A pilot study on the biomechanical assessment of obstructive sleep apnea pre and post bariatric surgery.

Obesity is a major risk factor for obstructive sleep apnea patients. In obese patients the severity of this risk can be reduced by bariatric surgery. This pilot study investigates the perioperative effects of bariatric surgery on obstructive sleep apnea and on the physical and biomechanical characteristics of the upper airway. Polysomnography and computer tomography data for 10 morbid obese patients promoted for bariatric surgery were conducted before surgery and at 6 and 12 months postoperatively for assessment of the oropharyngeal anatomy, and subsequent three-dimensional modelling of the airway. Mean values for the apnea/hypopnea index and body mass index significantly reduced after surgery. To combine the effect of changes in the upper airway volume and body mass index, a new volume body mass index is introduced. This index increases with a successful bariatric surgery. Although bariatric surgery leads to an effective weight reduction for all age groups, for obstructive sleep apnea patients it may be effective for middle age, less effective for 50-60 years, and further less effective for patients over the age of 60 years.

Meals of differing caloric content do not alter physical activity behavior during a subsequent simulated recess period in children.

OBJECTIVE: Research on adults and animals has demonstrated that chronic and acute overfeeding can alter physical activity behavior. However, there are no assessments of the acute effects of high-calorie (HC) meals on physical activity behavior in children. This is of importance as a typical school lunch is HC. If this type of meal negatively impacts subsequent physical activity behavior, the ability of post-lunch recess periods as a means to increase energy expenditure may be lessened. PURPOSE: To assess the effect of two meals of differing caloric content, HC and low calorie (LC), on children's subsequent physical activity behavior. METHODS: Nineteen healthy children (aged 6-10) completed two laboratory sessions where they were fed lunch with HC or LC content, but equivalent macronutrient distribution. Children had 15 min to consume as much of the meal as possible per session. Children consumed 659.5 ± 101.3 kcal in the HC condition and 291.8 ± 12.1 kcal in the LC condition. After the meal, children went to a gymnasium for 40 min. In the gymnasium children had free-choice access to obstacle courses, various sports equipment, and a table with sedentary activities. Children could play with any of the activities in any amount they wished for the entire activity session. Children's physical activity was monitored with accelerometers and that data was converted into caloric expenditure. Each child ate all meals and participated in the free-choice activity sessions with no other children present. RESULTS: Caloric expenditure during the free-choice activity sessions was not significantly different (p = 0.4) between the HC (89.2 ± 27.3 kcals) and LC (83.4 ± 34.9 kcals) conditions. However, caloric balance (kcals eaten-kcals expended) was 2.74-fold greater (p < 0.001) in the HC condition (Δ 570.3 ± 92.2 kcals) than the LC condition (Δ 208.4 ± 32.0 kcals). CONCLUSION: Children did not alter their physical activity behavior during a free-choice activity session after consuming a HC meal versus a LC meal. Because activity was not different across the two conditions, children had a much greater caloric surplus during the HC condition than the LC condition.

Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application.

OBJECTIVE: The study aimed to assess a one-month lifestyle intervention delivered via a web- and mobile-based weight-loss application (app) (LoseIt!) using a healthcare-provider interface. METHODS: Early-stage overweight/obese (body mass index [BMI]≥25kg/m(2)) cancer survivors (CS) diagnosed in the past three years, and without recurrent disease were enrolled and received exercise and nutrition counseling using the LoseIt! app. Entry and exit quality of life (FACT-G) and Weight Efficacy Lifestyle Questionnaire (WEL) measuring self-efficacy were measured along with anthropometrics, daily food intake, and physical activity (PA) using the app. RESULTS: Mean participant age was 58.4±10.3years (n=50). Significant reductions (p<0.0006) in anthropometrics were noted between pre- and post-intervention weight (105.0±21.8kg versus 98.6±22.5kg); BMI (34.9±8.7kg/m(2) versus 33.9±8.4kg/m(2)); and waist circumference (108.1±14.9cm versus 103.7±15.1cm). A significant improvement in pre- and post-intervention total WEL score was noted (99.38±41.8 versus 120.19±47.1, p=0.043). No significant differences were noted in FACT-G, macronutrient consumption, and PA patterns. CONCLUSION: These results indicate that a lifestyle intervention delivered via a web- and mobile-based weight-loss app is a feasible option by which to elicit short-term reductions in weight. Though these results parallel the recent survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED) trial, it is notable that they were achieved without encumbering significant cost and barrier-access issues (i.e. time, transportation, weather, parking, etc.).

Body mass index moderates the effects of portable oxygen transport modality on 6-minute walk distance in patients with COPD.

PURPOSE: While portable, supplemental oxygen is often necessary for patients with chronic obstructive pulmonary disease (COPD) to retain independence, it may provide functional limitations because of the increased workload imposed. This issue may result in nonuse, creating a need to identify carrying modalities that optimize transport. This study assessed the effects of 3 methods of portable oxygen transport on 6-minute walk distance (6 MWD), rate of perceived exertion (RPE), heart rate (HR), and oxyhemoglobin saturation (SpO2). As weight status is known to impact functional ability in COPD, effects of body mass index (BMI) were also assessed. METHODS: Data were analyzed using the mixed-model procedure to test for effects of transport modality (reference, rolling cart, backpack, shoulderstrap), time (minutes 1-6), BMI, non-overweight, overweight, and interactions of these variables on outcome parameters. RESULTS: A main effect of condition was found for 6 MWD, and an interaction of condition × BMI was found for HR and RPE, and of time × BMI for 6 MWD and SpO2. Participants walked the least distance in rolling cart condition, which was also characterized by the greatest RPE. For the overweight group, HR was least in the reference compared with other conditions; but for the non-overweight group, the opposite pattern was observed. At latter time points, 6 MWD was greater in the non-overweight group, while SpO2 was reduced. CONCLUSION: Results demonstrate that transport modality of portable oxygen exerts differential effects on functional performance in COPD patients and that BMI may moderate underlying physiologic factors that contribute to performance outcomes.

Use of the Breathlessness, Cough, and Sputum Scale (BCSS(©)) in Pulmonary Rehabilitation.

BACKGROUND: In pulmonary rehabilitation (PR) effective measures have been taken while in analyzing a patient's intervention with the help of entry to exit evaluations. The absence of an objective and quantifiable scale are limitations of PR that allow analyzing of a patient's self reported symptoms throughout PR. The Breathlessness, Cough and Sputum Scale (BCSS(©)) is used to predict patient exacerbations by evaluating common symptoms identified in the COPD population. This study used the BCSS(©) survey to track complex symptom changes throughout the course of PR intervention. The BCSS(©) tool measured the patient's self reported symptoms in real time for each visit when patient enrolled in PR. METHODS: Thirty-five patients with COPD from three outpatient PR centers were asked to report the severity of breathlessness, cough, and sputum prior to each PR session using the BCSS(©) survey. RESULTS: There was a significant decrease in self reported symptoms of the mean BCSS(©) score from entry 4.6(± 2.9) to exit 2.3 (± 2.5), p < 0.001. The results showed variable decrease in the self reported symptoms with more PR visits. The secondary outcome showed high correlations with quality of life measures using the Pulmonary Function Status Scale (PFSS) on entry and exit to PR. CONCLUSIONS: The BCSS(©) tool is an effective means for measuring the impact of PR on improving patient tolerance and self-reported symptoms as a result of COPD. More research is needed to better assess the complex symptoms of COPD patients in PR to enhance programmatic outcomes.

The asthma awareness patch program for Girl Scouts: an evaluation of educational effectiveness.

BACKGROUND: Carefully designed educational programs can improve asthma knowledge, management practices, and health outcomes. We used pre-post testing to determine if the curriculum provided in the Girl Scouts of the USA Asthma Awareness Patch Program improved recipients' knowledge of basic respiratory system function, asthma pathophysiology, triggers, and asthma exacerbation recognition and management. We hypothesized that participants would have improved post-test scores following an interactive asthma educational program. METHODS: Girl Scouts ages 5-17 years from a 4-county area in northeastern Ohio were recruited. Educational components were in compliance with the guidelines established by the National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program. Participants completed a demographic form and pre-test before, and a post-test and program evaluation immediately following, the program. Descriptive statistics were used to report participant demographics. Frequencies and percentages described the participants' responses to pre- and post-test questions. Cronbach's alpha analysis determined internal consistency and reliability of post-test items. T tests assessed differences in pre-post scores. Fishers exact tests determined differences in proportions of responses, between the pre- and post-test time points. A P value of < 0.05 was considered statistically significant. RESULTS: Eighty-six girls, between 5 and 16 years of age (mean ± SD 8.97 ± 2.36 y) participated, 84% of whom were white. Twenty-one percent of the participants were diagnosed and treated for asthma, 48% resided with an asthmatic, and 72% knew someone with asthma. The post-test scores (mean ± SD 89.6 ± 9.0) were significantly higher (P < .001) than the pre-test scores (62.5 ± 20.8). A Cronbach alpha raw score of 0.448 and a standardized score of 0.518 were realized. CONCLUSIONS: The assessment tool demonstrated moderate internal reliability. Participation in the program enhanced participants' knowledge of lung function, trigger identification, asthma pathophysiology, and treatment.

Age and gender exert differential effects on blood lipids in patients after LAGB and LRYGB.

BACKGROUND: Although bariatric surgery is known to exert favorable effects on dyslipidemia, few studies have systematically considered how the demographic variables might modulate the outcomes. The aim of the present study was to examine the interactive effects of gender, age, and surgery type on dyslipidimia in bariatric surgery patients at a tertiary hospital in the United States. METHODS: In a retrospective review of 294 patients who had undergone laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic adjustable gastric bypass (LAGB), we examined the changes in lipid profiles and antihyperlipidemic use for ≤4 years postoperatively. The data were analyzed using longitudinal mixed modeling methods, in which the effects on lipid concentrations and medication use were tested in models with gender, surgery type, age, postoperative duration, and all possible interactions entered as factors. RESULTS: Significant 2-way interactions of surgery type*time were found for total cholesterol and high-density lipoprotein cholesterol, gender*time for high-density lipoprotein cholesterol, and age*time for triglycerides. A 3-way interaction of surgery type*age*time was noted for low-density lipoprotein cholesterol. For older patients, low-density lipoprotein cholesterol was reduced by 20% from baseline in the LRYGB group but did not lessen significantly in the LAGB group. In the younger patients, however, decreases from the preoperative concentrations were not evident in either surgery group. An interaction of surgery type*time on antihyperlipdemic medication use, in which values changed significantly from baseline was found in both groups. However, the pattern in the LRYGB patients opposed that in the LAGB patients. CONCLUSION: Our results have demonstrated that bariatric surgery imparts a pronounced improvement in the blood lipid profile of recipients; however, these effects might be moderated by other factors, such as age and gender, independently of the baseline weight status of the patients.

Active learning in the classroom: a muscle identification game in a kinesiology course.

It is often difficult for educators to teach a kinesiology and applied anatomy (KAA) course due to the vast amount of information that students are required to learn. In this study, a convenient sample of students (class A) from one section of a KAA course played the speed muscle introduction and matching game, which is loosely based off the premise of the adult game of "speed dating." The game involves student's taking on a "muscle" personality when introducing themselves to potential mates. The experimental group (class A) played the game at two time points throughout the semester after a series of lectures focusing on the body's muscles. A control group (class B) from another section of the KAA course still received the series of lectures but did not play the games throughout the semester. A postgame questionnaire given to class A revealed the following scores: 1) overall perception of the game (score: 4.43 +/- 0.68), whether goals and objectives were met (score: 4.05 +/- 0.67 to 4.95 +/- 0.22), and perceptions of the organization of the game (score: 3.81 +/- 0.81 to 4.48 +/- 0.60). Overall, the game was well received by class A. When evaluating outcome scores of final grades between the two groups, class A improved final grades by 5.82% for a mean grade of 79.52 +/- 10.0; however, the final grades were not statistically significant (P > 0.05) compared with class B (73.7 +/- 15.6). The results show that an interactive game may contribute to improved final grades in a KAA course and could be an alternative means of disseminating kinesiology information.

Effects of L-phenylalanine on energy intake in overweight and obese women: interactions with dietary restraint status.

L-Phenylalanine (Phe), is a potent releaser of the satiety hormone, cholecystokinin (CCK) and previous studies, conducted primarily in men, show that ingestion of Phe reduces energy intake. The objective of the current study was to test the effects of Phe on energy intake in overweight and obese women. Subjects (n=32) received three treatments (high-dose (10 g Phe), low-dose (5 g Phe and 5 g glucose) or control (10 g glucose)) 20 min before an ad libitum lunch and dinner meal in a within-subjects', counterbalanced, double-blind study. No effect of Phe was found, however, interactions with dietary restraint status were detected in post-hoc analyses. Energy intake over the day was 11% lower following high-dose Phe versus control for women classified in the lower tertile of rigid restraint, a subscale of the dietary restraint scale, whereas no effects were noted for women in the middle and upper tertiles. High-dose Phe increased ratings of nausea, however, reduced energy intake in the high-dose condition was noted only for subjects with low nausea ratings. These results suggest that the satiety response to Phe is modulated by rigid restraint status and that reductions in food intake occur independently of Phe's effects on nausea.

Dietary restraint and menstrual cycle phase modulated L-phenylalanine-induced satiety.

l-phenylalanine (Phe) has been shown to elicit release of the gut hormone cholecystokinin (CCK) and reduce energy intake. Furthermore, studies in some animal models demonstrate potentiation of CCK-induced satiety by estradiol (E(2)). As E(2) is elevated in the follicular phase, we expected greater satiety effects than in the luteal phase when the effects may be antagonized by concomitant elevations in progesterone (P). Women with low dietary restraint were tested over two cycles and received encapsulated Phe or dextrose (control) during both phases within each cycle. Data from 20 women and 32 menstrual cycles were analyzed. Daily energy intake was suppressed by 9% for Phe compared to control and 8% in the follicular versus luteal phase of the menstrual cycle. Significant three-way interactions showed that the effects of condition and phase differed as a function of status on the rigid dietary restraint subscale. Phe suppressed daily energy intake by 15% relative to control in the follicular phase for women in the lower 50th percentile of rigid restraint, whereas for women in the higher 50th percentile group, Phe reduced energy intake by 15% in the luteal phase. The results replicate previous findings showing effects of cycle phase and Phe on food intake. The interaction between variables suggests that rigid restraint status modulates the satiety response to Phe, possibly through effects of reproductive hormones. Further studies are needed to replicate these findings and examine other aspects of satiety that may be altered by rigid restraint status.