The Impact of Health Coaching on Weight and Physical Activity in Obese Adults: A Randomized Control Trial.

Health Coaching (HC) is an evidence-based, patient-centered approach to assisting individuals in achieving their health-related goals. Studies have generally shown positive effects of HC on weight loss in obese adults. However, limitations do exist, that if addressed would further clarify HC's viability as a clinical, obesity treatment approach. To examine the effects of HC on weight loss, moderate-to-vigorous physical activity (MVPA), and psychosocial constructs in obese adults. A randomized control trial with 44 [Mean body mass index (BMI) 36.5] middle-aged, White adults. Participants were randomly assigned to HC (n = 22) or control (n = 22) groups. A certified health coach provided bi-weekly, in-person and telehealth HC for 12 weeks. Percent excess weight loss was 15.7% in HC vs. 2.5% in controls (p< .001). The change in MVPA was significantly greater in HC (+50.3 min/wk) vs controls (+7.1 min/wk). Psychosocial constructs also changed more favorably in HC than controls. Health coaching is an effective approach for weight loss in obese adults. The results of this study support the consideration of HC as a treatment option for obese adults looking to lose weight.

The associations between place-based measures of walkability and physical activity across a range of diverse streetscapes.

Walkability relates to aspects of a physical environment that have the potential to influence walking in that environment. In 2019, the Environmental Protection Agency developed the National Walkability Index (NWI), an easily accessible, U.S. Census block-group-level indicator of walkability. Although the NWI could be the metric of choice for researchers and urban planners, there is a lack of empirical evidence for its validity. The current study examined the validity of the NWI and Walk Score for predicting physical activity (PA) occurring along urban streetscapes. A wearable video device (Gogloo E7 SMART eyewear) was used to capture videos of streetscapes in 24 U.S. Census block groups in three different sized cities. The block groups varied in walkability, income level, and minority composition. The videos, collected over 10 months during 2019 at different times on weekdays and weekends, were reviewed by experts to obtain counts of walkers/h and individuals performing leisure PA/h (dependent variables). The independent variables were the NWI, its components - transit stop proximity, intersection density, employment/household occupancy mix, and employment mix, and Walk Score. Block group was the level of analysis. Linear regression indicated Walk Score, employment/household occupancy mix, and employment mix were associated with walkers/h (p < .001) while only employment/household occupancy mix, and employment mix were associated with leisure PA/h (p < .001). The NWI did not account for a significant portion of the variance in PA outcomes. A place-based examination of PA and walkability indexes favors the use of Walk Score and a modified version of the NWI.

Perspectives on Engagement With Youth Physical Activity Opportunities in Low-Income, African American, Urban Neighborhoods.

PURPOSE: To identify and describe factors related to low-income, African American youth's participation in neighborhood youth physical activity opportunities (YPAO). APPROACH: Formative research. SETTING: Face-to-face focus groups in New Castle County, Delaware. PARTICIPANTS: Fifty-five adults (parents/guardians of youth, YPAO providers, small business representatives) living and/or working in low-income, African American neighborhoods. METHOD: Nine, 60-90 minute focus groups were conducted from December 2018 through March 2019. Focus group questions were developed a priori and included domains related to neighborhood YPAOs. The domains were awareness of YPAOs, benefits and barriers to providing YPAOs, ways to increase youth participation in YPAOs, and strategies for creating, improving, and sustaining YPAOs. Focus group recordings were transcribed, and thematic analysis was performed to identify themes related to increasing youth participation in YPAOs. RESULTS: Four major themes related to YPAOs emerged: 1) exposure/access, 2) parent buy-in/accountability (e.g., personal values and trust with YPAOs), 3) technology, and 4) increasing a sense of community. Three minor themes included liability, advertising, and schools. Small businesses desired to support YPAOs mainly through non-monetary means, while mutually benefitting from receiving local recognition. CONCLUSION: Developing strategies to incorporate effective community partnerships, creative program ideas with advertising, and active, multisector involvement including small businesses into practice has the potential to increase engagement of low-income, African American youth in YPAOs.

Impact of an Intuitive Eating Intervention on Disordered Eating Risk Factors in Female-Identifying Undergraduates: A Randomized Waitlist-Controlled Trial.

Dietary restraint and low body appreciation are common among female-identifying undergraduates and are related to the development of disordered eating, which female-identifying undergraduates engage in throughout college. Training students in intuitive eating, an approach that promotes eating by internal cues, may be a way to ameliorate dietary restraint and low body appreciation, ultimately decreasing disordered eating. The purpose of this study was to examine the impact of a five-week intuitive eating intervention on dietary restraint, body appreciation, and intuitive eating in female-identifying undergraduates. A five-week intuitive eating intervention (NCT0394700) was facilitated by two Registered Dietitians. One treatment group (TG) (n = 7) and one waitlist control group (WLCG) (n = 7) participated in the trial. From baseline to post-intervention, there was a significant decrease in dietary restraint, t(12) = -2.88, p = 0.01, and a significant increase in intuitive eating, t(12) = 4.03, p = 0.002, in the TG compared to the WLCG. The intervention had replicable effects on all outcome variables. Measurements at the five-week follow-up suggested the impact was sustained. This study provides preliminary data suggesting an intuitive eating intervention may help improve disordered eating risk factors by decreasing dietary restraint and increasing intuitive eating in female-identifying undergraduates.

Small Business Support Is Associated with the Quantity, Quality, and Usage of Youth Physical Activity Opportunities in Urban, Low-Income, African American Neighborhoods.

Evidence suggests small businesses could play a significant role in bringing quality youth physical activity opportunities (YPAOs) to urban areas. Knowing more about their involvement with YPAOs in African American neighborhoods would be of significant value given the relatively low PA rates of African American youth. The current study examined associations between small businesses and YPAOs in low-income, African American urban neighborhoods. Surveys were conducted with 46.4% (n = 223) of eligible small business owners/managers and 44.2% (n = 38) of eligible YPAO providers in 20 low-income, African American urban neighborhoods to ascertain business and YPAO characteristics. Audits were conducted at the YPAOs and parks (n = 28) in the study areas to obtain counts of users and data on amenities/incivilities. Analyses included multiple linear regression. Only 33.6% of all businesses were currently supporting YPAOs. The percentage of businesses supporting only local YPAOs (YPAOs near the business) was significantly associated with the number of YPAOs in the area, number of YPAO amenities, youth participants, teams, amenity quality, and the severity of incivilities after controlling for neighborhood demographics. Businesses supporting only local YPAOs were at their location longer, and their owners were more likely to have a sports background, children, and believe small businesses should support YPAOs than business not supporting local YPAOs. This study provides evidence that YPAOs in low-income, African American urban neighborhoods are improved by support from small businesses. Efforts to enhance PA among African American youth living in low-income urban neighborhoods could benefit from involving small businesses.

Assessing Park Quality with a Wearable Video Device and an Unmanned Aerial System.

Parks are ideal places for promoting physical activity, which is vital for achieving and sustaining good health. Thus, it is important to develop and provide the best methods for assessing aspects of parks that could influence physical activity. This study examined the use of high-tech video capture for describing park quality. Videos were obtained with a wearable video device (WVD) and an unmanned aerial system (UAS) at 28 and 17 parks, respectively. In-person audits of park attributes were performed using the Physical Activity Readiness Assessment (PARA) instrument while video was simultaneously captured. The PARA provides quality ratings of park attributes that range from poor to good. Kappa statistics were calculated to compare in-person PARA outcomes with PARA outcomes obtained by reviewing the WVD and UAS videos. Substantial and almost-perfect agreements were found between WVD and in-person PARAs on the quality of features and amenities and the severity of incivilities. Agreements between UAS and in-person PARAs on feature and amenity quality and incivility severity were unacceptable (mostly fair and moderate). In conclusion, being able to reliably assess park quality using video provides advantages over in-person assessments (e.g., retrospective analysis). In addition, it sets up the possibility of utilizing computer vision to automate the video analysis process.

A comprehensive evaluation of physical activity on sidewalks and streets in three U.S. Cities.

A considerable proportion of outdoor physical activity (PA) is done on sidewalks/streets. The purpose of the current study was to create a comprehensive picture of PA and non-PA (sitting and standing) occurring on sidewalks/streets. A wearable video device was used to capture videos during 2019 in three different size (small, medium, large), U.S. cities along 24 observation routes (sidewalks/streets) located in 24 study areas that varied in walkability, income level, and minority composition. Videos were collected over the course of one year during different times of week and weekend days. Expert reviewers examined each video to extract data on counts of people engaged in different types of activities (e.g., walking) per minute of video. A total of 1154 individuals were described in 1237 min of video as either walking (66.9%), sitting/standing (25.7%), jogging (4.2%), cycling (1.8%) or skating/playing (1.4%). A greater number of active people/min were seen in the evening and in the small city (P < 0.05) while more non-PA people/min were observed in the medium city and during the weekend (P < 0.05). Active and non-PA people/min were associated with walkability, income, and minority composition. For instance, in high walkability, low income areas, 3.2 active people/min were observed in areas with a high percentage of non-minority residents compared to 0.9 active people /min in areas with a high percentage of minority residents. Sidewalks/street activities are related to dynamic interactions between social and physical environmental factors. The results of this study may serve as a reference to which future, similar evaluations can compare.

Direct Observation of COVID-19 Prevention Behaviors and Physical Activity in Public Open Spaces.

Mask wearing and physical distancing are effective at preventing COVID-19 transmission. Little is known about the practice of these behaviors during physical activity (PA). In this longitudinal study, direct observation was used to describe COVID-19 prevention behaviors among physically active individuals. The Viral Transmission Scan (VT-Scan) was used to assess COVID-19 prevention behaviors of people standing, sitting, walking, jogging, and cycling in educational, retail, and residential areas. The VT-Scan was performed once per week over 22 weeks between 11:00 a.m. and 2:30 p.m. Information was manually extracted from videos collected during VT-Scans. A total of 4153 people were described, of which 71.2% were physically active, 80.0% were 18-30 years of age, 14.0% were non-white, 61.0% were female, and were 19.6% obese. Individuals not engaged in PA were less compliant with COVID-19 prevention behaviors than physically active people. Compliance differed by PA type, with walkers less compliant with COVID-19 prevention behaviors than joggers and cyclists. Among those physically active, non-compliance with COVID-19 prevention behaviors was higher in 18-30-year-olds, whites, and men. Engagement in COVID-19 prevention behaviors varies as a function of PA. Efforts to promote compliance with recommendations may benefit from tailored messaging, taking into account PA participation, PA type, and characteristics of physically active individuals.

Prevalence and characteristics of starvation-related malnutrition in a mid-Atlantic healthcare system: A cohort study.

BACKGROUND: Malnutrition in the hospital negatively impacts outcomes, including readmissions, mortality, and cost. Starvation-related malnutrition (SRM) is a state of chronic undernutrition with little to no inflammation. Research on SRM within the hospital setting is lacking. Our objective was to determine the prevalence and characteristics of malnutrition within the hospital, focusing on characteristics associated with readmissions in those with SRM. METHODS: We conducted a retrospective cohort study analyzing characteristics of adult in patients with acute disease-related malnutrition (ADM) and chronic disease-related malnutrition (CDM) compared with patients with SRM. Prevalence of all malnutrition types was calculated as the total number of malnourished patients divided by the total number of hospital discharges. Analysis of variance with Tukey post hoc analysis was performed to determine differences between characteristics of patients with SRM and other forms of malnutrition. RESULTS: Total prevalence of malnutrition was 2.8%. Of malnourished patients, 17.6%, 79.9%, and 2.5% had ADM, CDM, and SRM, respectively. Patients with SRM had lower body mass index (BMI) (P < .001) and higher rates of readmission (P = 0.046), infectious disease (P < .001), psychiatric disease (P < .001), and substance abuse (P < .001) than patients with ADM or CDM. Readmitted patients with SRM had lower BMI and higher rates of infection and drug abuse than those without readmission. CONCLUSION: The high incidence of comorbid substance abuse and mental illness in patients with SRM provide important targets for treatment that might reduce readmission and improve outcomes.

Effects of resistance training interventions on muscular strength in adults with intellectual disability: a systematic review and meta-analysis.

PURPOSE: Muscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities. This article reports the results of the first systematic review and meta-analysis of peer-reviewed clinical trials that evaluated the effects of resistance training (RT) interventions on muscular strength in adults with ID. METHODS: The protocol was registered with PROSPERO (CRD42020184905). The review focuses on clinical trials that recorded quantitative measures of maximum muscular strength. Eleven electronic databases were searched from their earliest available record up to May 2020. After screening 1996 search records, 11 clinical trials were reviewed. RESULTS: The RT interventions, while heterogeneous, had an overall significant (p ≤ 0.05) effect on muscular strength in adults with ID, ages 25-58 years. The findings were more significant and less heterogeneous for non-combined RT interventions than for interventions that combined RT exercises with aerobic or balance exercises. The TESTEX overall score was 8.3 ± 3.6. CONCLUSIONS: RT interventions (particularly when not combined with other exercises) are effective in promoting muscular strength in adults with ID. The limited number of studies and the low study quality scores indicate a potential risk of bias, which limits the interpretation of the findings and warrants further investigation.IMPLICATIONS FOR REHABILITATIONMuscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities.RT interventions are an effective means of improving muscular strength in adults with ID, especially when not combined with other forms of exercise.Testing and assessment protocols used in RT programs should be individualized for adults with ID to accommodate their characteristics and should be implemented under conditions similar to those experienced during the training regimen.It is important to implement familiarization sessions before carrying out muscular strength testing or initiating an RT program to ensure safety, accuracy, and effectiveness of the program for adults with ID.

A Direct Observation Video Method for Describing COVID-19 Transmission Factors on a Micro-Geographical Scale: Viral Transmission (VT)-Scan.

The COVID-19 pandemic severely affected many aspects of human life. While most health agencies agree mask wearing and physical distancing reduce viral transmission, efforts to improve the assessment of these behaviors are lacking. This study aimed to develop a direct observation video method [Viral Transmission (VT)-Scan] for assessing COVID-19 transmission behaviors and related factors (e.g., environmental setting). A wearable video device (WVD) was used to obtain videos of outdoor, public areas. The videos were examined to extract relevant information. All outcomes displayed good to excellent intra- and inter-reliability with intra-class correlation coefficients ranging from 0.836 to 0.997. The majority of people had a mask (60.8%) but 22.1% of them wore it improperly, 45.4% were not physical distancing, and 27.6% were simultaneously mask and physical distancing non-compliant. Transmission behaviors varied by demographics with white, obese males least likely to be mask-compliant and white, obese females least likely to physical distance. Certain environments (e.g., crosswalks) were identified as "hot spots" where higher rates of adverse transmission behaviors occurred. This study introduces a reliable method for obtaining objective data on COVID-19 transmission behaviors and related factors which may be useful for agent-based modeling and policy formation.

A Resistance Training Intervention for Adults With Intellectual Disability in the Community: A Pilot Randomized Clinical Trial.

Adults with an intellectual disability have significantly lower levels of fitness compared with the general population. This study examined the effects of a 13-week theoretically guided, community-based, multicomponent resistance training intervention, resistance training for empowerment, on muscular strength and independent functional performance in 24 adults with an intellectual disability, aged 18-44 years. Twelve participants were randomly allocated to an experimental group and 12 to an active control group. An analysis of covariance revealed that the experimental group had significantly greater increases (p < .05) on the chest press and leg press one-repetition maximum tests and the 6-min walk test from the baseline to postintervention compared with the control group. The experimental group correctly and independently performed a significantly greater number of steps of resistance training exercise tasks than the control group. Marginal significance and large effect sizes were found for the prone plank test and the stair climb test. The resistance training for empowerment was effective in promoting muscular strength and independent functional performance among adults with an intellectual disability.

Development and implementation of a logic model: Occupational stress, physical activity, and sedentary behavior in the workplace.

BACKGROUND: An increasing level of occupational stress is a major problem in the workplace that requires innovative approaches and strategies. An understudied research area pertains to the effects that physical activity performed during the workday have on occupational stress. OBJECTIVE: To determine if and how an intervention that increases physical activity and reduces sedentary behavior affects workplace stress. The population of interest are employees at a large university medical center including supportive staff, healthcare professionals, physicians, and faculty members; the study design is longitudinal; the approach is the implementation of an innovative workplace program (i.e., the Booster Break). METHODS: We present a logic model promoting physical activity and reducing sitting time during the workday as a feasible and practical strategy to cope with occupational stress. RESULTS: The logic model approach emphasizes that funding, partnerships, and incentives are inputs to implementing program activities such as Booster Break sessions, weekly meetings, social support, and personal self-monitoring. Short-term outcomes were categorized as psychosocial, goal setting, organizational, and social; intermediate outcomes were behavioral and psychosocial; and long-term outcomes were health status and physiological status. CONCLUSIONS: This study is the first known effort to outline a comprehensive intervention based on changing physical activity and sedentary behavior during the workday and the concomitant effects on occupational stress. The findings of this study can be used to develop and implement interventions at workplaces to target increases in physical activity, decreases in sedentary time, and improvements in overall employee health.

Dover Micro Open Street Events: Evaluation Results and Implications for Community-Based Physical Activity Programming.

Open Streets events provide opportunities for residents to be active. The current program developed and implemented five smaller scale, Micro Open Streets Events (MOSE) in Dover, DE that provided a range of opportunities for physical activity over a <0.5 miles stretch of closed road. Our objective was to evaluate the capacity of this approach to reach residents and improve knowledge and intention to engage in physical activity once the event was over. We used individual surveys, observational, and neighborhood audit factors to assess MOSE participation and conduciveness to physical activity. Our results showed that MOSE attendance ranged from 40 to 500 adults from a high-risk demographic (i.e., non-Caucasian, middle-age, overweight), who demonstrated a strong liking of the MOSE and increased knowledge of, and intention to engage in physical activity following the event. Our data suggest that where a full-scale Open Streets event is not feasible, a MOSE may be a viable alternative.

Added Sugar Intake is Associated with Blood Pressure in Older Females.

Hypertension or high blood pressure (BP) is highly prevalent in the aging population. Notably, diet and lifestyle have a strong influence on BP. We investigated the association between dietary factors and BP in older adults. This cross-sectional study included 128 participants, aged 65-80 years. Multiple linear regressions were conducted to examine the associations between diet, including meats, vegetables, grains, fruits, dairy, fats, and added sugar, and BP. There was a significant association between intake of added sugar and systolic BP and diastolic BP in females after controlling for age, income, body mass index, physical activity levels, daily calorie intake, and BP medication use. The model predicted that a decrease of 2.3 teaspoons (0.5 standard deviation) of added sugar would result in a 8.4 mmHg drop in systolic BP and a 3.7 mmHg drop in diastolic BP. Whole fruit was associated with a reduction in diastolic BP in both males and females, and the model predicted that, for every 0.71 cup increase in whole fruit consumption, there would be a decrease in diastolic BP of 2.8 mmHg. Our findings support the dietary guidelines of limiting daily intake of added sugar and increasing fruit consumption to promote overall cardiovascular health in older adults.

Validation of the Block Walk Method for Assessing Physical Activity occurring on Sidewalks/Streets.

The block walk method (BWM) is one of the more common approaches for assessing physical activity (PA) performed on sidewalks/streets; however, it is non-technical, labor-intensive, and lacks validation. This study aimed to validate the BWM and examine the potential for using a wearable video device (WVD) to assess PA occurring on sidewalks/streets. Trained observers (one wearing and one not wearing the WVD) walked together and performed the BWM according to a previously developed protocol along routes in low, medium, and high walkable areas. Two experts then reviewed the videos. A total of 1150 (traditional) and 1087 (video review) individuals were observed during 900 min of observation. When larger numbers of individuals were observed, the traditional method overestimated the overall number of people as well as those walking and sitting/standing, while underestimating the number of runners. Valid estimates of PA occurring on sidewalks/streets can be obtained by the traditional BWM in low and medium walkability areas and/or with non-common activities (cycling); however, its validity is questionable when sidewalks/streets use volume is high. The use of WVDs in PA assessment has the potential to establish new levels of accuracy, reduce resource requirements, and open up the possibility for retrospective analysis.

The association between television viewing time and percent body fat in adults varies as a function of physical activity and sex.

BACKGROUND: Data suggest that sedentary behavior is an independent risk factor for obesity; however, the extent to which physical activity (PA) and sex alter this relationship remains unclear. To address this gap, the current study examined the association between television (TV) viewing time and percent body fat (%BF) as a function of PA level and sex. METHODS: Trained interviewers assessed 454 adults at their place of residence. Participants completed questionnaires to determine h of TV watched per week, PA level (inactive = not meeting PA guidelines vs. active = meeting PA guideline), and covariates including demographics (e.g., sex), depression symptoms, perceived stress, fruit and vegetable intake, and environmental support for PA. Foot-to-foot bioelectrical impedance (Tanita TBF-300, Tokyo, Japan) was used to assess %BF. Mixed models were generated to examine the association between TV h/wk. and %BF as a function of PA level and sex while accounting for the multi-level nature of the data (neighborhood- and individual-levels) and covariates. RESULTS: Participants were 44.4 ± 14.0 (Mean + Standard Deviation) years of age with 33.2 ± 11.1%BF, and watched 19.3 ± 15.5 h/wk. of TV. Most were female (70.9%) and inactive (63.2%). Mixed model regression demonstrated that among inactive participants, each additional h of TV viewed/wk. was associated with a 1.03% increase in %BF; TV h/wk. and %BF were not associated in active adults. When models were further stratified by sex, h of TV viewed/wk. were significantly associated with %BF only in inactive females. Each additional h of TV viewed/wk. was associated with an increase in %BF of 1.14%. CONCLUSION: Interventions targeting PA and/or TV viewing time may be a high-priority to curb excess BF accumulation especially among inactive females.

Physical education teachers' and principals' perspectives on the use of FitnessGram.

OBJECTIVES: FitnessGram is commonly used to measure physical fitness and improve physical activity and health in youth. However, little is known about its use for informing physical activity and health promotion policy within schools and school districts, especially from the perspective of key decision-makers like principals. Therefore, this study examined physical education teachers' and principals' perceptions of FitnessGram use and its relationship with school and district efforts to promote physical activity. METHODS: Principal and physical education teacher surveys were developed, converted to an online format, and then emailed along with a project description and instructions to all Delaware public and charter school physical education teachers (N = 183) and principals (N = 193) with a valid email. RESULTS: Completed surveys were received from 35.5% of the teachers and 21.2% of the principals. All teachers and 95.1% of the principals reported their school used FitnessGram the past academic year. FitnessGram was significantly more likely to be used if FitnessGram results better aligned with school/district policies (r = 0.39) and were considered important in the school's decision-making process (r = 0.53). Significantly more principals than teachers said that FitnessGram results were important in their school's decision-making process and that FitnessGram results were used to inform policy-/decision-making. CONCLUSION: Use of FitnessGram was correlated with how well it related to school/district policy. Unfortunately, most of the physical education teachers and principals did not think FitnessGram was adequately integrated into the policy-/decision-making process.

Steady State Hydration Levels of Career Firefighters in a Large, Population-Based Sample.

OBJECTIVES: To establish the extent of steady state hypohydration among firefighters and examine factors associated with their hydration status. METHODS: Data on 450 career firefighters from 11 randomly selected fire departments had their body composition, total body water (TBW), and hypohydration status assessed using bioelectrical impedance. Measured height and weight were used to determine body mass index (BMI) and weight classification. RESULTS: The hypohydration rate was 17% and 94% of hypohydrated firefighters were obese. A one-unit increase in BMI was associated with an 83% greater likelihood of being hypohydrated. CONCLUSIONS: This study indicates that steady state hypohydration is a significant issue among obese firefighters. Current hydration policies based on previous reports that most (more than 90%) firefighters are hypohydrated in the steady state should be revisited and additional, confirmatory research in this area should be conducted.