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Mothers' experiences of a lifestyle intervention for weight reduction 12 months after gestational diabetes mellitus: Qualitative findings from the PAIGE2 study.
Kemp, BJ, Creighton, RM, Cupples, G, Kelly, B, McAuley, E, Fleck, O, Wallace, H, Graham, U, McCance, DR
Midwifery. 2024;:103911
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Abstract
The standardised pooled prevalence of gestational diabetes mellitus (GDM) globally is approximately 14 %, a reflection of increasing rates of obesity in women of childbearing age. Lifestyle interventions to reduce GDM and subsequent type 2 diabetes (T2D) have been deemed a research priority but are challenging to perform and have variable success rates. The PAIGE2 study was a pragmatic lifestyle randomised controlled trial for women with GDM and body mass index ≥25 kg/m2, which began during pregnancy and continued for one year postnatally. The primary outcome was weight loss 12 months postnatally compared with mothers receiving standard maternity care. Qualitative results are presented from end of study focus groups conducted amongst intervention mothers to gather feedback and determine acceptability of the PAIGE2 intervention. In total, 19 mothers participated in five virtual focus groups. Content analysis explored general study experience, longer term changes to lifestyle and suggested improvements of intervention components including monthly phone calls, motivational text messages, Fitbit experience, Slimming World, and study contact timings. Overall, most mothers found the individual PAIGE2 intervention components enjoyable, although opinions differed as to which were the most effective. Several mothers claimed the intervention helped them make long-term changes to their behaviours. A common suggested improvement was the establishment of a local group where mothers could share their experiences. In conclusion, most mothers deemed the intervention acceptable, and felt that with minor enhancements, it could be utilised as an effective tool to support weight loss after pregnancy and reduce future risk of obesity and T2D.
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Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease-Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review.
MacLaughlin, HL, McAuley, E, Fry, J, Pacheco, E, Moran, N, Morgan, K, McGuire, L, Conley, M, Johnson, DW, Ratanjee, SK, et al
Nutrients. 2023;(1)
Abstract
Potassium dysregulation can be life-threatening. Dietary potassium modification is a management strategy for hyperkalaemia. However, a 2017 review for clinical guidelines found no trials evaluating dietary restriction for managing hyperkalaemia in chronic kidney disease (CKD). Evidence regarding dietary hyperkalaemia management was reviewed and practice recommendations disseminated. A literature search using terms for potassium, hyperkalaemia, and CKD was undertaken from 2018 to October 2022. Researchers extracted data, discussed findings, and formulated practice recommendations. A consumer resource, a clinician education webinar, and workplace education sessions were developed. Eighteen studies were included. Observational studies found no association between dietary and serum potassium in CKD populations. In two studies, 40-60 mmol increases in dietary/supplemental potassium increased serum potassium by 0.2-0.4 mmol/L. No studies examined lowering dietary potassium as a therapeutic treatment for hyperkalaemia. Healthy dietary patterns were associated with improved outcomes and may predict lower serum potassium, as dietary co-factors may support potassium shifts intracellularly, and increase excretion through the bowel. The resource recommended limiting potassium additives, large servings of meat and milk, and including high-fibre foods: wholegrains, fruits, and vegetables. In seven months, the resource received > 3300 views and the webinar > 290 views. This review highlights the need for prompt review of consumer resources, hospital diets, and health professionals' knowledge.
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A pragmatic lifestyle intervention for overweight and obese women with gestational diabetes mellitus (PAIGE2): A parallel arm, multicenter randomized controlled trial study protocol.
McAuley, E, Fleck, O, Cassidy, L, Kemp, BJ, Cupples, G, Kelly, B, Creighton, RM, Graham, U, Wallace, H, Patterson, CC, et al
Frontiers in clinical diabetes and healthcare. 2023;:1118509
Abstract
BACKGROUND The global epidemic of type 2 diabetes (T2D) and obesity has been translated into pregnancy, with approximately 18% of women being diagnosed worldwide with Gestational Diabetes Mellitus (GDM). Whilst preventive strategies have proven effective in the non-pregnant context, attrition rates are high and there is an urgent need to develop a customized, pragmatic lifestyle intervention for women both during and after pregnancy. Diet and exercise modification, behavioral support, and Commercial Weight Management Organizations have been strongly recommended to aid postpartum weight reduction for mothers with previous GDM, subsequently reducing their risk of developing obesity and T2D. This study, informed by a previous pilot study, aims to determine the effectiveness of a pragmatic pregnancy and postpartum lifestyle modification program for overweight women with previous GDM (PAIGE2) to reduce body weight at 12 months postpartum. METHODS/DESIGN This paper summarizes the protocol for the PAIGE2 study, which has been developed based on results from a pilot study (PAIGE). A six center, two parallel arm, 12-month, randomized controlled trial will be conducted across Northern Ireland and the Republic of Ireland (3 centers each), involving 340 women with GDM and body mass index ≥25 kg/m2 recruited during pregnancy. The lifestyle intervention involves a one-hour virtual educational program (to take place at 32-36 weeks gestation). Postpartum, the intervention will include monthly phone calls, weekly motivational text messages, weekly step counts, and referral for three months to a Commercial Weight Management Organization (Slimming World). The control arm will receive usual care as offered by the local maternity hospital. The primary outcome is weight loss at 12 months postpartum. Study visits for anthropometric and clinical measurements, fasting blood samples, questionnaires pertaining to health, wellbeing and physical activity will take place at 6 weeks, 6- and 12-months postpartum. Focus groups will be conducted with intervention mothers' post-intervention to determine the acceptability of the study design including utility of a Commercial Weight Management Organization, feasibility of remote patient contact, family involvement and patient satisfaction. DISCUSSION The PAIGE2 study will address the gaps in previously conducted research and, if positive, has the potential to have major public health implications for the prevention of future GDM and subsequent T2D. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1, identifier NCT04579016.
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Relationships between Obesity, Exercise Preferences, and Related Social Cognitive Theory Variables among Breast Cancer Survivors.
Brown, NI, Pekmezi, DW, Oster, RA, Courneya, KS, McAuley, E, Ehlers, DK, Phillips, SM, Anton, P, Rogers, LQ
Nutrients. 2023;(5)
Abstract
Breast cancer survivors with obesity have an increased risk of cancer recurrence, second malignancy, and comorbidities. Though physical activity (PA) interventions are needed, investigation of the relationships between obesity and factors influencing PA program aspects among cancer survivors remain understudied. Thus, we conducted a cross-sectional study examining associations amongst baseline body mass index (BMI), PA program preferences, PA, cardiorespiratory fitness, and related social cognitive theory variables (self-efficacy, exercise barriers interference, social support, positive and negative outcome expectations) from a randomized controlled PA trial with 320 post-treatment breast cancer survivors. BMI was significantly correlated with exercise barriers interference (r = 0.131, p = 0.019). Higher BMI was significantly associated with preference to exercise at a facility (p = 0.038), lower cardiorespiratory fitness (p < 0.001), lower walking self-efficacy (p < 0.001), and higher negative outcome expectations (p = 0.024), independent of covariates (comorbidity score, Western Ontario and McMaster Universities osteoarthritis index score, income, race, education). Those with class I/II obesity reported a higher negative outcome expectations score compared with class III. Location, walking self-efficacy, barriers, negative outcome expectations, and fitness should be considered when designing future PA programs among breast cancer survivors with obesity.
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BAILA: A Randomized Controlled Trial of Latin Dancing to Increase Physical Activity in Spanish-Speaking Older Latinos.
Marquez, DX, Wilbur, J, Hughes, S, Wilson, R, Buchner, DM, Berbaum, ML, McAuley, E, Aguiñaga, S, Balbim, GM, Vásquez, PM, et al
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2022;(12):1231-1243
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BACKGROUND Latinos are the fastest growing minority group of the older adult population. Although physical activity (PA) has documented health benefits, older Latinos are less likely to engage in leisure time PA than older non-Latino whites. Dance, popular among Latinos, holds promise as a culturally relevant form of PA. PURPOSE To describe self-reported and device-assessed changes in PA as a result of a randomized controlled trial of BAILAMOS, a 4-month Latin dance program with a 4-month maintenance program, versus a health education control group. METHODS Adults, aged 55+, Latino/Hispanic, Spanish speaking, with low PA levels at baseline, and risk for disability were randomized to the dance program (n = 167) or health education condition (n = 166). Data were analyzed using multilevel modeling with full information maximum likelihood. RESULTS A series of multilevel models revealed significant time × group interaction effects for moderate-to-vigorous physical activity (MVPA), dance PA, leisure PA, and total PA. Exploring the interaction revealed the dance group to significantly increase their MVPA, dance PA, leisure PA, and total PA at months 4 and 8. Household PA and activity counts from accelerometry data did not demonstrate significant interaction effects. CONCLUSIONS The study supports organized Latin dance programs to be efficacious in promoting self-reported PA among older Latinos. Efforts are needed to make dancing programs available and accessible, and to find ways for older Latinos to add more PA to their daily lives. CLINICAL TRIAL INFORMATION NCT01988233.
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Latin Dance and Working Memory: The Mediating Effects of Physical Activity Among Middle-Aged and Older Latinos.
Aguiñaga, S, Kaushal, N, Balbim, GM, Wilson, RS, Wilbur, JE, Hughes, S, Buchner, DM, Berbaum, M, McAuley, E, Vásquez, PM, et al
Frontiers in aging neuroscience. 2022;:755154
Abstract
BACKGROUND Physical activity (PA) is a promising method to improve cognition among middle-aged and older adults. Latinos are at high risk for cognitive decline and engaging in low levels of PA. Culturally relevant PA interventions for middle-aged and older Latinos are critically needed to reduce risk of cognitive decline. We examined changes in cognitive performance among middle-aged and older Latinos participating in the BAILAMOS™ dance program or a health education group and compared the mediating effects of PA between group assignment and change in cognitive domains. METHODS Our 8-month randomized controlled trial tested BAILAMOS™, a 4-month Latin dance program followed by a 4-month maintenance phase. A total of 333 older Latinos aged 55+ were randomized to either BAILAMOS™, or to a health education control group. Neuropsychological tests were administered, scores were converted to z-scores, and specific domains (i.e., executive function, episodic memory, and working memory) were derived. Self-reported PA was assessed, and we reported categories of total PA, total leisure PA, and moderate-to-vigorous PA as minutes/week. A series of ANCOVAs tested changes in cognitive domains at 4 and 8 months. A mediation analysis tested the mediating effects of each PA category between group assignment and a significant change in cognition score. RESULTS The ANCOVAs found significant improvement in working memory scores among participants in the dance group at month 8 [F (1,328) = 5.79, p = 0.017, d = 0.20], but not in executive functioning [F (2,328) = 0.229, p = 0.80, Cohen's d = 0.07] or episodic memory [F (2,328) = 0.241, p = 0.78, Cohen's d = 0.05]. Follow-up mediation models found that total PA mediated the relationship between group assignment and working memory, in favor of the dance group (β = 0.027, 95% CI [0.0000, 0.0705]). Similarly, total leisure PA was found to mediate this relationship [β = 0.035, 95% CI (0.0041, 0.0807)]. CONCLUSION A 4-month Latin dance program followed by a 4-month maintenance phase improved working memory among middle-aged and older Latinos. Improvements in working memory were mediated by participation in leisure PA. Our results support the current literature that leisure time PA influences cognition and highlight the importance of culturally relevant PA modalities for Latinos. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT01988233].
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The Daily Activity Study of Health (DASH): A pilot randomized controlled trial to enhance physical activity in sedentary older adults.
Ai, M, Morris, TP, Ordway, C, Quinoñez, E, D'Agostino, F, Whitfield-Gabrieli, S, Hillman, CH, Pindus, DM, McAuley, E, Mayo, N, et al
Contemporary clinical trials. 2021;:106405
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Sedentary behavior increases the risk for multiple chronic diseases, early mortality, and accelerated cognitive decline in older adults. Interventions to reduce sedentary behavior among older adults are needed to improve health outcomes and reduce the burden on healthcare systems. We designed a randomized controlled trial that uses a self-affirmation manipulation and gain-framed health messaging to effectively reduce sedentary behavior in older adults. This message-based intervention lasts 6 weeks, recruiting 80 healthy but sedentary older adults from the community, between the ages of 60 and 95 years. Participants are randomly assigned to one of two groups: 1) an intervention group, which receives self-affirmation followed by gain-framed health messages daily or 2) a control group, which receives daily loss-framed health messages only. Objective physical activity engagement is measured by accelerometers. Accelerometers are deployed a week before, during, and the last week of intervention to examine potential changes in sedentary time and physical activity engagement. Participants undertake structural and functional (resting and task-based) MRI scans, neuropsychological tests, computerized behavioral measures, and neurobehavioral inventories at baseline and after the intervention. A 3-month follow-up assesses the long-term maintenance of any engendered behaviors from the intervention period. This study will assess the effectiveness of a novel behavioral intervention at reducing sedentarism in older adults and examine the neurobehavioral mechanisms underlying any such changes.
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The Association Between Light Physical Activity and Cognition Among Adults: A Scoping Review.
Erlenbach, E, McAuley, E, Gothe, NP
The journals of gerontology. Series A, Biological sciences and medical sciences. 2021;(4):716-724
Abstract
BACKGROUND The physical and cognitive benefits of moderate-vigorous intensity physical activity (MVPA) for adults have been well documented. Recently, there has been increasing interest in the independent health benefits of light-intensity physical activity (LPA). This research has primarily focused on the relationship between LPA and morbidity and mortality risk, with few studies investigating cognitive associations. The purpose of this scoping review was to catalog existing evidence on the association between device-based or technologically measured LPA and cognition among adults, identify trends in the literature, and recommend future areas for research. METHODS Six electronic databases were searched between January and June 2020. Forty published studies met the inclusion criteria, which included both healthy and clinical young and older adult populations. Among the 40 articles were 14 acute exercise studies, 4 randomized control trials (RCTs), 18 cross-sectional studies, and 4 longitudinal studies. RESULTS 7/14 (50%) acute, 3/4 (75%) RCT, 10/18 (56%) cross-sectional, and 2/4 (50%) longitudinal studies reported a significant, positive relationship between LPA and one or more cognitive outcomes. These heterogeneous findings can largely be attributed to the diverse study designs and populations, as well as the numerous assessments used to test the cognitive domains. CONCLUSION These collective findings suggest LPA may be a potential lifestyle intervention to improve cognition across adulthood. However, the inconsistent approaches used among these studies suggest a more concerted, unified scientific approach is needed to further understand the LPA-cognition relationship.
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White matter plasticity in healthy older adults: The effects of aerobic exercise.
Mendez Colmenares, A, Voss, MW, Fanning, J, Salerno, EA, Gothe, NP, Thomas, ML, McAuley, E, Kramer, AF, Burzynska, AZ
NeuroImage. 2021;:118305
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White matter deterioration is associated with cognitive impairment in healthy aging and Alzheimer's disease. It is critical to identify interventions that can slow down white matter deterioration. So far, clinical trials have failed to demonstrate the benefits of aerobic exercise on the adult white matter using diffusion Magnetic Resonance Imaging. Here, we report the effects of a 6-month aerobic walking and dance interventions (clinical trial NCT01472744) on white matter integrity in healthy older adults (n = 180, 60-79 years) measured by changes in the ratio of calibrated T1- to T2-weighted images (T1w/T2w). Specifically, the aerobic walking and social dance interventions resulted in positive changes in the T1w/T2w signal in late-myelinating regions, as compared to widespread decreases in the T1w/T2w signal in the active control. Notably, in the aerobic walking group, positive change in the T1w/T2w signal correlated with improved episodic memory performance. Lastly, intervention-induced increases in cardiorespiratory fitness did not correlate with change in the T1w/T2w signal. Together, our findings suggest that white matter regions that are vulnerable to aging retain some degree of plasticity that can be induced by aerobic exercise training. In addition, we provided evidence that the T1w/T2w signal may be a useful and broadly accessible measure for studying short-term within-person plasticity and deterioration in the adult human white matter.
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Sensor-measured sedentariness and physical activity are differentially related to fluid and crystallized abilities in aging.
Burzynska, AZ, Voss, MW, Fanning, J, Salerno, EA, Gothe, NP, McAuley, E, Kramer, AF
Psychology and aging. 2020;(8):1154-1169
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Aerobic exercise and physical activity (PA) are known to benefit cognition in adulthood. However, a typical older adult spends most of the day sedentary or in light PA, behaviors that are typically poorly captured by questionnaires. To better understand the associations between time spent in different intensities of lifestyle PA and cognition, we measured average time spent daily in sedentariness, light, and moderate to vigorous PA using hip-worn sensors (ActiGraph accelerometers). We studied baseline data from 228 cognitively normal adults (Age 60-80) who took part in a clinical trial (clinical study identifier: NCT01472744). Fluid (processing speed, memory, and reasoning) and crystallized abilities (vocabulary knowledge) were assessed with the Virginia Cognitive Aging Battery. Adjusting for age, sex, and several modifiable socioeconomic, physical and functional health factors, time spent daily in moderate to vigorous PA was positively related with fluid abilities (perceptual speed and reasoning). Furthermore, we found that those spending more time sedentary performed better on vocabulary knowledge and reasoning tasks. In contrast, time spent in light PA was not related to either fluid or crystallized abilities. Our results add to the previous literature by providing the first sensor-based evidence that crystallized and fluid abilities in older age may be associated with engagement in different intensities of daily activity. Moreover, our findings suggest that the behavior of moderate to vigorous PA is at least as important in relation to cognition as the desirable long-term physiological effects of higher intensity PA and exercise. (PsycInfo Database Record (c) 2020 APA, all rights reserved).