Factors Influencing Physical Medicine and Rehabilitation Trainee Research Engagement.

ABSTRACT: Research engagement during physical medicine and rehabilitation residency and fellowship training is essential for advancing evidence-based medicine and fostering the development of clinician-scientists. Current Accreditation Council for Graduate Medical Education guidelines regarding research requirements during physical medicine and rehabilitation training are ambiguous, and it is unknown whether physical medicine and rehabilitation trainees receive adequate support to pursue research at the level they desire. This anonymous survey study aimed to identify perceived barriers and facilitators to research engagement among US physical medicine and rehabilitation residents and fellows. Our findings suggest that physical medicine and rehabilitation trainees value research engagement. However, research productivity during physical medicine and rehabilitation residency is limited, with many trainees reporting inadequate support and time to participate in research in a meaningful way. Additional support from residency and fellowship programs, including protected time for research, as well as research-specific education and mentorship should be considered to enhance physical medicine and rehabilitation trainee research engagement.

Association of physical activity on changes in cognitive function: Boston Puerto Rican Health Study.

OBJECTIVE: To evaluate the association of habitual physical activity engagement on changes in cognitive function among Puerto Rican adults. METHODS: Longitudinal data (2-year follow-up) from the Boston Puerto Rican Health Study were analyzed (n = 862; mean age = 56.5 year). A daily energy expenditure score was calculated using the number of hours over a 24-h period engaged in various activities, including sleeping, light activity, and moderate-to-vigorous exercise. Energy expenditure estimates were weighted based on the rate of oxygen consumption associated with each activity. Seven cognitive function outcomes were evaluated, including an assessment of general cognitive function, episodic memory, attention and working memory, cognitive flexibility, response inhibition, processing speed, and visuo-spatial organization. From these, overall executive function and memory capacity were derived using principal components analysis. RESULTS: Physical activity was not associated with changes in overall executive function. However, compared to those with low baseline physical activity, those with moderate physical activity had 48% reduced odds of having ≥1 standard deviation decline in memory function (OR = 0.52; 95% CI: 0.32, 0.84; p = 0.008) in 2 years. CONCLUSION: Among Puerto Rican adults, physical activity may help attenuate memory decline.

Evaluation of the convergent validity of an estimated cardiorespiratory fitness algorithm.

PURPOSE: Examine the convergent validity of a cardiorespiratory fitness (CRF) algorithm when compared to treadmill-assessed CRF. METHODS: Data from the 1999-2004 NHANES were used (N = 3259 adults 20-49 years). Cardiorespiratory fitness was estimated from an algorithm. Participants completed a submaximal treadmill-based protocol. We (1) evaluated the pairwise association (and ICC) between estimated and measured cardiorespiratory fitness, (2) employed a paired samples t test to examine potential mean differences between estimated and measured cardiorespiratory fitness, (3) constructed a Bland-Altman plot and 95% limits of agreement (LoA) to explore systematic differences and random error between estimated and measured cardiorespiratory fitness, and (4) examined the association (via linear regression) of estimated and measured cardiorespiratory fitness with chronic disease prevalence and C-reactive protein (CRP). RESULTS: Mean estimated CRF (10.68 METs) was lower than the mean measured CRF of 11.37 METs (p < 0.0001). The calculated pairwise correlation was of a moderate strength, r = 0.43 (p < 0.0001), with an ICC of 0.40 (p < 0.001). Calculated LoA indicated that estimated CRF may differ from measured CRF by 40% below to 48% above. Regression analyses yielded statistically significant inverse associations of estimated (unstandardized coefficient = - 0.026; p < 0.001) and measured (unstandardized coefficient = - 0.007; p = 0.002) CRF with chronic disease and estimated (unstandardized coefficient = - 0.08; p < 0.001) and measured (unstandardized coefficient = - 0.03; p < 0.001) CRF with CRP. CONCLUSION: Measured and estimated CRF were moderately correlated. However, estimated and measured CRF were statistically significant different from one another with noteworthy scatter around the average difference. As such, when feasible, objective measurements of CRF should be taken.

Association between dietary behavior and mortality among American adults with mobility limitations.

BACKGROUND: Limited research has evaluated the relationship between dietary behavior and mortality among those with mobility limitations. OBJECTIVE: To examine the association between dietary behavior and mortality in a national sample of American adults with mobility limitations. METHODS: Data from the 2003-2006 National Health and Nutrition Examination Survey were utilized. Participants were followed through 2011. Based on self-report, analyzed participants included those with mobility limitations (N = 1369). Dietary behavior was assessed from the alternate healthy eating index (AHEI). RESULTS: For the sample, 108,010 person-months occurred with an all-cause mortality rate of 2.07 per 1000 person-months. Dietary behavior was associated with reduced all-cause mortality risk when expressed both as a continuous variable and binary variable (i.e., meeting dietary guidelines). With regard to the latter, and after adjustments, those meeting dietary guidelines (vs. not) had a 40% reduced hazard of all-cause death (HR = 0.60; 95% CI: 0.38-0.97; P = 0.03). CONCLUSION: Among adults with mobility limitations, and thus, who unable to engage in sufficient physical activity, dietary behavior may have survival benefits.

Accelerometer-Determined Physical Activity and All-Cause Mortality in a National Prospective Cohort Study of Adults Post-Acute Stroke.

PURPOSE: No epidemiological study has examined the association of objectively measured physical activity with all-cause mortality among adults who have had a stroke, which was the purpose of this study. DESIGN: Prospective. SETTING: National Health and Nutrition Examination Survey 2003 to 2006. PARTICIPANTS: One hundred eighty-four patients with stroke. MEASURES: Physical activity assessed via accelerometry (ActiGraph 7164), with stroke assessed via self-report of physician diagnosis. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011. ANALYSIS: Cox proportional hazard model. RESULTS: The median follow-up period was 71.96 months, with 13 241 person-months; 53 deaths occurred during this follow-up period. After adjustments, for every 60 min/d increase in total physical activity, adults who have had a stroke had a 28% (hazard ratio = 0.72; 95% confidence interval: 0.59-0.88) reduced risk of all-cause mortality. CONCLUSION: Physical activity among stroke survivors is inversely associated with all-cause mortality.

Individual and Combined Associations of Cognitive and Mobility Limitations on Mortality Risk in Older Adults.

OBJECTIVE: To evaluate the potential independent and combined associations of cognitive and mobility limitations on risk of all-cause mortality in a representative sample of the US older adult population who, at baseline, were free of cardiovascular and cerebrovascular disease. PATIENTS AND METHODS: Data from the 1999 to 2002 National Health and Nutrition Examination Survey were used to identify 1852 adults (age, 60-85 years) with and without mobility and/or cognitive limitations. Hazard ratios (HRs) for mortality risk were calculated for 4 mutually exclusive groups: no limitation (group 1 as reference), mobility limitation only (group 2), cognitive limitation only (group 3), both cognitive and mobility limitations (group 4). RESULTS: Compared with group 1, the adjusted HRs (95% CI) for groups 2, 3, and 4 were 1.72 (1.24-2.38), 2.00 (1.37-2.91), and 2.18 (1.57-3.02), respectively. The mortality risk when comparing group 4 (HR, 2.18) with group 3 (HR, 2.00), however, was not statistically significant (P=.65). Similarly, the mortality risk when comparing group 4 (HR, 2.18) with group 2 (HR, 1.72) was not statistically significant (P=.16). CONCLUSION: Although the highest mortality risk occurred in those with both limitations (group 4), this point estimate was not statistically significantly different when compared with those with cognitive or mobility limitations alone.

Physical activity, body mass index and waist circumference change, and normal-range glycated hemoglobin on incident diabetes: Jackson Heart Study.

OBJECTIVES: The purpose of this study was to 1) evaluate whether physical activity has a protective effect on incident diabetes among African Americans across combinations of body mass index (BMI) and waist circumference (WC), 2) evaluate the effect of changes on BMI and WC on incident diabetes, and 3) evaluate the effect of 'normal range' glycated hemoglobin (A1C) on incident diabetes. METHODS: Data from the prospective Jackson Heart Study were evaluated, with baseline data assessed between 2001 and 2004 and follow-up data occurring between 2009 and 2013. Physical activity was assessed via a validated questionnaire, with measured BMI, WC and A1C assessed via standard procedures. RESULTS: The sample included 2,450 adults who did not have evidence of diabetes at the baseline assessment, with 286 incident diabetes cases occurring at the follow-up assessment. Physical activity did not have a protective effect against incident diabetes across different BMI and WC combinations. Notably, BMI change from baseline to follow-up was associated with incident diabetes (HR = 1.08; 95% CI: 1.03-1.13). Further, higher levels of A1C within the 'normal-range' was associated with incident diabetes (HR = 7.51, 95% CI = 2.66-21.25). CONCLUSION: Increases in BMI over time and higher A1C within the normal range were associated with incident diabetes. Serial monitoring of BMI, as well as A1C, even among those with a 'normal' A1C, may be warranted by clinicians. Future work evaluating this novel three-way model (physical activity, BMI and WC) should consider utilizing an objective measure of physical activity.

Cross-sectional association of exercise, strengthening activities, and cardiorespiratory fitness on generalized anxiety, panic and depressive symptoms.

OBJECTIVE: Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20-39 years) adults, with considerations by sex. METHODS: Data from the 1999-2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2.1). PA and MSA were assessed via validated self-report questionnaires and CRF was determined via a submaximal treadmill-based test. An index variable was created summing the number (range = 0-3) of these parameters for each participant. For example, those meeting PA guidelines, MSA guidelines and having moderate-to-high CRF were classified as having an index score of 3. RESULTS: MSA was not independently associated with generalized anxiety, panic and depressive symptoms, but those with higher levels of PA and CRF had a reduced odds of these symptoms (ranging from 40 to 46% reduced odds). Compared to those with an index score of 0, those with an index score of 1, 2, and 3, respectively, had a 39%, 54% and 71% reduced odds of having generalized anxiety, panic and depressive symptoms. Results were consistent across both sexes. CONCLUSION: PA and CRF, but not MSA, were independently associated with generalized anxiety, panic and depressive symptoms. There was evidence of an additive association between PA, CRF, and MSA on these symptoms.

Safe sex self-efficacy and safe sex practice in a Southern United States College.

Background: The purpose of this study was to assess the association between safe sex self-efficacy and safe-sex practice in a Southern college setting. Methods: Multivariable logistic regression models were used to examine the association between safe sex self-efficacy in four domains (mechanics, partner disapproval, assertiveness, intoxicants) and safe sex practice (outcome variable). Results: For every 1-unit increase in the composite condom use self-efficacy score, there was an 8% increase in the odds of being beyond the median safe-sex practice score (odds ration [OR]: 1.08, 95% CI: 1.02-1.15). Additionally, for every 1-unit increase in intoxicants self-efficacy score, there was a 31% increase in the odds of being beyond the median safe-sex practice score (OR: 1.31, 95% CI: 1.08-1.58). Conclusion: A greater degree of safe-sex self-efficacy is associated with increased odds of safe-sex practice. These findings are informative for the development of targeted approaches to foster safe-sex behavior in Southern US colleges.

Association between muscle strengthening physical activities and mortality among American adults with mobility limitations.

Compared to aerobic-based physical activity, less research has evaluated the effects of muscle-strengthening physical activity (MSPA) on mortality. Additionally, limited research has evaluated this among adults with mobility limitations, which was this study's purpose. Data from the 2003-2006 NHANES, with follow-up through 2011, were used (analyzed in 2016). MSPA was assessed via self-report, with all-cause, CVD-specific, and cancer-specific mortality assessed as the outcome variables. Analyses were limited to adults with mobility limitations (N=1411), assessed via a validated questionnaire. After adjustments, those meeting MSPA guidelines (vs. not) had a 38% reduced hazard of all-cause death (HR=0.62; 95% CI: 0.41-0.95). Results were similar for CVD-specific mortality (HR=0.46; 95% CI: 0.23-0.97) and cancer-specific mortality (HR=0.27; 95% CI: 0.06-1.20). Meeting MSPA guidelines is associated with reduced all-cause and cause-specific mortality among adults with mobility limitations. This is an encouraging observation as adults with mobility limitations may be unable to engage in sufficient amounts of aerobic-based physical activity. Thus, promotion of MSPA among this population may be of critical importance.

A Conceptual Neurocognitive Affect-Related Model for the Promotion of Exercise Among Obese Adults.

PURPOSE OF REVIEW: Obesity remains a prominent societal threat and burden despite well-promoted prevention and treatment strategies, such as regular engagement in physical activity. Obese individuals, in particular, may be prone to inactivity as a result of a variety of displeasure-related parameters resulting from exercise, such as dyspnea, for instance. RECENT FINDINGS: This brief conceptual review discusses the integral roles of exercise-induced affective responses within a novel conceptual-based neurocognitive affect-related model. Specifically, this model includes three pathways: (1) pathway A proposes that neurocognition, and especially, executive function-based cognition, may play an influential role in fostering exercise-induced affective responses, (2) pathway B connects an individual's affective response from exercise to their future exercise behavior, and (3) pathway C suggests a cyclical, bi-directional relationship with executive function indirectly influencing future exercise behavior via affective responses to exercise, and exercise itself playing an important role in executive functioning. Future studies should empirically test this model, which may have utility for promoting exercise among the obese population.

Convergent validity of the ACC/AHA pooled cohort equations in associating with health-related quality of life among adults in the United States.

Background: The potential convergent validity of the pooled cohort risk (PCR) equations in predicting health-related quality of life (HRQOL) has yet to be evaluated, which was this study's purpose. Methods: Data from the 2001-2011 National Health and Nutrition Examination Survey (NHANES) were used (N = 8978 adults, 40-79 years, free of cardiovascular disease at baseline). Calculation of an individual's 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event was determined via the PCR equation. The Centers for Disease Control and Prevention (CDC) HRQOL measure was assessed utilizing 4 questions regarding participants' perceived mental and physical health status from the past 30 days. Results: When adjusting for moderate-to-vigorous physical activity (MVPA), obesity, age, gender and race-ethnicity, an ASCVD score of >20% (vs. <20%) was associated with a 0.53-unit (95% CI: 0.34-0.71) higher HRQOL score. A higher HRQOL score indicates a poorer patient perception of their mental and physical health. Conclusion: The observed association between PCR-determined ASCVD-risk scores and HRQOL provides evidence for the convergent validity of the PCR algorithms, indicating that individuals with a higher risk for a first time ASCVD-event may also have an overall worse HRQOL. As such, employing ASCVD risk reduction efforts may be an important strategy in improving an individual's HRQOL.

Sedentary behavior and residual-specific mortality.

Background: The purpose of this study was to examine the association of accelerometer-assessed sedentary behavior and residual-specific mortality. Methods: Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) were used (N = 5536), with follow-up through 2011. Sedentary behavior was objectively measured over 7 days via accelerometry. Results: When expressing sedentary behavior as a 60 min/day increase, the hazard ratio across the models ranged from 1.07-1.40 (P < 0.05). There was evidence of an interaction effect between sedentary behavior and total physical activity on residual-specific mortality (Hazard ratiointeraction [HR] = 0.9989; 95% CI: 0.9982-0.9997; P = 0.008). Conclusion: Sedentary behavior was independently associated with residual-specific mortality. However, there was evidence to suggest that residual-specific mortality risk was a function of sedentary behavior and total physical activity. These findings highlight the need for future work to not only examine the association between sedentary behavior and health independent of total physical activity, but evaluate whether there is a joint effect of these two parameters on health.

Predictive validity of the ACC/AHA pooled cohort equations in predicting residual-specific mortality in a national prospective cohort study of adults in the United States.

OBJECTIVE: The predictive validity of the Pooled Cohort risk (PCR) equations for residual-specific mortality (deaths not resulting from the 9 leading causes of death) among a national sample of U.S. adults has not previously been evaluated, which was the purpose of this study. METHODS: Data from the 1999-2010 National Health and Nutrition Examination Survey were used, with participants followed up through 31 December 2011 to ascertain mortality status. The analyzed sample included 11,171 cardiovascular disease-free adults (40-79 years of age). The 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event was determined from the PCR equations. RESULTS: For the entire sample, 849,202 person-months occurred with an incidence rate of 0.29 (95% CI: 0.25-0.33) residual-specific deaths per 1,000 person-months. The unweighted median follow-up duration was 72 months. For all analyses, ASCVD risk score (via the PCR equations) was significantly associated with residual-specific mortality. In a fully adjusted model including moderate-to-vigorous physical activity (MVPA), obesity, age (yrs; continuous measure), gender (male/female) and race-ethnicity (Mexican American, non-Hispanic white, non-Hispanic black and other) as covariates, those with an ASCVD ≥ 20 (vs. < 20) had a 91% increased hazard of residual-specific death during the follow-up period (HR = 1.91; 95% CI: 1.10-3.31). Expressed as probability, there was a 66% chance that those with ASCVD ≥ 20 (vs. < 20) would have a residual specific-death during the follow-up period. CONCLUSION: The 10-year predicted risk of a first ASCVD event via the PCR equations was directly associated with residual-specific mortality among those free of cardiovascular disease (CVD) at baseline, providing evidence of predictive validity of the PCR equations among this national sample of U.S. adults.

Physical Activity-Related Obesity Risk Classification Model and All-Cause Mortality.

BACKGROUND: This study evaluated a physical activity-related obesity model on mortality. METHODS: Data from the 1999-2006 NHANES were used (N = 16,077), with follow-up through 2011. Physical activity (PA) was subjectively assessed, with body mass index (BMI) and waist circumference (WC) objectively measured. From these, 12 mutually exclusive groups (G) were evaluated, including: G1: Normal BMI, Normal WC and Active; G2: Normal BMI, Normal WC and Inactive; G3: Normal BMI, High WC and Active; G4: Normal BMI, High WC and Inactive; G5: Overweight BMI, Normal WC and Active; G6: Overweight BMI, Normal WC and Inactive; G7: Overweight BMI, High WC and Active; G8: Overweight BMI, High WC and Inactive; G9: Obese BMI, Normal WC and Active; G10: Obese BMI, Normal WC and Inactive; G11: Obese BMI, High WC and Active; and G12: Obese BMI, High WC and Inactive. RESULTS: Compared with G2, the following had a reduced mortality risk: G1, G3, G5, G6, G7, G8, G9, and G11. Compared with G12, the following had a reduced mortality risk: G1, G3, G5, G7, G9, and G11. In each respective group for BMI and WC, the active group had a reduced mortality risk. CONCLUSIONS: Across all BMI and WC combinations, PA improved mortality risk identification.

The association of physical activity and cholesterol concentrations across different combinations of central adiposity and body mass index.

BACKGROUND: The purpose of this study was to investigate if those who are physically active,compared to physically inactive, have better cholesterol profiles across different combinations of body mass index (BMI) and waist circumference (WC). METHODS: Data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) were used (N = 16 095). Cholesterol parameters included total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), TC/HDL-C ratio, triglycerides and at herogenic index(Log10 [triglycerides/HDL-C]). Physical activity (PA) was assessed via self-report, with BMI and WC objectively measured. Cholesterol concentrations of 6 combinations of BMI and WC were evaluated among active and inactive participants. Multivariable linear regression analysis was utilized. RESULTS: Findings were not consistent across sex. There was little evidence to suggest an association of PA on TC across varying BMI and WC combinations. For example, among those who had an obese BMI and high WC, inactive participants did not have different TC level when compared to active participants (ß = -1.2; 95% CI: -3.9-1.5, P = 0.38). There was evidence to suggest a favorable association of PA on HDL-C, triglycerides and at herogenic index across varying BMI and WC combinations. For example, among those who had an obese BMI and high WC, inactive (vs. active) participants had a lower HDL-C (ßadjusted = -1.6, P < 0.01). When considering either gender, there was sufficient evidence to suggest a favorable association of PA on at least one of the evaluated cholesterol parameters for each of the BMI/WC combinations with the exception of normal BMI and high WC. CONCLUSION: Except for those having normal weight central obesity, PA is favorably associated with cholesterol parameters across various combinations of BMI and WC.