as possible in the lifting phase with traditional strength training in healthy, community-living older adults (age ≥60 years). Data Extraction and Synthesis: Two authors independently selected trials, extracted data, assessed the risk of bias using the Cochrane risk-of-bias tool 2, and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Summary effect size measures were calculated using a multilevel random-effects model with cluster robust variance estimation and are reported as standardized mean differences (SMDs). Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Main Outcomes and Measures: Primary outcomes included physical function and self-reported physical function. Secondary outcomes included power, strength, muscle mass, walk speed, balance, and adverse effects. Results: A total of 20 RCTs enrolling 566 community-living older adults (mean [SD] age, 70.1 [4.8] years; 368 [65%] women) were included. For the primary outcomes, PT was associated with an improvement in physical function with low-certainty evidence in 13 RCTs (n = 383) (SMD, 0.30; 95% CI, 0.05-0.54) and self-reported function with low-certainty evidence in 3 RCTs (n = 85) (SMD, 0.38; 95% CI, -0.62 to 1.37). The evidence was downgraded by 2 levels for high risk of bias and imprecision for physical function and very serious imprecision for self-reported physical function. Conclusions and Relevance: In this systematic review and meta-analysis, PT was associated with a modest improvement in physical function compared with traditional strength training in healthy, community-living older adults. However, high-quality, larger RCTs are required to draw more definitive conclusions.

Longitudinal association between cardiometabolic comorbidities and physical activity in middle aged and older adults living with HIV.

OBJECTIVES: Cardiometabolic comorbidities have been associated with lower levels of physical activity (PA) among people living with HIV (PLWH). However, little is known about the longitudinal relationship between cardiometabolic comorbidities and PA participation. Therefore, the aim of this study was to determine the longitudinal association between cardiometabolic comorbidities and PA in PLWH. METHODS: PLWH from New York City and with complete PA and cardiometabolic comorbidity data between December 2016 and October 2020 were included. PA was evaluated using energy expenditure from the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ). Body composition was measured using body mass index (BMI) and different waist circumference measures. Diabetes and hyperlipidemia were determined by physician diagnosis. Hemoglobin A1c (HbA1c) was evaluated through blood samples. Linear mixed-effects models analyses were conducted to assess the longitudinal relationship between cardiometabolic comorbidities and PA. RESULTS: A total of 164 participants (mean age 59.6 years; 48.2% females) were included. The mean follow-up period was 22.7 months (SD = 7.9). Higher BMI was associated with lower levels of PA in kcals/week (p < .05). An obese BMI was associated with lower levels of physical activity in kcals/week (p < .05). Higher mid-waist and umbilical circumference were associated with lower levels of PA in kcals/week (p < .05). Having hyperlipidemia was associated with lower levels of PA in kcals/week (p < .01). Having a diabetes diagnosis and elevated HbA1c were also associated with lower levels of PA in kcals/week (p < .05). CONCLUSION: Cardiometabolic comorbidities can have repercussions on PA participation among PLWH, which can in turn increase the risk of cardiovascular disease and mortality.

Prevalence of Cardiometabolic Risk Factors Among People Living with HIV in Southern Texas.

The aim of this study is to estimate the prevalence of cardiometabolic risk factors among people living with HIV (PLWH) in the south Texas region between 2014 and 2018. A total of 2,808 PLWH from the southern Texas region were included using electronic medical records from a combination of health care system databases. The prevalence of cardiometabolic factors such as elevated blood pressure (BP), triglycerides, total cholesterol and blood glucose, low high-density lipoprotein cholesterol (HDL-C), and obesity was evaluated. The association between cardiometabolic risk factors and age, sex, race/ethnicity, and HIV-related variables was evaluated using logistic regression. Approximately 50.8% had elevated BP, followed by low HDL-C (41.7%), elevated glucose (40.3%), elevated triglycerides (35.5%), obesity (27.8%), and elevated total cholesterol (20%). Hispanics had a higher prevalence of low HDL-C (45.5% vs. 39.7%, p = .012), elevated glucose (48.9% vs. 36.3%, p < .001), elevated triglycerides (40.4% vs. 33.0%, p = .001), and obesity (31.3% vs. 26.0%, p = .004) than non-Hispanics. Females had a higher prevalence of low HDL-C (51.9% vs. 39.1%, p < .001), elevated total cholesterol (24.4% vs. 18.8%, p = .010), and obesity (49.5% vs. 21.8%, p < .001) than males. Variables such as age, sex, race/ethnicity, CD4+ T cell count, and viral load use were associated with multiple cardiometabolic risk factors. The prevalence of cardiometabolic risk factors remains high among PLWH in the southern Texas region, especially among Hispanics and females.

Validity, reliability, and measurement error of a sit-to-stand power test in older adults: A pre-registered study.

OBJECTIVES: Lower body power declines with age and is associated with decreased physical function in older adults. However, the majority of the tools available to measure power are expensive and require considerable space and expertise to operate. The purpose of this study was to assess the validity, reliability, and measurement error of a sit-to-stand power test (STSp) to assess lower body power. METHODS: 51 community-dwelling adults, 65 years or older, completed a power test using a pneumatic leg press (LP), the Short Physical Performance Battery (SPPB) that includes a test of balance, usual walking speed, and chair stand tests; Timed Up and Go (TUG) test at both usual and fast paces, and Patient-Reported Outcome Measures (PROMs). A two-week test-retest assessed the reliability in 36 participants. The study hypotheses and analysis were pre-registered prior to data collection and statistical analyses were blinded. RESULTS: The mean age was 71.3 years, with 63% females, and an average SPPB score of 10.6 (median = 12). STSp peak power was strongly correlated with LP (r = 0.90, 95% CI (0.82, 0.94). As hypothesized, the STSp peak power showed similar or higher correlations with physical function tests relative to LP peak power: SPPB (0.41 vs. 0.29), chair stand test (-0.44 vs. -0.35), TUG test at usual pace (-0.37 vs. -0.29) and fast pace (-0.41 vs. -0.34) and balance (0.33 vs. 0.22), but not for mobility (0.34 vs. 0.38) and function (0.41 vs. 0.48) questionnaire. For discriminant validity, as hypothesized, males showed higher STSp peak power compared to females (Δ = 492 W, p < .001, Cohen's d = 2.0). Test-retest assessment yielded an intraclass correlation coefficient of 0.96 and a standard error of measurement of 70.4 W. No adverse events were reported or observed for both tests. CONCLUSION: The STSp showed adequate validity and reliability in measuring lower body power in community-dwelling older adults. The test is quick, relatively inexpensive, safe, and portable and thus should be considered for use in aging research.

The effects of exercise on lipid profile and blood glucose levels in people living with HIV: A systematic review of randomized controlled trials.

Exercise is commonly prescribed to improve lipid profile and glucose levels in people living with HIV (PLWH). This systematic review was performed in order to examine the effects of exercise interventions on lipid profile and glucose levels on PLWH. Randomized controlled trials (RCTs) investigating the effects of exercise on blood glucose, triglycerides (TG), total cholesterol (TC), HDL and LDL published up to November 2017 were reviewed. Two reviewers assessed inclusion and exclusion criteria, methodological quality and extracted the data. The PEDro scale was used to assess the quality of the included studies. Nine RCTs involving 638 PLWH met inclusion criteria. The median PEDro scale score was 5 out of 10. Three combined aerobic exercise + resistance exercise studies (AE+RE) showed improvements in blood glucose levels, one study showed improvements in HDL, one showed improvements in TG, and one showed improvements in TC. The AE only study reported improvements in HDL, while the RE only study reported improvements in TG, TC, HDL and LDL. Exercise can be effective for the improvement of some metabolic parameters, especially blood glucose and HDL. However, due to methodological issues, small number of studies and differences in exercise protocols, these findings should be interpreted with caution.

Effectiveness of an 8-Week Aerobic Exercise Program on Autonomic Function in People Living with HIV Taking Anti-Retroviral Therapy: A Pilot Randomized Controlled Trial.

This study assessed the effectiveness of an 8-week aerobic exercise program on heart rate variability (HRV) in people living with HIV taking antiretroviral therapy. Twenty-six participants were randomly assigned to a control group or an aerobic exercise group. Resting HRV was measured for 5 min in supine position using an electrocardiogram. Estimated maximal oxygen uptake (VO2max) was assessed through a treadmill 6-min walk test. The training program consisted of aerobic exercise thrice per week at 65%-75% of heart rate max for 45 min per session. Repeated measures ANOVA was used to test for differences between groups, and Spearman's rho was used to assess for the correlation between HRV measures and estimated VO2max. There was no significant group by time interactions for any of the HRV indices. However, the standard deviation of normal-to-normal (NN) R-R intervals increased significantly in the aerobic exercise group (pre: 46.97 ± 32.70 ms vs. post: 59.49 ± 37.20 ms, p = .045). There was a strong correlation between the VO2max and the standard deviation of NN intervals (SDNN) (r = 0.617; p = .002). There was a moderate correlation between VO2max and the square root of the mean squared differences of successive normal-to-normal intervals (rMSSD) (r = 0.424; p = .049), the low frequency power (r = 0.506; p = .016), and the standard deviation of differences between successive differences of normal-to-normal intervals (SDSD) (r = 0.424; p = .049). While differences in HRV were not observed between groups, our data suggest that overall autonomic function can improve across time with aerobic exercise, and these changes are associated with greater levels of VO2max. These results advocate the importance of improvements in HRV given their association with lower risk of cardiovascular disease and mortality.

Validity and Reliability of the Exercise Vital Sign Questionnaire in an Ethnically Diverse Group: A Pilot Study.

The purpose of this study was to determine the validity and reliability of the Exercise Vital Sign (EVS) questionnaire in an ethnically diverse sample. Participants (N = 39) were asked to wear an accelerometer at the hip for at least 7 days and to complete the EVS at the beginning (T1) and end (T2) of the wear period. The EVS questionnaire validity was determined against accelerometry, and bias was calculated as the mean difference between measures. The sensitivity and specificity of the EVS questionnaire were also evaluated. The reliability of the questionnaire was calculated using intraclass correlation coefficient (ICC) between EVS responses at T1 and T2. The mean difference in EVS- and accelerometer-determined time in MVPA was 24 min/wk. The reliability for the questionnaire was excellent (ICC = 0.98). The EVS specificity and sensitivity at T2 were 56% and 78%, respectively. The EVS questionnaire may be an acceptable measure of weekly MVPA time compared to accelerometry in an ethnically diverse sample; however, further research is needed to confirm these findings.

Resting Autonomic Function in Active and Insufficiently Active People Living with HIV.

Autonomic dysfunction appears to be prevalent in people living with HIV/AIDS (PLWHA). However, there are limited data on the resting autonomic responses to exercise in active and insufficiently active PLWHA. We aimed to determine whether active PLWHA have better autonomic responses compared with insufficiently active PLWHA. Active PLWHA receiving anti-retroviral therapy (n=13) and insufficiently active PLWHA (n=10) were recruited. A 10-min recording of the supine electrocardiogram was taken. Resting heart rate variability was analyzed from this electrocardiogram. Parasympathetic modulation, as measured by high frequency power in normalized units, was greater in active PLWHA when compared to insufficiently active PLWHA (41.0±15.6 vs. 25.2±9.7; p<0.05). Sympathetic modulation as measured by low frequency power in normalized units was greater in insufficiently active PLWHA when compared to active PLWHA (55.6±15.8 vs 79.3±17.5; p<0.05). Sympathovagal balance as measured by low frequency/high frequency ratio was greater in insufficiently active PLWHA when compared to active PLWHA (3.4±1.8 vs 1.6±0.9; p<0.05), indicating greater parasympathetic dominance in the active group. In conclusion, PLWHA who regularly exercised demonstrated enhanced autonomic function compared with insufficiently active PLWHA. These results suggest that exercise is associated with enhanced autonomic function, and may improve cardiovascular risk.

Association Between Physical Activity, Depression, and Diabetes in Urban-Dwelling People Living with HIV.

Physical activity (PA) may improve physical and mental health in people living with HIV (PLWH). However, the associations between PA participation and physical and mental health problems of PLWH in urban settings remain largely unknown. Our objective was to determine the relationships between PA and physical and mental health in urban-dwelling PLWH. There were 289 adult PLWH who responded to an electronic survey including questions on PA and current physical and mental health. The associations between physical and mental health and PA were investigated using linear and logistic regression. A large proportion of participants met recommended volumes of PA. Eighty-three percent of respondents reported symptoms of severe mental distress. Diabetes mellitus was associated with a lower total volume of PA (p = .035). Similarly, depression was negatively associated with muscle-strengthening exercise participation (p = .030). Sufficient amounts of aerobic activity and/or muscle strengthening exercise are associated with better physical and mental health.